Firearm-Related Years of Potential Life Lost Before Age 65 Years -- United States, 1980-1991

In 1991, deaths from suicide and homicide combined were the third leading cause of years of potential life lost before age 65 (YPLL-65) in the United States (1). Firearms were used in 60.1% of all suicides, in 67.8% of all homicides, and in less than 2.0% of unintentional injury deaths (2). Firearm-related death rates increased during the late 1980s, particularly among adolescents and young adults (3). To characterize trends in premature mortality attributed to firearm-related injuries, annual mortality data were analyzed for 1980-1991 (the most recent years for which complete data were available). This report summarizes the results of the analysis.

YPLL-65 were calculated using final mortality data for 5-year age groups obtained from the underlying cause of death files produced by CDC's National Center for Health Statistics (NCHS). In standard vital statistics tabulations, firearm-related deaths are recorded in four separate categories: homicides (International Classification of Diseases, Ninth Revision {ICD-9}, codes E965.0- E965.4 and E970), suicides (ICD-9 codes E955.0-E955.4), unintentional (ICD-9 code E922), and intent undetermined (ICD-9 codes E985.0-E985.4). For this report, categories were combined to assess the overall impact of firearm-related injuries on U.S. mortality.

In 1991, there were 38,317 firearm-related deaths that accounted for 1,072,565 YPLL-65 and represented 9.0% of the total YPLL-65 for all causes of death. Firearms were the fourth leading cause of YPLL-65, following nonfirearm-related unintentional injuries (2,002,616), malignant neoplasms (1,772,010), and diseases of the heart (1,312,765). From 1980 through 1991, YPLL-65 attributed to nonfirearm-related unintentional injury and heart disease declined 25.2% and 18.1%, respectively, and YPLL-65 attributed to cancer remained virtually unchanged (1.1% increase). In comparison, during the same period, firearm-related YPLL-65 increased 13.6% (Figure_1). Except for infection with human immunodeficiency virus, no other leading cause of death increased substantially in YPLL-65 during this study period.

In 1980, firearm-related homicides exceeded firearm-related suicides. Homicides accounted for 46.8% of firearm-related fatalities and 52.6% of firearm-related YPLL-65. Suicide accounted for 45.6% of firearm-related deaths and 37.8% of firearm-related YPLL-65. In 1991, firearm-related suicides exceeded homicides (48.3% and 46.9% of firearm-related deaths, respectively). However, firearm-related homicides accounted for a greater proportion (57.4% compared with 36.7% for suicide) of firearm-related YPLL-65. During 1980-1991, YPLL-65 attributed to unintentional and undetermined firearm-related injuries declined 30.1%.

From 1980 through 1991, both the number of firearm-related deaths and the proportion of homicides and suicides attributable to firearms increased. The number of firearm-related suicides increased 20.3%, compared with a 13.8% increase for firearm-related homicides. YPLL-65 attributed to homicide increased 16.0% and to suicide increased 14.7%. Most of the increase in YPLL-65 attributed to homicide (97.6%) and suicide (79.4%) was attributed to firearm-related deaths. YPLL-65 attributable to firearm-related homicide has increased more substantially than YPLL-65 attributable to firearm-related suicide (23.9% and 10.5%, respectively).

Reported by: Div of Violence Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note

Editorial Note: The findings in this report indicate that firearm-related YPLL-65 increased substantially during 1980-1991. YPLL-65 attributable to firearm-related homicide increased more rapidly than did YPLL-65 for firearm-related suicide because rates of firearm-related homicide increased most markedly among teenaged and young adult populations, while rates of firearm-related suicide increased more dramatically among older persons (2). If present trends continue, firearm-related injuries will become the leading cause of injury-related mortality in the United States during the next 10 years (4,5).

Causes of death that primarily affect young persons may not rank among the leading causes of death for the total population. YPLL-65 emphasizes causes of death among young persons to better represent the burden of premature deaths. For example, firearm-related injuries are the second leading cause of death in the United States for persons aged 10-34 years but are the eighth leading cause of death for the total population. Firearm-related injuries are the fourth leading cause of YPLL-65.

The findings in this report are subject to at least four limitations. First, deaths of foreign nationals and of U.S. citizens living abroad are not included in these calculations. Second, a small number of intentional deaths may be misclassified as unintentional or undetermined. Third, the method used to calculate YPLL-65 is based on the assumption that deaths occur uniformly within age groups. The results calculated for this report differ slightly from previously published values that were calculated from different age groups (1); however, these differences do not affect the relative ranking of leading causes of YPLL-65. Fourth, in addition to YPLL-65, several other methods exist for calculating YPLL. One method uses maximum life expectancy as the cut-off point and may provide a more exact approximation of premature mortality, especially for conditions that cause death later in life. Another method weighs each death according to the net economic gains and losses experienced by society to estimate the valued years of potential life lost (VYPLL) (6). Using this methodology, firearm-related fatalities were second to nonfirearm-related unintentional injuries as a leading cause of VYPLL.

A systematic, science-based approach is needed to reduce firearm-related injury and death; this approach would include surveillance, research, intervention, and evaluation (4). Improved surveillance is needed to assess the magnitude of fatal and nonfatal firearm-related injuries and to evaluate intervention efforts. Research to identify modifiable factors associated with risk for firearm-related injury is essential for developing effective prevention programs. Interventions to reduce firearm-related morbidity and mortality should combine behavioral, social, economic, legislative, and technologic strategies. Efforts are needed to assess the impact of these strategies (7).

References

1. CDC. Years of potential life lost before age 65 -- United States, 1990 and 1991. MMWR 1993;42:251-3.

2. NCHS. Vital statistics mortality data, underlying cause of death, 1991 {Machine-readable public-use data tapes}. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1993.

3. Fingerhut LA. Firearm mortality among children, youth, and young adults 1-34 years of age: trends and current status -- United States, 1985-90. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, NCHS, 1993. (Advance data no. 231).

4. CDC. Deaths resulting from firearm- and motor-vehicle-related injuries -- United States, 1968-1991. MMWR 1994;43:37-42.

5. Fingerhut LA, Jones C, Makuc D. Firearm and motor vehicle injury mortality: variation by state and race and ethnicity -- United States, 1990-1991. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1994. (Advanced data no. 242).

6. Gardner JW, Sanborn JS. Years of potential life lost (YPLL) -- what does it measure? Epidemiology 1990;1:322-9.

7. Loftin C, McDowall D, Wiersma B. Evaluating effects of changes in laws. Am J Prev Med 1993;9:39-43.

   
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