JAMA Devotes Special Issue to Gun Violence

A theme issue in this week's JAMA boldly proclaims that gun violence research falls firmly into medicine's lane.

Daily firearm violence and repeated mass shootings "serve as grim reminders that every person in the U.S. is potentially vulnerable to firearm violence," JAMA Executive Editor Phil Fontanarosa, MD, MBA, and Editor-in-Chief Kirsten Bibbins-Domingo, PhD, MD, MAS, wrote in an editorial about the issue.

With 11 viewpoint essays, two news articles, and a JAMA patient page, the issue spans the epidemiology of gun violence, the economic costs of that violence, regulatory actions, and strategies for promoting prevention and advancing research.

Fontanarosa and Bibbins-Domingo wrote that there were 45,222 firearm-related deaths in the U.S. in 2020, which amounts to some 124 people dying from gun violence each day. More than 50% of these deaths were suicide and more than 40% were homicide.

Early CDC data show that the number of gun fatalities rose in 2021, tallying more than 48,000 firearm-related deaths, "which would reflect nearly the same number of deaths as those attributable to influenza and pneumonia (53,000) and kidney disease (52,000) in 2020," they wrote.

Fontanarosa and Bibbins-Domingo noted that three of the viewpoint essays focused on the epidemiology of firearm injuries and homicide, including a piece by Elinore Kaufman, MD, MSHP, and M. Kit Delgado, MD, MS, both of the University of Pennsylvania in Philadelphia, that highlights the limitations of available data sources and proposes a system for comprehensively tracking firearm injury and death.

Marian Betz, MD, MPH, of the University of Colorado in Aurora, and colleagues reported that 60% of firearm deaths in 2020 were due to suicide, and that among the 45,979 suicide deaths that year, 51% were due to firearm injury. Lori McPherson, JD, of the University of Richmond in Virginia, reported that the homicide rate among American Indian and Alaska Native people (almost half involve firearms) was disproportionately higher than all other racial and ethnic groups except for Black communities.

Two other viewpoint essays address topics that have garnered "increasing and long overdue attention" -- including how firearm violence disproportionately affects Black communities. Roger Mitchell, MD, of Howard University in Washington, D.C., and Jay Aronson, PhD, of Carnegie Mellon University in Pittsburgh, reported that homicide is the leading cause of death among Black males ages 15 to 34, and most of these fatalities are gun deaths. Zirui Song, MD, PhD, of Harvard University, reported that gun injuries cost the U.S. $557 billion per year, and 88% of that comes from quality-of-life losses among those injured by guns and their families.

Three viewpoint essays address legislative and regulatory actions, including a piece by Sandro Galea, MD, DrPH, and Salma Abdalla, MBBS, DrPH, both of Boston University, on state-level policies, and an explainer by Daniel Webster, ScD, MPH, of Johns Hopkins in Baltimore, and Lawrence Gostin, JD, of Georgetown University in Washington, D.C., on the Supreme Court decision New York State Rifle & Pistol Association v. Bruen, which scrapped "good cause" requirements for concealed carry licenses.

Philip Cook, PhD, of Duke University in Durham, North Carolina, and John Donohue, PhD, JD, of Stanford University in California, reported that while the U.S. House of Representatives passed the Assault Weapons Ban of 2022, it's likely to face resistance in the Senate, leaving states to individually ban assault weapons or restrict large-capacity magazines.

Finally, three essays focus on strategies for preventing violence and for advancing firearm-related research. Joseph Sakran, MD, MPH, of Johns Hopkins in Baltimore, and colleagues called for establishing an "Office of National Violence Prevention" to identify opportunities to more proactively address all forms of violence and to oversee federal actions to "make meaningful change."

Rebecca Cunningham, MD, of the University of Michigan in Ann Arbor, and colleagues wrote that academic medical centers bear responsibility to their communities to do more about gun violence in terms of education, supporting firearm research, and providing leadership. Finally, Andrew Morral, PhD, and Rosanna Smart, PhD, both of the RAND Corporation in Santa Monica, California, noted a "new era" for gun violence prevention research, as Congress has appropriated $25 million in annual funding since 2019 and private philanthropies have made additional investments.

The issue includes two news articles, one of which reports on a consensus guidance recently published in the Journal of the American College of Surgeons about how to respond to mass shootings and improve care during these events. The guidance was written by emergency medicine physicians, surgeons, and emergency medical services (EMS) professionals who responded to six mass shootings in which 15 or more people were injured or killed.

The other news article in the issue focuses on the relationship between firearm safety laws and suicide.

Overall, the theme issue "provide[s] information that should increase professional awareness and public understanding about firearm injuries and highlight the importance of approaching firearm violence prevention from medical and public health perspectives."

"Without deliberate action," Fontanarosa and Bibbins-Domingo wrote, "firearm-related violence will not abate."

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