The relationship of nursing practice laws to suicide and homicide rates: a longitudinal analysis of US states from 2012 to 2016.
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ABSTRACT:
SUBMITTER: Choi KR
PROVIDER: S-EPMC7059356 | biostudies-literature | 2020 Mar
REPOSITORIES: biostudies-literature
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The relationship of nursing practice laws to suicide and homicide rates: a longitudinal analysis of US states from 2012 to 2016.
Choi Kristen R KR Takada Sae S Saadi Altaf A Easterlin Molly C MC Buchbinder Liza S LS Natsui Shaw S Zimmerman Frederick J FJ
BMC health services research 20200306 1
<h4>Background</h4>Nursing resources can have a protective effect on patient outcomes, but nurses and nursing scope of practice have not been studied in relation to injury outcomes. The purpose of this study was to examine whether scope of practice and ease of practice laws for nurse practitioners and registered nurses are associated with suicide and homicide rates in the United States.<h4>Methods</h4>This state-level analysis used data from 2012 to 2016. The outcome variables were age-adjusted ...[more]
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Project description:BackgroundFirearm-related violence is a leading cause of mortality in the United States (US). Prior research suggests that public policy plays a role in firearm mortality, but the role of healthcare resources (physicians, insurance coverage) within the US policy context has not yet been studied.ObjectiveTo examine how healthcare resources and social/firearm policy affect firearm-related suicide and homicide rates in the US.DesignLongitudinal, ecological study.SettingUS.ParticipantsUS states from 2012 to 2016 (N = 242).MeasurementThe outcome variables were age-adjusted, firearm-related suicide and homicide rates. Predictor variables were healthcare resources (physicians, Medicaid benefits generosity) and policy context (social policy, firearm policy) with covariates for sociodemographic factors.ResultsHealthcare provider variables did not have significant associations to firearm-related suicide or homicide. In fully saturated models, more worker protection laws, greater average population density, more alcohol regulation, and more firearm prohibition policies were associated with fewer firearm-related suicides. Higher generosity of Medicaid benefits was associated with fewer firearm-related homicides. Poverty rate was a predictor of both outcomes.LimitationsThis state-level study cannot make individual-level inferences. Only proxy variables were available for measuring gun ownership and actual gun ownership rates may not have been ideally captured at the state level.ConclusionsAt the state level, there are protective associations of certain social, healthcare, and firearm policies to firearm-related suicide and homicide rates. Healthcare resources play a role in population-level firearm outcomes but alone are not sufficient to decrease firearm-related homicide or suicide.
| S-EPMC7352015 | biostudies-literature
Project description:ObjectiveTo estimate the association between homicide and suicide rates in Brazilian municipalities over a period of 7 years.DesignWe conducted a longitudinal ecological study using annual mortality data from 5507 Brazilian municipalities between 2008 and 2014. Multivariable negative binomial regression models were used to examine the relationship between homicide and suicide rates. Robustness of results was explored using sensitivity analyses to examine the influence of data quality, population size, age and sex on the relationship between homicide and suicide rates.SettingA nationwide study of municipality-level data.ParticipantsMortality data and corresponding population estimates for municipal populations aged 10 years and older.Primary and secondary outcome measuresAge-standardised suicide rates per 100 000.ResultsMunicipal suicide rates were positively associated with municipal homicide rates; after adjusting for socioeconomic and demographic factors, a doubling of the homicide rate was associated with 22% increase in suicide rate (rate ratio=1.22, 95% CI: 1.13 to 1.33). A dose-response effect was observed with 4% increase in suicide rates at the third quintile, 9% at the fourth quintile and 12% at the highest quintile of homicide rates compared with the lowest quintile. The observed effect estimates were robust to sensitivity analyses.ConclusionsMunicipalities with higher homicide rates have higher suicide rates and the relationship between homicide and suicide rates in Brazil exists independently of many sociodemographic and socioeconomic factors. Our results are in line with the hypothesis that changes in homicide rates lead to changes in suicide rates, although a causal association cannot be established from this study. Suicide and homicide rates have increased in Brazil despite increased community mental health support and incarceration, respectively; therefore, new avenues for intervention are needed. The identification of a positive relationship between homicide and suicide rates suggests that population-based interventions to reduce homicide rates may also reduce suicide rates in Brazil.
