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Publication Details

Title :

Global Mortality From Firearms, 1990-2016

Journal:

JAMA

Impact Factor:

47.661

Authors:

Mohsen Naghavi, PhD; Laurie B. Marczak, PhD; Michael Kutz, BS; Katya Anne Shackelford, BA; Megha Arora, BSA; Molly Miller-Petrie, MSc; Miloud Taki Eddine Aichour, MA; Nadia Akseer, PhD; Rajaa M. Al-Raddadi, PhD; Khurshid Alam, PhD; Suliman A. Alghnam, PhD; Carl Abelardo T. Antonio, MD; Olatunde Aremu, PhD; Amit Arora, PhD; Mohsen Asadi-Lari, PhD; Reza Assadi, PhD; Tesfay Mehari Atey, MS; Leticia Avila-Burgos, PhD; Ashish Awasthi, PhD; Beatriz Paulina Ayala Quintanilla, PhD; Suzanne Lyn Barker-Collo, PhD; Till Winfried Bärnighausen, MD; Shahrzad Bazargan-Hejazi, BEP; Masoud Behzadifar, PhD; Meysam Behzadifar, MS; James R. Bennett, BA; Ashish Bhalla, MD; Zulfiqar A. Bhutta, PhD; Arebu Issa Bilal, MSc; Guilherme Borges, DSc; Rohan Borschmann, PhD; Alexandra Brazinova, MD; Julio Cesar Campuzano Rincon, PhD; Félix Carvalho, PhD; Carlos A. Castañeda-Orjuela, MS; Lalit Dandona, MD; Rakhi Dandona, PhD; Paul I. Dargan, MB; Diego De Leo, DSc; Samath Dhamminda Dharmaratne, MD; Eric L. Ding, DSc; Huyen Phuc Do, PhD; David Teye Doku, PhD; Kerrie E. Doyle, PhD; Tim Robert Driscoll, PhD; Dumessa Edessa, MS; Ziad El-Khatib, PhD; Aman Yesuf Endries, MPH; Alireza Esteghamati, MD; Andre Faro, PhD; Farshad Farzadfar, MD; Valery L. Feigin, PhD; Florian Fischer, PhD; Kyle J. Foreman, PhD; Richard Charles Franklin, PhD; Nancy Fullman, MPH; Neal D. Futran, MD; Tsegaye Tewelde Gebrehiwot, MPH; Reyna Alma Gutiérrez, PhD; Nima Hafezi-Nejad, MD; Hassan Haghparast Bidgoli, PhD; Gessessew Bugssa Hailu, MS; Josep Maria Haro, MD; Hamid Yimam Hassen, MPH; Caitlin Hawley, MSPH; Delia Hendrie, PhD; Martha Híjar, PhD; Guoqing Hu, PhD; Olayinka Stephen Ilesanmi, PhD; Mihajlo Jakovljevic, PhD; Spencer L. James, MD; Sudha Jayaraman, MD; Jost B. Jonas, MD; Amaha Kahsay, MPH; Amir Kasaeian, PhD; Peter Njenga Keiyoro, PhD; Yousef Khader, PhD; Ibrahim A. Khalil, MD; Young-Ho Khang, MD; Jagdish