| Summary: | <p><strong>Background:</strong> Federal law requires background checks for firearms purchased from licensed dealers, but states can extend requirements to private sales of handguns and purchases at gun shows (universal background checks for handguns: UBC-HG). Although firearm homicide disproportionately affects African Americans, little is known about how UBG-HG impacts African Americans. We hypothesized that implementation of UBC-HG would reduce rates of firearm homicide of African Americans.</p>
<p><strong>Methods:</strong> We collected Centers for Disease Control firearm homicide counts for African American and white populations in the 50 states, 1999-2017. Laws were drawn from the State Firearm Laws Database. The exposure and outcome of interest were UBC-HG adoption and firearm homicide. We included non-Hispanic African American and non-Hispanic White populations. We used Poisson regression to perform a differences-in-differences analysis. A categorical variable for state accounted for time-stable state characteristics. We controlled for year to account for trends over time unrelated to policy. We controlled for state-specific, time-variable factors including median household income, population <25 or ≥65 years, alcohol consumption, and count of firearm laws (UBC-HG excluded). Standard errors were adjusted for clustering at the state level.</p>
<p><strong>Results:</strong> The firearm homicide rate among whites was 1.8 per 100,000 (Interquartile Range [IQR] 1.2-2.7) ranging from 1.4 in 2011 to 1.8 in 2016. The firearm homicide rate was 15.6 per 100,000 (IQR 11.6-21.0) among African Americans, ranging from 14.0 in 2009 to 19.6 in 2017. While no significant difference in firearm homicides among whites (Incidence rate ratio [IRR] 0.93, 95% CI 0.73, 1.20) was appreciated, the passage of UBC-HG was associated with an 19% decrease in African Americans firearm homicides (IRR 0.81, 95% CI 0.70, 0.94; p=0.006).</p>
<p><strong>Conclusions:</strong> Implementing UBC-HG was associated with decreased firearm homicides among African Americans—the population most at risk. Expanding UBC-HG may be an effective approach to reducing racial disparities in firearm homicides.</p>
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