Firearm-related mortality remains a public health concern in the United States (US). This study examines firearm-related mortality trends in Pennsylvania from 2012 to 2023, with an emphasis on demographic disparities.

Firearm-related mortality data was obtained from the Pennsylvania Enterprise Data Dissemination Informatics Exchange, categorizing deaths as intentional (suicide, homicide) or unintentional based on ICD-10 codes. Crude mortality rates were analyzed by sex, age, race/ethnicity, and county. Annual percentage changes were computed to assess trends, and statistical significance was determined using chi-square tests and linear regression models.

From 2012 to 2023 in Pennsylvania, there were 19,470 firearm-related deaths, including 11,520 suicides and 7446 homicides. Firearms accounted for 51.4% of all suicides (11,520 of 22,395) and 76.8% of all homicides (7446 of 9691). The proportion of firearm-related suicide was significantly higher among males compared to females (57.2% [10,151/17,740] vs 29.4% [1369/4654]; p < 0.001) and among Whites compared to Blacks (52.7% [10,514/19,939] vs 47.4% [655/1381]; p < 0.001). Among racial subgroups, the firearm-related suicide rate increased among Whites, Blacks, and Hispanics, however, the statistically significant increase over time occurred among Whites ( p = 0.011) and Blacks ( p < 0.001). The proportion of firearm-related homicide rate mortality was significantly higher among males compared to females (81.3% [6439/7924] vs 57.0% [1007/1766]; p < 0.001) and among Blacks compared to Whites (87.3% [5126/5875] vs 54.5% [1505/2760]). Subgroup analysis showed the highest rate increase was among Black males aged 40–59 years (122.7%).

Firearm-related mortality rates increased substantially in Pennsylvania in the past decade, with disparities observed in subgroup populations. Firearm safety policies, mental health support, and violence prevention programs are needed to reduce firearm-related mortality in Pennsylvania.