Today, guns are outpaced only by motor vehicles as a cause of fatal injury stemming from a household or recreational consumer product. The federal Centers for Disease Control and Prevention (CDC) has estimated that by the year 2001, firearms will surpass motor vehicles as the leading cause of product-related death in our nation.⁵ In 1996, this crossover had already occurred in five states and the District of Columbia. ⁶

Contrary to popular perception, most gun death in America is not crime related. Most firearm deaths stem not from homicide (14,327 in 1996) but suicide (18,166 in 1996). And even for those who are murdered with firearms,^a the Uniform Crime Reports published by the Federal Bureau of Investigation (FBI) reveals that the majority of firearm homicide victims die not as the result of criminal activity, but because of arguments between people who know each other.

When compared to other industrialized nations, the United States stands alone in the number of its citizens felled by guns. A 1997 study by the CDC analyzed firearm deaths for children less than 15 years old in 26 countries and found that 86 percent of the deaths occurred in the U.S.⁷ A 1998 study in the International Journal of Epidemiology found that the overall rate of firearms death in the U.S. is eight times higher than the firearms death rate of 25 other high-income countries combined.⁸

The higher mortality rate in the U.S. is not the result of more violence, but of more lethal violence. For example, a recent analysis by the U.S. Department of Justice�s Bureau of Justice Statistics (BJS) compared crime rates in the U.S. with those in England and Wales from 1981 to 1996. BJS found that British crime rates now exceed those of the U.S. in several categories, and to a surprising degree. The British assault rate has been rising steadily, for instance, and is now more than double the U.S. rate.⁹ However, violent crimes in England and Wales are far less likely to involve guns, and thus far less likely to end in death. According to 1996 police statistics, firearms were used in five percent of British robberies and seven percent of murders, compared with 41 percent of American robberies and 68 percent of American murders.^b

In addition to the human toll exacted by firearms, the monetary cost�as measured in hospitalization, rehabilitation, and lost wages�is staggering. In 1995, the cost of providing medical care for firearm-related injuries was estimated to be $4 billion�with much of the financial cost passed on to private health insurance subscribers and taxpayers.¹⁰ Annually, each bullet sold in the United States carries an injury price tag of almost $23�including 60 cents for medical care and emergency services, $7.20 for lost work, and $15.10 for lost quality of life.¹¹ Other less tangible costs associated with firearms violence include the fear that perme-ates our streets, a gnawing concern for our children's safety, and, perhaps worst of all, a debilitating hopelessness that anything can ever be done to stop the bloodshed.

In reality, firearms violence stems not from "guns in the wrong hands," but from the virtually unregulated distribution of an inherently dangerous consumer product. Unlike virtually every other consumer product, firearms are exempt from federal health and safety regulations. Specific categories of firearms�such as handguns and assault weapons�have very limited utility and inflict high costs on society in the form of premature death and debilitating injury. Identifying the variations in firearms death and injury among demographic groups provides an opportunity to move beyond the popular but narrow perception of firearms violence as solely a crime issue to place it in its proper perspective: a widespread public health problem of which crime is merely the most recognized aspect.

While no segment of American society is immune to firearms violence, there are those who bear a disproportionate share of victimization. Lower-income urban neighborhoods consistently record higher rates of homicide¹²�especially among young males.^c Firearms suicide is most prevalent in western¹³ states, and rates have remained highest among elderly white males.¹⁴ The nature of victimization also varies among groups. In its 1996 Uniform Crime Reports, the FBI reports that, in single victim/single offender incidents, while male victims were murdered by other males 89 percent of the time, nine out of 10 female victims were slain by a male.¹⁵

The following sections provide an overview of the differences in firearms homicide and suicide among groups by sex, age, and race. The examination then turns to a general analysis of unintentional firearms death, nonfatal firearm injuries, and the economic burden created by this violence. Finally, the study ranks the difference in firearms death and injury rates among states.

^a Firearms were the weapons used in approximately seven out of every 10 homicides committed in the United States in 1996.

b These statistics are from the year before Great Britain banned the private ownership of handguns in the wake of the attack on a Dunblane, Scotland kindergarten class.

^c In his June 14, 1995 Journal of the American Medical Association article, "Race, Socioeconomic Status, and Domestic Homicide," researcher Brandon Centerwall affirmed that socioeconomic factors were more important than race in explaining variations in homicide rates. Evan Stark, in his 1990 International Journal of Health Services article, "Rethinking Homicide: Violence, Race, and the Politics of Gender," noted that racism has created: less access to resources to cope with violence; increased stereotyping about acceptable levels of violence; and, consequently, disproportionate levels of fatal violence.