Challenges, Successes, and the Future of Firearm Injury Prevention

Centennial Issue Population Health

Policy Points:

  • Firearm injury is a leading cause of death in the United States, with fatality rates increasing 34.9% over the past decade (2010-2020).
  • Firearm injury is preventable through multifaceted evidence-based approaches.
  • Reviewing past challenges and successes in the field of firearm injury prevention can highlight the future directions needed in the field.
  • Adequate funding, rigorous and comprehensive data availability and access, larger pools of diverse and scientifically trained researchers and practitioners, robust evidence-based programming and policy implementation, and a reduction in stigma, polarization, and politicization of the science are all needed to move the field forward.

Firearm injuries constitute a major US public health crisis that requires urgent attention. Fatality rates have increased 34.9% over the past decade (2010-2020), with firearms responsible for over 400,000 deaths and an estimated 1.2 million emergency department visits for nonfatal injuries during this time.1–4 In 2017, firearm deaths surpassed motor vehicle crash deaths for the first time in a generation3,4 and remain even higher today.3 Firearms were responsible for 45,222 fatalities in 2020, the highest absolute number of annual deaths ever recorded by the Centers for Disease Control and Prevention (CDC) and second only to opioid overdoses as an injury-related cause of death,1 and in 2020 firearms became the leading cause of death for children and teens.5 Although such injuries result from many causes, the overwhelming majority (98%) result from intentional forms of firearm violence such as nonpartner/partner homicides and assaults, self-inflicted firearm suicides, police violence, and active shooter incidents (e.g., school shootings).1,6 It should be noted that although active shooter incidents, such as mass shootings and school shootings, are devastating and receive the majority of national attention, they only make up a small fraction of the deaths and injuries occurring from firearms.7 Most deaths from firearms are self-inflicted firearm suicides.1 Additionally, long-term morbidity from firearm injuries is substantial, with 70% of adults reporting substantially worse physical health and function five years postinjury8 and 50% of children requiring disability and/or rehabilitative care on inpatient hospital discharge9 because of a firearm injury. Furthermore, individuals who survive an initial firearm injury are at elevated risk for repeat firearm injuries (some of which are fatal),10–13 substance use disorders,14 mental health issues (e.g., anxiety, PTSD),15 and criminal justice system involvement.12,16

The effects of firearm violence extend beyond the victims of firearm injuries to include those who witness a shooting or experience the injury or death of family and friends, yet we know relatively little about this secondhand experience and its sequelae. Communities are also affected by firearm violence because events such as mass shootings and firearm homicides and assaults can affect the collective community wide sense of safety and security,17–19 and firearm-related suicides can leave communities and family members dealing with long-term mental health sequalae.20–24 The economic costs of firearm injuries are high, estimated at $229 billion annually1,25–27 when including acute and longterm medical costs and disability care, lost work and productivity, and costs for criminal justice proceedings. Importantly, these estimated costs do not include the costs associated with the efforts of witnesses, friends, families, and communities to recover from this type of violence.

Open Access


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  10. Cunningham RM, Carter PM, Ranney M, et al. Violent reinjury and mortality among youth seeking emergency department care for assault-related injury: a 2-year prospective cohort study. JAMA Pediatr. 2015;169(1):63-70.
  11. Carter PM, Walton MA, Roehler DR, et al. Firearm violence among high-risk emergency department youth after an assault injury. Pediatrics. 2015;135(5):805-15. peds.2014-3572
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Roche JS, Carter PM, Zeoli AM, Cunningham RM, Zimmerman MA. Challenges, Successes, and the Future of Firearm Injury Prevention. Milbank Q. 2023;101(S1): 579-612.