Impact of Licensed Federal Firearm Suppliers on Firearm-Related Mortality

Background Legal firearm sales occur largely through suppliers that have Federal Firearm Licensees (FFLs). Since FFL density might reflect ease-of-access to firearm purchases, we hypothesized that the number of FFL dealers would be associated with firearm-related deaths. We further hypothesized that licensee-type subsets would be associated with differential risks for gun-related deaths. Methods We used data from the National Center for Health Statistics National Vital Statistics System (2008-2014) and national data on Federal Firearms Licensees for 2014. Correlation analysis and linear regression analysis were performed to determine the relationship between different licensee types and firearm-related deaths. We controlled for population, number of statewide registered firearms, and the density of other types of FFLs. Results We identified a total of 65,297 FFLs. There was a moderate correlation (R = 0.53, ρ = 0.48) between total FFL density and firearm-related death rates. Further analysis by type of firearm-related death showed a strong correlation (R = 0.81, ρ = 0.76) between total FFL density and firearm-related suicide rates. No correlation was found between total FFL density and firearm-related homicide rate. Among individual FFL types, FFL02 (firearm dealing pawnshop) density was the only FFL-type found to be correlated with firearm-related death rates. We found a strong correlation between FFL02 density and overall firearm-related death rate (R = 0.69, ρ = 0.78) and firearm-related suicide rate (R = 0.72, ρ = 0.78). Linear regression analysis showed that even while controlling for number of registered firearms and population, the number of firearm-dealing pawnshops remained significantly associated with overall firearm-related deaths and firearm-related suicides. Conclusion Access to legally-distributed firearms is associated with firearm-related death rates, particularly firearm-related suicides. Specifically, firearm-dealing pawnshops were associated with suicide-related deaths. These findings suggest that deeper exploration of legal firearm access and firearm-related injuries would benefit discussion of preventative measures. LEVEL OF EVIDENCE IV TYPE OF STUDY Prognostic and Epidemiological Email Addresses: Stephanie Chao: stephanie.chao@stanford.edu Zachary Kastenberg: zacharykastenberg@gmail.com Sriraman Madhavan: Division of Pediatric Surgery, Department of Surgery, Stanford School of Medicine, 300 Pasteur Drive, M116, Stanford, CA 94305 Kristan Staudenmayer: kristans@stanford.edu Corresponding Author: Stephanie D. Chao, MD Division of Pediatric Surgery, Department of Surgery, Stanford School of Medicine, 300 Pasteur Drive, M116, Mail code: 5733, Stanford, CA 94305, Tel: (650)723-6439, Fax: (650)725-5577, Email: Stephanie.chao@stanford.edu Conflict of Interest Disclosures: None Funding/Support: None Meeting Presentation: 77th Annual Meeting of AAST and Clinical Congress of Acute Care Surgery and 4th World Trauma Congress. Quick Shot session September 29, 2018. Session XXVII, number 26. © 2018 Lippincott Williams & Wilkins, Inc.

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