Pediatric Firearm Injury Mortality Epidemiology

Background: Gun violence is a leading and preventable cause of death for youth in the US. There has not been a comprehensive update on pediatric firearm injury epidemiology since 2014. The objective of this study is to examine fatal firearm injury data among youth age 0-19.

Methods: Centers for Disease Control’s Web-based Injury Statistics Query and Reporting System (WISQARS) was queried for fatal injury reports from 2001-2019. Overall number of deaths due to firearm injuries was compared to deaths due to motor vehicle traffic collisions, which has been the leading cause of death for youth in the US for decades. Mortality rates (deaths/100,000 youth) were reported overall and by intent category. Proportion of firearm deaths due to homicide, suicide and unintentional shootings were reported by age group. Trends in mortality rate over time were reported by race/ethnicity and by intent.

Results: In 2019, firearm injuries surpassed motor vehicle traffic collisions to become the leading cause of death for youth age 0-19 in the US. Homicide is the most common intent across all age groups. Unintentional injuries account for 29% of the firearm deaths among 0-4 year old youth, with a decreasing proportion in other age groups. Suicide represents a significant proportion of firearm deaths in both 10-14 and 15-19 year old age groups. There are significant racial/ethnic disparities in overall mortality rate and homicide rate. In 2019, Black youth had a firearm mortality rate 4.3x that of white youth and a firearm homicide rate >14x that of white youth. American Indian youth have a significantly higher firearm suicide mortality rate than all other race/ethnicity groups and the rate has increased significantly since 2001.

Conclusion: Firearm injury surpassed motor vehicle traffic collisions to become the leading cause of death among youth age 0-19 in the US in 2019. There are significant and widening racial inequities with Black youth disproportionately affected. This public health crisis demands physician advocacy to reduce the burden of these preventable deaths among youth.