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Firearm deaths in Sweden: epidemiology with emphasis on accidental deaths and prevention
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rättsmedicin.
2018 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Prevention of firearm deaths and injuries is an important public health issue that may save human lives. The aim of this thesis was to investigate the epidemiology and attributes of accidental firearm fatalities in Sweden, and to provide a basis for further preventive measures. Data were obtained from the database of the National Board of Forensic Medicine, the National Patient Register, the Prescribed Drug Register, the Firearm Register, and from questionnaire responses.

All 48 accidental firearm fatalities that involved hunting in 1983-2008 were investigated (Paper I). The victims’ mean age was 50 years, 96% were males. During moose hunting, most victims were mistaken for game (41%), whereas during small game hunting, fatalities were mostly related to falls (31%) and improper weapon handling (15%). Hunters’ habits and attitudes towards preventive measures and their experience of firearm incidents were investigated through a questionnaire, which was sent to 1,000 hunters (Paper II). The response rate was approximately 50%. The mean age of the respondents was 54 years and females accounted for 5%. One quarter of the respondents stated that they had witnessed a firearm incident caused by another hunter, of which more than half suggested that improper handling of the weapon and inappropriate hunting strategies were the main causes of these events.

All 43 accidental non-hunting firearm deaths in Sweden 1983-2012 were investigated (Paper III). In 56% of cases, the fatality was caused by another person. Victims were mostly young males (mean age 25 years). The main cause of the incidents was human error. The majority of cases (63%) involved legal firearm. Most victims killed by illegal firearm (85%) were under the influence of alcohol and/or drugs at the time of death. Both the risk of being killed as a result of hunting (Paper I) and non-hunting accidental firearm injury (Paper III) decreased after the introduction of the mandatory hunter’s exam in 1985 (p < 0.001).

Firearm deaths in Sweden including 52 accidental fatalities and 3 cases with undetermined manner of death in 1987-2013, as well as 213 suicides and 23 solved homicides in 2012-2013, were studied (Paper IV). The number of firearm suicides was positively correlated to the number of licensed firearm owners. Legal firearm use predominated in firearm suicides and accidental deaths, illegal in firearm homicides. The majority of the shooters in accidental deaths and suicides had no registered visits to inpatient care or specialized outpatient care. Less than half (42%) of all suicide victims had had a health care contact due to mental health problems. Physician’s mandatory reporting to the police of patients deemed unsuitable for possessing a firearm license did not include any of the suicide victims and the shooters in accidental deaths.

This thesis confirmed that accidental firearm deaths are rare, and indicates that the firearm law changes in 1985 contributed to a decline of such fatalities. Human error was the main “cause” of the fatalities and future prevention measures should target improper weapon handling. Physician’s mandatory reporting to the police was suboptimal and barely contributed to the decline of accidental firearm deaths. If streamlined it may, however, represent an important prevention strategy in firearm suicides, claiming most lives among firearm deaths. A significant fraction of non-hunting fatalities, firearm suicides and homicides was associated with illegal firearm use, a fact calling for prevention issues targeting such firearm use.

Abstract [sv]

Prevention av skottskador representerar en viktig folkhälsofrämjande insats som kan rädda människoliv. En av de största utmaningarna är skottskadornas höga dödlighet. Självmord utgör den största andelen av dödsfall med skjutvapen i Sverige, följt av mord/dråp och dödsolyckor. Studier av dödliga skottskador är emellertid fåtaliga, både i Europa och i Sverige. Dödliga skjutvapenolyckor har tidigare undersökts i Sverige på 1980-talet. Det visade sig då bland annat att dödsolyckor relaterade till jakt var något vanligare än dödsolyckor utan samband med jakt.

Syftet med denna avhandling var att undersöka dödsfall med skjutvapen i Sverige med särskilt fokus på dödsolyckor och deras tidsmässiga utveckling. Undersökningen omfattar preventionsaspekter relevanta för dödsskjutningar, oavsett dödssätt. Uppgifter om dödsfallen inhämtades huvudsakligen från Rättsmedicinalverkets databas, men även från Patientregistret, Läkemedelsregistret och Vapenregistret. Genom en enkät till svenska jägare undersöktes även icke dödliga skjutvapenincidenter vid jakt.

