Original Article

Homicide in the South: Higher Rates Among Whites and Fewer Racial Disparities

Authors: Berna Buyukozturk, BS, Joanna Drowos, DO, MPH, Charles H. Hennekens, MD, DrPH, Maria C. Mejia de Grubb, MD, MPH, Jason L. Salemi, PhD, MPH, Robert S. Levine, MD


Objective: Describe southern US homicide rates in whites and blacks between 1999 and 2015.

Methods: The Centers for Disease Control and Prevention Multiple Cause of Death Files provided mortality rates and 95% confidence intervals (CIs) for non-Hispanic whites (NHW) as well as non-Hispanic blacks and African Americans (NHB).

Results: Overall, age-adjusted (1 to ≥85 years) homicide was significantly higher in the South (7.6/100,000, 95% CI 7.6–7.7) than the rest of the United States (4.9/100,000, 95% CI 4.8–4.9) even though the southern rate among NHB (18.7/100,000, 95% CI 18.5–18.8) was lower than the rest of the United States (23.3/100,000, 95% CI 23.1–23.5). The overall southern NHB:NHW mortality rate ratio was 5.1 and 10.6 in the rest of the nation. Homicide rates among NHW men were higher in the South than in each of the other US Census areas, whereas corresponding rates among NHB men were lower. For both men and women the NHB:NHW mortality rate ratio was lower in the South than in any other region. In addition, homicide rates among NHB women in the South were equal to or lower than corresponding rates in the West and Midwest. Finally, higher rates for NHW in metropolitan areas led to overall higher NHW mortality rates and relatively low NHB:NHW rates. Southern NHW had a higher percentage of firearms-related homicides (58.4%) than the corresponding percentage in the rest of the United States (49.8%; P < 0.001). Southern NHB used firearms for 78.8% of homicides compared with 83.9% in the rest of the United States (P < 0.001).

Conclusions: The overall high homicide rates in the southern United States were attributable to relatively higher NHW rates than those found in the rest of the country. Further research targeting the role of firearms as well as cultural and other issues could further the understanding of the interrelations of homicide with complex regional and cultural factors.

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1. Rutherford A, Zwi AB, Grove NJ, et al. Violence: a priority for public health? (part 2). J Epidemiol Community Health 2007;61:764-770.
2. Lyons BH, Fowler KA, Jack SP, Betz CJ, Blair JM. Surveillance for violent deaths-National Violent Death Reporting System, 17 states, 2013. MMWR Surveill Summ 2016;65:1-42.
3. McCall PL, Land KC, Cohen LE. Violent criminal behavior: is there a general and continuing influence of the South? Soc Sci Res 1992;21:286-310.
4. McCall PL, Land KC, Parker KF. An empirical assessment of what we know about structural covariates of homicide rates: a return to a classic 20 years later. Homicide Stud 2010;14:219-243.
5. Lee MR, Bankston WB, Hayes TC, et al. Revisiting the southern culture of violence. Sociol Q 2007;48:253-275.
6. Centers for Disease Control and Prevention, National Center for Health Statistics, CDC WONDER Online Database. Multiple cause of death data, 1999-2015. https://wonder.cdc.gov/mcd.html. Accessed August 6, 2018.
7. Centers for Disease Control and Prevention. Mortality data from the National Vital Statistics System. MMWR Morb Mortal Wkly Rep 1989;38:119-123.
8. Arias E, Heron M, National Center for Health Statistics, et al. The validity of race and Hispanic-origin reporting on death certificates in the United States: an update. Vital Health Stat 2 2016;1-21.
9. Logan JE, Hall J, McDaniel D, et al. Homicides-United States, 2007 and 2009. MMWR Suppl 2013;62:164-170.
10. Kellerman AL, Mercy JA. Men, women, and murder: gender-specific differences in rates of fatal violence and victimization. J Trauma 1992;33:1-5.
11. Campbell JC, Glass N, Sharps PW, et al. Intimate partner homicide: review and implications of research and policy. Trauma Violence Abuse 2007;8:246-269.
12. Rosenfeld R. Documenting and explaining the 2015 homicide rise: research directions. https://www.ncjrs.gov/pdffiles1/nij/249895.pdf. Published June 2016. Accessed December 2, 2017.
13. Rosenfeld R, Gaston S, Spivak H, et al. Assessing and responding to the recent homicide rise in the United States. https://www.ncjrs.gov/pdffiles1/nij/251067.pdf. Published November 2017. Accessed March 11, 2018.
14. Jamieson C. Gun violence research: history of the federal funding freeze. http://www.apa.org/science/about/psa/2013/02/gun-violence.aspx. Published February 2013. Accessed January 5, 2018.
15. Hennekens CH, Buring JE, Mayrent SL, eds. Epidemiology in Medicine. 1st ed. Philadelphia: Lippincott Williams & Wilkins; 1987.
16. Feldman JM, Gruskin S, Coull BA, et al. Quantifying underreporting of law-enforcement-related deaths in United States vital statistics and news-media-based data sources: a capture-recapture analysis. https://doi.org/10.1371/journal.pmed.1002399. Published October 10, 2017. Accessed August 6, 2018.