Transportation Access as a Structural Determinant of Firearm Violence

BackgroundTransportation access, a recently recognized key social determinant of health, has an understudied relationship to gun violence. We hypothesized that poor transportation access would be associated with increased firearm violence.MethodsThis cross-sectional analysis examined indices of transportation access using University of Minnesota Access Across America (UMAAA) data, which assigns separate rankings based on transit, auto, biking, and walking access scores. Violent firearm injuries and deaths were obtained from the Gun Violence Archive (GVA). Data for educational attainment, income, employment, and housing characteristics came from the US Census's American Community Survey. Data was aggregated from 2019 to 2021 by the 56 largest metropolitan statistical areas (MSA) in the US. Negative binomial Poisson regression models (univariate and multivariate) were used to examine the association between transportation indices and violent firearm injuries and deaths.ResultsNegative Binomial Poisson regression analysis found that lowered overall transit and auto access scores were associated with slightly lower risk of violent firearm injury and death. This relationship persisted even when adjusted for Gini and ICE. Poverty, unemployment, Gini, and the percentage of persons without a vehicle were directly associated and had higher effects compared to AAA score.DiscussionThis study does not support a strong protective effect of transportation access on firearm violence rates, instead suggesting a relatively small, inverse relationship. These findings underscore the complex nature of urban violence, which is influenced by multiple socioeconomic and community factors. Further studies are needed to determine how injury preventive strategies can target important determinants of firearm injury.