Global, Regional, and National Burden of Homicide Mortality 1990 to 2023: A Systematic Analysis for the Global Burden of Disease Study 2023

<p>Background: Deaths from homicide are a major public health challenge – not only because of their direct impact on premature mortality, but because homicides profoundly affect the health and wellbeing of communities and society as a whole. This study provides a quantification of the global burden of homicide, with attention to its geographic distribution, temporal trends, variation across age and sex, type of lethal means, and its relationship to wealth inequality.</p> <p>Methods: We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023 to produce estimates of the number of deaths and age-standardised mortality rates of homicide globally, regionally, and for 204 countries and territories from 1990 to 2023 and disaggregated these results by age and sex. In addition, we reanalysed the data to calculate relative rankings of countries by time, mean age at death, age-specific and sex-specific trends, and correlation between the Gini coefficient with homicide mortality rates. GBD 2023 estimates of homicide deaths were broken down into three collectively comprehensive and mutually exclusive categories: those by firearms, sharp objects, and by other means. We additionally calculated the fraction of all homicides that each fatal category represents by location, age, sex, and year. We used the Gini coefficient in our analysis to identify regional disparities and provide a quantitative measure to understand how income inequality is related to rates of homicide. We acquired data from vital registration, verbal autopsy, police records, and mortality surveillance from GBD 2023. Uncertainty intervals (UIs) were generated using the 2.5th and 97.5th percentiles from a 250-draw distribution for each metric.</p> <p>Findings: Globally, from 1990 to 2023, there were 15.0 million (95% UI 13.8–16.4) homicide deaths. In 2023, there were 436 000 deaths (384 000–508 000), including 350 000 male deaths (300 000–427 000) and 85 600 female deaths (67 600–117 000). Ranking countries based on homicide mortality rates showed that 61 countries shifted into lower deciles, indicating relative improvement, while 65 countries moved to higher deciles, indicating relative worsening. There were 78 countries that remained in the same decile group relative to other countries. Homicide is a highly geographically concentrated cause of death that continuously ranks among the top ten causes of death in four regions, while global progress has stalled over the past decade. When measuring the relationship between homicide and wealth inequality through the Gini coefficient, we found a statistically significant positive relationship globally. This relationship holds true for different types of lethal means, across different super-regions, and between males and females. Additionally, we found that a smaller percentage of homicide victims were female when firearms were used, but a higher percentage were female when other means were used.</p> <p>Interpretation: Although most forms of violence – including homicide – are considered preventable through targeted public health approaches, global homicide rates have remained largely unchanged since 1990, apart from the considerable declines throughout the 2000s. This decline is marked by the post-Soviet transition in eastern Europe and central Asia, following the instability and crisis created by the fall of the USSR, and by concurrent improvements in central Latin America. In regard to type of lethal means, our findings identify a critical divergence in homicide profiles: the Americas remain dominated by male-centric firearm mortality, while other regions exhibit a disproportionate burden of female homicides perpetrated by non-firearm means. These distinct epidemiological patterns suggest that global homicide prevention cannot rely on uniform strategies; rather, it requires precision policy-making that addresses regional weapon availability and sex-specific risk factors to achieve measurable declines in mortality.</p>