Lately, I have been working on the chapter of my book on American gun culture that explores negative outcomes with firearms.
Although I differ from most scholars studying guns by beginning not with gun deviance but with the normality of guns and gun owners, I do take negative outcomes seriously.
Trying to get a better understanding of how the United States compares to other countries in the world in terms of negative outcomes with firearms, I recently stumbled upon the Institute for Health Metrics and Evaluation (IHME) and its cross-national Global Burden of Disease (GBD) database (more about IHME GBD at the end).
The scope of the IHME GBD data is impressive:
The Global Burden of Disease is collected and analyzed by a consortium of more than 9,000 researchers in 162 countries and territories. The data capture premature death and disability from 370 diseases and injuries in 204 countries and territories, by age and sex, from 1990 to the present.
Even better, the database is publicly accessible (though permission must be requested to download) through the IHME website: https://vizhub.healthdata.org/gbd-results/.
I will be looking at the data to better understand how the United States compares to other nations in terms of homicide, suicide, and accidental death rates. Today I begin with the most straightforward of the three: accidental death by firearm.
This is interesting not only in itself, but also because it highlights something important about understanding risk when it comes to firearms. I am not among those who deny that firearms introduce risk into the lives of their owners. As I have argued on this blog and on my “Light Over Heat” YouTube channel, guns are tools that are by design dangerous, so gun owners assume a certain amount of risk for themselves and their loved ones when they bring firearms into their homes and lives. The key is to be thoughtful in understanding and mitigating risk.
When assessing how much risk firearms pose to members of a household, public health scholars typically examine the relative risk: compared to households with no firearms, how much additional risk do firearms-owning homes have? Examples abound but include the landmark studies of “gun ownership as a risk factor” by Arthur Kellermann and associates.
Now, I have critically engaged these studies, noting the limits of case-control designs, for example, but also appreciating more recent cohort studies that have been published.
Today, I want to highlight the importance of looking not just at relative risk but also at absolute risk.
For example, a recent study found that use of hormonal contraception (vs. non-use) raises the relative risk of developing breast cancer by 30%. But because the average woman has a 1-in-8 chance of developing breast cancer, the absolute risk of developing breast cancer in connection with hormonal contraception is only 0.2% more than what would be expected overall. And hormonal contraception has other benefits that offset that absolute and relative risk.
So, for starters, what does the IHME GBD data tell us about the relative and absolute risk of accidental death by firearm in the United States compared to other countries? I sorted the 204 countries for which the IHME has data from highest to lowest rate. The range is from 5.22 per 100,000 (Haiti) to 0.01 per 100,000 (Oman).
The United States falls in the middle of the pack, #103 out of 204 at 0.21 accidental gun deaths per 100,000 population. The risk is not zero, of course, but I judge the absolute risk to be low, especially considering how many guns (hundreds of millions) and gun-owning households (tens of millions) there are in the U.S. There are many more things that are likely to kill me than someone unintentionally shooting me or me unintentionally shooting myself.
But this data could be used to tell a very different story. Imagine a headline that reads: “Rate of accidental gun deaths in U.S. twice as high as Italy.” This would be true, since the rate in the U.S. is 0.21 per 100,000 and the rate in Italy is 0.11 per 100,00.
But the relative risk tells a different story than the absolute risk. The absolute risk of dying from an unintentional firearms injury in Italy is 1 in a million and in the U.S. it is 2 in a million.
Are there too many unintentional firearms deaths in the United States? Absolutely. As Kids S.A.F.E. Foundation president Derek LeBlanc says, “ZERO firearm accidents are the only acceptable goal!!®”
But these data highlight, for me at least, the importance of always examining absolute risk alongside the more commonly cited relative risk of negative outcomes with firearms.
An independent population health research organization based at the University of Washington School of Medicine, the Institute for Health Metrics and Evaluation (IHME) works with collaborators around the world to develop timely, relevant, and scientifically valid evidence that illuminates the state of health everywhere. In making our research available and approachable, we aim to inform health policy and practice in pursuit of our vision: all people living long lives in full health.
