The United States has the highest rate of gun-related deaths among industrialized countries, with more than 30 000 fatalities annually.1 To date, research on gun violence has been limited. A 1996 congressional appropriations bill stipulated that “none of the funds made available for injury prevention and control at the Centers for Disease Control and Prevention [CDC] may be used to advocate or promote gun control.”2 Similar restrictions were subsequently extended to other agencies (including the National Institutes of Health), and although the legislation does not ban gun-related research outright, it has been described as casting a pall over the research community.2,3 This study sought to determine whether funding and publication of gun violence research are disproportionately low relative to the mortality rate from this cause.

Methods

CDC mortality statistics were accessed from 2004 to 2014 (the most recent year available).1 Thirteen nonspecific causes of death (ie, “all other diseases”) were excluded and the top 30 causes of death were retained for further analysis (details, excluded causes of death, and annotated code available at https://github.com/davidestark/gun-violence-research/).

CDC-derived causes of death were manually mapped to their corresponding Medical Subject Heading (MeSH) term(s). For each cause of death, MEDLINE was queried for the total number of publications between 2004 and 2015 indexed with the corresponding MeSH term(s), including descendant terms (terms subsumed under a parent term within the MeSH hierarchy).

Research funding data from 2004 to 2015 (all years available) were accessed from Federal RePORTER, a database of projects funded by US federal agencies.4 Projects are indexed using the computerized Research, Condition, and Disease Categorization system derived in part from MeSH. For each cause of death, Federal RePORTER was queried for the total funding awarded to projects containing corresponding MeSH terms, including descendant terms.

To determine how research funding and publication volume correlated with mortality, 2 linear regression analyses were performed using mortality rate as a predictor and funding or publication count as outcomes. The predictor and outcomes were log-transformed and studentized residuals (residual divided by estimated standard error) were calculated to determine the extent to which a given cause of death was an outlier in terms of research funding or publication volume. All analyses were performed in R (R Foundation for Statistical Computing), version 3.2.2.

Results

Compared with other leading causes of death, gun violence was associated with less funding and fewer publications than predicted based on mortality rate (Figure 1). Gun violence had 1.6% of the funding predicted ($1.4 billion predicted, $22 million observed) and had 4.5% of the volume of publications predicted (38 897 predicted, 1738 observed) from the regression analyses. Gun violence killed about as many individuals as sepsis. However, funding for gun violence research was about 0.7% of that for sepsis and publication volume about 4%. In relation to mortality rates, gun violence research was the least-researched cause of death and the second-least funded cause of death after falls (Figure 2).

Discussion

Between 2004 and 2015, gun violence research was substantially underfunded and understudied relative to other leading causes of death, based on mortality rates for each cause. Ladapo and colleagues5 previously found a smaller-than-expected increase in gun violence publications between 1991 and 2010. The present study incorporates mortality and funding data, and demonstrates the magnitude of the research funding disparity.

The study was limited by its cross-sectional design and imperfect mappings between data sources. CDC-derived causes of death were manually mapped to MeSH terms for retrieving publications. MeSH terms were used to retrieve funded projects although projects were categorized using terms only partly derived from MeSH.

Injury research has been generally undersupported6—a finding replicated in the present study. Gun violence had less funding and fewer publications than comparable injury-related causes of death including motor vehicle accidents and poisonings. Given that gun violence disproportionately affects the young and inflicts many more nonfatal injuries than deaths, it is likely that the true magnitude of research funding disparity, when considering years of potential life lost or lived with disability, is even greater.

Section Editor: Jody W. Zylke, MD, Deputy Editor.

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Corresponding Author: David E. Stark, MD, MS, Institute for Next Generation Healthcare, Icahn School of Medicine at Mount Sinai, 770 Lexington Ave, 14th Floor, New York, NY 10065 (david.stark@mssm.edu).

Author Contributions: Dr Stark had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Stark.

Acquisition, analysis, or interpretation of data: Both authors.

Drafting of the manuscript: Stark.

Critical revision of the manuscript for important intellectual content: Both authors.

Statistical analysis: Stark.

Obtained funding: Stark.

Administrative, technical, or material support: Both authors.

Conflict of Interest Disclosures: Both authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Funding/Support: This work was supported by grant T15LM007033 from the National Library of Medicine of the National Institutes of Health (Dr Stark).

Role of the Funder/Sponsor: The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.