Violence, Guns, and Policy in the United States

The United States is a uniquely violent country among high-income democracies. And by the best available data on homicides, the US has always been more violent. Homicides are useful to look at because we generally have the best data on these (murders are the most likely crime to be reported) and it’s the most serious of all violent crimes.

Just how much more violent is the US than other high-income democracies? As measured by the homicide rate, about 6-7 times as violent. We can see this first by comparing the US to several European countries (and a few groupings of similar countries).

Let me make a few things clear about this chart. First, this is data for homicides, which are typically defined as interpersonal violence. Thus, it excludes deaths on the battlefield, genocides, acts of terrorism (generally speaking), and other deaths of this nature. That’s how it is defined. If we plotted a chart of battlefield deaths, it would look quite different, but there’s not much good reason to combine these different forms of violent death.

On the specifics of the chart, prior to 1990 these data are averages from multiple observations over multi-year timespans (generally 25 or 50 years). The data on European countries comes from a paper by Eisner on long-term crime trends (Table 1). The countries chosen are from this paper, as are the years chosen. Remember that historical data is always imperfect, but these are some of the best estimates available. For the US, I used Figure 5 from this paper by Tcherni-Buzzeo, and did my best to make the timeframes comparable to the Eisner data. The data are not perfect, but I think they are about as close as we can get to long-run comparisons. For the data from 1990 forward, I use the IHME Global Burden of Disease study, and the death rates from interpersonal violence (to match Eisner, I average across grouped countries).

When we average across all the European countries in the first chart and compare the US to Europe, we can see that the US has always been more violent, though the 20th century onwards does seem to show even more violence in the US relative to Europe. (These charts are slightly different from some that I posted on Twitter recently, especially the pre-1990 data as I tried to more carefully use the same periods for the averages — still only take this a rough guide).

And what is the main form by which this violence is carried out? In the US, it is undeniably clear: firearms. Between 1999 and 2020, there were almost 400,000 homicides in the US (using CDC data). Over 275,000 of these, or about 70%, were carried out with firearms. The next largest category is murder with a knife or other sharp object, with about 10% of murders. And homicides have become even more gun-focused in recent years: about 80% of murders in 2020-21 were committed with guns.

So, there’s the data. But the important social scientific question is: Can we do anything about it? Are there any public policies, either about guns or other things, that will reduce gun violence? Could restrictions on gun use actually increase homicides, since no doubt guns are also used defensively?

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COVID Deaths, Excess Deaths, and the Non-Elderly (Revisited)

While we know that COVID primarily affects the elderly, the mortality and other effects on the non-elderly aren’t trivial. I have explored this in several past posts, such as this November 2021 post on Americans in their 30s and 40s. But now we have more complete (though not fully complete) mortality data for 2021, so it’s worth revisiting the question of COVID and the non-elderly again.

For this post, I will primarily focus on the 12-month period from November 2020 through October 2021. While data is available past October 2021 on mortality for most causes, data classified by “intent” (suicides, homicides, traffic accidents, and importantly drug overdoses) is only fully current in the CDC WONDER data through October 2021. This timeframe also conveniently encompasses both the Winter 2020/21 wave and the Delta wave of COVID (though not yet the Omicron wave, which was quite deadly).

First, let’s look at excess mortality using standard age groups. For this calculation, I use the period November 2018 through October 2019 as the baseline. The chart shows the increase in all-cause deaths in percentage terms. It is also adjusted for population growth, though for most age groups this was +/- 1% (the 65+ group was 3% larger than 2 years prior).

A few things jump out here. First notice the massive increase in mortality for the 35-44 age group (much more on this later). Almost 50% more deaths! To put that in raw numbers, deaths increased from about 82,000 to 122,000 for the 35-44 age group, and population growth was only about 1%. And while that is the largest increase, there were huge increases for every age group that includes adults.

Also notice that the 65+ age group certainly saw an increase, but it is the smallest increase among adults! Of course, in raw numbers the 65+ age group had the most excess deaths: about 450,000 of the 680,000 excess deaths during this time period. But since the elderly die at such high rates in every year, the increase was as large in percentage terms.