Jakt är en traditionell fritidsaktivitet i Sverige, ofta av familjekaraktär. Alla jägare ska sedan 1985 ha genomgått jägarexamen innan jaktvapenlicens utfärdas av Polismyndigheten. Detta år blev jägarexamen obligatorisk och utbildningen ger en bred kunskap om bland annat jaktformer, viltarter, lagstiftning, skytte och tillvaratagande av bytet. Dödsolyckor med skjutvapen under jakt har varit ovanliga i Sverige men har inte undersökts under senare decennier.

Avhandlingens första delstudie handlar om dödliga vådaskjutningar i samband med jakt (N = 48) och under åren 1983-2008. De avlidnas medelålder var 50 år och 96% var män. Den mänskliga faktorn, som var den viktigaste orsaken till dessa olyckor, innebar oftast en felaktig bedömning av målet (människa förväxlades med djur), felaktig vapenhantering, eller fall med laddat och eventuellt osäkrat vapen. Incidensen av dödsolyckor har sjunkit i Sverige sedan 70-talet. Införande av obligatorisk jägarexamen har bidragit till en signifikant incidensminskning efter 1985 (1985-2008), jämfört med perioden dessförinnan (1970-1984).

Jägarnas jaktvanor, attityd kring säkerhet under jakten och erfarenhet av skjutvapenrelaterade incidenter undersöktes i den andra delstudien. En enkät skickades till 1,000 jägare och svarsfrekvensen var kring 50%. Medelåldern för dem som svarade var 54 år, och 5% var kvinnor. Omkring 1/4 del hade bevittnat en incident med skjutvapen som orsakats av en annan jägare. Jägarna föreslog ”den mänskliga faktorn” som orsak till dessa incidenter. Rapporterade incidenter ledde sällan till att en människa blev skadad eller dödad. Endast få jägare uppgav flera riskfaktorer eller flera riskbeteenden.

Dödliga skjutvapenolyckor utan samband med jakt och under åren 1983-2012 (N = 43) undersöktes i den tredje delstudien. Mer än hälften (56%) av dödsfallen orsakades av en annan person. Offren var främst unga män och medelåldern var 25 år. I 63% av fallen användes ett legalt vapen, men fynd av alkohol och narkotika i blodet var vanligare bland de offer där ett illegalt vapen använts. Den mänskliga faktorn var den huvudsakliga olycksorsaken. Risken att dödas i en skjutvapenolycka minskade signifikant efter införandet av jägarexamen 1985, jämfört med åren 1970-1984.

Den fjärde studien omfattade 52 dödsolyckor med skjutvapen (1987-2013), 3 fall av dödliga skottskador med oklart dödssätt (1987-2013), och, under åren 2012-2013, 213 självmord med skjutvapen och 23 lösta mord/dråp med skjutvapen. Antalet självmord korrelerade till antalet vapenägare i respektive län. Användning av ett legalt vapen dominerade bland självmord och dödsolyckor, medan ett illegalt vapen var vanligast bland lösta mord/dråp. Majoriteten av skyttarna i dödsolyckor och självmord hade inget registrerat besök i slutenvård eller den specialiserade öppenvården. 42 procent av alla självmordsoffer hade undet det sista året i livet kontakt med sjukvården pga psykiska problem. Inget självmordsoffer och ingen skytt i en dödsolycka hade rapporterats till polisen av läkare enligt vapenlagen.