Khubchandani, PhD; Aliasghar Ahmad Kiadaliri, PhD; Christian Kieling, MD; Yun Jin Kim, PhD; Soewarta Kosen, MD; Kristopher J. Krohn, MPH; G. Anil Kumar, PhD; Faris Hasan Lami, PhD; Van C. Lansingh, PhD; Heidi Jane Larson, PhD; Shai Linn, DrPH; Raimundas Lunevicius, PhD; Hassan Magdy Abd El Razek, MD; Muhammed Magdy Abd El Razek, MB; Reza Malekzadeh, MD; Deborah Carvalho Malta, PhD; Amanda J. Mason-Jones, PhD; Richard Matzopoulos, PhD; Peter T. N. Memiah, DrPH; Walter Mendoza, MD; Tuomo J. Meretoja, MD; Haftay Berhane Mezgebe, MS; Ted R. Miller, PhDr; Shafiu Mohammed, PhD; Maziar Moradi-Lakeh, MD; Rintaro Mori, PhD; Devina Nand, MPH; Cuong Tat Nguyen, MPH; Quyen Le Nguyen, MD; Dina Nur Anggraini Ningrum, MPH; Felix Akpojene Ogbo, PhD; Andrew T. Olagunju, MD; George C. Patton, MD; Michael R. Phillips, MD; Suzanne Polinder, MA; Farshad Pourmalek, PhD; Mostafa Qorbani, PhD; Afarin Rahimi-Movaghar, MD; Vafa Rahimi-Movaghar, MD; Mahfuzar Rahman, PhD; Rajesh Kumar Rai, MPH; Chhabi Lal Ranabhat, PhD; David Laith Rawaf, MD; Salman Rawaf, PhD; Ali Rowhani-Rahbar, PhD; Mahdi Safdarian, MD; Saeid Safiri, PhD; Rajesh Sagar, MD; Joseph S. Salama, MS; Juan Sanabria, MD; Milena M. Santric Milicevic, PhD; Rodrigo Sarmiento-Suárez, MPH; Benn Sartorius, PhD; Maheswar Satpathy, PhD; David C. Schwebel, PhD; Soraya Seedat, MD; Sadaf G. Sepanlou, MD; Masood Ali Shaikh, MD; Nigussie Tadesse Sharew, MS; Ivy Shiue, PhD; Jasvinder A. Singh, MD; Mekonnen Sisay, MS; Vegard Skirbekk, PhD; Adauto Martins Soares Filho, DSc; Dan J. Stein, MD; Mark Andrew Stokes, PhD; Mu’awiyyah Babale Sufiyan, MD; Mamta Swaroop, MD; Bryan L. Sykes, PhD; Rafael Tabarés-Seisdedos, PhD; Fentaw Tadese, MPH; Bach Xuan Tran, PhD; Tung Thanh Tran, BMedSc; Kingsley Nnanna Ukwaja, MS; Tommi Juhani Vasankari, MD; Vasily Vlassov, MD; Andrea Werdecker, PhD; Pengpeng Ye, MPH; Paul Yip, PhD; Naohiro Yonemoto, MPH; Mustafa Z. Younis, DrPH; Zoubida Zaidi, DrPH; Maysaa El Sayed Zaki, PhD; Simon I. Hay, DSc; Stephen S. Lim, PhD; Alan D. Lopez, PhD; Ali H. Mokdad, PhD; Theo Vos, PhD; Christopher J. L. Murray, DPhil.