One related fact that doesn’t show up in the chart: while there were about 680,000 excess deaths during this time frame in the US in total, there were only about 480,000 deaths where COVID-19 was listed as the underlying cause of death. That means we have about 200,000 additional deaths in this 12-month time period to account for, or a 24% increase (population growth overall was only 0.4%).

That’s a lot of other, non-COVID deaths! What were those deaths? Let’s dig into the data.

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Are the COVID Vaccines Effective at Preventing Death?

A recent analysis by the Kaiser Family Foundation of CDC data suggests that about 234,000 COVID deaths in the US could have been prevented if everyone was vaccinated. That’s about 25% of all COVID deaths throughout the pandemic, and about 60% of COVID deaths since June 2021 (roughly the time when most older adults in most states had had a chance to be vaccinated).

The first way to think of that death rate is tragic, given that so many lives could have been saved. Rather than being the high-income nation with the highest COVID death rate, the US could have been more in line with countries like Italy, the UK, and France. The US actually had a lower COVID death rate than Italy and the UK when the vaccine roll-out began, and today we could be at about France’s level with better vaccination rates.

But there’s a flipside to the KFF numbers. If 60% of COVID deaths since June 2021 were preventable, that means 40% weren’t preventable. Furthermore, the same data show that about 40% of COVID deaths in January and February 2022 were fully vaccinated or had boosters. That sounds like the vaccines might not work very well! So what does this all mean? Let’s dig into the data from the CDC a little bit.

The first, and most important thing, to recognize is that most American adults are vaccinated (about 78%), so unless vaccines are 100% effective (and they aren’t, despite some public officials overenthusiastic pronouncements early in the vaccine rollout), there are still going to be a lot of COVID deaths among the vaccinated. If 100% of the population was vaccinated, 100% of the deaths would be among the vaccinated. The key question is whether vaccines lower the chance of death.

And they do. Let’s see why.

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What’s a Sewer Worth?

Have access to clean water and a functioning sewer system is something that many Americans take for granted. Not all Americans, of course, especially those in rural areas not connected to an urban water system. But most Americans do. But how much is it worth?

It’s a hard question to answer. We know clean water and sewers probably have large effects on disease transmission. For example, Ferrie and Troesken (2008) looked at several major improvements in Chicago’s water system, and found that there were large declines in mortality from diseases like typhoid fever after the improvements (here’s an ungated working paper, with the much better title “Death and the City“). But the limits of earlier studies like this are that they primarily looking at a time series of mortality rate and relating this to some change in public infrastructure. A good attempt, but perhaps not convincing to everyone.

A better method would be to look at not mortality rates but property values. People are, surely, willing to pay more for a home with piped water and a sewer system. But how much more? Knowing this could give us better information on the value of the water systems. And that’s exactly what the authors of a new working paper do, once again visiting Chicago in the nineteenth century to look at how much property values increased after the installation of water and sewer systems. The paper is “The Value of Piped Water and Sewers” by Coury, Kitagewa, Shertzer, and Turner (ungated version).

The effects are huge. There most conservative estimate is that sewer and water systems doubled property values (a 110% increase), but the effect could be much larger (almost 4 times as much, if I am reading it correctly, under other reasonable assumptions).

People are willing to pay a lot for sanitation, it turns out.

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Are Car Accidents Getting Labeled as “COVID Deaths”?

Of all the increases in mortality in 2020, one that is notable is motor vehicle accidents. There were 43,045 deaths from motor vehicle accidents, according to the final CDC data. This means motor vehicle accident was listed on the death certificate, even if it was not determined to be the “underlying cause,” though for 98% of these deaths the accident was listed as the underlying cause.

The increase from past years was large. Compared with 2019, there were over 3,000 more motor vehicle deaths, though such as increase is not unheard of: 2015 and 2016 each saw increases of around 2,500. Even so, the crude death rate from motor vehicle accidents in 2020 was the highest it has been since 2008.

