New study calculates lifetime risk of death from firearms and drug overdoses in the United States

One of every 100 American children will die from firearms if current death rates continue; one of every 70 will die from overdoses

A new study published in The American Journal of Medicine calculates the lifetime risk of death from firearms and drug overdoses in the United States.

The lifetime risk of death from firearms is about 1%, meaning approximately one of every 100 children will die from firearms if current death rates continue. And the lifetime risk of death from drug overdoses is 1.5%, meaning one of every 70 children will die from overdoses. 

The lifetime risks vary depending on who you are and where you live. The lifetime risk of firearm death is highest among Black boys: one of almost every 40 will die from a gunshot. The lifetime risk of overdose death is highest in West Virginia, where one of about every 30 children will die from overdoses.

“News media and politicians frequently discuss the high toll of deaths from firearms and drug overdoses,” said lead researcher Ashwini Sehgal, a professor of medicine at Case Western Reserve University and a physician at MetroHealth Medical Center. “They usually mention the numbers of deaths, citing figures like 40,000 firearm deaths last year, or death rates such as 20 overdose deaths per 100,000 population. But for most people, it’s hard to grasp the real meaning of both the large absolute numbers and the small annual rates.”

Sehgal used official death-certificate data from the U.S. Centers for Disease Control and Prevention for the year 2018. Age-specific death rates were used to estimate the cumulative risk of firearm, drug overdose and motor vehicle accident deaths from birth to age 85 after accounting for other causes of death.

Lifetime risks also varied greatly across states, with some having especially striking overdose risks. For example, residents of West Virginia had a 3.5% lifetime risk of death from overdoses, indicating that one of 28 would be expected to die from overdoses. Residents of Mississippi had the highest lifetime risks for firearm deaths. The states with the lowest lifetime risks of death from firearms, drug overdoses and motor vehicle accidents were Rhode Island, South Dakota and New York, respectively.

Several limitations must be considered in interpreting these results, the study cautioned. The standard method used for estimating lifetime risk assumes that future death rates will match those of the year studied. Such long-term extrapolations may under- or overestimate actual future risks. Moreover, lifetime risk estimates may be less relevant to individuals who have already survived for several decades.

“While absolute numbers of deaths and annual death rates describe mortality over a short period of time,” Sehgal said, “lifetime risk tells us more about long-term consequences.”

Presenting information on lifetime risks may be a practical way to educate the public and policymakers about the impact of firearm and overdose deaths, Sehgal said. Lifetime risk should be included in news stories and government reports and contrasted with lifetime risk of other causes of death and with figures from other countries.

For example, the lifetime risk of dying from an overdose is similar to the lifetime risk of dying from colon cancer. Examining changes over time is also enlightening: American drug-overdose deaths have quadrupled over the last two decades.

There are several things policymakers can do to reduce the exposure to and consequences of firearms and potentially lethal drugs, the study urges. Examples include background checks and waiting periods for gun purchases and improving access to substance-use treatment and needle-exchange programs. 

Health providers can also advocate for measures likely to reduce deaths, the study concludes. They can ask patients about the presence of firearms in the home, review safe-storage practices and screen for depression. They can also limit or avoid prescribing drugs with overdose potential and carefully monitor patients on such drugs.

Sehgal concluded that lifetime risk calculations are based on the assumption that future death rates will match current ones. 

“But it does not have to be that way,” he said. “The big differences in firearm and overdose deaths by race, gender, state and country, and the sizeable changes over time indicate that high levels of firearm and overdose deaths are not inevitable. Let’s take sensible steps now to help our children avoid the preventable tragedies of firearm and overdose deaths.”