Affiliations:

Institute for Health Metrics and Evaluation, University of Washington, Seattle (Naghavi, Marczak, Kutz, Shackelford, M. Arora, Miller-Petrie, Bennett, L. Dandona, R. Dandona, Dharmaratne, Feigin, Foreman, Fullman, Hawley, James, Khalil, Krohn, Larson, Salama, Hay, Lim, Lopez, Mokdad, Vos, Murray); Higher National School of Veterinary Medicine, Algiers, Algeria (Aichour); Centre for Global Child Health, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada (Akseer, Bhutta); Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia (Al-Raddadi); School of Population and Global Health, University of Western Australia, Perth, WA, Australia (Alam); Department of Population Health, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia (Alghnam); Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines (Antonio); Department of Public and Community Health, Birmingham City University, Birmingham, England (Aremu); School of Science and Health, Western Sydney University, Penrith, NSW, Australia (A. Arora); Oral Health Services, Sydney Local Health District, Sydney, Australia (A. Arora); Department of Epidemiology and Biostatistics, Iran University of Medical Sciences, Tehran, Iran (Asadi-Lari); International Relations Department, Iranian Ministry of Health and Medical Education, Tehran, Iran (Asadi-Lari); Education Development Center, Mashhad University of Medical Sciences, Mashhad, Iran (Assadi); Department of Pharmacy, Mekelle University, Mekelle, Ethiopia (Atey); Center of Health System Research, The National Institute of Public Health, Cuernavaca, Mexico (Avila-Burgos); Indian Institute of Public Health, Gandhinagar, India (Awasthi); Public Health Foundation of India, Gurugram, India (Awasthi, L. Dandona, R. Dandona, Kumar); The Judith Lumley Centre, La Trobe University, Melbourne, VIC, Australia (Ayala Quintanilla); General Office for Research and Technological Transfer, Peruvian National Institute of Health, Lima, Peru (Ayala Quintanilla); School of Psychology, University of Auckland, Auckland, New Zealand (Barker-Collo); Institute of Public Health, Heidelberg University, Heidelberg, Germany (Bärnighausen, Mohammed); Department of Global Health and Population, Harvard University, Boston, Massachusetts (Bärnighausen); Department of Psychiatry, Charles R. Drew University of Medicine and Science, Los Angeles, California (Bazargan-Hejazi); Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles (Bazargan-Hejazi); Social Determinants of Health Research Center, Lorestan University of Medical Sciences, Khorranmabad, Iran (M. Behzadifar); Faculty of Health and Nutrition, Lorestan University of Medical Sciences, Khorranmabad, Iran (M. Behzadifar); Department of Internal Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India (Bhalla); Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan (Bhutta); School of Pharmacy, Addis Ababa University, Addis Ababa, Ethiopia (Bilal); Department of Epidemiology, National Institute of Psychiatry Ramón de la Fuente, Mexico City, Mexico (Borges); Centre for Adolescent Health, Murdoch Children’s Research Institute, Parkville, Melbourne, VIC, Australia (Borschmann); Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (Borschmann); Institute of Epidemiology, Comenius University, Bratislava, Slovakia (Brazinova); National Institute of Health, Cuernavaca, Mexico (Campuzano Rincon); Escuela de Medicina, Universidad Valle de Cuernavaca, Cuernavaca, Mexico (Campuzano Rincon); Ucibio, Requimte, Faculty of Pharmacy, University of Porto, Porto, Portugal (Carvalho); Colombian National Health Observatory, Instituto Nacional de Salud, Bogota, Colombia (Castañeda-Orjuela); Epidemiology and Public Health Evaluation Group, Universidad Nacional de Colombia, Bogota, Colombia (Castañeda-Orjuela); Department of Clinical Toxicology, Guy’s and St. Thomas’ NHS Foundation Trust, London, United Kingdom (Dargan); Department of Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom (Dargan); Australian Institute for Suicide Research and Prevention, Griffith University, Mt Gravatt, QLD, Australia (De Leo); Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka (Dharmaratne); Harvard School of Public Health, Department of Nutrition, Harvard University, Boston, Massachusetts (Ding); Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam (Phuc Do, Tat Nguyen, Le Nguyen, Thanh Tran); Department of Population and Health, University of Cape Coast, Cape Coast, Ghana (Doku); Faculty of Social Sciences, University of Tampere, Tampere, Finland (Doku); School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology University (RMIT), Bundoora, VIC, Australia (Doyle); Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia (Driscoll); School of Pharmacy, Haramaya University, Harar, Ethiopia (Edessa); Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden (El-Khatib); Department of Public Health, Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia (Endries); Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran (Esteghamati); Department of Psychology, Federal University of Sergipe, Sao Cristovao, Brazil (Faro); Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran (Farzadfar); National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand (Feigin); Department of Public Health Medicine, Bielefeld University, Bielefeld, Germany (Fischer); College of Public Health Medical and Veterinary Science, James Cook University, Douglas, QLD, Australia (Franklin); School of Medicine Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle (Futran); Department of Epidemiology and Biostatistics, Jimma University, Jimma, Ethiopia (Gebrehiwot); Epidemiological