Social Science & Medicine 64 (2007) 656–664
State-level homicide victimization rates in the US in relation to
survey measures of household firearm ownership, 2001–2003
Matthew Miller
Ã
, David Hemenway, Deborah Azrael
Harvard School of Public Health, Boston, MA, USA
Available online 27 October 2006
Abstract
Two of every three American homicide victims are killed with firearms, yet little is known about the role played by
household firearms in homicide victimization. The present study is the first to examine the cross sectional association
between household firearm ownership and homicide victimization across the 50 US states, by age and gender, using
nationally representative state-level survey-based estimates of household firearm ownership. Household firearm prevalence
for each of the 50 states was obtained from the 2001 Behavioral Risk Factor Surveillance System. Homicide mortality data
for each state were aggregated over the three-year study period, 2001–2003. Analyses controlled for state-level rates of
aggravated assault, robbery, unemployment, urbanization, per capita alcohol consumption, and a resource deprivation
index (a construct that includes median family income, the percentage of families living beneath the poverty line, the Gini
index of family income inequality, the percentage of the population that is black and the percentage of families headed by a
single female parent). Multivariate analyses found that states with higher rates of household firearm ownership had
significantly higher homicide victimization rates of men, women and children. The association between firearm prevalence
and homicide victimization in our study was driven by gun-related homicide victimization rates; non-gun-related
victimization rates were not significantly associated with rates of firearm ownership. Although causal inference is not
warranted on the basis of the present study alone, our findings suggest that the household may be an important source of
firearms used to kill men, women and children in the United States.
r 2006 Published by Elsevier Ltd.
Keywords: Homicide; Firearms; Guns; Violence; Epidemiology; USA
Introduction
Approximately two in three homicide victims in
the US are killed with guns(Centers for Disease
Control and Prevention), yet the role of household
firearms in homicide victimization has not been well
characterized. Case-control studies suggest that the
presence of a gun in the home is a risk factor for
homicide in the home (Kellermann et al., 1993), that
the risk is higher for women than for men (Bailey et
al., 1997a, b), and that when any family member
purchases a handgun all members of the household
are at increased risk of homicide victimization
(Cummings, Koepsell, Grossman, Savarino, &
Thompson, 1997). Limitations of existing case–
control studies include not controlling for (1)
possible differential recall of firearm ownership by
ARTICLE IN PRESS
www.elsevier.com/locate/socscimed
0277-9536/$ - see front matter r 2006 Published by Elsevier Ltd.
doi:10.1016/j.socscimed.2006.09.024
Ã
Corresponding author. Tel.: +1 617 432 1459.
E-mail addresses: mmiller@hsph.harvard.edu (M. Miller),
hemenway@hsph.harvard.edu (D. Hemenway),
azrael@hsph.harvard.edu (D. Azrael).