Denna avhandling bekräftar att dödliga skjutvapenolyckor är sällsynta i Sverige. Obligatorisk jägarexamen bedöms ha bidragit till incidensminskningen efter 1985. För dödsolyckor är den mänskliga faktorn en viktig bakomliggande orsak som kan påverkas av framtida preventionsinsatser. Av alla dödliga skottskador tar dock självmord flest liv. Läkares anmälningsskyldighet enligt vapenlagen är emellertid inte välfungerande i dagsläget. En förändring krävs i denna del, liksom andra åtgärder för att minska antalet självmord. Illegala skjutvapen har varit inblandade i en betydande andel dödsfall, och dessa kan inte förebyggas genom läkares anmälningsskyldighet. Även detta fynd bör beaktas vid framtida preventionsinsatser.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet , 2018. , s. 86
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1950
Nyckelord [en]
Firearm, fatality, accidental, hunting, non-hunting, suicide, homicide
Nationell ämneskategori
Rättsmedicin
Forskningsämne
rättsmedicin
Identifikatorer
URN: urn:nbn:se:umu:diva-150987ISBN: 978-91-7601-851-4 (tryckt)OAI: oai:DiVA.org:umu-150987DiVA, id: diva2:1240665
Disputation
2018-09-14, Hörsal D, våning 9, Norrlands universitetssjukhus, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2018-08-24 Skapad: 2018-08-22 Senast uppdaterad: 2018-08-27Bibliografiskt granskad
Delarbeten
1. Unintentional firearm hunting deaths in Sweden
Öppna denna publikation i ny flik eller fönster >>Unintentional firearm hunting deaths in Sweden
2012 (Engelska)Ingår i: Forensic Science International, ISSN 0379-0738, E-ISSN 1872-6283, Vol. 216, nr 1-3, s. 12-18Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

This study examined all unintentional firearm fatalities while hunting that occurred in Sweden between 1983 through 2008. The circumstances as well as the impact of the hunter's exam on fatality frequency were analysed. During these 26 years, there were 48 such fatalities, representing 53% of all (n = 90) unintentional firearm deaths during the same period. The average annual number of fatalities decreased over the last few decades. Very restrictive firearm legislation in Sweden combined with the introduction of a mandatory hunter's exam since 1985 accounted, at least partly, for this finding. Moose hunting accounted for 46% of the fatalities and small game hunting for the remaining cases. The mean age of the victims was 50 years and 96% of them were males; all shooters were males. During moose hunting, most of the victims were mistaken for game, whereas in small game hunting most of the fatalities were related to falls and improper handling of the weapon. Human error was thus the main cause of these fatalities.

Ort, förlag, år, upplaga, sidor
Elsevier, 2012
Nyckelord
Firearm, Hunting, Unintentional deaths
Nationell ämneskategori
Rättsmedicin
Forskningsämne
rättsmedicin
Identifikatorer
urn:nbn:se:umu:diva-46270 (URN)10.1016/j.forsciint.2011.08.010 (DOI)000300837000004 ()21908112 (PubMedID)
Tillgänglig från: 2011-08-30 Skapad: 2011-08-30 Senast uppdaterad: 2018-08-22Bibliografiskt granskad
2. Swedish hunters' safety behaviour and experience of firearm incidents
Öppna denna publikation i ny flik eller fönster >>Swedish hunters' safety behaviour and experience of firearm incidents
2013 (Engelska)Ingår i: Accident Analysis and Prevention, ISSN 0001-4575, E-ISSN 1879-2057, Vol. 60, s. 64-70Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Since any firearm injury is potentially lethal, it is of great interest to prevent firearm incidents. This study investigated such incidents during hunting and Swedish hunters' safety behaviour. A 48-item questionnaire was posted to a random sample of 1000 members of the Swedish Association for Hunting and Wildlife Management. The questions considered demographics, hunting experience/hunting habits/safety behaviour/attitudes and experience of careless weapon handling, hunters' weapons and safety behaviour relating to weapons, health status, firearm incidents and their preventability, and personal comments on the questionnaire. The response rate was almost 50%. The mean age of the responders was 54 years; 5% were females. Almost none (1%) reported hunting under the influence of alcohol. Young age and male sex were positively associated with risk behaviour, although the presence of multiple risk behaviours in the same responder was not common. A very high degree of compliance with Swedish laws regarding weapon storage was reported. One-quarter of the responders had witnessed a firearm incident caused by another hunter, which in most situations did not result in human injury or death. An unsafetied weapon was the most common reported "cause" of these incidents. Experience of a firearm incident was not uncommon and the majority of the responders considered the incident in question to be preventable. This study provides a picture of the possible risk behaviour among hunters and the results suggest that future prevention work should target safer weapon handling.

