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U.S. Trends in Poisonings, Firearms, and Other Injuries by Intent, 1999-2020

Death rates due to poisonings, firearms, and all other injuries increased substantially in the U.S. between 1999 and 2020, according to a cross-sectional study.

National death certificate data from the National Center for Health Statistics that listed external causes of 3,813,894 deaths among individuals aged 20 years or older during the study period were examined. Age-standardized mortality rates and average annual percentage change (AAPC) in rates calculated by intent (suicide, homicide, unintentional, and undetermined) and demographic factors showed the following: “From 1999 to 2020, poisoning death rates increased annually (AAPC, 7.0%; 95% CI, 5.4%-8.7%). From 2014 to 2020, poisoning death rates increased the most among men (APC, 10.8%; 95% CI, 7.7%-14.0%). During the study period, poisoning death rates increased in all the racial and ethnic groups examined; the most rapid increase was among American Indian and Alaska Native individuals (AAPC, 9.2%; 95% CI, 7.4%-10.9%). During the study period, death rates for unintentional poisoning had the most rapid rate of increase (AAPC, 8.1%; 95% CI, 7.4%-8.9%). From 1999 to 2020, firearm death rates increased (AAPC, 1.1%; 95% CI, 0.7%-1.5%). From 2013 to 2020, firearm mortality increased by an average of 4.7% annually (95% CI, 2.9%-6.5%) among individuals aged 20 to 39 years. From 2014 to 2020, mortality from firearm homicides increased by an average of 6.9% annually (95% CI, 3.5%-10.4%). From 2019 to 2020, mortality rates from external causes accelerated further, largely from increases in unintentional poisoning, and homicide due to firearms and all other injuries.”

Commentary: “Recognizing that the causes of preventable illness are structural, that they require a wholesale engagement with difficult and seemingly intractable social and political forces, could dispirit the best-intentioned clinician,” an author writes. “But challenges do not preclude success; the status quo can change, and there are plenty of reasons to believe that it will. The opioid death rate was stabilizing in the years preceding the COVID-19 pandemic, as a range of nationwide efforts—notably, easier access to naloxone—were beginning to yield results. Recent years saw the first federal funding for firearm injury prevention research in a quarter century and a growing number of innovative community efforts to address gun violence.

“Perhaps most importantly, the visibility of the COVID-19 pandemic has motivated a new generation of activists and future health leaders who are centering the importance of health for all in the public conversation. This offers hope that the current moment can lead to a shift in national efforts to prioritize the work needed to minimize preventable illness. Scholarship like [this study] that helps identify populations and places bearing the greatest burden of preventable death in the country is a step in that direction.”

Source: JAMA Internal Medicine