Your neighborhood matters: an ecological social determinant study of the relationship between residential racial segregation and the risk of firearm fatalities

Background: Firearm fatalities are a major public health concern in the United States, claiming approximately 40,000 lives annually. It remains unclear how social determinants of health (SDOH) such as residential racial segregation, income inequality, and community resilience impact firearm fatalities. This study investigates relationships between these SDOH and the likelihood of firearm fatalities. Methods: County-level SDOH data from the Agency for Healthcare Research and Quality (AHRQ) for 2019 were analyzed across 72 Wisconsin counties. The dependent variable was the number of firearm fatalities per county (counts). The primary independent variable was residential racial segregation measured by the Dissimilarity Index (0–100; higher indicates greater segregation), categorized into low, moderate, and high. Covariates included income inequality (Gini index; low, moderate, high), community resilience risk factors (low, moderate, high risk), and rural-urban classification. Descriptive statistics and unadjusted/adjusted negative binomial regression (population-weighted) were conducted in STATA/MP v17.0 (p≤0.05). ArcMap was used for GIS analysis. Results: In 2019, there were 802 firearm fatalities. After adjustment, the risk of firearm fatalities was higher in areas with high residential racial segregation versus low (IRR 1.26, 95% CI 1.04–1.52) and higher in areas with high income inequality versus low (IRR 1.18, 95% CI 1.00–1.40). Compared to areas with low-risk community resilience, the risk estimates for moderate (IRR 0.61, 95% CI 0.48–0.78) and high risk (IRR 0.53, 95% CI 0.41–0.68) were lower in the model, while narrative interpretation emphasized higher likelihood of fatalities with low resilience. GIS mapping showed areas with high segregation also had high firearm fatality rates. Conclusion: Areas with high residential racial segregation exhibit higher rates of firearm fatalities. The likelihood increases with high income inequality and low community resilience, underscoring the need for structural, community-level interventions.

Abdul R Shour, Ronald Anguzu, Yuhong Zhou, Alice Muehlbauer, Adedayo Joseph, Tinuola Oladebo, David Puthoff, Adedayo A Onitilo