Death in the City

Objective. —To look at trends in mortality and homicide rates in a specific metropolitan area, comparing the urban and suburban mortality trends.

Design. —Descriptive study of mortality rates. Linear regression determined whether changes in mortality rates over time represented significant trends.

Setting. —Industrial metropolitan area in the United States, population, 2337891.

Participants. —Pediatric deaths (1 to 18 years of age) in a 9-year period. Population characteristics: 36% black, 64% white, 50% each urban and suburban.

Main Outcome Measures. —Pediatric mortality rates for 1980 through 1988, grouped by urban vs suburban, age, gender, and race. Rates calculated using national census figures and plotted over time.

Results. —There was a 50% increase in all-cause mortality in the urban pediatric population as compared with no change or a slight decline in the suburban and national populations. The increase was found in the black urban population. Homicide showed the largest increase (252%). Firearm-related homicides accounted for the majority of homicide deaths.

Conclusions. —(1) There were significant differences in mortality between the urban and suburban pediatric populations. (2) The increase in homicides, specifically firearm homicides, in the urban population accounted for the increase in overall mortality rates. (3) The increase in homicide rates was significant only for the 10- to 14-year-old males and the 15- to 18-year-old male and female portions of the black urban population. (4) Firearm homicides have become epidemic in the black urban population we studied.

(JAMA. 1992;267:2905-2910)