'People think that it's just a city problem, while it's not;' death by gunfire is more likely in rural America, study shows

Map by Joe Murphy, NBC News, from Centers for Disease Conrol and Prevention data

It's perhaps an unexpected truth: If you're an urban dweller, you are less likely to die from a gun-inflicted wound than someone living in small-town America. "Gun death rates are consistently higher in rural areas than in big cities, two decades of data show," report Aria Bendix and Joe Murphy of NBC News. "From 2011 to 2020, the most rural counties in the U.S. had a 37% higher rate of gun deaths per capita than the most urban counties, according to research published in the Journal of the American Medical Association, Surgery. That's up from a 25% difference from 2000 to 2010. . . . Findings are based on an analysis of data from the Centers for Disease Control and Prevention. The authors attributed the trend to a rise in gun suicides, which outnumbered gun homicides in 2021 by more than 5,300 and are more likely to occur in rural counties."

Paul Reeping, who conducted the research at Columbia University, told NBC, "Rural areas are sort of ignored when we pass firearm laws because people think that it's just a city problem, while it's not. Suicides were always the highest in rural areas. That hasn't changed. It's just that the gun deaths overall have gone up, including firearm suicides, in those areas." NBC reports, "From 2011 to 2020, the most rural counties had a 46% lower rate of gun homicide deaths than the most urban counties but a 76% higher rate of gun suicide deaths, according to Reeping's analysis."

Gun ownership and the number of firearm deaths rates may trend together. "CDC data suggests firearm death rates tend to be highest in mountain Arizona, Idaho, Nevada and Wyoming. Research from the Rand Corp., a nonpartisan think tank, found a similar trend for gun suicides in 2020." Andrew Morral, a senior behavioral scientist at Rand, told NBC, "These are also states that, not coincidentally, have particularly high firearm ownership rates at the population level. . . . The urban areas have a little bit higher rate of firearm homicides, but it's not huge."

Digging into the data gets sticky, "Because there is no comprehensive national firearm registry and very few state registries, it is difficult to track gun ownership in the U.S., so estimates of gun ownership rely on survey data or measures closely related to gun ownership–such as the number of firearm laws," reports Heather Saunders of the Kaiser Family Foundation. But given the date that's available, "More than twice as many suicides by firearm occur in states with the fewest gun laws, relative to states with the most laws."

More relaxed gun laws, combined with a higher number of gun owners could explain some of the increase. NBC reports, "Researchers suspect that higher rates of firearm ownership in rural counties could drive up gun suicide rates. A 2020 study found that owning a handgun was associated with a greatly elevated risk of firearm suicide among both men and women." Saunders reports, "Firearms are the most lethal method of suicide attempts, and about half of suicide attempts take place within 10 minutes of the current suicide thought, so having access to firearms is a suicide risk factor."

What could lower the number of gun deaths in rural America? "Reeping said safe storage laws — which require guns at home to be unloaded, locked and stored when people who can't legally possess guns are present — might help," NBC reports. "Reeping also noted that doctors at hospitals can assess whether people at risk for suicide have access to firearms, then work with the patient's families to limit that access — a process known as 'lethal means counseling.'. . . Morral, meanwhile, highlighted the effectiveness of red flag laws —which allow state courts to order the temporary removal of firearms from people's possession if they pose significant threats to themselves or others — at preventing both suicides and homicides. . . . He also pointed to a Harvard-led initiative called the Gun Shop Project, which helps gun retailers display and distribute suicide prevention materials and teaches them how to avoid selling or renting firearms to customers at risk of suicide."