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Firearm Injury After Gun Shows: Evidence to Gauge the Potential Impact of Regulatory Interventions
Annals of Internal Medicine ( IF 39.2 ) Pub Date : 2017-10-24 , DOI: 10.7326/m17-2638
Ali Rowhani-Rahbar 1 , Frederick P Rivara 1
Affiliation  

The recent mass shooting in Las Vegas, Nevada, was a painful reminder that injuries and deaths resulting from access to guns continue to bedevil many parts of U.S. society, including communities; the health care industry; and the families of those injured, killed, or threatened by firearms. Although the problem created by more than 300 million guns in the United States will ultimately need a political solution, science and scientific publications have important roles in assessing and promoting awareness about interventions that may reduce the 36 000 fatal and 85 000 nonfatal firearm injuries each year (1).
The lack of meaningful action by Congress has left states to chip away in myriad ways at reducing access to guns by those likely to use them for harm against themselves or others. Several studies have shown an inverse association between the stringency of state legislation to restrict firearm access and the rate of firearm injuries and deaths (2). However, our knowledge about the effect of policies regulating gun shows on firearm morbidity and mortality is severely limited.
Matthay and colleagues (3) examined the association between gun shows occurring separately in California and Nevada and short-term changes in the rates of fatal and nonfatal firearm injuries in California regions exposed to those shows. Gun shows account for only a small proportion of private-party firearm transfers; nevertheless, they can be a source of guns used in crime (4). Gun shows allow both licensed dealers and unlicensed persons to sell firearms to attendees. Whereas purchases from federally licensed dealers require a background check of the potential buyer before a sale is made, several states do not require these checks in private-party sales, as was the case in Nevada during Matthay and colleagues' study period. In California, on the other hand, firearm transfers at shows must be processed through a licensed dealer (5). Thus, the concern was raised that California residents can simply drive over the state line and purchase guns at a Nevada show without any background check or waiting period.
Matthay and colleagues compared the rates of firearm injuries in the 2 weeks after and before gun shows among California residents within convenient driving distance of shows in Nevada versus California. Their analysis accounted for California's 10-day waiting period between purchasing and obtaining a gun. Comparing California regions exposed to Nevada shows with those exposed to California shows, the ratios of after–before rate ratios were 1.70 (95% CI, 1.17 to 2.47) for all-intent firearm injuries and 2.23 (CI, 1.01 to 4.90) for interpersonal firearm injuries. This ratio was mainly driven by changes in firearm injuries after Nevada shows. Whereas firearm injuries of any intent did not change meaningfully among California regions exposed to California gun shows, the rate of interpersonal firearm injuries increased significantly among California regions exposed to Nevada shows. However, as the authors note, the difference in absolute rates of firearm injuries was small: an overall increase from 0.67 to 1.14 injuries per 100 000 California residents exposed to Nevada shows.
The authors should be commended for using various strategies, including negative control analysis and quantitative bias analysis, to gauge their findings' sensitivity to assumptions and robustness to potential confounding. These approaches are important, especially considering the differences between California regions exposed to California versus Nevada shows. Table 2 of the article shows notable differences between the absolute rates of firearm injuries before shows in those 2 types of region: In regions exposed to California shows, the rate of interpersonal firearm injuries was greater than that of each other type of firearm injury, whereas in regions exposed to Nevada shows, the rate of unintentional firearm injuries was highest. As such, unmeasured differences might exist between those 2 California regions that can influence short-term changes in the rates of firearm injuries after gun shows. A limitation of the study, as acknowledged by authors, is that firearm injuries were not examined among Nevada residents themselves. If unregulated gun shows increase firearm injuries in the short term, one may expect to see such an association among Nevada residents exposed to shows in that state.
The data in Matthay and colleagues' study may suggest some association between gun shows and self-directed and unintentional firearm injuries, but the estimates (that is, about 50% to 60% relative increase) were not statistically significant. It is often forgotten that about two thirds of firearm deaths in the United States are suicides. A prior study by Wintemute and colleagues showed that purchasers of a handgun had a 57-fold and 7-fold increased risk for firearm suicide in the first week and first year, respectively, after purchase (6). Evidence indicates that the means available to commit self-harm matter and that restricting the most lethal means (that is, firearms) can prevent the loss of lives due to suicide (7). Also, future research should examine whether gun shows affect unintentional firearm injuries, and if so, what plausible explanations might exist.
The study by Matthay and colleagues has many implications for gun policy in the United States. Laws regulating access to guns matter and do make a difference, especially collectively (2); however, their impact on an individual basis is a somewhat small chip in the granite wall of firearm injuries and deaths. The state-by-state nature of these laws, due to the lack of federal legislation, results in barriers to gun access that can be easily breached by a car trip. It does not reduce the importance of the laws but does reduce their impact.
Unfortunately, the amount of research on firearms is disproportionately low compared with the burden they impose on health care and society as a whole. In 1996, Congress inserted language into the Centers for Disease Control and Prevention appropriation bills that essentially prevented it from conducting and funding firearm-related research (8, 9); this lack of funding continues to this day. Nevertheless, the public health burden of firearm-related injuries and death demands that research on interventions to reduce this toll be continued, funded by local and state governments, foundations, and philanthropy.

References

  1. Centers for Disease Control and Prevention; National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). Accessed at www.cdc.gov/injury/wisqars on 3 October 2017.
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  5. Law Center to Prevent Gun Violence. Gun Shows in California. 2016. Accessed at http://smartgunlaws.org/gun-shows-in-california on 3 October 2017.
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  9. Department of Health and Human Services Appropriations Act, Pub. L. No. 104-208, 110 Stat. 1996. Accessed at www.congress.gov/104/plaws/publ208/PLAW-104publ208.pdf on 11 October 2017.


