Gun death rates are consistently higher in rural areas than in big cities, two decades of data show.
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 Wednesday in the journal JAMA Surgery. That's up from a 25% difference from 2000 to 2010.
The 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.
"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," said Paul Reeping, a postdoctoral fellow at the University of California, Davis' Violence Prevention Research Program, who conducted the research as a doctoral student at the Columbia University Mailman School of Public Health.
"Suicides were always the highest in rural areas. That hasn’t changed," Reeping said. "It's just that the gun deaths overall have gone up, including firearm suicides, in those areas."
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.
The map below, which uses a different CDC dataset from the set the report used, shows where gun deaths were concentrated from 2011 to 2020. Counties in darker blue had higher rates of firearm deaths per 100,000 people.
CDC data suggests firearm death rates tend to be highest in mountain states like Arizona, Idaho, Nevada and Wyoming. Research from the Rand Corp., a nonpartisan think tank, found a similar trend for gun suicides in 2020.
"These are also states that, not coincidentally, have particularly high firearm ownership rates at the population level," said Andrew Morral, a senior behavioral scientist at Rand.
The Rand report found that gun homicide rates were highest in Southern states — particularly Louisiana and Mississippi — in 2020.
"The urban areas have a little bit higher rate of firearm homicides, but it's not huge," Morral said.
What's driving the urban-rural divide?
An analysis of 1990s data from the National Center for Health Statistics, published in 2003, found no difference in intentional firearm deaths in highly rural areas compared to big cities.
Researchers aren't sure yet why the pattern has changed since then.
Reeping and Morral said county-level trends are difficult to interpret, because each county has unique demographics and local regulations. Gun laws, however, are often determined at the state level, so they don't fully explain discrepancies between rural and urban areas in the same state.
"In many states, there’s not much control local jurisdictions have over the regulations that they have to follow," Morral said.
Still, 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.
How can states prevent gun suicides?
Researchers pointed to several policies that could lower gun suicide rates throughout the country.
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. A 2004 study found that people who locked or unloaded their stored firearms were less likely to die by suicide with guns than people who kept their firearms stored loaded or unlocked.
Reeping also noted that doctors at hospitals can assess whether people at risk for suicide have access to firearms, then work with the patients' 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.
CORRECTION (April 27, 2023, 1:15 p.m. ET): A previous version of the map in this article showed the wrong numbers for county populations. When clicking on a county, it now shows the 10-year average population per county, not the 10-year total population.