Firearm violence in communities increases risk of cardiovascular disease death, study finds
Living in areas with higher rates of gun violence may increase the risk of dying from stress-related cardiovascular disease, according to new research from University of Michigan School of Public Health researchers.
The study, which analyzed data from six Michigan counties between 2017 and 2021, found that for every 10 additional firearm incidents per year in a census tract, residents had a 1.6% higher chance of dying from cardiovascular disease linked to stress. This association held true even when researchers accounted for individual factors like age, race/ethnicity, gender, education, and tobacco use, as well as community-level factors like poverty level and whether an area was urban or rural.
"This research shows an important connection between firearm violence and cardiovascular disease risk beyond mental health impacts," said Esther Lee, a PhD student in the Department of Health Behavior & Health Equity at Michigan Public Health. "It reveals that firearm violence can be considered an environmental stressor with lasting area-wide effects, pointing to potential opportunities for integrating cardiovascular disease prevention efforts with violence prevention work."
What this means for communities
Cardiovascular disease—which includes heart attacks, strokes, and conditions like high blood pressure—is the leading cause of death in both Michigan and the United States. Meanwhile, firearm injuries have become the leading cause of death among youth aged 14-17, yet the broader health impacts of firearm violence on communities remain less understood.
The study suggests these two major public health crises may be connected and draws on previous research that suggests they may be linked through mental health, behaviors, chronic stress, and other pathways. For instance, when people are repeatedly exposed to violence in their neighborhoods, their bodies may experience ongoing stress that can damage the heart and blood vessels over time.
About the study
The research team analyzed 93,983 cardiovascular deaths and 964,921 firearm-related crime incidents across 1,050 census tracts (small geographic areas typically containing 1,200 to 8,000 people) in six Michigan counties: Calhoun, Genesee, Kent, Muskegon, Saginaw, and Wayne.
The study included only interpersonal firearm incidents—such as shootings and gun-related crimes—and excluded accidents and suicides. Researchers then mapped these incidents to specific census tracts and compared them with cardiovascular death rates in the same location.
"From a public health perspective, these findings support the idea that serious health problems like heart disease are more complicated than just adding up individual risk factors," said Justin Heinze, the study's senior author and an associate professor of Health Behavior & Health Equity at Michigan Public Health. "To truly understand a person's risk, we need to look at all the different things in their life that could play a role."
Studies like this are also important for understanding the true firearm injury burden in the US, added Heinze, who is faculty lead for the school's Public Health IDEAS for Preventing Firearm Injuries initiative, which funded the research. "It's not just the damage from a bullet. There are many other ways that firearm violence exposure negatively affects human health."
Rethinking heart disease risk beyond individual behaviors
The findings add complexity and nuance to discussions around what causes cardiovascular disease. Prevention efforts have long focused on individual risk factors like smoking, obesity, and high blood pressure, but this research suggests environmental factors like community violence also play an important role as social determinants of health.
Living in high-violence areas can keep the body's stress response system constantly activated, leading to inflammation and damage to the heart and blood vessels over time. Living in high-violence areas can be an environmental stressor that can shape health behaviors, impacting the likelihood of cardiovascular disease death. Because of structural inequities, these areas also tend to experience limited access to healthcare, healthy food, and outdoor exercise opportunities that can also shape individuals' health behavior and likelihood of cardiovascular disease.
Interestingly, the study found that gun violence was a stronger predictor of cardiovascular disease death than traditional area-level factors like poverty levels or whether an area was urban or rural. This suggests that violence itself—not just the economic conditions often associated with it—may be contributing to poor health outcomes.
The research points to potential evidence-based strategies that could simultaneously reduce gun violence and improve cardiovascular health, such as converting vacant lots into green spaces, expanding mental health services, and implementing hospital-based violence intervention programs. This approach represents a shift toward viewing violence prevention as a cardiovascular health strategy.
Study limitations
The research has some limitations. Because it looked at data from one time period, it cannot prove that gun violence directly causes cardiovascular disease deaths—only that the two are associated. The study also couldn't account for individual risk factors like blood pressure, weight, or family history that might influence both exposure to violence and cardiovascular disease risk.
Additionally, the research only included six Michigan counties where complete crime data was available, which may limit how well the findings apply to other areas.
Looking forward
The research team plans to examine these relationships over longer time periods and at smaller geographic scales to better understand how gun violence affects health. They also want to identify factors that might protect communities from these harmful effects.
The study adds to growing evidence that addressing gun violence requires a comprehensive public health approach that considers not just immediate injuries, but the broader health impacts on entire communities.
Paper cited: "Firearm incidents and cardiovascular disease mortality: A census-tract level study." Social Science & Medicine, DOI: 10.1016/j.socscimed.2025.118371
Additional authors: Wenchu Pan and Lu Wang, Department of Biostatistics, University of Michigan School of Public Health
Funding: This research was supported by the University of Michigan School of Public Health IDEAS for Preventing Firearm Injuries pilot funding.
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