Question What is the burden of firearm mortality at the global, regional, and national level between 1990 and 2016 by sex and age? Findings Using a combination of deidentified aggregated data from vital registration, verbal autopsy, census and survey data, and police records in models for 195 countries and territories, this study estimated 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died globally from firearm injuries in 2016, compared with 209 000 (95% UI, 172 000-235 000) deaths in 1990. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Meaning This study provides an estimate of the global burden of firearms deaths in 2016, change in this burden from 1990, and variation in levels and rates among countries. Importance Understanding global variation in firearm mortality rates could guide prevention policies and interventions. Objective To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. Design, Setting, and Participants This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths. Exposures Firearm ownership and access. Main Outcomes and Measures Cause-specific deaths by age, sex, location, and year. Results Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (−0.2% [95% UI, −0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide ( P < .001; R 2 = 0.21) and homicide ( P < .001; R 2 = 0.35). Conclusions and Relevance This study estimated between 195 000 and 276 000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups. This population epidemiology study estimates national rates of firearm homicide and suicide and unintentional gun deaths in 195 countries and territories from 1990 to 2016.
