Leading Cause of Death in Children Since 2020

On May 25 2022, ongoing discussions and discourse about the devastating Uvalde, Texas school shooting included a circulating statistic — that as of 2020, the leading cause of death in children was gun related:

In the tweet embedded above, a Politico reporter stated that the leading cause of death for American children had, for six decades, been car accidents.. As of 2020, the tweet added, gun violence had overtaken car accidents in terms of juvenile mortality in America.

We were able to track down the source of the claims to a New England Journal of Medicine letter to the editor from several University of Michigan medical researchers dated May 19 2022 (published in late April 2022.)

Filed under “Correspondence” and bearing the title, “Current Causes of Death in Children and Adolescents in the United States,” the letter detailed the Michigan University researchers’ analysis of CDC data. It began:

The Centers for Disease Control and Prevention (CDC) recently [as of April 2022] released updated official mortality data that showed 45,222 firearm-related deaths in the United States in 2020 — a new peak. Although previous analyses have shown increases in firearm-related mortality in recent years (2015 to 2019), as compared with the relatively stable rates from earlier years (1999 to 2014) these new data show a sharp 13.5% increase in the crude rate of firearm-related death from 2019 to 2020. This change was driven largely by firearm homicides, which saw a 33.4% increase in the crude rate from 2019 to 2020, whereas the crude rate of firearm suicides increased by 1.1%. Given that firearm homicides disproportionately affect younger people in the United States, these data call for an update to the findings of Cunningham et al. regarding the leading causes of death among U.S. children and adolescents.

Immediately thereafter, the letter continued:

The previous analysis, which examined data through 2016, showed that firearm-related injuries were second only to motor vehicle crashes (both traffic-related and nontraffic-related) as the leading cause of death among children and adolescents, defined as persons 1 to 19 years of age. Since 2016, that gap has narrowed, and in 2020, firearm-related injuries became the leading cause of death in that age group (Figure 1). From 2019 to 2020, the relative increase in the rate of firearm-related deaths of all types (suicide, homicide, unintentional, and undetermined) among children and adolescents was 29.5% — more than twice as high as the relative increase in the general population. The increase was seen across most demographic characteristics and types of firearm-related death[.]

The researchers pointed out that this is part of a broader issue that has been emerging for many years, rather than a new and sudden change:

“The increasing rates of firearm mortality are a longer-term trend and demonstrate that we continue to fail to protect our youngest population from a preventable cause of death,” said Goldstick, research associate professor of emergency medicine at Michigan Medicine and of health behavior and health education at the U-M School of Public Health.

“Recent investments in firearm injury prevention research by the CDC and National Institutes of Health, in addition to community violence prevention funding in the federal budget, are a step in the right direction, but this momentum must continue if we truly want to break this alarming trend.”

As for the previous statistic, that was easy enough to find in National Center for Health Statistics data, also by way of the Centers for Disease Control and Prevention. A May 2010 white paper had the leading cause of death among teens as motor vehicle accidents as a bullet point:

As a category of accidents, motor vehicle fatality is the leading cause of death to teenagers, representing over one-third of all deaths.

And a 2018 New England Journal of Medicine article concurred, adding still more data:

In 2016, children and adolescents (1 to 19 years of age) represented a quarter of the total estimated U.S. population¹; reflecting relatively good health, they accounted for less than 2% of all U.S. deaths.² By 2016, death among children and adolescents had become a rare event. Declines in deaths from infectious disease or cancer, which had resulted from early diagnosis, vaccinations, antibiotics, and medical and surgical treatment, had given way to increases in deaths from injury-related causes, including motor vehicle crashes, firearm injuries, and the emerging problem of opioid overdoses. Although injury deaths have traditionally been viewed as “accidents,” injury-prevention science that evolved during the latter half of the 20th century increasingly shows that such deaths are preventable with evidence-based approaches.

A May 24 2022 tweet asserted that the leading cause of death for children in the United States had, in 2020, changed to gun related mortality; it was previously automobile accidents. A May 19 2022 NEJM letter, published prior to the Uvalde, Texas shooting, was titled “Current Causes of Death in Children and Adolescents in the United States.” That correspondence noted that gun deaths in children outpaced vehicular deaths in 2020, citing then-new CDC data.