Racial Differences in the Association of Physical Disability and Healthcare Access With Firearm Violence at the Neighborhood Level in Chicago.

Abstract

Firearm violence remains a public health crisis in the U.S., disproportionately affecting racially marginalized and historically disinvested neighborhoods. The relationship between neighborhood-level disability prevalence and healthcare access and firearm violence risk remains poorly understood. This ecological, spatiotemporal analysis of 77 community areas in Chicago from 2011 to 2023 used Bayesian negative binomial models to estimate the associations between community-level disability prevalence and healthcare underservice-defined as the proportion of land designated as a medically underserved area-with annual rates of nonfatal firearm victimizations and firearm homicides. Stratified models by neighborhood racial/ethnic plurality were also explored. Analyses were conducted from April 2025 to March 2026. A 5-percentage point increase in disability prevalence was associated with a 10% higher rate of firearm victimization (95% credible interval=2%-18%) and a 19% higher rate of firearm homicide (95% credible interval=8%-31%). A 5-percentage point increase in medically underserved area coverage was associated with a 10% increase in firearm victimization (95% credible interval=6%-15%) and a 9% increase in firearm homicide (95% credible interval=5%-13%). In stratified models, disability was most strongly associated with firearm violence in plurality non-Hispanic Black neighborhoods. Associations between medically underserved area coverage and firearm violence were largest in plurality non-Hispanic White and Hispanic neighborhoods. Neighborhood-level disability and healthcare underservice are significantly associated with firearm violence in Chicago, with differences according to racial/ethnic composition. Findings underscore the need to integrate disability and healthcare access into public health violence prevention frameworks.