Firearm Suicide and Perceived Physical Health Challenges: A Case-Control Study

Firearm suicide is a critical public health issue in the United States as firearms are the mechanism for the majority of all suicides and suicides account for more than half of all firearm-related deaths. Prior research has identified certain physical health diagnoses as well as functional disability as risk factors for suicide particularly among individuals 65 years and older. This project expands on this relationship by exploring indicators of perceived poor physical health among firearm suicide decedents drawn from King County Medical Examiners Office (KCMEO) records from 2005 – 2020 in comparison with individuals who report living in households with firearms on the Behavioral Risk Factor Surveillance System (BRFSS) survey. We conducted logistic regression with adjustment for age, sex, race, and year as well as a quantitative bias assessment to account for potential exposure misclassification. We found that the odds of perceived poor physical health were higher among firearm suicide decedents and explored the methodological opportunities and challenges for using BRFSS as a control population for vital registry-drawn cases.