Simulating the bounds of plausibility: Estimating the impact of high-risk versus population-based approaches to prevent firearm injury.

Autor: Keyes KM; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America., Hamilton A; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America., Tracy M; Department of Epidemiology and Biostatistics, State University of New York at Albany, Albany, New York, United States of America., Kagawa RMC; Department of Emergency Medicine, Violence Prevention Research Program, School of Medicine, University of California, Davis, Sacramento, California, United States of America., Pear VA; Department of Emergency Medicine, Violence Prevention Research Program, School of Medicine, University of California, Davis, Sacramento, California, United States of America., Fink D; Division of Translational Epidemiology, New York State Psychiatric Institute, New York, New York, United States of America., Branas CC; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, United States of America., Cerdá M; Department of Population Health, New York University Langone Health, New York, New York, United States of America.
Jazyk: angličtina
Zdroj: PloS one [PLoS One] 2022 Jun 02; Vol. 17 (6), pp. e0269372. Date of Electronic Publication: 2022 Jun 02 (Print Publication: 2022).
DOI: 10.1371/journal.pone.0269372
Abstrakt: Background: Firearm violence remains a persistent public health threat. Comparing the impact of targeted high-risk versus population-based approaches to prevention may point to efficient and efficacious interventions. We used agent-based modeling to conduct a hypothetical experiment contrasting the impact of high-risk (disqualification) and population-based (price increase) approaches on firearm homicide in New York City (NYC).
Methods: We simulated 800,000 agents reflecting a 15% sample of the adult population of NYC. Three groups were considered and disqualified from all firearm ownership for five years, grouped based on prevalence: low prevalence (psychiatric hospitalization, alcohol-related misdemeanor and felony convictions, 0.23%); moderate prevalence (drug misdemeanor convictions, domestic violence restraining orders, 1.03%); and high prevalence (all other felony/misdemeanor convictions, 2.30%). Population-level firearm ownership was impacted by increasing the price of firearms, assuming 1% price elasticity.
Results: In this hypothetical scenario, to reduce firearm homicide by 5% in NYC, 25% of the moderate prevalence group, or 12% of the high prevalence group needed to be effectively disqualified; even when all of the low prevalence group was disqualified, homicide did not decrease by 5%. An 18% increase in price similarly reduced firearm homicide by 5.37% (95% CI 4.43-6.31%). Firearm homicide declined monotonically as the proportion of disqualified individuals increased and/or price increased. A combined intervention that both increased price and effectively disqualified "high-risk" groups achieved approximately double the reduction in homicide as any one intervention alone. Increasing illegal firearm ownership by 20%, a hypothetical response to price increases, did not meaningfully change results.
Conclusion: A key takeaway of our study is that adopting high-risk versus population-based approaches should not be an "either-or" question. When individual risk is variable and diffuse in the population, "high-risk approaches" to firearm violence need to focus on relatively prevalent groups and be highly efficacious in disarming people at elevated risk to achieve meaningful reductions in firearm homicide, though countering issues of social justice and stigma should be carefully considered. Similar reductions can be achieved with population-based approaches, such as price increases, albeit with fewer such countering issues.
Competing Interests: The authors have declared that no competing interests exist.
Databáze: MEDLINE
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