A Look at 2020’s Impact on America’s Gun Violence Epidemic

To mark National Gun Violence Awareness Month, The American Journal of Managed Care® assessed how events in 2020 shaped the United States' gun violence epidemic.

Despite a relative lack of high-profile mass shootings throughout the majority of the COVID-19 lockdown in the United States, 2020 marked the deadliest year for gun violence in the country in decades, with over 43,500 gun deaths and 610 mass shootings—defined as 4 or more shot or killed, not including the shooter—recorded by the Gun Violence Archive.

However, every trend can break, and the nation was once again subjected to headlines of mass casualties reported from Atlanta, Georgia; Boulder, Colorado; and San Jose, California, between March and May 2021 alone.

But these events don’t accurately characterize the epidemic of gun violence that consistently leads to completed suicides and disproportionately impacts communities of color in the United States, explained Michael D. Anestis, PhD, in an interview with The American Journal of Managed Care® (AJMC®). Anestis is the executive director of the New Jersey Gun Violence Research Center and an associate professor at the Rutgers School of Public Health.

“We think about these high-profile mass shootings; those actually represent an extraordinarily small percentage of gun deaths in this country,” Anestis said. “It doesn't make them unimportant; it doesn't mean we shouldn’t talk about them or that we should talk about them less. But it means that, oftentimes, our conversations around gun violence are these reactive conversations in response to these high-profile events that are just fundamentally different than most day-to-day gun violence and most gun violence overall in the country.”


In the United States, suicide accounts for roughly 2 of every 3 gun deaths, while the homicide-by-firearm rate is dramatically focused on the nation’s Black population. “And yet, when you hear about gun deaths in this country, it's often these high-profile, often very White mass shootings," Anestis noted.

Skewed perceptions of what the gun violence epidemic is may inhibit effective solutions to the actual problem, he said.

Throughout this past June—National Gun Violence Awareness Month—a spate of additional shootings in Texas, Illinois, and Georgia sparked concern that the summer of 2021 may bear witness to increased rates of gun violence compared with those seen throughout the pandemic, as public spaces begin to reopen and more people regularly leave their homes.

Although the massive mental health toll of the pandemic contributed in part to rises in emergency department visits for suicide attempts, violence, and mental health during the past 18 months, in July of 2020, gun sales to new owners in the United States hit record highs as individuals grappled with not just pandemic-induced stressors, but a national reckoning on racial justice and a fast-approaching and contentious presidential election.

“Even before this purchasing surge, there were more firearms than there are people in the United States,” said Anestis. “We were inundated with firearms in a way that's fundamentally different than any other country in the world. And despite this, we saw a dramatic uptick in sales this past year.”

Numerous studies have detailed the negative consequences of greater firearm access, with specific attention paid to increased rates of suicide carried out via firearm. For example, data from California show “handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm,” while a loosening of Missouri’s permit-to-purchase and concealed carry firearm laws was associated with increased rates of firearm suicides among young residents.

In addition to the association between handgun access and suicide, one report documented the high prevalence of long gun (rifle and shotgun) use in youth and rural suicide rates. The study, published in Injury Epidemiology, found that from 2003 to 2018, 28.4% of suicides by gun in Maryland resulted from long guns. That proportion jumps to 51.6% in rural counties compared with just 16.8% in the state’s urban counties.

Research also shows that just having a firearm in the home increases the risk of suicide by 3 to 5 times for members of that household. Access to firearms predicts suicide death above and beyond all sorts of factors like mental illness, suicidal thoughts, substance use, demographics, and economic struggle, Anestis explained.

In 2018, every 4 days a young person died by suicide via firearm in Missouri, reflecting national trends of increased suicide rates among young adults. Data from June 2019 showed suicide rates for teens and young adults in 2017 reached their highest level since 2000.

But a relative lack of research exists when it comes to suicide ideology among gun owners. To address this knowledge gap, Anestis and his team surveyed individuals who purchased a firearm between March and July of 2020—the opening months of the COVID-19 pandemic.

Of the 3500 participants—broken down by those who purchased a firearm in these months, those who owned firearms but did not purchase in these months, and those who aren’t firearm owners—responses revealed those who purchased firearms during this window were more likely to have had lifetime suicidal thoughts, past-year suicidal thoughts, and past-month suicidal thoughts compared with the 2 other cohorts.

Those who were not firearm owners and those who did not purchase during these months were equally as likely to have had suicidal thoughts.

“To put it in context, about 7 of 10 folks who purchased during the surge endorsed having had suicidal thoughts at some point in their life, and 1 in 4 reported having had suicidal thoughts just in the past month alone,” Anestis said.

“So, what you've got is a group of folks unlike most firearm owners, in that they are prone to suicidal thoughts. And we've now introduced the most lethal method for suicide into their home. And it's likely to stay there for a long, long time.”

Because most people who die by suicide via firearm do so with a gun that has been in their home for 10 or 11 years, this fact renders point-of-sale restricting policies largely ineffective for gun-inflicted suicide prevention, he explained.

Racial and Economic Disparities

In addition to the danger firearm access poses to those with suicidal thoughts, increased access can also lead to higher rates of child or adolescent gun violence. One study published in Pediatrics found that during the first 6 months of the COVID-19 pandemic, there was a “surge in firearm injuries in young children and inflicted by young children.”

More guns purchased and stored in the home open more opportunities for risk, especially when these guns are bought by first-time owners who may not be familiar with safe storage practices, Anestis said, noting compelling data indicate “adolescents are far more aware of how to access firearms in the home than their parents think they are.”

