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Differences by Level of Urbanization, United States, 1979 Through 1989

Lois A. Fingerhut, MA; Deborah D. Ingram, PhD; Jacob J. Feldman

JAMA. 1992;267(22):3048-3053.

Abstract
Objective.
—To examine trends (1979 through 1989) and current status in firearm and nonfirearm homicide rates by level of urbanization among persons 15 through 19 years of age.

Design.
—The Compressed Mortality File, a county-level mortality and population database maintained by the National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md, and the 1980 Human Resource Profile County Codes are used to analyze age-, sex-, and race-specific firearm and nonfirearm homicide rates by urbanization level.

Setting.
—United States, 1979 through 1989.

Subjects.
—Black and white males and females 15 through 19 years of age whose underlying cause of death was either firearm homicide (E965.0 through E965.4 or E970) or nonfirearm homicide (E960 through E964, E965.5 through E969, or E971 through E978) in the ICD-9 (International Statistical Classification of Diseases, Injuries, and Causes of Death, Ninth Revision).

Main Outcome Measures.
—Urbanization level-specific firearm and nonfirearm homicide rates.

Results.
—The 1989 firearm homicide rate in metropolitan counties was nearly five times the rate in nonmetropolitan counties (13.7 vs 2.9 deaths per 100000 population). Firearm homicide rates were highest in core metropolitan counties, 27.7 per 100000 population; rates were higher for black males than for any other race-sex group in each of five county urbanization strata for 1979 through 1989. Nonfirearm homicide rates are considerably lower, with smaller urban differentials; the rate in metropolitan counties was 1.4 times the rate in nonmetropolitan counties (2.6 vs 1.8 per 100 000 population). From 1979 through 1984, firearm homicide rates declined in each of the county strata. From 1984 through 1987, firearm homicide rates increased, and from 1987 through 1989 they increased rapidly, from 23% to 35% per year in the four metropolitan strata. From 1979 through 1989, nonfirearm homicide rates declined or remained stable.

Conclusions.
—Large urbanization differentials in firearm homicide and smaller differentials in nonfirearm homicide are identified. Firearm homicide rates are highest and increasing the fastest among black teenage males in the core, fringe, and medium metropolitan strata.

(JAMA. 1992;267:3048-3053)

Author Affiliations
From the Office of Analysis and Epidemiology, National Center for Health Statistics, Centers for Disease Control, Hyattsville, Md.

Footnotes
Reprint requests to Office of Analysis and Epidemiology, National Center for Health Statistics, Room 1080, 6525 Belcrest Rd, Hyattsville, MD 20782 (Ms Fingerhut).

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