Gun Violence

MMR Vaccine Risks in Perspective

This post is a follow-up to my recent post about measles and MMR vaccine. The purpose of this post is to compare the risk of adverse effects from the MMR vaccine to other risks that we take with our children every day.

Annual Deaths of children under 18

In the US 37,000 children under the age of 18 die every year. In 2022, the last year for which we have complete data, 604 children were killed in automobile accidents. This figure includes those killed as passengers, walking to school or in their neighborhoods, or riding their bicycles. Here is a table from the New England Journal of Medicine showing the most common causes of death of children since 1999.

As you can see from the graph, motor vehicle deaths of children have gone down significantly since 1999, but are still the second leading cause of death in children. Firearm injuries have now surpassed motor vehicle deaths as the leading cause of death in children.

All of these risks are small, the highest being 4.5 deaths per 100,000 Children. These are risks we take with our children every day. There is a risk when they ride in your car. There is a risk when they walk in their neighborhoods. There is a risk when they ride their bicycles. There is a risk that they will be killed by a mass murderer when they go to school. The risks of adverse reactions to vaccines are actually lower than the risks that we take with our children every day. Adverse reactions to vaccines almost never kill children

Deaths of children due to MMR vaccine

There have been only two documented deaths due to MMR vaccine in the 62 years it has been available. Both of these deaths were in children with Severe Combined Immunodeficiency Syndrome (SCIDS). You may remember a movie about a child with this syndrome. It was called “The Boy in the Bubble.” These children should never have received a live virus vaccine, such as MMR.

MMR Vaccine and Autism

Robert F. Kennedy Jr, the current head of HHS, has contended that MMR vaccine causes autism. There was a paper published by Andrew Wakefield in the medical journal, the Lancet, that studied 12 children and concluded that MMR vaccine was linked to autism. It was later discovered that he had falsified his results and the paper was retracted by the Lancet. This discredited paper, plus another one by the same author are still cited by people, including our current head of HHS, as evidence that MMR vaccine causes autism.

Study by Brent and Taylor

Brent and Taylor and colleagues examined the records of 498 children with autism. Cases were identified before and after MMR vaccine became available in the UK. They compared the incidence of autism in vaccinated and unvaccinated children and found no difference.

Study by Madsden and Colleagues

Madsden and colleagues did one one of the best and most rigorous studies. The study included 537,303 children representing 2,129,864 person-years of study. Approximately 82% of children had received the MMR vaccine. The risk of autism in the group of vaccinated children was the same as that in unvaccinated children. Furthermore, there was no association between the age at the time of vaccination, the time since vaccination, or the date of vaccination and the development of autism.

Other studies

Many other well designed studies have shown no association between the MMR vaccine and autism.

Bottom Line

We daily accept small risks of injury and death of our children. There are no activities involving children that are without some risk. The risks of MMR vaccine side effects (or any other vaccine) are no larger than the risks we take with our children every day. See my last post for a list of possible side effects of MMR vaccine. Severe side effects of MMR vaccine are very rare. When given appropriately to children with normal immune systems, death is not one of the risks. The one study by Andrew Wakefield that showed a connection with MMR vaccine and autism was shown to be fraudulent and was retracted. Multiple well designed studies have definitively shown that MMR vaccine does not cause autism.

Firearm Violence Statistics in the US – Not Exactly What We Hear on Television

Access to guns and firearms is third in the top five health concerns of people in the US. What gets reported in the news media about gun violence gives the impression that most deaths from gun violence are murders and mass shootings. The actual data give a substantially different story. In this post I will write about the statistics on death from gun violence in the US as well as comparing it to that in some other countries.

Total deaths vs death rates

The number of gun violence deaths has been increasing in the US, but so has the population. The best way to know whether gun violence deaths are increasing, decreasing or staying the same is to look at death rates from gun violence per 100,000 people. The news media never report it that way.

Suicide

The most recent year for which we have complete data is 2021. In 2021, as in previous years a large majority of firearm deaths were suicides (54%). The rate of firearm suicides was 7.5 per 100,000 people. This essentially equals the peak gun suicide rate of 7.7 per 100,000 people which occurred in 1977.

Firearm suicides vary considerably by state. The states with the highest firearm suicide rates are Wyoming (22.8 per 100,000 people), Montana (21.1), Alaska (19.9), New Mexico (13.9) and Oklahoma (13.7).

The states with the lowest firearm suicide rates are  Massachusetts (1.7 per 100,000 people), New Jersey (1.9), New York (2.0), Hawaii (2.8) and Connecticut (2.9).

For people with depression, access to a gun in the home increases the risk of suicide death by 300%. Suicide attempts by firearm result in death 90% of the time, while suicide attempts by other methods have a much higher survival. Of those who survive suicide attempts, 70% do not attempt suicide again. Men are much more likely to commit suicide by firearm than women, but a substantial number of women commit firearm suicides as well. Physicians, therapists and or family members should try to see that guns are removed from the home of any person who has major depression. Despite best efforts, that is not always possible.

