National Analysis Reveals Devastating Ripple Effect of Gun Violence on Communities in New York and Across the United States

Gun Violence in 2021 Alone Will Cost Nation $47 Billion in Lifetime Income Lost, $563 Billion in Quality-Adjusted Life Years Lost

Firearms the Leading Cause of Death for Children in 2020; 30,000 Children Lost a Parent to Gun Violence in 2021

NEW YORK, NY—March 15, 2023— An estimated 158,216 people in the United States were killed or injured by guns in 2021—48 victims for every 100,000 people. This firearm violence levied a huge financial burden on the nation: an estimated: $2.2 billion per year in direct medical costs, $47 billion in lifetime income lost, and $563 billion in quality-adjusted life years lost, according to a national analysis released today by United Hospital Fund, produced in a collaboration with Boston Consulting Group. 

The report reaffirms that firearms were the leading cause of death for children in 2020, overtaking motor vehicle accidents, while approximately 30,000 children lost a parent to gun violence in 2021. “Children are unlikely to reach adulthood without exposure to gun violence,” the report concludes, and estimates that the costs of counteracting the traumatic psychological and social impacts of gun violence on the nation’s children will total an estimated $4 billion over their lifetime.

The report, The Ripple Effect of Firearms: How Families, Communities, and Society in the U.S. Are Affected by Firearms, analyzed the impact of gun violence in 2021 nationwide, and county-by-county in New York State, broken down by gender, race, and age. Southern states had the highest ratio of gun victims, led by Mississippi with 104.9 shooting victims per 100,000 residents. Although New York State ranked 48th, with 18.1 victims per 100,000, because of its large population more New Yorkers died by firearms than residents of most other states—over 1,000 in 2021 alone. 


Other key findings:

•    More than half of all firearm deaths are suicides, and 85 percent of suicide attempts by gun are fatal, compared with less than three percent of suicide attempts by drug overdose.

•    Race, age, gender, and zip code determine how likely you are to die from gun violence. White men over 50 in rural areas are most likely to die by gun suicide, while gun homicide is the leading cause of death for Black men in their early 20s. Nationally, 32 percent of gun homicide victims are Black, though Black people make up only 14 percent of the overall population.

•    Black women were nine times as likely to be killed by guns as white women and 4.5 times as likely as Hispanic women. When a gun is involved, domestic violence is five times more likely to result in death. 

•    Federal spending on research into gun violence is only $63 per life lost, compared with median funding of $4,852 per life lost for all leading causes of death. Disparities in federal funding make gun violence the second most neglected cause of death after falls. 

Within New York State, rural Allegany and Delaware Counties had the highest per capita rate of firearm deaths, each recording 14.2 people killed by guns per 100,000 residents. More than 84 percent of firearms deaths in those two counties were the result of suicides.

Brooklyn (Kings County) had the highest number of firearm fatalities in the state—an estimated 444, equal to 4.3 deaths per 100,000. However, only 33 percent of firearm deaths in New York State in 2021 were in New York City, despite it being home to 43 percent of New Yorkers.  


“The prevalence of gun violence is desensitizing many of us to the tremendous toll it is exacting on our communities and our nation,” said Alexandra Brandes, the report’s lead author and director of UHF’s Medicaid Institute. “This report highlights the need to treat gun violence as a public health problem at the national, state, and community levels.”

“This data-rich report demonstrates that gun violence must be viewed as a major public health issue that disproportionately harms the most underserved communities,” said Oxiris Barbot, MD, UHF president and CEO. “As more children and adults are killed, injured, and traumatized by gun violence, we must focus on prevention and treatment.”

In addition to Alexandra Brandes, the report was co-authored by UHF research analyst Giovanna Braganza and Joan Guzik, director, Quality and Efficiency. It can be downloaded for free here

About United Hospital Fund
United Hospital Fund works to build an effective and equitable health care system for every New Yorker. An independent, nonprofit organization, we are a force for improvement, analyzing public policy to inform decision-makers, finding common ground among diverse stakeholders, and developing and supporting innovative programs that improve health and health care. We work to dismantle barriers in health policy and health care delivery that prevent equitable opportunities for health. For more on our initiatives and programs please visit our website at and follow us on Twitter


March 15, 2023