In 2021, firearm deaths continued to be the leading cause of death for US children, with further worsening disparities noticed, according to a study published in Pediatrics.
Review of the Centers for Disease Control and Preventions’ (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER) for children and adolescent firearm mortalities, published online in Pediatrics, revealed pediatric firearm deaths increased in 2021, and continued to be the leading cause of death among US children. Further, race and ethnicity, age, gender, and geographic disparities worsened in the same timeframe.
Amid the COVID-19 pandemic, firearm sales spiked, and approximately 30 million children were living in homes with firearms. In recent years, in all intents, pediatric firearm deaths increased with homicide making up the majority of deaths.
In the study, CDC WONDER was used for mortality data related to firearms and additional injury mortalities for children and adolescents aged 0 to 19 from 2018 to 2021. Stratification was broken into 4 age groups; 0 to 4 years, 5 to 9 years, 10 to 14 years, and 15 to 19 years. Crude death rates, absolute mortality numbers, and baseline characteristics were reported. Crude death rate is defined as the total number of deaths for a specific year in a specific category, divided by the at-risk population times 100,000. Across all stratified analyses, the death rate refers to the rate of deaths per 100,000 people in the specified population for a specific year. Further subanalyses for firearm injury were stratified by intent, race, age, and gender.
In the 2018-to-2021 study period, a 41.5% increase in the pediatric firearm death rate was observed, with a fitted linear regression model of R2 = 0.91 and a death rate = 0.63 (year) to 1267 (P = .0475). In 2020, a 28.8% increase in pediatric firearm deaths was observed compared to prior years. In 2021, a death rate spike of 8.8% was observed compared to 2020, as 4752 pediatric firearm deaths were recorded. Among these deaths, 64.3% were homicides, 29.9% were suicides, and 3.5% were due to unintentional injury. Two percent of deaths were categorized as undetermined deaths, and 0.3% were legal intervention. Death rates for firearm homicide and suicide increased from 2020 to 2021, (5.7% [3.5 to 3.7 per 100,000 persons] and 1.6 to 1.7 per 100,000 persons, respectively).
Overall, firearms continued to be the leading cause of death for children and adolescents, compared to other injury-related causes of death. Firearms were the leading causes of death at ages 14 years and up in 2018 and 2019, 13 years and up in 2020, and 12 years and up in 2021, when stratified by age. For each year in the study period, the firearm death rate increased per 100,000 persons, increasing by 0.1 from 2018 to 2019, by 1.2 from 2019 to 2020, and by 0.4 from 2020 to 2021.
The 15-to-19-year age group accounted for 82.6% of all firearm deaths in 2021, with an increased death rate per 100,000 persons of 5.2%, while lower firearm death rates were observed in younger children; 0.8 per 100,000 for ages 0 to 4 years, and 0.7 per 100,000 for ages 5 to 9 years. An increase in firearm-related homicides was observed in all age ranges, including a 66% increase from 2018 to 2021 for children in the 0 to 4 years and 5 to 9 years subgroups. In the same timeframe, a 100% increase was observed in children aged 10 to 14 years, while a 62% increase was observed in individuals in the 15 to 19 year subgroup.
Males made up 84.8% of all pediatric firearm mortalities in 2021. This group’s death rate per 100,000 persons increased from 6.8 in 2018 to 9.6 in 2021. The firearm death rate in females increased from 1.2 to 1.8 per 100,000 persons from 2018 to 2021. Males accounted for 84.2% of firearm homicides by intent in 2021, resulting in a 3.7 per 100,000 rate increase from 2018. Males were also disproportionately affected by firearm suicide, as 86.2% of all suicide deaths in 2021 were male.
Black children were disproportionately affected by firearm mortalities, the analysis demonstrated. Black children accounted for the greatest increase in death rate, going from 16.6 per 100,000 in 2020 to 18.9 in 2021. The rate of 18.9 increased from 10.9 in 2018. A lower overall firearm death rate was observed for Hispanic children (4.0) compared to non-Hispanic children (6.4) in 2021, and both ethnicities had an increase in death rate compared to 2018 (4.5 to 6.4, non-Hispanic children and 2.7 to 4.0, Hispanic children).
Compared to White children, the 2021 firearm homicide death rate was 11 times higher for Black children (1.5 vs 16.3 per 100,000 persons, respectively), the largest disparity gap during the study period. Between 2020 and 2021, a 12.4% increase in the homicide rate was observed for Black children (14.5 to 16.3) while a 13.3% increase was observed in multiracial firearm homicides. These observations contrast moderate to no increases for White, Asian American, and American Indian and Alaska Native (AIAN) children. A 7.7% and 8.1% increase was observed in homicide rate from 2020 to 2021 for Hispanic and non-Hispanic children, respectively.
White children accounted for 78.4% of all firearm suicide deaths in 2021, while Black children made up 14.1%. Firearm suicide rates for White and Black children increased by 0.2 and 0.3 per 100,000 persons, respectively, from 2020 to 2021. AIAN children had the highest firearm suicide rate in 2021 (2.0 per 100,000), a decrease from a rate of 2.6 observed in 2020. Increases in firearm suicide rates were also observed for both Hispanic and non-Hispanic children.
Related to geographic disparities among children and adolescent firearm deaths, mortalities were “largely concentrated in Southern states,” the authors wrote. Death rates per 100,000 were 17.0 in Louisiana, 14.8 in Mississippi, 11.4 in Alabama, 11.1 in Montana, and 10.2 in South Carolina. The 5 states with the highest increases in death rates from 2018 to 2021 were; Louisiana (123.7%), Wisconsin (110.7%), Kansas (90.5%), North Carolina (88.6%), and Illinois (73.9%). In the District of Columbia and Alaska, decreased rates were observed from 2020 to 2021, with both locations falling to unreliable levels (less than 20 total deaths).
Socioeconomic disparities were also observed in the study, as the percentage of residents living in poverty resulted in a positive correlation with increased firearm death rates in 2021 (Pearson R = 0.75 [P < .001]).
Despite reduced pandemic-related fears and anxiety, firearm mortalities in the pediatric population continued to be the leading cause of death among children and adolescents in 2021, while disparities continued and widened. Overall, the findings of this study, according to the authors, “highlight the necessity and urgency of real-time epidemiologic surveillance of this epidemic and implementation of evidence-informed strategies to prevent pediatric firearm fatalities among children and adolescents at highest risk.”
Roberts BK, Nofi CP, Cornell E, Kapoor S, Harrison L, Sathya C. Trends and disparities in firearm deaths among children. Pediatrics 2023; e2023061296. Doi:10.1542/peds.2023-061296