NASHVILLE, Tenn. (WKRN) — Shooting deaths in Tennessee have been rising for nearly a decade, and recent studies show the state reached historic highs in 2021, with more than 1,500 Tennesseans killed by gunfire.

The number of deaths that year marked a grim statistic, putting Tennessee at 10th in the nation for firearm mortality per capita, according to data from the Centers for Disease Control and Prevention (CDC).

The death rate is calculated per 100,000 total population, with Mississippi at number one for gun-related deaths in 2021 and Massachusetts at the bottom of the list. Like Tennessee, most states in the top 10 were in the southern United States.

A study by the Sycamore Institute found that Tennessee’s death rate grew over 66% between 2011 and 2021, largely due to a spike in homicides, which accounted for 46% of firearms deaths in 2021. That adds up to an additional 623 deaths each year.

Just over half of firearm deaths in 2021 were suicides, but according to the Sycamore Institute, homicides accounted for the most deaths among people aged 35 years and younger and Black Tennesseans.

The rate of homicides involving guns also doubled between 2011 and 2021. Meanwhile, the Sycamore Institute’s study showed that fatal crimes where another means of force was used actually fell by 5% during that period.

Overall, Tennessee’s shooting death rate in 2021 was nearly 50% higher than the country as a whole. That year, gunfire was also the 10th leading cause of death in Tennessee. Infectious diseases, Alzheimer’s and cancer all ranked above gunfire, with over 18,000 people killed by the number one leading cause of death: heart disease.

While firearm deaths were less frequent among minors than any other age group, gunfire remained the leading cause of death for Tennesseans ages 1 to 18 in 2021. Those deaths were largely concentrated among teens aged 15 to 18.

According to the Sycamore Institute, gunfire overtook car crashes as the leading cause of death among Tennessee’s children in 2017. A study conducted by the Tennessee Department of Health found guns were still the leading cause of death among kids in 2022.

By race, Black women and men experienced the largest increase in firearm deaths in Tennessee, with Black women being killed at a rate nearly 196% higher than in 2011. The overall rate of firearm deaths among Black Tennesseans was three times higher than other races.

The majority of firearm deaths in Tennessee happened in the state’s most populous counties, but the counties with the highest rates were largely concentrated in the western part of the state.

Among the top two were Shelby County with 2,627 firearm deaths and Davidson County with 1,171 deaths. Altogether, almost half, or 43%, of the state’s shooting deaths happened in the four largest counties — Shelby, Davidson, Knox and Hamilton.