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Spending on social and public health services and its association with homicide in the USA: an ecological study
  1. Heather L Sipsma1,2,
  2. Maureen E Canavan1,
  3. Erika Rogan1,
  4. Lauren A Taylor3,
  5. Kristina M Talbert-Slagle1,
  6. Elizabeth H Bradley4
  1. 1Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut, USA
  2. 2Department of Public Health, Benedictine University, Lisle, IL, USA
  3. 3Harvard Business School, Boston, Massachusetts, USA
  4. 4Vassar College, Poughkeepsie, New York, USA
  1. Correspondence to Dr Elizabeth H Bradley; ebradley{at}


Objective To examine whether state-level spending on social and public health services is associated with lower rates of homicide in the USA.

Design Ecological study.

Setting USA.

Participants All states in the USA and the District of Columbia for which data were available (n=42).

Primary outcome measure Homicide rates for each state were abstracted from the US Department of Justice Federal Bureau of Investigation’s Uniform Crime Reporting.

Results After adjusting for potential confounding variables, we found that every $10 000 increase in spending per person living in poverty was associated with 0.87 fewer homicides per 100 000 population or approximately a 16% decrease in the average homicide rate (estimate=−0.87, SE=0.15, p<0.001). Furthermore, there was no significant effect in the quartile of states with the highest percentages of individuals living in poverty but significant effects in the quartiles of states with lower percentages of individuals living in poverty.

Conclusions Based on our findings, spending on social and public health services is associated with significantly lower homicide rates at the state level. Although we cannot infer causality from this research, such spending may provide promising avenues for homicide reduction in the USA, particularly among states with lower levels of poverty.

  • spending
  • homicide
  • poverty

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors HLS, MEC, KMT-S, LT and EHB conceptualised the design of the study. MEC and ER gathered the data. HLS and MEC conducted the analyses, and HLS wrote the first draft. All authors contributed to the interpretation of results, revising the paper and approve the final version for submission.

  • Funding This work was funded by grants from the Robert Wood Johnson Foundation (grant #71531) and Blue Cross Blue Shield of Massachusetts Foundation, Inc.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are publicly available; for more details or questions about the analytic dataset, please contact the corresponding author.

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