Overdose Deaths, Gun Violence Steadily on the Rise

Lara Salahi

July 03, 2023


Deaths from external causes have nearly doubled over a 20-year period, and the largest increases in deaths were due to poisoning and firearms, according to data published today in JAMA Internal Medicine.


  • This cross-sectional study used National Center for Health Statistics data from January 1999 to December 2020 on deaths of 3.8 million people aged 20 and older.

  • Researchers categorized deaths into three types: firearms, poisoning, or by other means (ie, falls, car crashes), and then stratified cause of deaths as intentional, unintentional, or undetermined.

  • Deaths rates were calculated by age, sex, and race and ethnicity by calendar years.


  • The death rate in the United States from external causes increased from 65.6 per 100,000 people in 1999 to 103.5 per 100,000 people in 2020. The largest increases were the result of unintentional poisonings, which more than tripled during the study period, followed by intentional firearm injuries.

  • Drug overdose deaths, which accounted for most poisoning deaths, increased 10% annually between 2013 and 2020 (95% CI, 7.6% - 12.4%).

  • Firearm-related deaths increased nearly 5% annually between 2013 and 2020 among individuals aged 20-39.

  • Black individuals held the highest rate of firearm deaths compared with any other racial and ethnic groups. Firearm-related deaths were five times higher among Black individuals compared with Asian and Pacific Islanders (24.5 vs. 3.3 per 100,000 people, respectively).

  • Motor-vehicle related deaths, which increased annually by an average of 1.1% between 2010 and 2020 (95% CI, 0.3% - 1.8%), were one of the leading means of other external deaths.


"The study findings underscore the urgency of addressing the structural determinants of deaths from firearms, drug overdose, and other injuries, especially among racial and ethnic minoritized populations and their communities," the researchers write. 


The study was conducted by Wayne R. Lawrence, DrPH, National Cancer Institute, National Institutes of Health, and colleagues, and was published online in JAMA Internal Medicine.


The researchers relied on reported causes of death and intent, which may have been incorrectly classified. Researchers analyzed data from adults aged 20 and older, so the findings may not be generalizable to younger people. Deaths from 2021 were not included in the study because racial and ethnic classification in death certificate data changed. Asian and Pacific Islander racial groups were classified together during the time period studied, which did not allow for researchers to draw distinctions in mortality between the two groups.  


The study was supported by the Intramural Research Program of the National Cancer Institute. The authors report no relevant conflicts of interest.   


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