Contrary to popular belief, firearm deaths in the US are statistically more likely in small towns, not major cities, according to new research. Across the country, gun suicides are more common than gun homicides, and gun suicides are largely responsible for an increase in gun deaths over the past few decades, the study also finds.

The analysis of two decades of US mortality data was conducted by researchers at Columbia University Mailman School of Public Health, Children’s Hospital of Philadelphia, and the University of California, Davis, and published in the journal JAMA Surgery.

“Our study has found that the divide in total intentional firearm deaths between urban and rural counties is increasing, with rural counties bearing more of the burden. In the 2000s, the two most rural county types had statistically more firearm deaths per capita than any other county type, and by the 2010s, the most urban counties (cities) were the safest in terms of intentional firearm death risk,” the authors write. 

“Despite the pervasive nature of gun violence, high rates of gun homicide in urban centres have been the sole focus of many policymakers and used as justification to loosen gun laws, when in fact gun violence is an issue in counties of all sizes,” the authors add.  

Gun suicides outnumber gun homicides each year in the US, and the risk of gun suicides in most rural counties exceeds the risk of gun homicides in most urban counties.

Between 2001 and 2010, the two most rural counties had higher total firearm death rates than the most urban counties. Most rural counties had a 25% higher overall firearm death rate than most urban counties, a 54% higher gun suicide death rate, and a 50% lower gun homicide death rate compared with most urban counties.

Previous research from the 1990s found that there was no difference in total intentional firearm deaths between most urban and rural counties in the 1990s. The current study finds that the divide in total intentional firearm deaths between urban and rural counties is increasing, with rural counties bearing a great deal more of the burden.

The researchers based their findings on an analysis of multiple cause-of-death data files from the National Center for Health Statistics’ National Vital Statistics System over two decades, from the beginning of 2001 to the end of 2020.