Murder

In 2021 43% of the firearm deaths were murders. The firearm murder rate in the US was 6.7 per 100,000. It rose sharply to this value during the pandemic, but was still lower than the peak gun murder rate of 7.2 per 100,000 in 1974.

The firearm murder rate also varies markedly by state. The states with the highest firearm murder rates are District of Columbia (22.3 per 100,000 people), Mississippi (21.2), Louisiana (18.4), Alabama (13.9) and New Mexico (11.7).

The states with the lowest firearm murder rates are Massachusetts (1.5 per 100,000), Idaho (1.5), Hawaii (1.6), Utah (2.1) and Iowa (2.2).

Medical Response to Gunshot Wounds

People with gunshot wounds who make it to a level 1 trauma center within an hour have a significantly higher survival rate. Level 1 trauma centers are rarely located in poor neighborhoods where most of the gun violence happens. Murder rates therefore are affected by how well the medical system can get gunshot wounds to level 1 trauma centers. To really understand the level of gun violence, we need to know the total number of gunshot wounds, not only those who die from them. Unfortunately, no agency keeps those statistics. They are included under aggravated assault, which the FBI defines as an unlawful attack by one person upon another for the purpose of inflicting severe or aggravated bodily injury. That could include fist fights, knocking someone down, threatening someone with a knife or inflicting a gunshot wound. If the medical system is doing a good job, then the murder rate will be lower, despite the fact the gunshot wounds may be increasing. We currently have no way to measure this.

Change in gun violence deaths over time

Below is a graph showing firearm suicide and murder rates in the US since 1968.

Mass Murder

The CDC defines mass murder by firearm as 4 or more people killed or injured in an attack. Although mass murders are widely reported in the media, they account for only a tiny sliver of total deaths from firearms. Using this definition 706 people were killed in mass shooting incidents in 2021 compared to total firearm deaths in 2021 of 48,830. In other words mass shootings account for about 1% of total firearm deaths. That does not make them any less horrific, but the chance of any individual being killed in a mass shooting is not zero but is very tiny. The number of mass shooting incidents has increased, however, from 3 in 2000 to 61 in 2021.

Who is at risk of dying by firearm murder?

Black people and particularly black men are at markedly increased risk of being murdered by firearms. People of Hispanic origin and native Americans are also at increased risk. This is almost certainly partly due to inadequate access of these communities to prompt treatment at a level 1 trauma center. Below is a graph from the CDC showing gun murder by racial group and gender.

Firearm deaths in children

In 2021, firearms continued to be the leading cause of death among US children. From 2018 to 2021, there was a 41.6% increase in the firearm death rate in children.  Over 3,000 children and adolescents ages 0 to 19 die each year in the U.S. from a firearm injury. In children and adolescents ages 10-19, approximately 4 in 10 of those deaths are suicides.

Firearm deaths in the US compared to other countries

Compared to other high income countries, the US has the highest rate of homicides from firearms. Below is a chart showing firearm homicide deaths for high income countries with populations over 10 million.

The US is also an outlier compared to other high income countries in firearm deaths of children. Below is a chart showing this.

Gun violence in Latin America is very high, due in part to the prevalence of criminal gangs and a vibrant drug trafficking industry. Countries that have a higher firearm death rate than the US are in the table below.

Venezuela36.75 per 100,000 people
El Salvador36.34
Guatemala33.06
Colombia25.29
Brazil22.84

Reasons people have guns in the home

Nearly three fourths (72%) of gun owners say their guns are for protection. A little less than a third (32%) say they own a gun for hunting. Other smaller percentages reasons are gun collecting, sport shooting, or for their job. Among gun owners with only one gun, handguns are by far the most common type of gun: 62% say this is the type of gun they own, while 22% own a rifle and 16% own a shotgun.

Bottom Line

Most deaths from firearms in the US are suicides, about 54%. About 43% of firearm deaths are murders, of which a disproportionate proportion are black men and to a lesser extent black women. Mass murders make up 1% of deaths from firearms. The rest are accidental, involve law enforcement or are of undetermined cause.

Prompt access (within the first hour) to level 1 trauma centers substantially reduces the death rate from gunshot wounds. Poor communities, especially black communities tend to live far from a level 1 trauma center.

Firearm suicide and firearm murder rates vary markedly by state. Firearms are the leading cause of death in children in the US. The US has vastly more firearm deaths of both adults and children than all other high income countries.

The total number of firearm deaths in the US in 2021 was 48,830. Anything else that killed nearly 49,000 people in the US in 1 year would be considered a national health emergency. We could markedly reduce this death toll if we had the political will to do so. Just banning assault weapons is not an adequate response. That would barely make a dent in the total death rate from firearms. It would not reduce gun suicides (the major cause of firearm deaths). Hospitals who treat gunshot wounds would not notice any measurable difference.

Some of the information in this post comes from Malcolm Gladwell’s podcast, Revisionist History. He did a six part series on gun violence in the US this past August. It is tremendously informative, though not comfortable to listen to. If you have any interest in this topic (as everyone in the US should) I highly recommend listening to it.