An estimated quarter of a million people were killed by firearms in 2016. Of those, more than half occurred in six countries in the Americas – a third of them in two countries, Brazil and the United States. That’s according to the first global count of deaths related to gun violence over a 26-year span published online in JAMA Network.

In 2016, Brazil had the most gun-related deaths with 43,200, the US came in second with 37,200, and Mexico third with less than half of that at 15,400. Venezuela and Guatemala round out the top five with 12,800 and 5,090, respectively. Globally, the majority of firearm injury deaths were homicidal (64 percent), followed by suicide (27 percent), and accidental (9 percent).

More than 3,000 researchers in more than 130 countries pulled data on gun-related deaths compiled under an initiative by the Institute for Health Metrics and Evaluation. Using data from census and police records, surveys, and autopsy results, they found 90 percent of violent firearm deaths around the world occur outside of conflict zones, including executions and police conflict, which were estimated separately. Per capita, the global death rate from homicide, suicide, and accidental death by guns decreased almost 1 percent, but the total number of deaths increased from 209,000 in 1990 to 251,000 in 2016 in due to worldwide population growth.

The global number and proportion of firearm injury deaths in 2016 by age, sex, and firearm subcause. JAMA

While there has been an overall decrease in firearm-related deaths since 1990, variations among countries and across demographic groups skew individual data because of “illegal drug trade, substance abuse (including alcohol), inadequate support for mental health, the social and intergenerational transmission of firearm violence (indicates parents, family members, intimate partners, friends, and peers), and socioeconomic inequities,” write the authors.

In general, Asia and Europe don’t have nearly as many gun deaths as the Americas, in part due to increased access and illicit drug trade. On the other hand, countries in Europe, Australasia, and portions of high-income North America have a higher suicide rate by firearm. Public attention is often drawn to homicide and mass shootings, but firearm suicide accounts for a large – but rarely talked about – a portion of gun-related deaths. In the US, nearly two-thirds of gun deaths are suicides and for those between 15 and 34, suicide is the most common cause of death in part because guns are more likely to be fatal and because a majority of suicides are a last-minute decision where access is crucial.