Steven Lippmann, M.D.

 

 

We hear people say, “I need guns to protect myself and family.” Is there a relationship between firearms and American health care being the most expensive in world?

Actually, rates for suicide, homicide, domestic violence, and accidental death all increase when there is possession of a gun in the home (1,2). It results in death or wounding family members much more often than shooting someone endangering the family.Among 395 deaths studied in such circumstances, suicide reportedly accounted for 333 fatalities, 41 were family members, 12 were fatal accidents, while only nine cases involved an intruder (3,4). Gunshots are the most common method of suicide for the whole household (5,6). When firearms are available, homicide to intimate partners is five times more likely and suicide by women is three times more frequent (7,8). Pre-existing psychopathology is not routine among shooters, impulsivity is a large factor (9).

Gun violence burdens health care facilities and raises the cost of medicine. The expense for gun violence is approximately $4 billion annually and at $100 billion when adding disability, unemployment, and related costs (10,11). Hospitals are overwhelmed with the cost for caring for the uninsured patients (11,12). Most of this is paid by taxpayers and it also raises insurance premiums.

Death is cheaper, but results in grief and hardship. Emotional upset follows traumatic events even when people themselves are not injured. This is even true when one feels consistently threatened by risk of shootings. Children, who see firearms as a mean of conflict resolution, copy this behavior. Criminal justice expenses are also increased and paid for in taxes.

Less gun violence would yield societal and financial benefits. Americans are worried about difficult economic times, health insurance costs, and taxes. Now might be an opportune time to open discussion about legislation on gun safety. We all could benefit.

 

Refernces:

1. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2006) [cited 2006 Feb 8]. Available from www.cdc.gov/injury/wisqars/. Accessed July 24, 2009.
2. Miller M, Hemenway D.Guns and Suicide in the United States. NEJM 2008; 359(10):989-991.
3. Kellermann A. Guns for safety? Dream on Scalia. The Washington Post. June 29, 2008.Page B02. Available at. http://www.washingtonpost.com/wp-dyn/content/article/2008/06/27/AR2008062702864.html Accessed on July 24,2009
4. Kellermann A, Heron S. Firearms and family violence. Emer Med Clinics of N Am 1999; 17( 3):699-716.
5. Miller M, Lippmann S, Azrael D., et.al. Household firearm ownership and rates of suicide across the 50 United States. J Trauma 2007; 62:1029-1035.
6. Wintemute J. Guns, fear, the constitution, and the public health. NEJM 2008; 358(14):1421-1424.
7. Campbell J, Webster D, Koziol-McLain J, et. al. Risk Factors For Femicide in Abusive Relationships: Results From A Multi-Site Case Control Study. Am J Pub Health 2003; 93(7):1089-1097.
8. Bailey J, Kellermann A , Somes G, et. al. Risk factors for violent death of women in the home. Arch Internal Med 1997; 157(7): 777-782.
9. Miller M, Barber C, Azrael D, et al. Recent psychopathology, suicidal thoughts and suicide attempts in households with and without firearms. Inj Prev 2009; 15: 183-187.
10. Cook P, Lawrence B, Ludwig J, et. al. The Medical Costs of Gunshot Injuries in the United States. JAMA1999; 282(5):447-454.
11. Gun Shot Wound Registry, Department of Emergency Medicine, University of Louisville School of Medicine. 2008.
12. Cook P, Ludwig J. Gun violence: The Real Costs. JAMA 2001; 286(5):605-607.