If that weren’t bad enough, another theory emerged in 2020 and continues to be suggested today: that car crashes are being labeled as “COVID deaths,” artificially inflating the COVID death count. While one can find this claim made almost daily by anonymous Twitter users, one of the most prominent statements was on Fox News in December 2020. Host Raymond Arroyo said that car accidents were being counted as COVID deaths, and that due to errors like this COVID deaths could be inflated by as much as 40 percent. Senator Marco Rubio made a similar claim on Twitter in December 2021, though he was talking about hospitalizations, not deaths.

Back in 2020, many doctors and medical professionals tried to debunk the “car accidents being labeled as COVID deaths” claim, but the problem was we didn’t have complete data. Anonymous anecdotes were cited, but medical professionals tried to reassure the public this wasn’t the case or at least wasn’t widespread.

But now, we have the data! That is, the complete CDC mortality data for 2020 available through the CDC WONDER database.

What does this data show us? Short answer: there aren’t that many car accidents being labeled as COVID deaths. At most, it’s about 0.03% of COVID deaths.

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800,000 Deaths? Or 1 Million Deaths?

According to the Johns Hopkins COVID tracker, the US has now surpassed 800,000 COVID deaths during the pandemic. The CDC COVID tracker is almost to 800,000 too. But is this number right? Confusion about COVID deaths and total deaths has been rampant throughout the pandemic, especially when comparing across countries.

One method that many have suggested is excess deaths, which is generally defined as the number of deaths in a country above-and-beyond what we would expect given pre-pandemic mortality levels. It’s a very rough attempt at creating a counterfactual of what mortality would have looked like without the pandemic. Of course, you can never know for sure what the counterfactual would look like. Would overdoses in the US have increased anyway? Hard to say, though they had been on the rise for years even before the pandemic.

So don’t treat excess deaths as a true counterfactual, but just a very rough estimate. I wrote about excess deaths in the US way back in January 2021 (feels like a lifetime ago!), and at the time for 2020 it looked like the US had about 3 million total deaths (in the first 48 weeks of 2020), which was about 357,000 deaths more than expected (again, based on historical levels of the past few years), or about 13.6% above normal.

But once we had complete data for 2020, deaths were even higher: about 19% above expected, or somewhere around 500,000 excess deaths. This compares with the official COVID death count of about 385,000 in 2020 for the US.

What happens if we update those numbers with the most recent available mortality data for 2021? Keep in mind that data reporting is always delayed, so I’ll just use data through October 2021. The following chart shows both confirmed COVID deaths and total excess mortality, cumulative since the beginning of 2020.

As we can see in the chart, there are a lot more excess deaths than confirmed COVID deaths. There were already over 1 million excess deaths through the end of October 2021 in the US, cumulative since January 2020. This compares with about 766,000 confirmed COVID deaths. That’s a big gap!

We could spend a lot of time trying to understand this gap of 250,000 deaths. Is this under-reporting of COVID deaths? Is it deaths caused by government restrictions? Is it caused by the overwhelming of the health system?

I won’t be able to answer any of those questions today. Instead, let’s ask a different question: is the potential US undercount of COVID deaths unusual?

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COVID and The Young

The CDC just approved vaccines from Americans aged 5-11. That’s great news! But today, I want to talk about another age group: mine.

A few months ago I wrote a post summarizing data for COVID-19 deaths among people in their 30s and 40s. While we have primarily thought of COVID as a disease impacting the elderly (and indeed in the aggregate, it is), there have been major health consequences for those under 65 too. Including major health consequences for the age group 30-49 (which I believe is the age range of all our bloggers here at EWED).

I wanted to update that data because a few new things have come to light. First, I highly recommend reading a recent paper by my friend Julian Reif and co-authors. They estimate the number of Years of Life Lost and Quality-Adjusted Years of Life Lost for different age groups from COVID-19. Their data runs through mid-March 2021, so before vaccines probably had much of a chance to impact the aggregate death numbers (though vaccines were being rolled out at the time).

Here’s their main result: while most of the deaths from COVID were among those aged 65 and older (80% through March 2021), most of the life lost in terms of years was for Americans under 65 (54% of QALYs). And even for very young adults, the risk in terms of years of life lost was not minimal. A comparison from the paper: “Adults aged 85 years or older faced 70 times more excess risk for death than those aged 25 to 34 years but only 3.9 times more individualized loss of QALYs per capita.” Compared to the 35-44 age group, the relevant factor is 2.8 times more individualized loss for the 85+ group.

