Trends in Firearm-Related Mortality in the United States (2018–2023): An Analysis by Year, Gender, Race, and Geographic Location

Background Firearm-related deaths remain a major U.S. public health concern, with over 46,000 deaths in 2023. These injuries, often requiring surgical care, disproportionately affect certain populations and regions. Monitoring trends is crucial for developing a transdisciplinary approach to prevention and care. Objective To analyze US firearm-related mortality trends from 2018 to 2023, stratified by year, gender, race, rural-urban status, and state variations, to guide prevention and policy interventions. Methodology: The CDC WONDER database was used to analyze death certificate data from 2018–2023. Age-adjusted mortality rates (AAMRs) per 100,000 population were calculated with 95% confidence intervals. Results were stratified by year, sex, race, urban-rural classification, and state. Results Firearm deaths rose from 39,773 in 2018 (AAMR = 11.9) to 48,830 in 2021 (14.65), then declined slightly to 46,728 in 2023 (13.73), staying above pre-pandemic levels. The 2020 spike aligned with COVID-19, economic stress, and civil unrest. Males had significantly higher AAMRs (20.7–23.7) than females (3.4–4.0), comprising over 85% of deaths. Black Americans had the highest AAMR (33.9 in 2021), primarily from homicides linked to structural inequities. White and Native Americans had higher suicide rates; Asian/Pacific Islanders had the lowest. Large urban areas accounted for nearly 20% of deaths. Mississippi had the highest AAMR (28.11), reflecting poverty and weak laws; Massachusetts had the lowest (3.56), linked to strict regulations. Conclusion Addressing rising firearm mortality requires collaboration across public health, surgery, policy, and social services. Priorities include strengthening trauma systems, expanding mental health care, enforcing gun laws, and tackling social determinants.