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Charles C. Branas, PhD, Michael L. Nance, MD, Michael R. Elliott, PhD, Therese S. Richmond, PhD and C. William Schwab, MD

Charles Branas and Michael Elliott are with the Department of Biostatistics and Epidemiology at the University of Pennsylvania School of Medicine, Philadelphia. Michael Nance is with the Department of Surgery at the Children’s Hospital of Philadelphia. Therese Richmond is with the Division of Foundational Sciences and Health Systems at the University of Pennsylvania School of Nursing. C. William Schwab is with the Division of Traumatology and Surgical Critical Care, University of Pennsylvania School of Medicine. Charles Branas, Michael Nance, Therese Richmond, and C. William Schwab are also with the Firearm and Injury Center at the University of Pennsylvania. Charles Branas and Therese Richmond are also with the Leonard Davis Institute for Health Economics at the University of Pennsylvania.

Correspondence: Requests for reprints should be sent to Charles C. Branas, PhD, Department of Biostatistics and Epidemiology, University of Pennsylvania, 829 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104–6021 (e-mail: cbranas{at}cceb.med.upenn.edu).

Objectives. We analyzed urban–rural differences in intentional firearm death.

Methods. We analyzed 584629 deaths from 1989 to 1999 assigned to 3141 US counties, using negative binomial regressions and an 11-category urban–rural variable.

Results. The most urban counties had 1.03 (95% confidence interval [CI]=0.87, 1.20) times the adjusted firearm death rate of the most rural counties. The most rural counties experienced 1.54 (95% CI=1.29, 1.83) times the adjusted firearm suicide rate of the most urban. The most urban counties experienced 1.90 (95% CI=1.50, 2.40) times the adjusted firearm homicide rate of the most rural. Similar opposing trends were not found for nonfirearm suicide or homicide.

Conclusions. Firearm suicide in rural counties is as important a public health problem as firearm homicide in urban counties. Policymakers should become aware that intentional firearm deaths affect all types of communities in the United States.

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