Analysis of Firearm Violence During the COVID-19 Pandemic in the US

IMPORTANCE: In the US, the COVID-19 pandemic intensified some conditions that may contribute to firearm violence, and a recent surge in firearm sales during the pandemic has been reported. However, patterns of change in firearm violence in the first year of the COVID-19 pandemic in the US remain unclear. OBJECTIVE: To quantify the changes in interpersonal firearm violence associated with the pandemic across all 50 US states and the District of Columbia. DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional study examined 50 US states and the District of Columbia from January 1, 2016, to February 28, 2021. The COVID-19 pandemic period was defined as between March 1, 2020, and February 28, 2021. Statistical analysis was performed from April to December 2021. MAIN OUTCOMES AND MEASURES: A 2-stage interrupted time-series design was used to examine the excess burden of firearm-related incidents, nonfatal injuries, and deaths associated with the pandemic while accounting for long-term trends and seasonality. In the first stage, separate quasi-Poisson regression models were fit to the daily number of firearm events in each state. In the second stage, estimates were pooled using a multivariate meta-analysis. RESULTS: In the US (all 50 states and the District of Columbia) during the pandemic period of March 1, 2020, to February 28, 2021, there were 62 485 identified firearm-related incidents, 40 021 firearm-related nonfatal injuries, and 19 818 firearm-related deaths. The pandemic period was associated with 8138 (95% empirical confidence interval [eCI], 2769-12 948) excess incidents (increase of 15.0% [95% eCI, 4.6%-26.1%]), 10 222 (95% eCI, 8284-11 650) excess nonfatal injuries (increase of 34.3% [95% eCI, 26.1%-41.1%]), and 4381 (95% eCI, 2262-6264) excess deaths (increase of 28.4% [95% eCI, 12.9%-46.2%]). The increase in firearm-related violence was more pronounced from June to October 2020 and in Minnesota and New York State. CONCLUSIONS AND RELEVANCE: In the US, the first year of the COVID-19 pandemic was associated with an excess burden of firearm-related incidents, nonfatal injuries, and deaths, with substantial temporal and spatial variations.