Compounding this issue, research shows adolescent exposure to deadly gun violence within 500 meters of home or school is correlated with race and income. After analyzing national data on deadly gun violence incidence, investigators found “rates of exposure were higher for Black and Hispanic adolescents than for White adolescents and higher for poor and near-poor adolescents than middle to high income adolescents.”

Furthermore, middle to high income Black and Hispanic adolescents were more likely to be exposed to violence near home or school even when compared with poorer White adolescents, authors wrote.

CDC data from 2019 show that compared with White males aged 15 to 34, Black men and boys in the same age group are 20 times more likely to die from a firearm. Despite this cohort only making up 2% of the nation’s population, they accounted for 37% of gun homicides in 2019. In addition, Black women are 4 times more likely to die by firearm than their White counterparts.

Of all Black teenagers aged 15 through 19 who died in 2019, more than half, 57%, were killed by gun violence.

Geographically, homicide rates are the highest in the nation’s urban counties. “When clustered by urbanization level, the highest rate of firearm homicide in 2019 was in large central metro counties, 1.3 times higher than the national average and 1.8 times higher than large fringe metro counties, where the homicide rate is lowest,” the report reads.

Unsafe gun storage marks 1 root cause perpetuating these trends. If an individual owns a firearm that is not safely stored (ie, is unsecured, stored loaded, and is easily accessible), the risk of unintended shootings, lethal domestic violence, and theft all increase.

“When firearms are not secured, they are more readily stolen. And when they're stolen, then often trafficked into urban spaces where they are then used in crimes. And in those situations, what you end up having is unsecured firearms resulting in death that disproportionately impacts communities of color across the United States,” Anestis said.

This reality once again underscores the potentially ineffective nature of point-of-sale policies to stem gun-related homicides in communities of color, as most of the homicides in US cities involve illicitly acquired firearms.


Because guns aren’t going anywhere, safe storage plays a critical role in mitigating the staggering rates of suicide and gun violence in the United States. To Anestis, this definition includes a firearm stored unloaded and separate from ammunition in a secure location, like a gun safe or lockbox. Ideally, this will have a locking device such as a trigger or cable lock in place.

“Secure storage also involves a plan for storing firearms legally and temporarily away from the home during times of stress,” he said.

Given the increased rates of gun death and violent crime throughout the country, President Joe Biden recently announced a series of steps to meet this crisis. The 5-point plan involves:

  • Stemming the flow of firearms used to commit violence by holding rogue firearms dealers accountable for violating federal laws
  • Supporting local law enforcement with federal tools and resources to help address summer violent crime
  • Investing in evidence-based community violence interventions
  • Expanding summer programming, employment opportunities, and other services and supports for teenagers and young adults
  • Helping formerly incarcerated individuals successfully reenter their communities

Notably, part of the administration’s initiative to invest in evidence-based community violence interventions involves leveraging “trusted messengers who work directly with individuals most likely to commit gun violence.”

A previous study, also carried out by Anestis and colleagues, illustrated the importance of understanding who exactly these trusted messengers are among those who own firearms. Because this population is not homogenous, they sought to determine which sources rank as most credible when it comes to safe firearm storage and suicide prevention.

Among different subgroups of firearm owners, “what you typically saw was law enforcement and military veterans and active-duty service members as being ranked as highly credible,” Anestis explained. Celebrities and casual acquaintances ranked poorly.

To improve messaging around safe storage and suicide prevention, “we have to make sure that we're not just packaging the right message…but that we're taking that message and delivering it in the right medium with the right messenger,” he explained.

Making assumptions about who these individuals are does not ensure the needs of the targeted communities are being met. “And it's more important to make sure we're meeting the needs the community we're trying to reach, than to meet the needs of our own assumptions.”

But understanding the nuances of effective firearms safety communication takes research, and research takes funding—a resource that is sorely missing from the mission to improve gun violence in the United States.

In 1996, the Dickey Amendment prohibited the federal government from advocating for or promoting gun control, effectively freezing research in this field. However, in 2019, as part of 2 spending packages signed into law by then-President Trump, provisions allowed federal funds to be allocated to the National Institutes of Health and CDC for the purpose of conducting research on gun violence.

In 2020, the first grants from this package were awarded, offering nearly $8 million to 16 awardees through The National Center for Injury Prevention and Control, Division for Violence Prevention.

“Having federal dollars is a big deal” and marks a vital step in the right direction, Anestis said. But in the end, these funds are not nearly sufficient. “If you look at the level of funding for gun violence, relative to the level of funding for other similar or even far less common causes of death, it's extraordinarily low. It is nowhere close to being funded at the level to which it is impacting the country.”

As experts await results from federally funded studies and privately funded research continues to be released, community partnerships involving gun owners and coordinated public/private efforts to disseminate the message of safe storage can yield positive impacts in at-risk populations.

Paramount in this effort is making safe storage commonplace and considered a habit to be followed as opposed to a threat to individual rights, Anestis explained. Training individuals who could normalize this conversation and speak with those at risk in context can also aid this effort.

Overall, a redefinition of gun violence in the United States needs to take place to effectively reduce suicide and homicide rates.

“What's tragic…is that we're not talking about suicide. It's that we're not talking about Black and Brown communities just being devastated by gun violence,” Anestis said.

“And because of that, we don't allocate our resources appropriately. We don't talk about effective solutions appropriately…You need to have policy solutions that address the actual problems. And if we don't talk about our problem with gun violence appropriately, that's not what's going to happen.”

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