Ort, förlag, år, upplaga, sidor
Elsevier, 2013
Nyckelord
Behaviour, Firearms, Safety
Nationell ämneskategori
Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi
Identifikatorer
urn:nbn:se:umu:diva-85306 (URN)10.1016/j.aap.2013.08.002 (DOI)000327825800010 ()24018010 (PubMedID)
Tillgänglig från: 2014-02-05 Skapad: 2014-01-31 Senast uppdaterad: 2018-08-22Bibliografiskt granskad
3. Unintentional non-hunting firearm deaths in Sweden, 1983-2012
Öppna denna publikation i ny flik eller fönster >>Unintentional non-hunting firearm deaths in Sweden, 1983-2012
2016 (Engelska)Ingår i: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 61, nr 4, s. 966-971Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

We examined the association between unintentional nonhunting firearm deaths and changes in firearm legislation in Sweden. There were 43 fatalities during the study time frame 1983-2012, representing 46% of all unintentional firearm deaths during the same period. The victims were predominantly young males (mean age 25 years). Slightly more than half of the deaths were caused by another person and were inflicted at close range. The main cause of the incidents was human error. The majority of the involved firearms were legal; however, most victims killed with illegal firearms were under the influence of alcohol and/or drugs at the time. The death rate decreased significantly following the introduction of the hunter's examination in 1985. Education and training associated with the hunter's examination was at least partially responsible for the decline in fatalities after 1985. Future prevention should target the availability of illegal firearms.

Ort, förlag, år, upplaga, sidor
Blackwell Publishing, 2016
Nyckelord
forensic science, accidents, deaths, firearms, legislation, prevention
Nationell ämneskategori
Rättsmedicin
Forskningsämne
rättsmedicin
Identifikatorer
urn:nbn:se:umu:diva-124293 (URN)10.1111/1556-4029.13098 (DOI)000379425800011 ()27364274 (PubMedID)
Tillgänglig från: 2016-08-02 Skapad: 2016-08-02 Senast uppdaterad: 2018-08-22Bibliografiskt granskad
4. Firearm deaths in Sweden
Öppna denna publikation i ny flik eller fönster >>Firearm deaths in Sweden
Visa övriga...
2019 (Engelska)Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, nr 2, s. 351-358Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background: Sweden’s firearm legislation obligates physicians to report patients that are deemed unsuitable to possess a firearm. This study aimed to explore the involvement of firearm use in firearm fatalities and to evaluate physician reporting concerning cases of firearm deaths.

Methods: Fatal firearm suicides and homicides in Sweden were studied for the years 2012–2013, accidental deaths and undetermined manner of deaths for the period 1987–2013. Police reports and autopsy protocols were collected from the National Board of Forensic Medicine, healthcare data in 1 year before the fatality from the National Board of Health, and information about physician reports and firearm licences from the Swedish Police.

Results: A total of 291 firearm deaths (213 suicides, 52 accidental deaths, 23 solved homicides and 3 cases with undetermined manner of death) were identified. Firearm suicides were positively correlated with the number of licensed firearm owners. Legal firearm use predominated in firearm suicides and accidental deaths, illegal in homicides. No suicide victim or shooter in an accidental death was previously reported by a physician to the police according to the firearm law. The majority of the shooters in accidental deaths and suicides had no registered health care visits. Less than half (42%) of all suicide victims had a previous health care contact due to mental health problems. Conclusions: Not one single suicide victim nor any shooter in accidental deaths in the present study had been reported according to the firearm law, bringing the evidence of a suboptimal framework.

Ort, förlag, år, upplaga, sidor
Oxford University Press, 2019
Nationell ämneskategori
Rättsmedicin
Forskningsämne
rättsmedicin
Identifikatorer
urn:nbn:se:umu:diva-150554 (URN)10.1093/eurpub/cky137 (DOI)000463809200028 ()
Tillgänglig från: 2018-08-12 Skapad: 2018-08-12 Senast uppdaterad: 2019-04-26Bibliografiskt granskad

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