Politicians and news media coverage have fueled a widespread belief that gun violence primarily affects urban communities. But researchers are urging the public to understand that shootings are a universal issue — and that many rural Americans experience higher rates of gun death than their big-city counterparts.

That’s the thrust of a new research letter, published April 26 in the Journal of the American Medical Association, which found that firearm deaths are more likely to occur in small towns than in major cities. The authors analyzed 20 years of mortality data across a range of county types — from most rural to most urban — and found that the most rural counties had the highest rates of firearm deaths compared to the most urban counties. The researchers also found that, regardless of county type, firearms deaths increased markedly from 2011 to 2020 compared to the previous decade, primarily because of an increase in gun suicides. 

“We felt like it was really important to point out that this isn’t simply a city problem,” said Charles Branas, the chair of epidemiology at Columbia University’s School of Public Health and one of the letter’s authors. “Gun deaths are also a problem in these small towns and rural areas.”

To conduct their research, Branas and his colleagues compared data from 2001-2010 to 2011-2020, looking for trends in mortality rates. They found that, compared to the period between 2001 to 2010, when the overall firearm death rate in the most rural counties was nearly 25 percent higher than the most urban counties, that margin had increased to nearly 40 percent between 2011 and 2020. In both time periods, rural counties experienced a significantly higher rate of gun suicides and a lower rate of gun homicides. 

The research builds on a previous study of gun deaths between 1989 through 1999, which found the risk of dying by gunshot was nearly the same in rural and urban areas. The researchers said they were motivated to follow up on the earlier research, but also felt it was important to complete the new study because of rural legislators’ unwillingness to focus on public health measures to reduce gun violence. 

Branas noted that the study did not analyze nonfatal shootings, which might affect the overall findings. 

“I do not want to minimize the risk that people face in cities,” he said, “but I do think that what the data points out is that this is everybody’s problem, and that we all need to get together on the issue if we really are going to make a difference.”

The perception that urban communities are the epicenters of America’s gun violence crisis persists even as data shows otherwise. In 2022, the Center for American Progress (CAP) published a report that found proportionally rural communities had higher rates of gun homicide than urban communities. 

Authors of the JAMA letter and CAP report note that misrepresentation of where gun violence takes place has legislative and judicial implications, including politicians not adequately allocating resources throughout the state to address gun violence throughout multiple communities. In addition, they both mentioned that racist historical narratives also contribute to the perpetuation of gun violence being only an issue for urban communities, which have historically had high populations of marginalized groups.

“I think it is important that we combat the narrative that this is a city problem,” said Nick Wilson, a researcher at CAP who worked on the report. “Gun violence impacts all communities, whether it’s rural, suburban or urban, and we are all in this together and have to pass stronger laws and invest in prevention.” 

In the past decade, more Americans than ever say they are purchasing guns for self-protection, although research shows that the presence of a firearm increases the odds that it is used against its owner. Studies also show that rural communities have the highest rates of gun ownership in the country.

The JAMA letter also illustrates how, although rural counties saw the largest increase in gun suicide rates, suicides have steadily increased in all county types since 2001. Gun homicides were not as consistent across all county types.

“When we say gun violence is a public health problem, we need to be very clear about what that means,” said Branas. “Gun suicides are not crimes, and they should not be classified or treated as such, and that means that the law system is not involved, this is a true public health responsibility.”