H2020 Expert Group to update and expand “Gendered Innovations/ Innovation through Gender” 

Chairperson: Londa Schiebinger 

Rapporteur: Ineke Klinge

Federal policy changes in 2002 and 2009 led some states to expand public health insurance coverage to non-US-born children and pregnant women who are lawful permanent residents during their first 5 years of residency in the United States. In other states, there were concerns that insurance expansion could attract immigrants to relocate to gain free health insurance coverage.

BACKGROUND

Research has consistently identified firearm availability as a risk factor for suicide. However, existing studies are relatively small in scale, estimates vary widely, and no study appears to have tracked risks from commencement of firearm ownership.

METHODS

We identified handgun acquisitions and deaths in a cohort of 26.3 million male and female residents of California, 21 years old or older, who had not previously acquired handguns. Cohort members were followed for up to 12 years 2 months (from October 18, 2004, to December 31, 2016). We used survival analysis to estimate the relationship between handgun ownership and both all-cause mortality and suicide (by firearm and by other methods) among men and women. The analysis allowed the baseline hazard to vary according to neighborhood and was adjusted for age, race and ethnic group, and ownership of long guns (i.e., rifles or shotguns).

RESULTS

A total of 676,425 cohort members acquired one or more handguns, and 1,457,981 died; 17,894 died by suicide, of which 6691 were suicides by firearm. Rates of suicide by any method were higher among handgun owners, with an adjusted hazard ratio of 3.34 for all male owners as compared with male nonowners (95% confidence interval [CI], 3.13 to 3.56) and 7.16 for female owners as compared with female nonowners (95% CI, 6.22 to 8.24). These rates were driven by much higher rates of suicide by firearm among both male and female handgun owners, with a hazard ratio of 7.82 for men (95% CI, 7.26 to 8.43) and 35.15 for women (95% CI, 29.56 to 41.79). Handgun owners did not have higher rates of suicide by other methods or higher all-cause mortality. The risk of suicide by firearm among handgun owners peaked immediately after the first acquisition, but 52% of all suicides by firearm among handgun owners occurred more than 1 year after acquisition.

CONCLUSIONS

Handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm. (Funded by the Fund for a Safer Future and others.)

Background Virtually all existing evidence linking access to firearms to elevated risks of mortality and morbidity comes from ecological and case–control studies. To improve understanding of the health risks and benefits of firearm ownership, we launched a cohort study: the Longitudinal Study of Handgun Ownership and Transfer (LongSHOT).

Methods Using probabilistic matching techniques we linked three sources of individual-level, state-wide data in California: official voter registration records, an archive of lawful handgun transactions and all-cause mortality data. There were nearly 28.8 million unique voter registrants, 5.5 million handgun transfers and 3.1 million deaths during the study period (18 October 2004 to 31 December 2016). The linkage relied on several identifying variables (first, middle and last names; date of birth; sex; residential address) that were available in all three data sets, deploying them in a series of bespoke algorithms.

Results Assembly of the LongSHOT cohort commenced in January 2016 and was completed in March 2019. Approximately three-quarters of matches identified were exact matches on all link variables. The cohort consists of 28.8 million adult residents of California followed for up to 12.2 years. A total of 1.2 million cohort members purchased at least one handgun during the study period, and 1.6 million died.

Conclusions Three steps taken early may be particularly useful in enhancing the efficiency of large-scale data linkage: thorough data cleaning; assessment of the suitability of off-the-shelf data linkage packages relative to bespoke coding; and careful consideration of the minimum sample size and matching precision needed to support rigorous investigation of the study questions.

An introduction to the new area of ignorance studies that examines how science produces ignorance—both actively and passively, intentionally and unintentionally.

Modelling of emerging vector borne diseases serves as an important complement to clinical studies of modern zoonoses. This article presents an archaeo‐historic epidemiological modelling study of Rift Valley fever (RVF), using data‐driven neural network technology. RVF affects both human and animal populations, can rapidly decimate herds causing catastrophic economic hardship, and is identified as a Category A biodefense pathogen by the US Center for Disease Control. Despite recent origins circa the early 1900s, little is known about the circumstances of its inception nor the relationships between factors that affect transmission. This evidence could be vital as the disease continues to expand from its epicentre in Kenya to other parts of Africa and the Arabian Peninsula. RVF is a relevant case for archaeological/palaeopathological investigations of disease as it intersects between numerous human, animal, spatial, temporal, and sociopolitical dimensions. By integrating landscape archaeology, historical evidence, and climatic data, with evidence of human behaviour gathered through ethnoarchaeological study, this article presents an applied framework for human–animal palaeopathology. This framework aligns with the One Health approach that observes disease to be intrinsically tied to ecological and societal factors. We provide a useable alternative way of thinking about disease modelling in the present and the past, ultimately seeking to support efforts to accurately predict future impacts. Tapping into longitudinal evidence from the last 50–300 years offers a powerful way to respond to the threat zoonoses will pose to human populations around the world as the climate warms.