Overview
. Would a randomized controlled trial have been feasible/ethical for this research question? Why or why not? In this case, I don’t believe a randomized controlled trial would have been feasible and/or ethical in this case because it would not capture the necessary nuances and give an accurate proportion to the question asked within the specific population.
5. What is/are the main outcome variable(s)?
6. What is/are the main exposure variable(s)?
7. How comparable do you think the homicide, suicide and other decedents were with respect to demographic characteristics (as shown in table 1)? Are there important differences on some factors?
8. What method(s) of analysis were used to assess whether there is an association between the risk of violent death in the home and the presence of guns in the home?
bivariable analysis and calculated prevalence estimates for the characteristics of the decedent and the main exposure variable—presence of a firearm in or around the home
multivariable analysis by using logistic regression to examine the association between each of the four outcome variables and the main exposure variable, after adjusting for demographic and behavioral characteristics of the decedent
for models assessing whether the presence of a firearm in the home increases the risk that a homicide or suicide will be committed with a firearm, we performed a more refined analysis of exposure.
All data were weighted to account for unequal selection probabilities and nonresponse and were poststratified to produce national estimates. Data were analyzed by using SUDAAN software (26) to account for the complex sampling design. p values of < 0.05 were considered statistically significant.
9. What measure(s) of association was/were used to describe the magnitude of this association?
10.What are the main findings of the study with respect to the presence or absence of this association? computed crude odds ratios and 95 percent confidence intervals to assess the association between each of the four outcome variables
11.Why did the investigators examine this question in multiple ways? (Give at least one example of a secondary analysis and the reason for it.)
12.Using the reported 95% confidence interval from the primary adjusted analysis, what is the minimal risk elevation for homicide in the home due to firearms in the home that is consistent with the observed data?
The study reports an adjusted odds ratio (OR) of 1.9 for homicide in the home associated with firearms in the home, with a 95% confidence interval (CI) of 1.1 to 3.4.
The minimal risk elevation for homicide that is consistent with the observed data corresponds to the lower limit of the confidence interval.
The minimal risk elevation for homicide in the home due to firearms in the home that is consistent with the observed data is an adjusted odds ratio of 1.1, indicating an 11% increase in risk.
13.Using the reported 95% confidence interval from the primary adjusted analysis, what is the minimal risk elevation for male suicide in the home due to firearms in the home that is consistent with the observed data? For female suicide?
14.In the abstract, the authors conclude “Results show that regardless of storage practice, type of gun, or number of firearms in the home, having a gun in the home was associated with an increased risk of firearm homicide and firearm suicide in the home.” Do you think this conclusion is justified by their data? Why or why not?
15.With what institutions(s) is/are the study authors affiliated? Do you think the authors’ conclusions were influenced by their affiliation(s)?