Background: Firearm suicides are more prevalent in cities than many recognise. Extant research-though conducted at different geographic levels or on different types of firearm deaths-suggests that firearms dealers may play a role in city firearm suicides. This study examines the relationship between rates of city firearms dealers and firearm suicides.

Methods: Data from the Center for Disease Control's National Vital Statistical System and the Bureau of Alcohol, Tobacco, Firearms and Explosives' Federal Firearms Listing included 284 cities in 2015-2021. Types, locations and rates of firearms dealers as well as firearm suicide rates were examined. Poisson regression models tested associations between city firearms dealer and firearm suicide rates, controlling for city characteristics. Models were stratified by city size and poverty level, and results were examined for firearms dealers overall and by type.

Results: Firearms dealer rates were highest in cities in the Midwest, South and West; with populations less than 500 000; and with the most veterans or white residents. Firearm suicide rates were 3.4 times higher in cities with the highest firearms dealer rates (9.8 per 100 000 population) than the lowest (2.9). In adjusted regression models, city firearms dealer rates were associated with firearm suicide rates, and results depended on dealer type, city size and poverty level.

Discussion and conclusions: City firearms dealers play an important role in access to lethal means, especially in small cities and through pawnshops. These findings hold implications for how cities can engage firearms dealers as suicide prevention partners.

Keywords: Firearm; Suicide/Self?Harm; Urban.

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