Cover: Impact on Nonfirearm Deaths of Firearm Laws Affecting Firearm Deaths

Impact on Nonfirearm Deaths of Firearm Laws Affecting Firearm Deaths

A Systematic Review and Meta-Analysis

Published in: American Journal of Public Health, Volume 110, No. 10 (October 2020). doi: 10.2105/AJPH.2020.305808

Posted on on April 13, 2021

by Rosanna Smart, Terry L. Schell, Matthew Cefalu, Andrew R. Morral


There is debate whether policies that reduce firearm suicides or homicides are offset by increases in non-firearm-related deaths.


To assess the extent to which changes in firearm homicides and suicides following implementation of various gun laws affect nonfirearm homicides and suicides.

Search Methods

We performed a literature search on 13 databases for studies published between 1995 and October 31, 2018 (PROSPERO CRD42019120105).

Selection Criteria

We included studies if they (1) estimated an effect of 1 of 18 included classes of gun policy on firearm homicides or suicides, (2) included a control group or comparison group and evaluated time series data to establish that policies preceded their purported effects, and (3) provided estimated effects of the policy and inferential statistics for either total or nonfirearm homicides or suicides.

Data Collection and Analysis

We extracted data from each study, including study timeframe, population, and statistical methods, as well as point estimates and inferential statistics for the effects of firearm policies on firearm deaths as well as either nonfirearm or overall deaths. We assessed quality at the estimate (study-policy-outcome) level by using prespecified criteria to evaluate the validity of inference and causal identification. For each estimate, we derived the mortality multiplier (i.e., the ratio of the policy's effect on total homicides or suicides; expressed as a change in the number of deaths) as a proportion of its effect on firearm homicides or suicides. Finally, we performed a meta-analysis to estimate overall mortality multipliers for suicide and homicide that account for both within- and between-study heterogeneity.

Main Results

We identified 16 eligible studies (study timeframes spanning 1977–2015). All examined state-level policies in the United States, with most estimating effects of multiple policies, yielding 60 separate estimates of the mortality multiplier. From these, we estimated that a firearm law's effect on homicide, expressed as a change in the number of total homicide deaths, is 0.99 (95% confidence interval = 0.76, 1.22) times its effect on the number of firearm homicides. Thus, on average, changes in the number of firearm homicides caused by gun policies are neither offset nor compounded by second-order effects on nonfirearm homicides. There is insufficient evidence in the existing literature on suicide to indicate the extent to which the effects of gun policy changes on firearm suicides are offset or compounded by their effects on nonfirearm suicides.

Authors' Conclusions

State gun policies that reduce firearm homicides are likely to reduce overall homicides in the state by approximately the same number. It is currently unknown whether the same holds for state gun policies that significantly reduce firearm suicides. The small number of studies meeting our inclusion criteria, issues of methodological quality within those studies, and the possibility of reporting bias are potential limitations of this review.

Public Health Implications

Policies that reduce firearm homicides likely have large benefits for public health as there is little evidence to support a strong substitution effect between firearm and nonfirearm homicides at the population level. Further research is needed to determine whether policies that produce population-level reductions in firearm suicides will translate to overall declines in suicide rates.

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