Disparities Revealed in Firearm and Car Crash Fatalities among U.S. Youth

Trends and dramatic changes highlight preventable deaths and potential for evidence-based interventions

KEY TAKEAWAYS

• In a retrospective study of U.S. children and adolescents under the age of 19, researchers documented more than 35,000 firearm and 40,000 motor vehicle crash fatalities from 2011-2021. These rates differed significantly by age, race, sex, and ethnicity.

• Firearm homicides increased by 87%, with the highest increase occurring among Black adolescent males.

• Firearm suicides went up by 68%, and although overall firearm suicide rates were highest among American Indian and Alaska native males, the highest increase in rates occurred among Black females aged 10-19 years old.

• Motor vehicle crash fatalities saw a sharp increase between 2019 and 2021, with the highest rates and sharpest increases occurring among youth who were American Indian or Alaska Native.

Researchers from Mass General Brigham, Boston Children’s Hospital, and the American Academy of Pediatrics have published new results revealing trends in the fatality rates among U.S. children from the two most common causes of preventable injury: firearms and motor vehicle crashes. In addition to identifying overall trends in fatalities from these causes between 2011 and 2021, the study shows disparities in how these trends differ by age, sex, race, and ethnicity and, in the case of firearms, by intent. The findings could help inform injury prevention strategies to address these disparities and reduce the nationwide burden of preventable deaths in children. Results are published in JAMA Pediatrics.

“None of us can be reduced to a singular identity,” said study author Eric Fleegler, MD, MPH, a physician in the Division of Pediatric Emergency Medicine at Massachusetts General Hospital (MGH), a founding member of the Mass General Brigham healthcare system. “If we can begin to parse out the relationships between different components of identity and these preventable deaths in children, we’re much better equipped to target certain youth populations with evidence-based interventions.”

For decades, injuries have been the leading cause of death among children in the United States. While motor vehicle crashes have been the leading cause of these injuries historically, firearms surpassed motor vehicle crashes for the first time in 2019. Existing research has identified disparities in the rates of fatalities from both firearms and motor vehicle crashes, yet much remains unclear about the drivers of these disparities.

While some of the trends identified in the study aligned with previously understood disparities, such as the high rate of fatalities from firearm homicides among adolescent Black males, other trends were more revealing. For example, Black females aged 10-19 had the highest fatality rate for firearm homicides among females, and this was nearly eight times greater than the next highest racial and ethnic group, which was Hispanic females.

The researchers also compared the relative change in fatality rates between different groups. For both Black males and Black females aged 15-19, the rate of firearm fatalities increased dramatically between 2019 to 2021, but the change was much greater among females even though their overall fatality rate was lower.

“The reasons for the increasing homicide rate among young women are likely multifactorial and may include intimate partner violence and community violence,” said Fleegler, who is also a senior research investigator at the MGH Gun Violence Prevention Center. “This is extremely useful information because it helps us understand what’s happening in the community in order to develop more targeted solutions.”

One notable strength of the study is that the researchers were able to identify fatality trends in groups who haven’t been considered in many previous analyses. For example, the study identified a sharp spike between 2019 and 2021 in motor vehicle crash fatalities among American Indian and Alaska Native youth, who also had the highest fatality rates from these crashes overall. While understanding the reasons for this disparity will take further research, the researchers hypothesize that factors related to geography could play a role, such as limited access to medical care on reservations and more dangerous roads in these rural areas.

To address the disparities uncovered in the study, the researchers emphasize that targeted legislative changes are necessary, which could include state-level firearm laws as well as addressing structural factors that contribute to high rates of community violence, such as poverty and housing insecurity. The researchers also call for increased community- and hospital-based violence prevention programs and increasing access to mental health screening and treatment for teens at risk of suicide.

The benefits of these and other interventions would, according to the researchers, ripple outwards into the community.

“In addition to the devastation it causes for immediate family members and other loved ones, the death of a young person has far-reaching repercussions for the wider community, given the years of life and possibilities that are lost with them,” said first study author Lois K. Lee, MD, MPH, a pediatric emergency medicine physician at Boston Children’s Hospital. “These losses are far from inevitable, and our hope is that by uncovering the driving factors contributing to fatalities in young people, we can come closer to a world in which they don’t occur.”

 Authorship: Additional authors include Lynn M. Olson, Suk-Fong S. Tang and William L. Cull.

Disclosures: No disclosures were reported.

Funding: The authors report no external sources of funding.

Papers cited: Lee, L. et al. “Firearm and Motor Vehicle Pediatric Deaths – Intersections of Age, Sex, Race, and Ethnicity JAMA Pediatrics. DOI:10.1001/jamapediatrics.2024.5089

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