When Lockdowns Were Not Equal: State COVID-19 Policies and Firearm Mortality Across Demographic Groups

BackgroundWhile firearm mortality increased during the COVID-19 pandemic in the United States, it remains unclear whether these changes were associated with state-level lockdown policy stringency for specific demographic groups and mortality intents. We hypothesized that state-level COVID-19 lockdown stringency would be positively associated with changes in firearm mortality rates, and that these associations would vary by demographic group and mortality intent.MethodsWe conducted an ecological cross-sectional study using CDC WONDER mortality data from 2018 to 2021. State-level lockdown stringency was measured with the Oxford COVID-19 Government Response Tracker Stringency Index. Primary outcomes were firearm mortality rate ratios comparing 2020-2021 to 2018-2019, stratified by intent, 10-year age group, sex, race, and ethnicity. Cohort rate ratios were regressed on stringency using univariable linear regression.ResultsOf 173,499 firearm deaths, 57.1% were suicides and 39.6% homicides. Of 122 analyzable demographic cohorts, only 15 (12.3%) demonstrated statistically significant associations with policy stringency. Stricter COVID-19 policies were associated with higher homicidal rate ratios among Black females of all ages, Black males and females aged 15-24, males of all races aged 25-34, and Black individuals aged 35-44. For firearm suicide, stricter policies were negatively associated among Black individuals aged 25-34 but positively associated for females of all races aged 65-74.ConclusionsStricter COVID-19 lockdown policies were linked to divergent changes in firearm mortality in selected demographic groups, but most cohorts showed no significant association. These findings underscore the importance of tailoring mental health and violence prevention interventions to address the differential associations between public health policies and firearm mortality across demographic groups.