Carolina Díez, BA; Rachel P. Kurland; Emily F. Rothman, ScD; Megan Bair-Merritt, MD, MSCE; Eric Fleegler, MD, MPH; Ziming Xuan, ScD, SM, MA; Sandro Galea, MD, DrPH, MPH; Craig S. Ross, PhD, MBA; Bindu Kalesan, PhD, MPH, MSc; Kristin A. Goss, PhD, MPP; Michael Siegel, MD, MPH
Acknowledgment: The authors thank James Alan Fox, PhD, the Lipman Family Professor of Criminology, Law, and Public Policy at the School of Criminology and Criminal Justice at Northeastern University, who provided the multiply imputed SHR File, 1976–2015, including the data sets and a codebook. They are especially grateful to Everytown for Gun Safety (particularly Ted Alcorn, Courtney Zale, Elizabeth Avore, Jonas Oransky, Sarah Tofte, Cecily Wallman-Stokes, and Billy Rosen), Legal Sciences LLC, and the LawAtlas Project, which produced the database from which the 32 provisions in this study's database were coded.
Grant Support: By grant 73337 from the Evidence for Action: Investigator-Initiated Research to Build a Culture of Health program of the Robert Wood Johnson Foundation.
Disclosures: Dr. Fleegler reports a consulting fee or honorarium from the Robert Wood Johnson Foundation during the conduct of the study and payment for lectures from Icahn School of Medicine at Mount Sinai, Children's Hospital of the King's Daughters, Regional Academic Pediatric Association, New York-Presbyterian Weill Cornell, and The Children's Hospital at Montefiore outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-2849.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol and data set: Available from Dr. Siegel (e-mail, firstname.lastname@example.org). Statistical code: See Appendix Table 8.
Requests for Single Reprints: Michael Siegel, MPH, Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118; e-mail, email@example.com.
Current Author Addresses: Ms. Díez; Ms. Kurland; and Drs. Rothman, Xuan, and Siegel: Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118.
Dr. Bair-Merritt: Department of Pediatrics, Boston Medical Center, 88 East Newton Street, Vose Hall, Boston, MA 02118.
Dr. Fleegler: Division of Emergency Medicine, Boston Children's Hospital, 300 Longwood Avenue, Main South, 0120, Boston, MA 02115.
Dr. Galea: Office of the Dean, Boston University School of Public Health, 715 Albany Street, TC3, Boston, MA 02118.
Dr. Ross: Department of Epidemiology, Boston University School of Public Health, 715 Albany Street, TE3, Boston, MA 02118.
Dr. Kalesan: Division of Preventive Medicine and Epidemiology, Department of Medicine, Boston University School of Medicine, 801 Massachusetts Avenue, 4th Floor, Boston, MA 02118.
Dr. Goss: Sanford School of Public Policy, Duke University, 234 Sanford School Building, Durham, NC 27708.
Author Contributions: Conception and design: C. Díez, R.P. Kurland, M. Bair-Merritt, E. Fleegler, S. Galea, C.S. Ross, M. Siegel.
Analysis and interpretation of the data: C. Díez, R.P. Kurland, E.F. Rothman, E. Fleegler, Z. Xuan, S. Galea, C.S. Ross, B. Kalesan, M. Siegel.
Drafting of the article: C. Díez, R.P. Kurland, E.F. Rothman, S. Galea, C.S. Ross, M. Siegel.
Critical revision of the article for important intellectual content: C. Díez, M. Bair-Merritt, E. Fleegler, Z. Xuan, B. Kalesan, K.A. Goss, M. Siegel.
Final approval of the article: C. Díez, R.P. Kurland, E.F. Rothman, M. Bair-Merritt, E. Fleegler, Z. Xuan, S. Galea, C.S. Ross, B. Kalesan, K.A. Goss, M. Siegel.
Provision of study materials or patients: B. Kalesan.
Statistical expertise: Z. Xuan, M. Siegel.
Obtaining of funding: B. Kalesan, M. Siegel.
