BACKGROUND Gun violence has shortened the average life expectancy of Americans, and better knowledge about the root causes of gun violence is crucial to its prevention. While some empirical evidence exists regarding the impacts of social and economic factors on violence and firearm homicide rates, to the author's knowledge, there has yet to be a comprehensive and comparative lagged, multilevel investigation of major social determinants of health in relation to firearm homicides and mass shootings. METHODS AND FINDINGS This study used negative binomial regression models and geolocated gun homicide incident data from January 1, 2015, to December 31, 2015, to explore and compare the independent associations of key state-, county-, and neighborhood-level social determinants of health-social mobility, social capital, income inequality, racial and economic segregation, and social spending-with neighborhood firearm-related homicides and mass shootings in the United States, accounting for relevant state firearm laws and a variety of state, county, and neighborhood (census tract [CT]) characteristics. Latitude and longitude coordinates on firearm-related deaths were previously collected by the Gun Violence Archive, and then linked by the British newspaper The Guardian to CTs according to 2010 Census geographies. The study population consisted of all 74,134 CTs as defined for the 2010 Census in the 48 states of the contiguous US. The final sample spanned 70,579 CTs, containing an estimated 314,247,908 individuals, or 98% of the total US population in 2015. The analyses were based on 13,060 firearm-related deaths in 2015, with 11,244 non-mass shootings taking place in 8,673 CTs and 141 mass shootings occurring in 138 CTs. For area-level social determinants, lag periods of 3 to 17 years were examined based on existing theory, empirical evidence, and data availability. County-level institutional social capital (levels of trust in institutions), social mobility, income inequality, and public welfare spending exhibited robust relationships with CT-level gun homicide rates and the total numbers of combined non-mass and mass shooting homicide incidents and non-mass shooting homicide incidents alone. A 1-standard deviation (SD) increase in institutional social capital was linked to a 19% reduction in the homicide rate (incidence rate ratio [IRR] = 0.81, 95% CI 0.73-0.91, p < 0.001) and a 17% decrease in the number of firearm homicide incidents (IRR = 0.83, 95% CI 0.73-0.95, p = 0.01). Upward social mobility was related to a 25% reduction in the gun homicide rate (IRR = 0.75, 95% CI 0.66-0.86, p < 0.001) and a 24% decrease in the number of homicide incidents (IRR = 0.76, 95% CI 0.67-0.87, p < 0.001). Meanwhile, 1-SD increases in the neighborhood percentages of residents in poverty and males living alone were associated with 26%-27% and 12% higher homicide rates, respectively. Study limitations include possible residual confounding by factors at the individual/household level, and lack of disaggregation of gun homicide data by gender and race/ethnicity. CONCLUSIONS This study finds that the rich-poor gap, level of citizens' trust in institutions, economic opportunity, and public welfare spending are all related to firearm homicide rates in the US. Further establishing the causal nature of these associations and modifying these social determinants may help to address the growing gun violence epidemic and reverse recent life expectancy declines among Americans.

中文翻译：

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美国与枪支相关凶杀案有关的健康问题社会决定因素：一项全国性的多层次研究。

背景技术枪支暴力已经缩短了美国人的平均寿命，并且更好地了解枪支暴力的根本原因对其预防至关重要。尽管存在一些关于社会和经济因素对暴力行为和枪械凶杀率的影响的经验证据，但据作者所知，对于枪支凶杀案和枪支凶杀案相关健康的主要社会决定因素，尚待全面，比较，滞后的多级调查。大规模枪击事件。方法和研究结果使用负二项式回归模型和地理位置枪支凶杀事件数据（从2015年1月1日至2015年12月31日），探索并比较了州，县和街区主要社会决定因素的独立关联健康-社会流动性，社会资本，收入不平等，种族和经济隔离，以及在美国的社会支出-与邻里枪支相关的凶杀案和大规模枪击事件，这说明了相关的州枪支法律以及各州，县和邻里（人口普查[CT]）的各种特征。有关枪支相关死亡的纬度和经度坐标先前是由枪支暴力档案馆收集的，然后根据2010年人口普查地理资料，由英国报纸《卫报》链接到CT。研究人群包括美国连续48个州的2010年人口普查定义的所有74,134个CT。最终样本涵盖了70,579枚CT，2015年估计有314,247,908个人，占美国总人口的98％。该分析基于2015年与130,060例枪支相关的死亡案例，其中8月份发生了11,244例非大规模枪击事件。138次CT中有673次CT和141次大规模枪击。对于区域级社会决定因素，根据现有理论，经验证据和数据可用性，对3到17年的滞后期进行了检查。县级机构的社会资本（对机构的信任水平），社会流动性，收入不平等和公共福利支出与CT级枪杀案的发生率，非大规模和大规模射击杀人案的总数以及非-仅凭枪击杀人事件。机构社会资本增加1个标准差（SD），与凶杀率下降19％有关（发生率[IRR] = 0.81，95％CI 0.73-0.91，p <0.001），而下降17％枪械凶杀事件的发生率（IRR = 0.83，95％CI 0.73-0.95，p = 0.01）。向上的社会流动性与枪杀凶杀率降低25％（IRR = 0.75，95％CI 0.66-0.86，p <0.001）和凶杀事件减少24％（IRR = 0.76，95％CI 0.67-0.87，p <0.001）。同时，贫困地区居民和单身男性的居所比例增加1-SD分别导致凶杀率增加26％-27％和12％。研究的局限性包括个人/家庭层面上可能存在的残留混杂因素，以及缺乏按性别和种族/民族划分的枪杀凶手数据。结论本研究发现，美国的贫富差距，公民对机构的信任程度，经济机会以及公共福利支出都与枪支凶杀率有关。