Firearm possession rates in home countries and firearm suicide rates among US- and foreign-born suicide decedents in the United States: Analysis of combined data from the National Violent Death Reporting System and the Small Arms Survey

Background: Suicide by firearms is a serious public health issue in the United States. However, little research has been conducted on the relationship between cultural backgrounds and suicide by firearms, specifically in those born and raised in the United States compared to those who have immigrated to the United States. Objective: To better understand the relationship between cultural backgrounds and suicide, this study aimed to examine firearm suicide rates among US- and foreign-born suicide decedents based on the firearm possession rate in the decedent’s home country. Methods: Multivariate logistic regression was performed to analyze data of 28,895 suicide decedents from 37 states obtained from the 2017 National Violent Death Reporting System data set. The firearm possession rate in the home countries of foreign-born suicide decedents was obtained from the 2017 Small Arms Survey. Results: The firearm suicide rate was about twice as high among US-born suicide decedents compared to their foreign-born counterparts. Meanwhile, suicide by hanging was about 75% higher among foreign-born compared to US-born suicide decedents. Those from countries with a low-to-medium firearm possession rate were significantly less likely to use firearms compared to US-born suicide decedents (adjusted odds ratio [AOR]=0.45, 95% CI 0.31-0.65, and AOR=0.46, 95% CI 0.39-0.53, respectively). Meanwhile, firearm suicide rates were not different between US- and foreign-born suicide decedents from countries with a similarly high firearm possession rate. Conclusions: The results suggest that there is an association between using firearms as a means of suicide and the firearm possession rate in the decedent’s home country. Suicide by firearms in the United States needs to be understood in the sociocultural context related to firearm possession.