| S-EPMC7643512 | biostudies-literature
Project description:BackgroundFirearm injuries are a major cause of mortality in the USA. Few recent studies have simultaneously examined the impact of multiple state gun laws to determine their independent association with homicide and suicide rates.ObjectiveTo examine the relationship between state firearm laws and overall homicide and suicide rates at the state level across all 50 states over a 26-year period.DesignUsing a panel design, we analyzed the relationship between 10 state firearm laws and total, age-adjusted homicide and suicide rates from 1991 to 2016 in a difference-in-differences, fixed effects, multivariable regression model. There were 1222 observations for homicide analyses and 1300 observations for suicide analyses.ParticipantsPopulations of all US states.Main measuresThe outcome measures were the annual age-adjusted rates of homicide and suicide in each state during the period 1991-2016. We controlled for a wide range of state-level factors.Key resultsUniversal background checks were associated with a 14.9% (95% CI, 5.2-23.6%) reduction in overall homicide rates, violent misdemeanor laws were associated with a 18.1% (95% CI, 8.1-27.1%) reduction in homicide, and "shall issue" laws were associated with a 9.0% (95% CI, 1.1-17.4%) increase in homicide. These laws were significantly associated only with firearm-related homicide rates, not non-firearm-related homicide rates. None of the other laws examined were consistently related to overall homicide or suicide rates.ConclusionsWe found a relationship between the enactment of two types of state firearm laws and reductions in homicide over time. However, further research is necessary to determine whether these associations are causal ones.
| S-EPMC6816623 | biostudies-literature
Project description:BACKGROUND:Older adults complete suicide at a disproportionately higher rate compared to the general population, with firearms the most common means of suicide. State gun laws may be a policy remedy. Less is known about Gun Violence Restricting Order (GVRO) laws, which allow for removal of firearms from people deemed to be a danger to themselves or others, and their effects on suicide rates among older adults. The purpose of this study was to examine the association of state firearm laws with the incidence of firearm, non-firearm-related, and total suicide among older adults, with a focus on GVRO laws. METHODS:This is a longitudinal study of US states using data from 2012 to 2016. The outcome variables were firearm, non-firearm and total suicide rates among older adults. Predictor variables were [1] total number of gun laws to assess for impact of overall firearm legislation at the state level, and [2] GVRO laws. RESULTS:The total number of firearm laws, as well as GVRO laws, were negatively associated with firearm-related suicide rate among older adults ages 55-64 and > 65 years-old (p < 0.001). There was a small but significant positive association of total number of firearm laws to non-firearm-related suicide rates and a negative association with total suicide rate. GVRO laws were not significantly associated with non-firearm-related suicide and were negatively associated with total suicide rate. CONCLUSION:Stricter firearm legislation, as well as GVRO laws, are protective against firearm-relate suicides among older adults.
| S-EPMC7137454 | biostudies-literature
Project description:Importance:Firearm laws in one state may be associated with increased firearm death rates from homicide and suicide in neighboring states. Objective:To determine whether counties located closer to states with lenient firearm policies have higher firearm death rates. Design, Setting, and Participants:This cross-sectional study of firearm death rates by county for January 2010 to December 2014 examined data from the US Centers for Disease Control and Prevention for firearm suicide and homicide decedents for 3108 counties in the 48 contiguous states of the United States. Exposures:Each county was assigned 2 scores, a state policy score (range, 0-12) based on the strength of its state firearm laws, and an interstate policy score (range, -1.33 to 8.31) based on the sum of population-weighted and distance-decayed policy scores for all other states. Counties were divided into those with low, medium, and high home state and interstate policy scores. Main Outcomes and Measures:County-level rates of firearm, nonfirearm, and total homicide and suicide. With multilevel Bayesian spatial Poisson models, we generated incidence rate ratios (IRR) comparing incidence rates between each group of counties and the reference group, counties with high home state and high interstate policy scores. Results:Stronger firearm laws in a state were associated with lower firearm suicide rates and lower overall suicide rates regardless of the strength of the other states' laws. Counties with low state scores had the highest rates of firearm suicide. Rates were similar across levels of interstate policy score (low: IRR, 1.34; 95% credible interval [CI], 1.11-1.65; medium: IRR, 1.36, (95% CI, 1.15-1.65; and high: IRR, 1.43; 95% CI, 1.20-1.73). Counties with low state and low or medium interstate policy scores had the highest rates of firearm homicide. Counties with low home state and interstate scores had higher firearm homicide rates (IRR, 1.38; 95% CI, 1.02-1.88) and overall homicide rates (IRR, 1.32; 95% CI, 1.03-1.67). Counties in states with low firearm policy scores had lower rates of firearm homicide only if the interstate firearm policy score was high. Conclusions and Relevance:Strong state firearm policies were associated with lower suicide rates regardless of other states' laws. Strong policies were associated with lower homicide rates, and strong interstate policies were also associated with lower homicide rates, where home state policies were permissive. Strengthening state firearm policies may prevent firearm suicide and homicide, with benefits that may extend beyond state lines.
