Healthcare indicators and firearm homicide: an ecologic study

Margaret K. Formica (Department of Public Health and Preventive Medicine, State University of New York Upstate Medical University, Syracuse, New York, USA)
Sonali Rajan (Department of Health and Behavior Studies, Teachers College, Columbia University, New York, New York, USA)
Nicholas Simons (Regional Gun Violence Research Consortium, Rockefeller Institute of Government, Albany, New York, USA)

Journal of Aggression, Conflict and Peace Research

ISSN: 1759-6599

Publication date: 8 April 2019



The purpose of this paper is to investigate the relationship between rates of firearm homicide in New York State (NYS) and indicators of access to and quality of healthcare from 2011 to 2017.


Utilizing data from the NYS Division of Criminal Justice Services Uniform Crime Reporting Supplemental Homicide Reports and Robert Wood Johnson Foundation County Health Rankings Program, a county-level ecologic study was conducted, descriptive statistics provided and multivariable analyses conducted to determine the associations between critical indicators of county health and firearm homicide.


The majority of firearm homicide victims (n=2,619) were young, Black, men and the highest rates of firearm homicide were situated in urban centers. Subgroup analyses excluding large urban centers and controlling for key demographics illustrated that those counties with lower rates of clinicians were significantly associated with higher rates of firearm homicide.

Research limitations/implications

Despite challenges integrating two large data sets, the present findings were able to illustrate the critical relationship between access to healthcare and prevalence of firearm homicide.

Practical implications

The results of this study reinforce the importance of access to primary healthcare services and its relationship to critical health outcomes.

Social implications

In urban settings, firearm homicides disproportionately impact young Black men, who are among the least likely to have access to healthcare. In more rural areas, access to healthcare is related directly to improved health outcomes, including reduced rates of firearm homicides.


This is the first study to explore and subsequently establish the relationship between indicators of community health and firearm homicide in NYS.



Formica, M., Rajan, S. and Simons, N. (2019), "Healthcare indicators and firearm homicide: an ecologic study", Journal of Aggression, Conflict and Peace Research, Vol. 11 No. 2, pp. 88-99.

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