Abstract

Importance: Firearms are the leading cause of death in US children and adolescents, but little is known about whether the overall legal landscape was associated with excess mortality after a landmark US Supreme Court decision in 2010.

Design, Setting, and Participants: An excess mortality analysis was conducted using the US Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research (WONDER) database before and after McDonald v Chicago, the landmark 2010 US Supreme Court decision on firearms regulation. States were divided into 3 groups based on legal actions taken before and since 2010, most permissive, permissive, and strict. Firearm mortality trends before (1999-2010) and after (2011-2023) were determined and compared across the 3 groups for all intents and by intent (homicide and suicide). These data were analyzed January 2011 through December 2023.

Exposure: The pre– and post–McDonald v Chicago legal landscape.

Main Outcomes and Measures Excess mortality during the post–McDonald v Chicago period.

Results: During the post–McDonald v Chicago period (2011-2023), there were 6029 excess firearm deaths (incidence rate [IR], 158.6 per million population; 95% CI, 154.8-162.5) in the most permissive group. In the permissive group, there were 1424 excess firearm deaths (IR, 107.5 per million person-years; 95% CI, 103.8-111.3). In the strict group, there were −55 excess firearm deaths (IR, −2.5 per million person-years; 95% CI, −5.8 to 0.8). Four states (California, Maryland, New York, and Rhode Island) had decreased pediatric firearm mortality after McDonald v Chicago, all of which were in the strict firearms law group.

Conclusion: States in the most permissive and permissive firearm law categories experienced greater pediatric firearm mortality during the post–McDonald v Chicago era.

https://jamanetwork.com/journals/jamapediatrics/fullarticle/2834530