| S-EPMC5885268 | biostudies-literature
Project description:ImportanceUnderstanding geographic and community-level factors associated with suicide can inform targeted suicide prevention efforts.ObjectivesTo estimate suicide rates and trajectories, assess associated county-level contextual factors, and explore variation across the rural-urban continuum.Design, setting, and participantsThis cross-sectional study included all individuals aged 25 to 64 years who died by suicide from January 1, 1999, to December 31, 2016, in the United States. Spatial analysis was used to map excess risk of suicide, and longitudinal random-effects models using negative binomial regression tested associations of contextual variables with suicide rates as well as interactions among county-level contextual variables. Data analyses were conducted between January 2019 and July 2019.ExposureCounty of residence.Main outcomes and measuresThree-year county suicide rates during an 18-year period stratified by rural-urban location.ResultsBetween 1999 and 2016, 453 577 individuals aged 25 to 64 years died by suicide in the United States. Decedents were primarily male (349 082 [77.0%]) with 101 312 (22.3%) aged 25 to 34 years, 120 157 (26.5%) aged 35 to 44 years, 136 377 (30.1%) aged 45 to 54 years, and 95 771 (21.1%) aged 55 to 64 years. Suicide rates were higher and increased more rapidly in rural than in large metropolitan counties. The highest deprivation quartile was associated with higher suicide rates compared with the lowest deprivation quartile, especially in rural areas, although this association declined during the period studied (rural, 1999-2001: incidence rate ratio [IRR], 1.438; 95% CI, 1.319-1.568; P < .001; large metropolitan, 1999-2001: 1.208; 95% CI, 1.149-1.270; P < .001; rural, 2014-2016: IRR, 1.121; 95% CI, 1.032-1.219; P = .01; large metropolitan, 2014-2016: IRR, 0.942; 95% CI, 0.887-1.001; P = .06). The presence of more gun shops was associated with an increase in county-level suicide rates in all county types except the most rural (rural: IRR, 1.001; 95% CI, 0.999-1.004; P = .40; micropolitan: IRR, 1.005; 95% CI, 1.002-1.007; P < .001; small metropolitan: IRR, 1.010; 95% CI, 1.006-1.014; P < .001; large metropolitan: IRR, 1.012; 95% CI, 1.006-1.018; P < .001). High social capital was associated with lower suicide rates than low social capital (IRR, 0.917; 95% CI, 0.891-0.943; P < .001). High social fragmentation, an increasing percentage of the population without health insurance, and an increasing percentage of veterans in a county were associated with higher suicide rates (high social fragmentation: IRR, 1.077; 95% CI, 1.050-1.103; P < .001; percentage of population without health insurance: IRR, 1.005; 95% CI, 1.004-1.006; P < .001; percentage of veterans: IRR, 1.025; 95% CI, 1.021-1.028; P < .001).Conclusions and relevanceThis study found that suicide rates have increased across the nation and most rapidly in rural counties, which may be more sensitive to the impact of social deprivation than more metropolitan counties. Improving social connectedness, civic opportunities, and health insurance coverage as well as limiting access to lethal means have the potential to reduce suicide rates across the rural-urban continuum.
| S-EPMC6735416 | biostudies-literature
Project description:Canada implemented a series of laws regulating firearms including background and psychological screening, licensing, and training in the years 1991, 1994, and 2001. The effects of this legislation on suicide and homicide rates were examined over the years 1981 to 2016. Models were constructed using difference-in-difference analysis of firearms and non firearms death rates from 1981 to 2016. In addition, negative binomial regression was used to test for an association between rates of suicide by Canadian Province and firearms prevalence, using licensing rates as a proxy for prevalence. No associated benefit from firearms legislation on aggregate rates of male suicide was found. In men aged 45 to 59 an associated shift from firearms suicide after 1991 and 1994 to an increase in hanging resulted in overall rate ratios of 0.994 (95%CI, 0.978,1.010) and 0.993 (95%CI, 0.980,1.005) respectively. In men 60 and older a similar effect was seen after 1991, 1994, and 2001, that resulted in rate ratios of 0.989 (95%CI, 0.971,1.008), 0.994 (95%CI, 0.979,1.010), and 1.010 (95%CI, 0.998,1.022) respectively. In females a similar effect was only seen after 1991, rate ratio 0.983 (95%CI, 0.956,1.010). No beneficial association was found between legislation and female or male homicide rates. There was no association found with firearm prevalence rates per province and provincial suicide rates, but an increased association with suicide rates was found with rates of low income, increased unemployment, and the percentage of aboriginals in the population. In conclusion, firearms legislation had no associated beneficial effect on overall suicide and homicide rates. Prevalence of firearms ownership was not associated with suicide rates. Multifaceted strategies to reduce mortality associated with firearms may be required such as steps to reduce youth gang membership and violence, community-based suicide prevention programs, and outreach to groups for which access to care may be a particular issue, such as Aboriginals.
