Reductions in firearm-related mortality and hospitalizations in Brazil after gun control

Health Affairs

Volumn 26, Issue 2, 2007, Pages 575-584

  De Souza, Maria De Fátima Marinho ^a,b   Macinko, James ^c   Alencar, Airlane Pereira ^a   Malta, Deborah Carvalho ^b,d   Neto, Otaliba Libânio De Morais ^e,f  

^a UNIVERSITY OF SÃO PAULO   (Brazil)

^b MINISTÉRIO DA SAÚDE   (Brazil)

^c UNIVERSITY OF PENNSYLVANIA   (United States)

^d FEDERAL UNIVERSITY OF MINAS GERAIS   (Brazil)

^e FEDERAL UNIVERSITY OF GOIÁS   (Brazil)

^f Secretariat of Health Surveillance   (Brazil)

Author keywords

[No Author keywords available]

Indexed keywords

ADOLESCENT; ADULT; AGE DISTRIBUTION; BRAZIL; CAUSE OF DEATH; FEMALE; FIREARM; GUNSHOT INJURY; HOMICIDE; HOSPITALIZATION; HUMAN; INCIDENCE; LEGAL ASPECT; MALE; MIDDLE AGED; MORTALITY; PREDICTION AND FORECASTING; REVIEW; SEX RATIO; STATISTICS; SURVIVAL;

ADOLESCENT; ADULT; AGE DISTRIBUTION; BRAZIL; CAUSE OF DEATH; FEMALE; FIREARMS; HOMICIDE; HOSPITAL MORTALITY; HOSPITALIZATION; HUMANS; INCIDENCE; MALE; MIDDLE AGED; PREDICTIVE VALUE OF TESTS; SEX DISTRIBUTION; SURVIVAL ANALYSIS; WOUNDS, GUNSHOT;

EID: 33947323885     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.26.2.575     Document Type: Review

References (31)

