Association between firearms and mortality in Brazil, 1990 to 2017: a global burden of disease Brazil study
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RESEARCH
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Association between firearms and mortality in Brazil, 1990 to 2017: a global burden of disease Brazil study Deborah Carvalho Malta1, Adauto Martins Soares Filho2, Isabella Vitral Pinto3, Maria Cecília de Souza Minayo4, Cheila Marina Lima2, Ísis Eloah Machado5, Renato Azeredo Teixeira3, Otaliba Libânio Morais Neto6, Roberto Marini Ladeira7, Edgar Merchan-Hamann8, Maria de Fatima Marinho de Souza3, Cíntia Honório Vasconcelos2, Carlos Cezar Flores Vidotti2, Ewerton Cousin9, Scott Glenn10, Catherine Bisignano10, Adrienne Chew10, Antonio Luiz Ribeiro11 and Mohsen Naghavi10*
Abstract Background: Brazil leads the world in number of firearm deaths and ranks sixth by country in rate of firearm deaths per 100,000 people. This study aims to analyze trends in and burden of mortality by firearms, according to age and sex, for Brazil, and the association between these deaths and indicators of possession and carrying of weapons using data from the global burden of diseases, injuries, and risk factors study (GBD) 2017. Methods: We used GBD 2017 estimates of mortality due to physical violence and self-harm from firearms for Brazil to analyze the association between deaths by firearms and explanatory variables. Results: Deaths from firearms increased in Brazil from 25,819 in 1990 to 48,493 in 2017. Firearm mortality rates were higher among men and in the 20–24 age group; the rate was 20 times higher than for women in the same age group. Homicide rates increased during the study period, while mortality rates for suicides and accidental deaths decreased. The group of Brazilian federation units with the highest firearm collection rate (median = 7.5) showed reductions in the rate of total violent deaths by firearms. In contrast, the group with the lowest firearm collection rate (median = 2.0) showed an increase in firearm deaths from 2000 to 2017. An increase in the rate of voluntary return of firearms was associated with a reduction in mortality rates of unintentional firearm deaths (r = −0.364, p < 0.001). An increase in socio-demographic index (SDI) was associated with a reduction in all firearm death rates (r = −0.266, p = 0.008). An increase in the composite index of firearms seized or collected was associated with a reduction in rates of deaths by firearm in the subgroup of females, children, and the elderly (r = −0.269, p = 0.005). Conclusions: There was a change in the trend of firearms deaths after the beginning of the collection of weapons in 2004. Federation units that collected more guns have reduced rates of violent firearm deaths. Keywords: Brazil, Firearms, Homicide, Mortality, Epidemiology
* Correspondence: nagham@uw.edu 10 Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA Full list of author information is available at the end of the article © The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as
