A new report by the Commonwealth Fund finds some US states have firearm death rates comparable to countries in conflict, and even states with the fewest firearms deaths are far higher than peer developed democracies.
For instance, Mississippi’s rate of firearm-related violence (28.5 per 100,000 people) was nearly double that of Haiti (15.1 per 100,000) in 2021, when mercenaries assassinated the country’s president, unleashing a fresh round of gang warfare which pushed the country into a state of civil war.
Rhode Island, which has the lowest firearm death rate in the US (three per 100,000) is still 23 times higher than the United Kingdom (0.13 per 100,000) and nearly 1.3 times higher than France (2.3 per 100,000).
The US overall is in the 93rd percentile of all countries and territories for overall firearm mortality, at 13.5 deaths per 100,000 people, the Commonwealth report found.
“No country we compare ourselves to has the rates and absolute deaths like we do in the US,” said Evan Gumas, a research associate at the Commonwealth Fund in international health policy and practice who helped author the report. “It comes up anytime there’s a shooting that makes the news, when it should be something we’re paying attention to.”
In another example, Mississippi, Louisiana, Alabama and New Mexico all have higher firearm mortality rates than Mexico, where decades of violence between state forces and rival drug cartels has caused hundreds of thousands of deaths and left more than 115,000 people missing.
Notably, firearm-related death and injury is not synonymous with an increase in crime. Violent crime fell 15% from 2023 to 2024, according to the FBI. More than half of all firearm-related deaths (56.1%) in 2022 were from suicide, according to a report from the US surgeon general.
Vivek Murthy, the US surgeon general, declared firearm violence “a public health crisis in America” in a June report, citing statistics that firearms injuries in the US far surpassed peer wealthy nations and were growing quickly, especially among children and adolescents.
Firearms became the leading cause of death for American children aged one to 17 in 2020, surpassing car accidents and all other causes of illness and injury, such as drowning or suffocation. For comparison, the rate of firearm deaths among American children is 72 times higher in the US than in the UK (36.4 deaths per million versus 0.5 deaths per million).
“I went to public school in the wake of Sandy Hook,” said Gumas, referencing the Connecticut massacre in which a gunman killed six adults and 20 first-grade children. “School shooting drills were a very big part of our every day. That’s not normal.”
Although mass shootings committed with semi-automatic rifles often make headlines, handguns cause more firearms deaths, with the burden carried unevenly across demographic groups.
Firearm-related deaths killed Black Americans at a rate of 34.2 per 100,000, the highest among racial groups, seconded by Native Americans and Alaska Native people. Firearms are also the weapons most often implicated in gender-related violence, according to the Centers for Disease Control and Prevention (CDC).
The Commonwealth Fund report drew on data from the Institute for Health Metrics and Evaluation, a project of the University of Washington that compares disease, injuries and risk factors across the globe. The Commonwealth study included 204 US states and other territories and countries. An overall firearms mortality number was then calculated according to the World Health Organization’s world standards population database.
