68% of deaths from firearms are from self-harm, majority in older men in rural regions

A new study of gun injuries and deaths in Ontario found that 68% of firearm-related deaths were from self-harm, and they most often occurred in older men living in rural regions, pointing to the need for targeted prevention efforts. The study is published in CMAJ (Canadian Medical Association Journal).

There were 2009 injuries secondary to self-harm over the study period, and "this is equivalent to a firearm-related injury ... every 3 days; 92% of these injuries were fatal," writes Dr. David Gomez, a trauma surgeon at St. Michael's Hospital, Unity Health Toronto, adjunct staff scientist at ICES, and assistant professor at the University of Toronto, with coauthors.

In Canada, nonfatal firearm-related injuries are largely unmeasured.

To better understand injuries and deaths from firearms, a major cause of morbidity and mortality, researchers looked at data on all residents of Ontario with a valid OHIP number who were injured or died of gun injuries between 2002 and 2016. They used hospital discharge and provincial death records to categorize injuries as assault, unintentional, self-harm and undetermined intent.

Some findings:

• Injuries related to assault accounted for 40% of nonfatal injuries and 25% of deaths. Young men living in low income neighborhoods were overrepresented in this group.
• Injuries and death rates were higher in rural areas versus urban areas, largely due to higher rates of self-harm in these regions.
• Injury patterns varied by age, with assault most common in people aged 15-34, and self-harm being most common among those aged 45 or older.
• Five of 10 Census divisions with the highest injury rates from assault were in the Greater Toronto Area and Hamilton.
• Firearm injury rates varied over time, with a high of 4.71 per 100 000 in 2005/06 after which rates declined, followed by an increase in the last 2 years of the study (3.51 per 100 000 in 2015/16). Both peaks were related to injuries from assault as self-harm rates showed less variability.

Targeted initiatives are required to address the different causes of injuries in rural and urban regions.

"This urban-rural divide highlights the need for tailored interventions to address these 2 contrasting injury patterns," write the authors. "Our findings highlight the need for suicide-prevention strategies in rural Ontario targeted at men aged 45 or older. Restricting access to lethal methods by such means as safe-storage campaigns and reduction in firearm ownership must go hand in hand with depression screening and treatment."

"Firearm-related injuries and deaths in Ontario, Canada, 2002-2016: a population-based study" is published October 19, 2020.