| S-EPMC7302582 | biostudies-literature
Project description:Pregnant and postpartum women may be at increased risk of violent death including homicide and suicide relative to nonpregnant women, but US national data have not been reported since the implementation of enhanced mortality surveillance.The objective of the study was to estimate homicide and suicide ratios among women who are pregnant or postpartum and to compare their risk of violent death with nonpregnant/nonpostpartum women.Death certificates (n = 465,097) from US states with enhanced pregnancy mortality surveillance from 2005 through 2010 were used to compare mortality among 4 groups of women aged 10-54 years: pregnant, early postpartum (pregnant within 42 days of death), late postpartum (pregnant within 43 days to 1 year of death), and nonpregnant/nonpostpartum. We estimated pregnancy-associated mortality ratios and compared with nonpregnant/nonpostpartum mortality ratios to identify differences in risk after adjusting for potential levels of pregnancy misclassification as reported in the literature.Pregnancy-associated homicide victims were most frequently young, black, and undereducated, whereas pregnancy-associated suicide occurred most frequently among older white women. After adjustments, pregnancy-associated homicide risk ranged from 2.2 to 6.2 per 100,000 live births, depending on the degree of misclassification estimated, compared with 2.5-2.6 per 100,000 nonpregnant/nonpostpartum women aged 10-54 years. Pregnancy-associated suicide risk ranged from 1.6-4.5 per 100,000 live births after adjustments compared with 5.3-5.5 per 100,000 women aged 10-54 years among nonpregnant/nonpostpartum women. Assuming the most conservative published estimate of misclassification, the risk of homicide among pregnant/postpartum women was 1.84 times that of nonpregnant/nonpostpartum women (95% confidence interval, 1.71-1.98), whereas risk of suicide was decreased (relative risk, 0.62, 95% confidence interval, 0.57-0.68).Pregnancy and postpartum appear to be times of increased risk for homicide and decreased risk for suicide among women in the United States.
| S-EPMC5003645 | biostudies-other
Project description:BackgroundFirearm violence is one of the leading preventable causes of death and injury in the United States and is on the rise. While policies regulating access to firearms offer opportunities to prevent firearm-related deaths, an understanding of the holistic impact of changing state firearm policies on firearm homicide rates over the last 30 years is limited.ObjectivesTo identify US states that showed unexpected decreases and increases in firearm homicide rates and summarise their firearm policy changes in the last three decades.MethodsWe analysed changes in firearm homicide rates by US state and county from 1990 to 2019. We triangulated across three estimation approaches to derive state rankings and identify the top and bottom three states which consistently showed unexpected decreases (low outliers) and increases (high outliers) in firearm homicide rates. We summarised firearm policy changes in state outliers using the RAND State Firearm Law Database.ResultsWe identified New York, District of Columbia, and Hawaii as low state outliers and Delaware, New Jersey, and Missouri as high state outliers. Low state outliers made more restrictive firearm policy changes than high state outliers, which covered a wider range of policy types. Restrictive changes in high state outliers primarily targeted high-risk populations (e.g., prohibited possessors, safe storage). Specific legislative details, such as the age threshold (18 vs 21 years old) for firearm minimum age requirements, also emerged as important for differentiating low from high state outliers.ConclusionsWhile no firearm law change emerged as necessary or sufficient, an accumulation of diverse restrictive firearm policies may be key to alleviating the death toll from firearm homicide.
| S-EPMC10024039 | biostudies-literature
Project description:We present the findings for homicides in Denmark for 1992-2016. There were 1417 homicide victims (62.2% males, 37.8% females) that were killed in 1321 homicide events. The most common methods were sharp force trauma (33.2%), gunshot (22.2%), blunt force trauma (21.9%) and asphyxia (17.6%), and all methods exhibited a reduction during the study period. The homicide rate was 1.05 per 100,000, 1.32 per 100,000 for males, and 0.78 per 100,000 for females. Domestic homicides were the largest main group of homicides (76.5% of all female victims vs. 23.6% of male victims). Of the non-domestic homicides, 84.2% of victims were male, the largest group being in the setting of nightlife and/or intoxication. Most female victims (76.9%) were killed by someone in their family, while the largest share of male victims (34.5%) were killed by a friend or acquaintance. The offenders were males in 87.9% of all homicides.
| S-EPMC7219188 | biostudies-literature