1. Pan American Health Organization, "Statistics on Homicides, Suicides, Accidents, Injuries, and Attitudes towards Violence," 2005, http://www.paho.org/English/AD/DPC/NC/violence-graphs.htm (accessed 13 December 2006).
2. E. Krug et al., World Report on Violence and Health (Geneva: World Health Organization, 2002);
3. and M.F. Peres and P.C. dos Santos, "Trends of Homicide Death in Brazil in the 90s: The Role of Firearms" (in Spanish), Revista de Saúde Pública 39, no. 1 (2005): 58-66.
4. Centers for Disease Control and Prevention, "Web-Based Injury Statistics Query and Reporting System (WISQARS)," 2006, http://www.cdc.gov/ncipc/wisqars (accessed 13December 2006).
5. The Brazilian Senate approved a gun control bill in September 2003, Congress approved it in October, and the president signed it into law in December (Law 10826 of 22 December 2003). Nevertheless, most states chose to implement portions of the act in October using the final text approved by Congress.
6. Government of Brazil, "Lei no 10.826" (Law number 10.826, in Portuguese), 22 December 2003, https://legislacao.planalto.gov.br/legislacao. nsf/0/6EBCB3394FA8BBC183257268004DA122?OpenDocument&seq=1 (accessed 19 January 2007).
7. Brazilian Ministry of Justice, "Referendum on Arms Collection" (in Portuguese), http://www.mj.gov.br/seguranca/desarmamento.htm (accessed 19 January 2007).
8. Causes of deathwere obtained from the 2005 release of the Mortality Information System (Sistema de Informação sobre Mortalidade, or SIM), and hospitalization data came from the national Hospital Information System (Sistema de Informação Hospitalar, or SIH).
9. Codes W32-W34 include accidental death or injury by handguns, rifles, shotguns, and other firearms; codes X72-X74 include intentional self-harm with firearms; codes X93-X95 include assault by firearms; and codes Y22-Y24 include firearm injuries and deaths due to undetermined intent. The Brazilian Ministry of Health estimates that the SIM reliably captures more than 90 percent of deaths for the country as a whole. The SIH captures all hospitalizations in the country except for those paid for by private health insurance. Only about 20 percent of the population has private insurance, and this does not preclude them from using the public system. The level of underreporting of deaths as a result of violence is likely to be lower than for other causes of death, since all deaths suspected to be due to violence are confirmed by the Medical Legal Institute. See Brazilian Ministry of Health, Health Brazil 2005: A Health Situation Analysis (in Portuguese), 2006, http://portal.saude.gov.br/portal/ arquivos/pdf/saude_brasil_2005.pdf (accessed 13 December 2006).
10. All rates are calculated using inter-census-year population counts. Brazilian Institute of Geography and Statistics, Population Estimated by Age, 2004 (in Portuguese) (Rio de Janeiro: Ministry of Planning, 2004).
11. Brazilian Ministry of Justice, "Learn More about the Disarmament Campaign" (in Portuguese), http://www.mj.gov.br/noticias/2005/Junho/ rls220605saiba.htm (accessed 10March 2006).
12. An ordinary least squares (OLS) regression model resulted in the best fit with the data. Sensitivity tests using Poisson regression yielded similar results, and squared or log-transformed models did not significantly improve the fit. Adjustment for other variables (such as sex and age) was not possible given the small population of some states. Given the short time series involved (less than six years), it is unlikely that major changes among states would have occurred for these variables.
13. Analysis of hospitalizations used data only from 2002 onward, since prior to that the SIH included primary diagnosis only. So, for example, in the case of having a broken leg due to a gunshot wound, the SIH would have listed only "fractured tibia." As of January 2002, the Ministry of Health required hospitals to list a second diagnostic code in the case of all external causes.
14. A table showing these findings is available in an online technical appendix at http://content.healthaffairs.org/cgi/content/full/26/2/575/DC1.
15. Ibid.
16. Ministry of Justice and National Secretariat of Public Security, Profile of Public Security Organizations, Volume 1: Profile of State and Municipal Organizations (in Portuguese), March 2006, http://www.mj.gov.br/ senasp/estatisticas/organiza%E7%F5es%20estaduais%20e%20municipais.pdf (accessed 19 January 2007).
17. "Criminosos queimam ônibus em Vitória, Espírito Santo (Criminals burn bus in Vitória, Espírito Santo)," Estadão, 2March 2006.
18. Similar reductions in suicide rates have been noted in Canada and New Zealand. See A.L. Beautrais, D.M. Fergusson, and L.J. Horwood, "Firearms Legislation and Reductions in Firearm-Related Suicide Deaths in New Zealand," Australia New Zealand Journal of Psychiatry 40, no. 3 (2006): 253-259.
19. Between 2004 and 2005, thirteen Brazilian states reported a major decline (3-48 percent) in the number of reported cases of illegal gun ownership, five states reported no change, and nine states showed increases (12-139 percent). All of those with increases were in the North and Northeast regions. Ministry of Justice and National Secretariat of Public Security, "Analysis of Information and Development of Public Safety Personnel" (in Portuguese), http://www.mj.gov.br/senasp/Institucional/inst_dep_dpadr.htm (accessed 31 October 2006).
20. R.B. Barradas and M.C. Ribeiro, "Correlation between Homicide Rates and Economic Indicators in São Paulo, Brazil, 1996" (in Portuguese), Revista Panamericana de Salud Pública 7, no. 2 (2000): 118-124;
21. and Brazilian Institute of Geography and Statistics, "Monthly Employment Survey 2006" (in Portuguese), http://www.ibge.gov.br/home/ estatistica/indicadores/trabalhoerendimento/pme_nova/default.shtm (accessed 15 May 2006).
22. Deaths from external causes such as car crashes remained the same or increased in some states during this time period. All-cause mortality in Brazil continued its overall decline, but there was no marked acceleration in 2003/04. In fact, several states' all-cause mortality did not decline significantly for black or mixed race populations (who have a higher risk of dying from firearm related violence than do whites). See Ministry of Health, Health Brazil 2005, http://portal.saude.gov.br/portal/arquivos/pdf/saude_brasil_2005.pdf (accessed 29 October 2006).
23. For example, contrast J.R. Lott, More Guns, Less Crime: Understanding Crime and Gun Control Laws (Chicago: University of Chicago Press, 1998);
24. with M. Duggan, "More Guns, More Crime," Journal of Political Economy 109, no. 5 (2001): 1086-1114.
25. A.A. Leenaars et al., "The Impact of Gun Control (Bill C-51) on Suicide in Canada," Death Studies 27 no. 2 (2003): 103-124.
26. V. Ajdacic-Gross et al., "Changing Times: A Longitudinal Analysis of International Firearm Suicide Data," American Journal of Public Health 96, no. 10 (2006): 1752-1755.
27. See also D.W. Webster et al., "Association between Youth-Focused Firearm Laws and Youth Suicides," Journal of the American Medical Association 292, no. 5 (2004): 594-601.
28. A. Villaveces et al., "Effect of a Ban on Carrying Firearms on Homicide Rates in Two Colombian Cities," Journal of the American Medical Association 283, no. 9 (2000): 1205-1209.
29. D. Morton, "Gunning for the World," Foreign Policy 152 (2006): 58-67.
30. See also T. Phillips, "Brazil Votes on Deadly Obsession with Guns," Guardian, 22 October 2005.
31. Several analysts suggest that the international gun lobby felt threatened by the proposed referendum in Brazil and took steps to mobilize its Brazilian counterparts. See K. Hearn, "As Brazil Votes to Ban Guns, NRA Joins the Fight," Nation, 21 October 2005; and Morton, "Gunning for the World."