Administrative, technical, or logistic support: M. Siegel.
Collection and assembly of data: C. Díez, R.P. Kurland, M. Siegel.
To prevent intimate partner homicide (IPH), some states have adopted laws restricting firearm possession by intimate partner violence (IPV) offenders. “Possession” laws prohibit the possession of firearms by these offenders. “Relinquishment” laws prohibit firearm possession and also explicitly require offenders to surrender their firearms. Few studies have assessed the effect of these policies.
To study the association between state IPV-related firearm laws and IPH rates over a 25-year period (1991 to 2015).
United States, 1991 to 2015.
Homicides committed by intimate partners, as identified in the Federal Bureau of Investigation's Uniform Crime Reports, Supplementary Homicide Reports.
IPV-related firearm laws (predictor) and annual, state-specific, total, and firearm-related IPH rates (outcome).
State laws that prohibit persons subject to IPV-related restraining orders from possessing firearms and also require them to relinquish firearms in their possession were associated with 9.7% lower total IPH rates (95% CI, 3.4% to 15.5% reduction) and 14.0% lower firearm-related IPH rates (CI, 5.1% to 22.0% reduction) than in states without these laws. Laws that did not explicitly require relinquishment of firearms were associated with a non–statistically significant 6.6% reduction in IPH rates.
The model did not control for variation in implementation of the laws. Causal interpretation is limited by the observational and ecological nature of the analysis.
Our findings suggest that state laws restricting firearm possession by persons deemed to be at risk for perpetrating intimate partner abuse may save lives. Laws requiring at-risk persons to surrender firearms already in their possession were associated with lower IPH rates.
Robert Wood Johnson Foundation.
Table 1. Differences in IPH Rates Associated With 4 Categories of IPV-Related Firearm Laws Considered Individually*
Appendix Table 1. IPV-Related Firearm Law Provisions Coded
Appendix Table 2. Firearm-Related and Total IPH Rates in 2015 and Total Number of IPV-Related Firearm Law Provisions in 2014
Appendix Table 3. Status of Selected IPV-Related Firearm Laws, by State, 2015
Appendix Table 4. Variables and Data Sources
Number of states with selected IPV-related firearm laws, by year, 1990 to 2014.
A map showing states with and without these laws in 2015 is provided in the Appendix Figure. IPV = intimate partner violence.
Status of state IPV-related restraining order firearm relinquishment laws in 2014 and IPH rates in 2015.
The year in which the law was implemented is shown. IPH = intimate partner homicide; IPV = intimate partner violence.
Table 2. Results of Final Model for Law Prohibiting Firearm Possession by Persons Subject to an IPV-Related Restraining Order and Requiring Them to Surrender Firearms They Already Have*
Appendix Table 5. Model Results When Analysis Was Restricted to Nonimputed Data on IPHs*
Difference in IPH rate between states with and without IPV-related restraining order firearm relinquishment laws, estimated from negative binomial regression model.
IPH = intimate partner homicide; IPV = intimate partner violence.
Appendix Table 6. Results of Final Model for IPV-Related Restraining Order Firearm Possession and Surrender Laws, Allowing for Different Effects of Law in Each State*
Appendix Table 7. Change in IPH Rates Before and After Implementation of IPV-Related Restraining Order Possession and Surrender Laws*
Appendix Table 8. Statistical Code for Models in Stata
Trends in IPH among states with and without IPV-related restraining order firearm relinquishment laws, 1991 to 2015.
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Carolina Díez, Rachel P. Kurland, Emily F. Rothman, Megan Bair-Merritt, Eric Fleegler, Ziming Xuan, et al. State Intimate Partner Violence–Related Firearm Laws and Intimate Partner Homicide Rates in the United States, 1991 to 2015. Ann Intern Med. 2017;167:536–543. doi: 10.7326/M16-2849
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Published: Ann Intern Med. 2017;167(8):536-543.
Published at www.annals.org on 19 September 2017
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