'Sobering' study reveals 'disturbing' trends in poisoning, firearm deaths

Key takeaways:

• Death rates due to poisonings, firearms and other injuries increased substantially in the U.S. from 1999 to 2020.
• Researchers said this is a national emergency requiring urgent public health interventions.

Deaths caused by firearms and poisonings increased substantially in the United States from 1999 to 2020, highlighting an urgent need for public health interventions, according to researchers.

Death by external causes is a leading cause of mortality in the U.S., but not much is known about trends over time by demographic characteristics and intent, Wayne R. Lawrence, DrPH, a research fellow at the National Cancer Institute/NIH, and colleagues wrote in JAMA Internal Medicine.

Lawrence told Healio that “external causes of deaths, including both intentional and unintentional injury, and poisoning deaths, have contributed substantially to recent declines in life expectancy.”

“Studies have suggested the COVID-19 pandemic further increased deaths from external causes as a result of socioeconomic hardship, psychosocial stress and reduced access to health care,” Lawrence said. “Nonetheless, changes in demographic trends over time and differences in rates of external causes of death by intent (homicide, suicide, unintentional) are not fully understood."

The researchers conducted a cross-sectional study to assess national trends in mortality rates from external causes — defined as poisonings such as drug overdoses, firearms and all other injuries, such as those from motor vehicles and falls — from 1999 to 2020 by demographic characteristics and intent (homicide, suicide, unintentional and undetermined).

To do so, they used national death certificate data from the National Center for Health Statistics and evaluated the external causes of 3,813,894 deaths among individuals aged 20 years or older from Jan. 1, 1999, to Dec. 31, 2020.

The researchers reported that poisoning death rates increased annually from 1999 to 2020 (average annual percentage change [AAPC] = 7%; 95% CI, 5.4-8.7). From 2014 to 2020 specifically, poisoning death rates increased the most among men (AAPC = 10.8%; 95% CI, 7.7-14).

When it came to demographic characteristics, the researchers found that poisoning death rates increased in every racial and ethnic group evaluated. The most rapid increase, however, was among American Indian and Alaska Native people (AAPC = 9.2%; 95% CI, 7.4-10.9).

Firearm death rates also increased from 1999 to 2020 (AAPC = 1.1%; 95% CI, 0.7-1.5). The years 2013 to 2020 saw firearm mortality increasing by an average of 4.7% each year (95% CI, 2.9-6.5) among those aged 20 to 39 years. From 2014 to 2020, though, mortality from firearm homicides increased by an average of 6.9% every year (95% CI, 3.5-10.4).

“The takeaway from this study for PCPs is the importance of screening patients for substance misuse as well as providing accessible intervention and treatment services for patients with substance use disorders and patients at risk of developing these disorders,” Lawrence said.

Lawrence and colleagues wrote that the rapid increase in deaths is a national emergency requiring urgent public health interventions at both local and national levels and the study’s findings “underscore the urgency of addressing the structural determinants of deaths from firearms, drug overdose, and other injuries, especially among racial and ethnic minoritized populations and their communities.”

“Targeted public health interventions at the local-, state- and national-levels are needed to counteract the rising trend in mortality due to external causes,” Lawrence said.

In a related editorial, Sandro Galea, MD, DrPH, dean and Robert A. Knox Professor at Boston University School of Public Health, and Steven H. Woolf, MD, MPH, a senior fellow at American Progress and professor of family medicine and population health at Virginia Commonwealth University School of Medicine, wrote that “the results are sobering.”

“These disturbing findings reinforce the challenges the country faces to return to health in the aftermath of the COVID-19 pandemic, a daunting task after more than 4 decades of diminishing health gains,” they wrote.

References:

• Galea S, et al. JAMA Intern Med. 2023;doi:10.1001/jamainternmed.2023.2518.
• Lawrence WR, et al. JAMA Intern Med. 2023;doi:10.1001/jamainternmed.2023.2509.