Mass shootings in major metropolitan areas in the United States disproportionately affect Black people, and structural racism may play a role, according to a study published on Wednesday in the journal JAMA Surgery.

Researchers at Tulane University analyzed data relating to the 51 largest metropolitan areas, including demographic and income data as well as reports of mass shootings from 2015 to 2019 compiled by the Gun Violence Archive, a non-profit organization that tracks gun violence in the US.

CNN and the Gun Violence Archive define a mass shooting as a shooting that injured or killed four or more people, not including the shooter.

The study found that in areas with higher Black populations, mass shootings are likelier to occur compared to communities with higher White populations. There are also more Black people injured and killed when mass shootings take place, the findings say.

The study examined 865 mass shootings between 2015 and 2019, which resulted in a combined 3,968 injuries and 828 fatalities.

Researchers intended to find whether mass shootings are a consequence of structural racism, which they described as "the normalized and legitimized range of policies, practices, and attitudes that routinely produce cumulative and chronic adverse outcomes for people of color."

They correlated the cities' Black-White segregation index, demographic data, poverty rates, educational attainment and crime rates.

Chicago had the greatest number of mass shootings during that period with 141, which led to 97 deaths and 583 injuries. According to the study, Milwaukee had the highest segregation index, which tracks racial disparities in schools and neighborhoods, while Baltimore had the highest unemployment rate.

Cleveland had the greatest income inequality.

Researchers said the study did not find a link between income and mass shooting events, but further research may be needed to define how income equality and poverty have an influence in mass shootings.

"The (study's) results have implications for targeted interventions to address firearm violence at community and national levels," Dr. Kimberly B. Golish and Dr. Leah C. Tatebe with the Department of Surgery at Northwestern University Feinberg School of Medicine in a commentary about the study's findings.

While the study "provides evidence to support interventions to decrease the downstream effects of structural racism," Golish and Tatebe said "it is time to focus on supporting patients beyond the hospital and research."

Golish and Tatebe said in addition to policy changes, something that could be critical to reducing mass shootings and the effect of racial disparities is creating a framework in which surgeons like them can combat gun violence.

"Solidifying how surgeons can combat the influence of structural racism on gun violence on a grander scale is critical to combat these prevalent and deadly disparities," they wrote. "We need to call on strengths from our interdisciplinary teams and ability to provide resources and support to those who have suffered from gun violence."

The study's authors cautioned the number of mass shootings and casualties reported by the GVA is not exact and subject to change as reports from law enforcement, media and other sources the group relies upon are updated and verified.

But they concluded "racial and ethnic minority populations are significantly more likely to be victims of (mass shootings)," systemic inequities lead to a variety of outbreaks of gun violence in the US, and it's something the public health sphere needs to address.