Mortality Among Recent Purchasers of Handguns

Abstract & Commentary

Synopsis: Although male handgun purchasers had increased suicide rates compared to the general population, the rates were even more dramatically increased among female handgun purchasers.

Source: Wintemute GJ, et al. N Engl J Med 1999;341: 1583-1589.

Despite recent restrictions put in place in many states, handgun ownership remains common in the United States. More than one-fourth of all men and approximately one in 12 women own a handgun. Wintemute and colleagues used data from California in an attempt to determine whether recent legal purchasers of handguns were at increased risk for suicide or firearm death following purchase.

All persons who purchased handguns from licensed firearm dealers in California in 1991 (238,292 individuals) represent the study group. These individuals were compared to all California residents. Although Wintemute et al focused on the first few weeks and months following handgun purchase, the cohort was followed for six years.

Suicide was the leading cause of death during the initial 12 months following handgun purchases, accounting for nearly one-fourth of all deaths in the study group. When suicide by means of a firearm was specifically examined, it ranked second only to heart disease as a cause of death among these adult men and women.

Although male handgun purchasers had increased suicide rates compared to the general population, the rates were even more dramatically increased among female handgun purchasers. (See Table.)

Table-Adult Females, California, One-Year Mortality from Suicide 1991-1992
Handgun Purchasers CA Adult Female Population
% of Suicides by Firearm 80.0 29.7
% of all Deaths from Suicide 39.0 0.8
Modified from: Wintemute GJ, et al. N Engl J Med 1999;341:1583-1589.

Among women 21-44 years of age, 52% of those who died during the first year after a handgun purchase had committed suicide, and 37% had used a firearm as their method of choice. Among all California women 21-44 years old, 6.5% of those who died had committed suicide and 2.8% had done so by means of a firearm. Female purchasers of handguns were 49 times more likely to commit suicide than the general state population.

In their discussion, Wintemute et al point out that, because all handgun purchases that served as the basis of this study were legal, such purchases identified a higher socioeconomic class than all handgun owners. In addition, because felons and others with a history of violent crime are excluded from the ability to purchase handguns in California, the rates found in this study do not apply to them.

COMMENT by Kenneth l. Noller, MD

Rarely have I read an article in a medical journal that has so dramatically affected me. Most studies have shown that anyone who lives in a household with a handgun is at increased risk for a violent death. Many explanations have been put forward to explain this increase but individual studies often contradict each other.

To my knowledge, this is the first large, population-based study performed in the United States that specifically looked at death rates among handgun purchasers and compared them to similar rates in the entire adult population. The results are disturbing and have great importance for those of us who provide health care to women. Although many of us have asked about "guns in the household" for years, this study suggests that it is important for us to refine the question and specifically ask about handgun purchases or planned purchases. Indeed, because so few handgun purchases are made by women, the fact that a patient has purchased or is considering the purchase of a handgun should alert us to the fact that she might be doing so to provide herself with a readily accessible method of suicide. I have always been taught that suicide by firearms was extremely rare in the female population. While it still occurs less frequently among women than among men, the fact that a woman who has purchased a handgun is 49 times more likely to die from suicide during the next year than the general female population must be acknowledged.

While there are limitations to this study (any studies dealing with state-collected statistics have severe limitations), I would strongly urge all readers to review this article. (Dr. Noller is Professor and Chairman, Department of OB/GYN, University of Massachusetts Medical Center, Worcester, MA.)

According to the article by Wintemute et al, the recent purchase of a handgun is most highly associated with death from which of the following causes?

a. Suicide

b. Heart disease

c. Homicide

d. Cancer