A City Under Siege: Time-Series Analysis of Shootouts and the Association with Health and Living Conditions in Rio de Janeiro, Brazil, 2017 to 2022

Armed violence is a multifactorial phenomenon resulting from adverse living conditions and difficulty in access to (or absence of) services that might otherwise mitigate it, besides broad behavioral, social, and historical characteristics such as spatial segregation, territorial disputes (turf wars), the consolidation of organized armed groups, and structural racism. To analyze time trends of episodes of armed violence and their association with health and living conditions in the city of Rio de Janeiro, 2017 to 2022. Ecological time-series study applying the <i>joinpoint</i> model based on data on shootouts in the city of Rio de Janeiro, Brazil, from 2017 to 2022. We analyzed the possible association between shootouts and living conditions based on linear and polynomial regressions. Decreases were observed in the number of shootouts in the city of Rio de Janeiro from 2017 to 2022, although current levels of violence are still far above those defined by international agencies as desirable or even acceptable. The statistically significant associations between indicators of living and health conditions and episodes of shootouts were nonlinear (Social Progress Index: -2747.9 [(-4973.8; -522.0]; Social Development Index: -2987.4 [(-537.1; -437.6)]). A decrease was observed in episodes of armed violence. The relationship with living conditions points to a complex association, not reducible to a possible linear relationship between violence and living conditions. The findings suggest that complex phenomena should be analyzed with state-of-the-art models, for the sake of a proper diagnosis and to inform structural interventions.