Abstract
BACKGROUND: Prevention efforts for mass shooting fatalities often focus on public events, overlooking where most fatalities occur. This study analyzes a comprehensive database to better inform prevention strategies. METHODS: Using data from the Gun Violence Archive (GVA), we identified 252 mass shooting events (2014-2023) with four or more deaths, excluding the perpetrator, resulting in 1,464 fatalities. A media analysis determined location and links to domestic violence. Mortality burden by location, age, gender, and domestic violence was calculated, with tests of association performed. RESULTS: We found that half (50%) of mass shooting fatalities occurred in homes-five times more than in businesses/workplaces (10%). Among children (0-9), 89% of fatalities occurred in homes, compared to 62% among older children and teens (10-17) and 44% among adults (18+). Women were more likely to be killed in mass shootings at home (50%) than men (40%). Fatalities were disproportionately concentrated in homes across all age groups (p < 0.001). Domestic violence-related mass shootings accounted for 46% of all fatalities, with 70% of fatalities from domestic violence-related events occurring in homes. CONCLUSIONS: Public discourse neglects home-based mass shootings, which disproportionately affect women and children. Targeted interventions, especially addressing domestic violence, are critical for reducing fatalities.