News Release

Adults living with gun owners significantly more likely to die by homicide, especially if they are female

Embargoed News from Annals of Internal Medicine

Peer-Reviewed Publication

American College of Physicians

1. Adults living with gun owners significantly more likely to die by homicide, especially if they are female



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An analysis of statewide data in California from 2004 to 2016 found that homicide rates for adults who live with handgun owners were twice as high compared to adults who did not. Among homicides occurring at home, adults were seven times more likely to die by homicide with a firearm at the hand of a spouse or intimate partner who owned a gun, with most of those victims being women. The findings are published in Annals of Internal Medicine.

One in three homes in the United States have at least one firearm. Firearm owners cite the protection of themselves and their family as the lead motivator for owning a gun, and three quarters of gun owners report feeling safer with a firearm in their home. Evidence from previous studies instead suggests that gun ownership increases rates of homicide in the home. However, these studies have been more limited in size and scope.

Researchers from Stanford University studied data gun purchasing and death records for more than 17.6 million California adults to estimate the association between living with a lawful handgun owner and risk for homicide victimization. The data revealed more than double the risk of homicide among the 595,448 adults living with handgun owners. The records showed that these elevated rates were driven largely by higher rates of homicide by firearm and two thirds of the people who lived with gun owners and faced these elevated risks were women.  The authors also note that while a small minority of homicides occurring at home were perpetrated by strangers, adults living with gun owners did not experience these attacks at lower rates than adults living with nonowners.

In an accompanying editorial, Christine Laine, MD, MPH, editor in chief of Annals of Internal Medicine and Sue Bornstein, MD, chair-elect of the American College of Physicians’ (ACP) Board of Regents, argue that gun violence both inside and outside the home should be treated as an epidemic and tackled with a multifaceted approach. To combat this issue, the authors suggest advancing legislation to enable risk protection orders, establishing programs to address social factors, and enforcing strong consequences for companies and individuals who facilitate the misuse of firearms. ACP has long advocated for the public and policy makers to recognize gun violence as a public health issue. As such, ACP says doctors should play an active role in preventing gun violence by talking to patients at risk.

Media contacts: For an embargoed PDF or to speak with someone from ACP, please contact Angela Collom at To speak with the corresponding author, David M. Studdert, LLB, ScD, please contact Beth Duff Brown at


2. Surviving nonfatal gunshot injury led to 400% increase in healthcare costs

Survivors and family members also experienced worse mental health and other health effects


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A large cohort study found that survivors of nonfatal firearm injuries faced an increased likelihood of psychiatric disease, substance use disorders, and pain as a result of the incident. The mental health of family members also deteriorated. In addition, surviving a nonfatal gunshot resulted in substantial increases in health care spending and use. The findings are published in Annals of Internal Medicine.

About 40,000 Americans suffer fatal firearm injuries each year, but more than twice as many sustain firearm injuries and survive. However, evidence on the clinical and economic implications of nonfatal firearm injuries remains limited.

Researchers from Harvard Medical School and Massachusetts General Hospital studied actual claims from commercial and Medicare data between 2008 and 2018 to measure changes in clinical and economic outcomes after nonfatal firearm injuries among survivors and their family members. The authors used advanced modern matching techniques to assess these outcomes among 6,498 firearm injury survivors, 12,489 family members, and 94,935 total matched control participants for both groups. They found that survivors, along with their employers, insurers, and society, end up paying large sums for health care as a result of firearm injuries (about $2,500 per person per month more or an over 400% increase in spending in the first year). Extrapolating this nationwide, it amounts to roughly $2.5 billion more for direct health care in the first year after firearm injury alone. Family members did not escape harm after their loved ones were injured. They experienced a 12% increase in mental health disorders, including depression, anxiety, and PTSD. According to the authors, these findings suggest that survivors and family members should be routinely evaluated for mental health care needs after firearm injury. They emphasize the importance of screening for firearm safety by frontline clinicians. More attention should also be paid to safe prescribing of pain medications and monitoring for alcohol and substance use disorders after firearm injury. 

Media contacts: For an embargoed PDF, please contact Angela Collom at To speak with the corresponding author, Zirui Song, MD, PhD, contact him directly at




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