Firearm Mortality in Saint Louis County: A Sub-County Approach Analyzing the Impact of Health Equity Indictors

BACKGROUND: Since Missouri is not a National Violent Death Reporting System participating state, gathering data on gun-related violent deaths is incomplete and difficult. Saint Louis County contains over one sixth of Missouri’s population and is more diverse. Municipal fragmentation, depicted by events in Ferguson, makes crime data difficult to obtain due to variations among approximately sixty-one police departments. Beginning with vital statistics data, firearm mortality was examined using a sub-county approach to highlight areas with elevated mortality due to firearms and illustrate the health equity indicators that are impacting those firearm-related mortality rates.

METHODS: Vital statistics data was obtained for firearm mortality in Saint Louis County and Saint Louis City. The outcomes of interest were mortality due to firearms, homicide, and suicide. Health equity indicators analyzed were poverty level, years of potential life lost, sex, age, race/ethnicity, and county region. Age-adjusted rates by census tract and region were mapped using ArcGIS10.3.1. Three logistic regression models were run to compare the odds of firearm mortality, homicide, and suicide in each region for variables of significance using SAS 9.3. Rates are the number of deaths per 100,000.

RESULTS: The 5 year rates for Saint Louis City and Saint Louis County homicide due to firearms are 24.3 and 7.0. Together, the rate is 11.7. African-Americans experience the highest rates for homicide in the city and county, 47.9 and 22.9. The 5 year rate for Saint Louis City and Saint Louis County suicide by firearms is 6.6 and 5.8 per 100,000. The overall rate is 6.0. White residents experience higher rates of suicide by firearms in the city and county, 9.1 and 6.9. We expect the models to show an increase in disparity for homicide odds among African-American males compared to white males and those who experience higher poverty. Suicide odds are expected to be higher for those with lower poverty and white residents. While homicide rates are expected to be higher in North County and City, suicide rates are expected to be higher in the more south and west regions were less poverty is found.

CONCLUSIONS: Using vital statistics data stimulated conversation and encouraged the formation of partnerships among community stakeholders around firearm mortality in Saint Louis. Shared data between the city and county health departments will help inform the Wash U Gun Violence Initiative and support the Ferguson Commission calls to action focused on building safe neighborhoods and fostering racial equity.