In some countries, the odds of getting shot are 1 in a million. In the US, it's 100 times higher

Imagine that, in the course of a single year, a ubiquitous household item was implicated in the death of every man, woman and child in the city of Glendale, Ariz., America's 87th largest city with a population of 251,269. The world would almost certainly take notice of such a loss.

That, in essence, was the global toll of humanity's obsession with firearms.

There are roughly 1 billion guns in the world, and new research finds that in 2016, they ended the lives of about 251,000 people in 195 countries and territories that kept reasonably detailed death records. Those deaths included homicides, suicides and accidents.

Just six countries that make up less than 10 percent of the world's population—Brazil, the United States, Mexico, Colombia, Venezuela and Guatemala—accounted for just over half of the world's gun-related deaths.

The new worldwide tally is a first-ever attempt to discern international patterns in gun access, gun ownership and fatalities caused by guns. The findings were published Tuesday in the Journal of the American Medical Association.

Wars, mass shootings and terrorist attacks may loom large in our consciousness. But the new work makes clear that guns' worldwide death toll actually is driven by personal despair, interpersonal conflict and carelessness.

"This constitutes a major public health problem for humanity," a trio of firearms-research specialists wrote in an editorial that accompanies the new study.

The census of gun fatalities did not include people killed in armed conflict situations. Indeed, in almost every year between 1990 and 2016, the non-combat toll of firearms dwarfed the number of gun deaths stemming from wars and insurrections. In 2001, for instance, there were 15 civilian gun deaths for every military gun death. The only exception was 1994, when Rwandans engaged in organized slaughter along tribal lines.

Worldwide, 64 percent of gun-related deaths were considered a homicide.

But from country to country, there were stark differences in the motivations of people wielding guns.

In affluent countries such as Australia, Canada and Germany, suicides typically outnumbered homicides by considerable margins. In the United States, there were nearly twice as many gun-related suicides as gun-related homicides in 2016. That year, the United States accounted for 35 percent of all firearm suicides around the world.

In countries where drug trafficking and gang violence are pervasive scourges, gun-related homicides clearly dominated. In China and Saudi Arabia, deaths by firearm were usually unintentional.

The research team, a multinational consortium of public health experts called the Global Burden of Disease 2016 Injury Collaborators, estimated that there were 209,000 firearms deaths in 1990—a figure that rose to 251,000 in 2016. But the global population expanded more rapidly during that period. As a result, between 1990 and 2016, worldwide rates of gun deaths decreased by close to 1 percent per year.

With no more than seven firearms-related deaths in 2016, tiny Singapore had the world's lowest rate of gun fatality—the risk of being killed by a bullet was literally 1 in a million. Japan was a close second, with an estimated 455 gun deaths in 2016 and a risk of 2 in a million. Both countries have strict limits on gun ownership.

The United States, by comparison, had about 106 gun-related deaths per 1 million people.

In the Philippines and Australia, the annual incidence of firearm suicides declined by more than 5 percent during the study period. In Estonia and Taiwan, the annual incidence of firearm homicides decreased by 6 percent.

Eighteen countries bucked this trend, with gun fatality rates that either remained constant or increased. Fourteen of those were in Latin America and the Caribbean.

Across national boundaries with differing laws and wildly varying attitudes toward guns, the findings raise many questions for researchers to pursue. But they makes one point clearly: Firearms are "an important public health problem with social and economic costs that extend beyond the immediate loss of life," the study authors wrote.

They cut down people—men overwhelmingly—who are in the prime of life, between the ages of 15 and 40. In 2016, they killed 7,220 children before they reached their 14th birthday. Boys in this age group died at 2 { times the rate of girls.

Guns cut short the lives of women too, with homicides vastly outnumbering suicides. Unintentional deaths involving women and guns are vanishingly rare.

Other research has found a link between firearms ownership and fatal "nonstranger" violence in the United States. The authors of the new report noted that "although men are most often the targets of firearm violence, they are also the most likely perpetrators, often in the context of domestic and relationship violence."

The study also makes clear that the United States has played a key role in setting the stage for gun-related deaths across the Americas, both by supplying the weapons and sustaining the drug trade that drives the mostly illegal use of guns in these countries. In many of these countries, few guns appear to be in the hands of legal owners.

By creating national baselines of gun deaths and showing trends over time, the new tally lays the foundation for cross-cultural comparisons. That could allow future researchers to explore why gun deaths have dropped so dramatically in some countries while rising in others, and to ask whether government policies played a role. It will permit them to study whether and how the circumstances of neighboring states—such as gun behemoth the United States—subvert or promote a country's efforts to drive down gun deaths.

It should also spur more and better data collection, according to the authors of the editorial.

"In addition to knowing how many people own guns, reliable estimates of how many people have easy access to guns would be valuable because this may be the strongest risk factor for firearm injury and death," wrote University of Washington pediatrician Dr. Frederick P. Rivara, Stanford Law School's David M. Studdert, and University of California, Davis emergency physician Dr. Garen J. Wintemute.

They added that future research must begin to explain why people keep firearms.

"Efforts to prevent firearm violence that do not proceed from a clear understanding of both why people own firearms and the perceived barriers to change will have limited success, as the experience to date demonstrates."

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