It’s a great paper, but it only goes through March. What has happened since March 2021? While 80% of the COVID deaths up through March 2021 were among the elderly (65 and older), since April 2021 only 60% of the COVID deaths have been among the elderly. Part of this is because deaths are down among the elderly, but it’s also because deaths are up for the non-elderly. The table is my attempt to show this effect, looking at the period from March-September in both 2020 and 2021 (data is current as of October 27, so the September 2021 data is still not complete, but instructive).

For the oldest Americans, COVID deaths fell by 50%. That’s great! But for younger Americans, COVID deaths roughly doubled. Not good!

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GDP Losses and COVID Deaths (6 month update)

Back in March of this year, I wrote blog posts providing data on GDP losses and COVID-19 deaths for 2020, both for selected countries and US states. Since we’ve now had another 6 months of GDP data and the pandemic continues to take lives, I thought it would be useful to update that data.

I will update the data for US states in a future post, but here is the most recent data for about 3 dozen countries (mostly European and North American countries, since they have the most believe COVID data).

*indicates that the GDP data is only through the first quarter of 2021
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COVID Deaths and Middle Age

We have known for a long time (basically since the start of the pandemic) that COVID primarily affects the elderly. Infection fatality rates are hard to calculate (since not all infections are reported), but most of the data suggest that the elderly are much more likely to die from COVID than other age groups.

For some, this has become one of the most important aspects of the pandemic. For example, Don Boudreaux emphasizes the age distribution of deaths many times in a recent episode of Econtalk, and he uses this point to argue that we addressed the pandemic incorrectly (to say the least). Boudreaux specifies that COVID is only deadly for those 70 and older. And while I won’t rehash the argument here, please also see my exchange with Bryan Caplan, where he argues that elderly lives are worth a lot less than younger lives (I disagree).

At first blush, the data seems to bear that out. The CDC reports that almost 80% of COVID-involved deaths were among those aged 65 and older (I will use the CDC’s definition of COVID-involved deaths throughout this post). In other words, of the currently reported almost 600,000 COVID deaths in the US, about 475,000 were 65 and older. Throw in the 50-64 age group, and you’ve now got 570,000 of the deaths (95% of the total).

But is this the right way to think about it? Remember, the elderly always account for a large share of deaths, around 75% in recent years. So it shouldn’t surprise us that most deaths from just about any disease are concentrated among the elderly.

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Excess Mortality in 2020

My last post of 2020 tried to end the year on an optimistic note: the rapid innovation of a new vaccine was truly a marvel. But I also warned you that I would have a post in the new year talking about the deaths of 2020 during the pandemic. And here it is.

Throughout 2020, I have tried to keep up with the most recent data, not only on officially coded COVID-19 deaths, but also on other measures. An important one is known as excess mortality, which is an attempt to measure the number of deaths in a year that are above the normal level. Defining “normal” is sometimes challenging, but looking at deaths for recent years, especially if nothing unusual was happening, is one way to define normal. The team at Our World in Data has a nice essay explaining the concept of excess mortality.

One thing to remember about death data is that it is often reported with a lag. The CDC does a good job of regularly posting death data as it is reported, but these numbers can be unfortunately deceptive. For example, while the CDC has some death data reported through 51 weeks of 2020, but they note that death data can be delayed for 1-8 weeks, and some states report slower than others (for reasons that are not totally clear to me, North Carolina seems to be way behind in reporting, with very little data reporting after August).

So there’s the caution. What can we do with this data? Since 2019 was a pretty “normal” year for deaths, we can compare the deaths in 2020 to the same weeks of data in 2019. In the chart at the right, I use the first 48 weeks of the year (through November), as this seems to be fairly complete data (but not 100% complete!). The red line in the chart shows excess deaths, the difference between 2019 and 2020 deaths. From this, we can see that there were over 357,000 excess deaths in 2020 in the first 11 months of the year, or about a 13.6% increase over the prior year.

Is 13.6% a large increase? In short, yes. It is very large. I’ll explain more below, but essentially this is the largest increase since the 1918 flu pandemic.

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