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- Title
Comparing Risks of Firearm-Related Death and Injury Among Young Adult Males in Selected US Cities With Wartime Service in Iraq and Afghanistan.
- Authors
del Pozo, Brandon; Knorre, Alex; Mello, Michael J.; Chalfin, Aaron
- Abstract
Key Points: Question: How does the risk of firearm-related death and injury for young adult males in parts of 4 major US cities compare with the corresponding risks faced by military personnel deployed to war? Findings: This cross-sectional study of 129 826 young adult men living in Chicago, Philadelphia, New York City, and Los Angeles in 2020 and 2021 found that young adult males from zip codes with the most violence in Chicago and Philadelphia had a notably higher risk of firearm-related death than US military personnel who served during the wars in Afghanistan and Iraq, while the most violent areas in New York City and Los Angeles were associated with less risk for young adult males than these theaters of war. In all zip codes studied, risks were overwhelmingly borne by young adult males from minoritized racial and ethnic groups. Meaning: This study's finding that young adult males of minoritized racial and ethnic groups in parts of major US cities faced greater firearm-related risks at home than did soldiers at war calls for an urgent response that emphasizes violence reduction and trauma-informed interventions. This cross-sectional study evaluates how the risks of firearm-related death and injury among young adult males living in Chicago, Los Angeles, New York, and Philadelphia compare with those encountered by military service members in Iraq and Afghanistan. Importance: In 2020, homicides in the United States saw a record single-year increase, with firearm injuries becoming the leading cause of death for children, adolescents, and young adults. It is critical to understand the magnitude of this crisis to formulate an effective response. Objective: To evaluate whether young adult males living in parts of 4 major US cities faced a firearm-related death and injury risk comparable with risks encountered during recent wartime service in Iraq and Afghanistan. Design, Setting, and Participants: In this cross-sectional study of young adult males aged 18 to 29 years living in the top 10% most violent zip codes in each domestic setting (as measured by fatal shooting rates), fatal and nonfatal shooting data for 2020 and 2021 were aggregated at the zip code level for 4 of the largest US cities (Chicago, Illinois; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania). Wartime mortality and combat injury rates for the conflicts in Iraq and Afghanistan were used to assess relative risk. Main Outcomes and Measures: The relative risk of firearm-related death and nonfatal shootings in each setting as compared with combat death and injury in the comparator setting. Results: Of 129 826 young adult males aged 18 to 29 years living in the top 10% most violent zip codes in the 4 cities studied, 45 725 (35.2%) were Black, 71 005 (54.7%) were Hispanic, and 40 355 (31.1%) were White. Among this population, there were 470 homicides and 1684 firearm-related injuries. Young adult males living in the most violent zip code of Chicago (2585 individuals aged 20-29 y) and Philadelphia (2448 individuals aged 18-29 y) faced a higher risk of firearm-related homicide than US soldiers who were deployed to Afghanistan, with risk ratios of 3.23 (95% CI, 2.47-4.68) and 1.91 (95% CI, 1.32-3.46), respectively. In expanding the analysis to the top 10% of the cities' most violent zip codes, the risks in Chicago likewise exceeded those of combat death faced by military service members, with a risk ratio of 2.10 (95% CI, 1.82-2.46), and the risks in Philadelphia were comparable with those of deployment to war 1.15 (95% CI, 0.98-1.39). Nonfatal shooting risks were comparable with, or exceeded, the injury risk of combat in Iraq, producing a combined annual firearm risk of 5.8% in Chicago and 3.2% in Philadelphia. However, these findings were not observed in the most violent zip codes of Los Angeles and New York City, where young men faced a 70% to 91% lower risk than soldiers in the Afghanistan war across fatal and nonfatal categories (eg, fatal shooting in most violent zip code in Los Angeles: risk ratio, 0.30; 95% CI, 0.26-0.34; nonfatal shooting in top 10% most violent zip codes in New York: risk ratio, 0.09; 95% CI, 0.08-0.10). The risk of violent death and injury observed in the zip codes studied was almost entirely borne by individuals from minoritized racial and ethnic groups: Black and Hispanic males represented 96.2% of those who were fatally shot (452 individuals) and 97.3% of those who experienced nonfatal injury (1636 individuals) across the 4 settings studied. Conclusions and Relevance: In this cross-sectional study, for young adult men in several of the communities studied, firearm violence carried morbidity and mortality risks that exceeded those of war. Health equity requires prioritizing effective responses.
- Subjects
AFGHANISTAN; IRAQ; UNITED States; MORTALITY risk factors; GUNSHOT wounds; CONFIDENCE intervals; FIREARMS; WAR; CROSS-sectional method; SHOOTINGS (Crime); MILITARY service; RESEARCH funding; MORTALITY
- Publication
JAMA Network Open, 2022, Vol 5, Issue 12, pe2248132
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2022.48132