September 27, 2004

Karen Kreeger
(215) 349-5658


Big Cities and Small Towns Bear Similar Risks of Gun Death, says Penn Public Health Study
Suicide Risk by Firearms Greater in Rural Areas

(Philadelphia, PA) - Americans in small towns are statistically as likely to die from gunfire as people in major cities, according to a new study from the University of Pennsylvania School of Medicine - with one key distinction. “The difference is who does the shooting,” says lead author Charles C. Branas, PhD, Assistant Professor of Epidemiology. Branas and colleagues found that when looking at all deaths by firearms, the risk of being murdered with a gun in large cities and the risk of committing suicide with a gun in rural areas were almost identical. In fact, the risk of gun suicide in rural areas was slightly higher than the risk of gun homicide in major cities.

After adjusting for income, education, employment rates, and other factors, the most rural counties had over 1.5 times the rate of gun suicides compared to the most urban counties. At the same time, urban areas experienced almost twice the gun homicide rate of the most rural counties. Similar trends were not found for other, non-gun forms of suicide or homicide.

The investigators analyzed urban-rural differences in intentional firearm deaths-homicides and suicides-using over 580,000 death certificates from 1989 to 1999 in all counties in the United States. Their findings are reported in the October issue of the American Journal of Public Health.

Over the last decade, gun suicides have outpaced gun homicides, accounting for over half of all firearm deaths in the United States. Even with that in mind Branas says that “gun suicide has become the forgotten side of all of this, and to reduce gun death in general we have to start making gun suicide a priority.”

In the 1990s, a great deal of legislation was aimed at reducing gun homicide, which decreased in the United States by about 5 percent per year. Much of this decrease was in big cities. But almost no attention has been paid to gun suicide, which increased by about 1 to 2 percent per year, most starkly in rural areas, over the same period.

“Ultimately we need to bring gun suicides out of the closet and raise public awareness about these tragic events,” says Branas. “We have to think more broadly about preventing gun suicide, especially in rural communities, through such efforts as better detection of mental-health problems and reduced access to guns for people who are known to be at risk for suicide.”

Gun death should be broadly thought of as a public health issue, adds Branas, since it includes gun suicide, which often falls outside the bounds of the criminal justice and medical-care systems. “Killing yourself with a gun is not a crime and the results are so immediate that a hospital is very often bypassed for the morgue,” he says.

The study also found that the same trend for gun death did not hold true for urban- versus-rural differences in non-gun methods of suicide or homicide. Thus, guns clearly functioned differently from other methods. But why the urban-rural difference? “We didn’t directly account for differences in availability of guns by location, but we can speculate how that might have affected our results,” says Branas, referring to the larger percentage of gun owners in rural areas versus cities. “A major take-home message from these findings is that although prevention efforts must be continued in big cities, dispelling the urban myth that gun death does not touch areas outside of big cities should be a high priority.”

This work was funded by grants from the National Institute on Aging and the Chicago-based Joyce Foundation. Other Penn researchers contributing to the study are Drs. Michael L. Nance, Michael R. Elliott, Therese S. Richmond, and C. William Schwab.


PENN Medicine is a $2.7 billion enterprise dedicated to the related missions of medical education, biomedical research, and high-quality patient care. PENN Medicine consists of the University of Pennsylvania School of Medicine (founded in 1765 as the nation’s first medical school) and the University of Pennsylvania Health System (created in 1993 as the nation’s first integrated academic health system).

Penn’s School of Medicine is ranked #3 in the nation for receipt of NIH research funds; and ranked #4 in the nation in U.S. News & World Report’s most recent ranking of top research-oriented medical schools. Supporting 1,400 fulltime faculty and 700 students, the School of Medicine is recognized worldwide for its superior education and training of the next generation of physician-scientists and leaders of academic medicine.

Penn Health System is comprised of: its flagship hospital, the Hospital of the University of Pennsylvania, consistently rated one of the nation’s “Honor Roll” hospitals by U.S. News & World Report; Pennsylvania Hospital, the nation's first hospital; Presbyterian Medical Center; a faculty practice plan; a primary-care provider network; two multispecialty satellite facilities; and home health care and hospice.

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