We steward one of the world’s largest scientific collaborations, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), which involves thousands of researchers around the world. Through this project, we quantify health loss worldwide to help leaders improve health systems and address disparities. We continue to publish new GBD results regularly, adding new causes and risk factors and working to improve our methods. Additional IHME research includes forecasting Future Health Scenarios, Health Financing, and US Health Disparities, among other endeavors.
11 thoughts on “Thinking About Absolute vs. Relative Risk of Negative Outcomes with Firearms”
“ZERO firearm accidents are the only acceptable goal!!®”
Yeah, well sure. And in traffic safety, in theory, we talk about “Vision Zero” and “zero” traffic deaths being a goal. Of course it is an absolutely unrealistic goal. The only way to get to zero traffic deaths is to have zero traffic. Not gonna happen, no way, no how. But I suppose the anti-gunners would be happy to get ride of guns as they drive around in their cars. And as you and I discussed over Charlie Komanoff’s blog post, accidental kid deaths in traffic are not unheard of.
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Unrealistic, acceptable, aspirational!
To answer your question rather than go off on a rant, I do think about risk. The key word you mention is analysis. What are the psychological and health cost/benefits to me of the things I do? How do I mitigate the riskiest parts of those activities while still enjoying them?
Like you, I enjoy alcohol. Fortunately in my case, decent wine and rarely bourbon or scotch. I partake where it is safe to do so and where I am not going to be driving, going somewhere unfamiliar, being around people I don’t trust, or engaging in other activity that would compound risk, such as handing firearms, cars, motorcycles, boats, etc.
I enjoy bicycling, which has tremendous physical as well as mental health benefits (distance riding was my Rx for getting over a divorce and finishing my Ph.D.), but I avoid high risk behavior, which I can analyze given my years of cycling in traffic and my League Cycling Instructor certification. I ride singletrack but leave the acrobatics to younger riders.
I handle guns prudently and while paying full attention to what I am doing, and leave them in predictable condition (locked up and unloaded except for a self defense firearm that is locked in a lockbox fully loaded). And practice to be familiar with all of them, including taking them apart and putting them back together.
I love motorcycling, but no longer, since my late twenties and early thirties, ride like an idiot (with thanks to a Suffolk County Sheriff Deputy who cut me a break in return for a promise). I read up on the most likely ways to get upside down on a motorcycle and avoid those. Especially as an older rider, I read an emergency medicine journal article written by a faculty member at my alma mater (the U of Rochester) that pointed out the risk factors for older riders–fading hearing and vision, increased reaction time, old bones, comorbidities, ridiculously big and fast motorcycles, etc. I use my mountain biking to keep my cardiovascular and musculature system taut in case I do FDGB on a bicycle or motorcycle. And I always wear motorcycle helmet, gloves, boots, and “body armor” in my jackets (and a brain bucket on my bicycle rides).
So sure, all those activities add risk. Some add benefits way out-costing the risks. They also add joy to my life and as we all know, none of us get out of this life alive. Every activity mentioned above has its version of Col. Cooper’s Four Rules we need to study and understand. But living while wrapped in bubble wrap, as my former post doc would sometimes comment, gets rather boring, even if it means a longer life.
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Somewhere I stole the idea that risk is a currency that we decide how to spend. At the end of the day, the lifetime odds of death is 1.
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I know you’re a busy man, but I’d be curious as to your thoughts on my critiques of that Studdert cohort study, particularly regarding the relative vs. absolute risk issue. Whereas Studdert, et al. report that “[o]verall rates of homicide were more than twice as high among cohabitants of handgun owners than among cohabitants of nonowners,” I calculated that their data show only a .0008% per year elevated risk.
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I’m interested to see it. Could you (re)post the link? I’m sorry I missed it the first time around.
I raise seven concerns in a comment on your post about that study:
The late Kevin O’Brien, of WeaponsMan fame, had one liner about the negative effects of the overindulgence of alcohol
“ETOH is a force multiplier. It takes small, piss poor decisions and magnifies them into tragedies of epic proportions.“
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Great quote. And very true IMO. A huge percentage of murderers and murder victims have alcohol in their systems, I read once somewhere. I need to dig those studies up again.
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