and Psychosocial Investigations, National Institute of Psychiatry Ramon de la Fuente, Mexico City, Mexico (Gutiérrez); School of Medicine, Tehran University of Medical Sciences, Tehran, Iran (Hafezi-Nejad); Department of Radiology, Johns Hopkins University, Baltimore, Maryland (Hafezi-Nejad); Institute for Global Health, University College London, London, United Kingdom (Haghparast Bidgoli); Biomedical Science Division, School of Medicine, Mekelle University, Mekelle, Ethiopia (Hailu); Research Unit, Parc Sanitari Sant Joan de Déu (CIBERSAM), Sant Boi de Llobregat, Spain (Haro); Department of Medicine, Universitat de Barcelona, Barcelona, Spain (Haro); Department of Public Health, Mizan-Tepi University, Mizan Teferi, Ethiopia (Hassen); Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Wilrijk, Belgium (Hassen); School of Public Health, Curtin University, Bentley, Perth, WA, Australia (Hendrie, Miller); Research Coordination, Fundación Entornos AC, Cuernavaca, Mexico (Híjar); CISS, National Institute of Public Health, Cuernavaca, Mexico (Híjar); Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China (Hu); Department of Public Health and Community Medicine, University of Liberia, Monrovia, Liberia (Ilesanmi); Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia (Jakovljevic); Department of Surgery, Virginia Commonwealth University, Richmond (Jayaraman); Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany (Jonas); Capital Medical University, Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Beijing Ophthalmology & Visual Science Key Laboratory, Beijing, China (Jonas); Department of Nutrition and Dietetics, Mekelle University, Mekelle, Ethiopia (Kahsay); Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran (Kasaeian); Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran (Kasaeian); School of Continuing and Distance Education, University of Nairobi, Nairobi, Kenya (Keiyoro); Public Health and Community Medicine, Jordan University of Science and Technology, Alramtha, Jordan (Khader); Department of Health Policy and Management, College of Medicine, Seoul National University, Seoul, South Korea (Khang); Institute of Health Policy and Management, SNU Medical Research Center, Seoul National University, Seoul, South Korea (Khang); Department of Nutrition and Health Science, Ball State University, Muncie, Indiana (Khubchandani); Clinical Epidemiology Unit, Lund University, Lund, Sweden (Ahmad Kiadaliri); Department of Psychiatry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Kieling); Child & Adolescent Psychiatry Division, Hospital of Clinics of Porto Alegre, Porto Alegre, Brazil (Kieling); School of Medicine, Xiamen University Malaysia, Sepang, Malaysia (Kim); Independent Consultant, Jakarta, Indonesia (Kosen); Department of Community and Family Medicine, Academy of Medical Science, Baghdad, Iraq (Lami); Helpmesee, New York, New York (Lansingh); Department of International Relations, Mexican Institute of Ophthalmology, Queretaro, Mexico (Lansingh); Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom (Larson); School of Public Health, University of Haifa, Haifa, Israel (Linn); General Surgery Department, Aintree University Hospital National Health Service Foundation Trust (NHS), Liverpool, United Kingdom (Lunevicius); School of Medicine, University of Liverpool, Liverpool, United Kingdom (Lunevicius); Department of Cardiology, Damietta University, Damietta, Egypt (H. Magdy Abd El Razek); Ophthalmology Department, Aswan Faculty of Medicine, Aswan, Egypt (M. Magdy Abd El Razek); Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran (Malekzadeh, Sepanlou); Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran (Malekzadeh, Sepanlou); Departamento Materno Infantil e Saúde Publica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (Carvalho Malta); Department of Health Sciences, University of York, York, United Kingdom (Mason-Jones); Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa (Matzopoulos); School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa (Matzopoulos); Department of Public Health, University of West Florida, Pensacola (Memiah); Peru Country Office, United Nations Population Fund (UNFPA), Lima, Peru (Mendoza); Comprehensive Cancer Center, Breast Surgery Unit, Helsinki University Hospital, Helsinki, Finland (Meretoja); Department of Surgery, University of Helsinki, Helsinki, Finland (Meretoja); School of Pharmacy, Academy of Medical Science, Baghdad, Iraq (Mezgebe); Pacific Institute for Research & Evaluation, Calverton, Maryland (Miller); Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria (Mohammed); Preventive Medicine and Public Health Research Center, Iran University of Medical Sciences, Tehran, Iran (Moradi-Lakeh); Department of Health Policy, National Center for Child Health and Development, Setagaya, Japan (Mori); Health Information Unit, Ministry of Health, Suva, Fiji (Nand); Accamargo Cancer Center, São Paulo, Brazil (Nand); Public Health Department, Semarang State University, Kota Semarang, Indonesia (Ningrum); Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei City, Taiwan (Ningrum); Western Sydney University, Penrith, NSW, Australia (Akpojene Ogbo); School of Medicine, University of Adelaide, Adelaide, SA, Australia (Olagunju); Department of Psychiatry, University of Lagos, Lagos, Nigeria (Olagunju); Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia (Patton); Department of Paediatrics, Murdoch Children’s Research Institute, Melbourne, VIC, Australia (Patton); Shanghai Mental Health Center, Shanghai Jiao Tong University, Shanghai, China (Phillips); Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands (Polinder); School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada (Pourmalek); Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran (Qorbani); Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran (A. Rahimi-Movaghar); Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran (V. Rahimi-Movaghar); Research and Evaluation Division, BRAC (Bangladesh Rehabilitation Assistance Committee), Dhaka, Bangladesh (Rahman); Society for Health and Demographic Surveillance, Suri, India (Rai); Department of Economics, University of Göttingen, Göttingen, Germany (Rai); Institute for Poverty Alleviation and International Development, Yonsei University, South Korea (Ranabhat); WHO Collaborating Centre for Public Health Education & Training, Imperial College London, London, United Kingdom (D. L. Rawaf); University College London Hospitals, London, United Kingdom (D. L. Rawaf); Department of Primary Care and Public Health, Imperial College London, London, United Kingdom (S. Rawaf); Public Health England, London, United Kingdom (S. Rawaf); Department of Epidemiology, University of Washington, Seattle (Rowhani-Rahbar); Sina Trauma and Surgery Center, Iran University of Medical Sciences, Tehran, Iran (Safdarian); Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, Maragheh University of Medical Sciences, Maragheh, Iran (Safiri); Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, India (Sagar); Department of Surgery, Marshall University, Huntington, West Virginia (Sanabria); Department of Nutrition and Preventive Medicine, Case Western Reserve University, Cleveland, Ohio (Sanabria); Faculty of Medicine, Institute of Social Medicine, Centre School of Public Health and Health Management, University of Belgrade, Belgrade, Serbia (Santric Milicevic); Department of Health and Society, Faculty of Medicine, Universidad Ciencias Aplicadas y Ambientales, Bogotá, Colombia (Sarmiento-Suárez); Department of Public Health Medicine, University of Kwazulu-Natal, Durban, South Africa (Sartorius); UGC Centre of Advanced Study in Psychology, Utkal University, Bhubaneswar, India (Satpathy); Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama (Schwebel); Department of Psychiatry, Stellenbosch University, Cape Town, South Africa (Seedat); Independent Consultant, Karachi, Pakistan (Shaikh); College of Health Science, Debre Berhan University, Debre Berhan, Ethiopia (Sharew); Instituts Für Medizinische Epidemiologie, Biometrie Und Informatik, Martin Luther University Halle-Wittenberg, Haale, Germany (Shiue); School of Medicine, University of Alabama at Birmingham (Singh); Department of Epidemiology, University of Alabama at Birmingham (Singh); School of Pharmacy, Haramaya University, Harar, Ethiopia (Sisay); Norwegian Institute of Public Health, Oslo, Norway (Skirbekk); Department of Diseases and Noncommunicable Diseases and Health Promotion, Federal Ministry of Health, Brasilia, Brazil (Soares Filho); South African Medical Research Council, Cape Town, South Africa (Stein); Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa (Stein); School of Psychology, Deakin University, Burwood, VIC, Australia (Stokes); Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria (Sufiyan); Department of Surgery, Northwestern University, Chicago, Illinois (Swaroop); Department of Criminology, Law, & Society, University of California Irvine (Sykes); Department of Medicine, University of Valencia, Valencia, Spain (Tabarés-Seisdedos); Department of Public Health, Wollo University, Dessie, Ethiopia (Tadese); Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam (Tran); Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria (Ukwaja); UKK Institute for Health Promotion Research, Tampere, Finland (Vasankari); Department of Health Care Management and Economics, National Research University Higher School of Economics, Moscow, Russia (Vlassov); Demographic Change and Ageing, Federal Institute for Population Research, Wiesbaden, Germany (Werdecker); Division of Injury Prevention and Mental Health Improvement, National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Xicheng District, China (Ye); Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong SAR, China (Yip); Department of Biostatistics, School of Public Health, Kyoto University, Kyoto, Japan (Yonemoto); Healthcare Management-Health Economics & Finance/Global Health, Jackson State University, Jackson, Missouri (Younis); Research Center for Public Health, Tsinghua University, Beijing, China (Younis); Department of Epidemiology, University Hospital of Setif, Setif, Algeria (Zaidi); Faculty of Medical Sciences, A.C.S. Medical College and Hospital, Algiers, Algeria (Zaidi); Faculty of Medicine, Mansoura University, Mansoura, Egypt (El Sayed Zaki); School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia (Lopez).

Year of Publication:

2018

DOI:

10.1001/jama.2018.10060

Abstract:

Importance  Understanding global variation in firearm mortality rates could guide prevention policies and interventions.

Objective  To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories.

Design, Setting, and Participants  This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths.

Exposures  Firearm ownership and access.

Main Outcomes and Measures  Cause-specific deaths by age, sex, location, and year.

Results  Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (−0.2% [95% UI, −0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P < .001; R2 = 0.21) and homicide (P < .001; R2 = 0.35).

Conclusions and Relevance  This study estimated between 195 000 and 276 000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups.