In Reply: We thank Dr. Berg for raising the issue of firearm availability in the interpretation of self-inflicted injury rates. In our Datapoints column, we intentionally made no reference to firearm availability as a factor contributing to the rise in self-inflicted injuries in the United States.

During the six-year period between 1993 and 1998, the rate of suicide by firearm dropped by approximately 15 percent, while the rate of firearm-related homicides fell by 42 percent and the rate of unintentional firearm-related deaths fell by 47 percent. During the same period, the rate of nonfatal suicide attempts by firearm declined by 48 percent, compared with a 49 percent decrease in the rate of firearm-related assaults and a 37 percent decrease in unintentional, nonfatal firearm-related injuries (1). Given these data, it is safe to assume that the overall increase in self-inflicted injuries seen during this period in U.S. emergency departments was not due to an increase in firearm-related injuries. Furthermore, although we agree with Dr. Berg that firearm availability in the home has been shown to be associated with self-inflicted harm (2), domestic rifle and handgun sales have been decreasing over the past decade (3).

Firearm-related injury remains a serious public health burden, accounting in 1998 for 31,000 deaths and 64,500 nonfatal injuries treated in hospital emergency departments (1). However, firearm-related injuries do not account for the increasing rate of self-inflicted injuries seen in emergency departments.