Report Details Impact of Rifles, Shotguns on Rural, Young Suicide Rates

While many Americans may associate firearm-related suicides with access to handguns, a report released this month documents the high prevalence of long gun (rifle and shotgun) use in youth and rural suicide rates.

While many Americans may associate firearm-related suicides with access to handguns, a report released this month documents 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 gun suicides in the state of 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. Young people under the age of 18 used long guns to commit suicide at a disproportionate rate compared with older cohorts. This is the first study to investigate firearm type in these deaths.

“For decedents 18 or younger, 44.6% used long guns, compared to 20.2% in those 65 or older. Compared to the most urban counties, firearm suicide decedents in the most rural counties were 3.74 times more likely to use long guns (odd ratio [OR], 3.74; 95% CI, 2.19-6.40; P&thinsp;<&thinsp;.001) after adjusting for demographics, intoxication, and hunting season,” researchers found. They continued, “Among rural firearm suicide decedents under 18, 4 out of 5 (80%) had used a long gun, while only 43% of their urban counterparts had done so.”

Non-Hispanic whites accounted for 82% of all firearm suicide decedents, and men were 2.4 times more likely to commit suicide via long gun than women (95% CI, 1.81-3.16; P<.001).

Long gun ownership is significantly less regulated than handgun ownership in Maryland. There is no minimum age for possessing a rifle or shotgun and “state regulations requiring waiting periods, permits to purchase and carry, and licensing of owners for handguns do not apply to long guns,” according to the study.

Although firearms are used in only a small proportion of suicide attempts, they account for more than half of fatal suicides, with a case fatality rate of over 80%. In addition, the majority of deaths resulting from firearms are self-inflicted.

“Coupled with the fact that attempt survivors rarely die in subsequent attempts, and most suicide decedents have no history of a past attempt, access to highly lethal means has been recognized as one of the most important contributors to high rates of completed suicide,” researchers said.

Maryland was selected for this study due in part to its accurate medical examiner system. The state was the first in the country to establish a protocolized system, guaranteeing consistency in statewide investigations.

The cross-sectional study included data recorded by Maryland’s Office of the Chief Medical Examiner (OCME) on 3931 firearm suicides between 2003 and 2018. Age, sex, race/ethnicity, county of residence, method of suicide, toxicology, and OCME and police reports of deaths were analyzed.

Each decedent’s county of residence was categorized using the National Center for Health Statistics’ Urban-Rural Classification Scheme for counties. Counties are sorted into 1 of 6 groups based on population size and adjacency to metropolitan areas. Researchers also looked at timing of long gun suicides in relation to Maryland’s hunting season based on the Maryland Deer Hunting Report.

Rifles are the most commonly used hunting weapon and data showed the proportion of rifle-inflicted suicides “increased dramatically during deer hunting season.” In addition, over 90% of hunters are white and/or male.

“Compared to the most urban decedents, the most rural decedents were more than 5 times as likely to have used a long gun (OR, 5.3; 95% CI, 3.17-8.79; P<.001), with each level of rurality associated with increasing likelihood,” researchers found.

Results of this study cannot be generalized to the nation as a whole, and researchers noted that Maryland’s proportion of rifle and shotgun ownership is not known. However, “these data are more current, more complete, and more consistently collected than national data sources derived from a mixture of coroner and medical examiner systems,” they said.

The findings may be due to the fact that long guns are more difficult to hide and more expensive to lock away, making them easier for children to access. In rural counties, young people may have more access to long guns for hunting purposes. Another explanation could be the limited legal restrictions on long gun ownership in the state of Maryland, enabling younger purchasers.

More studies are needed to determine why youth are more likely to use long guns in rural areas, but it is certain that suicides are often impulsive, especially in young people, and “younger people have been shown to have greater increases in suicide rates when exposed to a firearm in the home than those 18 and older,” authors state.

The results of the study follow a growing trend of “deaths of despair,” a term coined by Princeton economists Anne Case, PhD, and Angus Deaton, PhD, in 2015. In general, it refers to rising mortality and morbidity rates among mostly white Americans resulting from drug or alcohol use or suicide.

Nationally, from 2005 to 2019, suicide rates increased nearly 30% and saw the sharpest increase between 2016 and 2017, more so any other year-long period in recent history. According to the Pew Research Center, “In 2017, six-in-ten gun-related deaths in the U.S. were suicides (23,854).”

Between 1999 and 2016, suicide rates among people living in rural counties were 25% higher than those in major metropolitan areas, NBC reported in September 2019. Poverty, low income, and underemployment could all be accountable for the uptick. “Counties with high levels of social fragmentation—based on the levels of single-person households, unmarried residents and transient residents&mdash;and a high percentage of veterans had higher rates of suicide. All of those factors were more pronounced in rural counties,” NBC reported.

The latest CDC data showed the suicide rate gap in rural and urban areas steadily grew from 1999 to 2015, and since 2007 the gap has widened more quickly. The CDC also states, “The rate of suicide with a firearm is almost two times higher among rural than urban residents.”

Researchers hope the study will lead to increased preventative practices involving long guns, such as safe storage measures and limiting access to the weapons. “Firearm-owner led outreach and education groups have been effective in reaching rural gun owners and reducing firearm suicides, and equivalents have already gained traction in Maryland,” they said. Hunting supply retailers could also promote safety practices among gunowners.


Nestadt PS, MacKrell K, McCourt AD, et al. Prevalence of long gun use in Maryland firearm suicides. Inj Epidemiol. 2020;7(4). doi: 10.1186/s40621-019-0230-y.

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