中文翻译:

枪展后的枪支伤害:衡量监管干预潜在影响的证据

最近在内华达州拉斯维加斯发生的大规模枪击事件令人痛苦地提醒人们,因获得枪支而造成的伤亡继续困扰着美国社会的许多方面,包括社区;医疗保健行业;以及受到枪支伤害、死亡或威胁的人的家属。尽管美国 3 亿多支枪造成的问题最终需要政治解决方案,但科学和科学出版物在评估和提高对干预措施的认识方面发挥着重要作用,这些干预措施可能会减少每年 36 000 起致命和 85 000 起非致命枪支伤害(1)。
由于国会缺乏有意义的行动,各州不得不以各种方式减少那些可能使用枪支对自己或他人造成伤害的人获得枪支的机会。几项研究表明,州立法限制枪支使用的严格程度与枪支伤害和死亡率之间存在负相关关系 (2)。然而,我们对枪支管制政策对枪支发病率和死亡率的影响的了解非常有限。
Matthay 及其同事 (3) 研究了分别在加利福尼亚州和内华达州发生的枪支表演与接触这些表演的加利福尼亚地区致命和非致命枪支伤害率的短期变化之间的关联。枪支表演仅占私人枪支转让的一小部分;然而,它们可能成为犯罪中使用的枪支的来源 (4)。枪支表演允许持牌经销商和无牌人士向与会者出售枪支。尽管从联邦许可的经销商处购买需要在进行销售之前对潜在买家进行背景调查,但一些州并不要求在私人销售中进行这些检查,内华达州在 Matthay 及其同事的研究期间就是这种情况。另一方面,在加利福尼亚州,演出中的枪支转让必须通过有执照的经销商处理 (5)。因此,
Matthay 及其同事比较了内华达州和加利福尼亚州在枪展方便驾驶距离内的加州居民在枪展前后 2 周内的枪伤率。他们的分析解释了加州从购买到获得枪支的 10 天等待期。将接触过内华达州表演的加利福尼亚地区与接触过加利福尼亚表演的地区进行比较,全因枪械伤害的事后发生率比为 1.70(95% CI,1.17 至 2.47),人际交往的事后发生率为 2.23(CI,1.01 至 4.90)枪伤。这一比例主要是由内华达州演出后枪支伤害的变化推动的。鉴于任何意图的枪支伤害在加利福尼亚州暴露于加利福尼亚枪支表演的地区之间没有显着变化,在暴露于内华达州表演的加州地区,人际枪支伤害率显着增加。然而,正如作者所指出的,枪支伤害的绝对比率差异很小:每 10 万加州居民接触内华达州表演,总体上从 0.67 人增加到 1.14 人受伤。
作者使用各种策略(包括阴性对照分析和定量偏差分析)来衡量他们的发现对假设的敏感性和对潜在混杂因素的稳健性应该受到赞扬。这些方法很重要,特别是考虑到加利福尼亚地区与内华达州表演的差异。文章的表 2 显示了这两种地区在演出前的枪伤绝对率之间的显着差异:在加州演出的地区,人际枪伤的发生率高于其他类型的枪伤,而在暴露于内华达州表演的地区,意外枪伤的发生率最高。因此,这两个加利福尼亚地区之间可能存在无法衡量的差异,这些差异可能会影响枪支展示后枪支伤害率的短期变化。正如作者所承认的,该研究的一个局限性是,内华达州居民自己没有检查枪伤。如果不受管制的枪支表演在短期内增加了枪支伤害,人们可能会期望看到内华达州居民在该州接触表演时会出现这种关联。
Matthay 及其同事研究中的数据可能表明枪支表演与自我导向和无意的枪支伤害之间存在某种关联,但估计值(即相对增加约 50% 至 60%)没有统计学意义。人们常常忘记,在美国,大约三分之二的枪支死亡是自杀。Wintemute 及其同事之前的一项研究表明,购买手枪的人在购买后的第一周和第一年的枪支自杀风险分别增加了 57 倍和 7 倍(6)。证据表明,可用于自残的手段和限制最致命的手段(即枪支)可以防止因自杀而造成的生命损失(7)。此外,未来的研究应该检查枪支展示是否会影响意外的枪支伤害,如果是的话,
Matthay 及其同事的研究对美国的枪支政策有很多影响。管理枪支获取的法律很重要并且确实有所作为,尤其是集体(2);然而,它们对个人的影响只是枪械伤害和死亡的花岗岩墙上的一小块碎片。由于缺乏联邦立法,这些法律的州际性质导致了枪支使用的障碍,开车旅行很容易突破这些障碍。它不会降低法律的重要性,但会降低其影响。
不幸的是,与它们给医疗保健和整个社会带来的负担相比,对枪支的研究数量少得不成比例。1996 年,国会在疾病控制和预防中心拨款法案中插入了一些语言,基本上阻止了它进行和资助与枪支相关的研究 (8, 9);这种缺乏资金的情况一直持续到今天。尽管如此,枪支相关伤害和死亡的公共卫生负担要求继续研究减少这种伤亡的干预措施,并由地方和州政府、基金会和慈善机构资助。

参考

  1. 疾病预防与控制中心; 国家伤害预防和控制中心。基于网络的伤害统计查询和报告系统 (WISQARS)。2017 年 10 月 3 日访问www.cdc.gov/injury/wisqars 。
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  5. 防止枪支暴力法律中心。加州枪展。2016 年。2017年 10 月 3 日访问http://smartgunlaws.org/gun-shows-in-california 。
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更新日期:2017-10-26
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