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Study: Firearm deaths among children continue to rise, disparities widen

August 21, 2023

Firearm death rates among children and teens rose almost 9% from 2020 to 2021, while disparities worsened, according to a new study.

The increasing rates meant firearms remained the leading cause of death for youths.

“Implementation of prevention strategies and policies among communities at highest risk is critical,” researchers from Northwell Health wrote in “Trends and Disparities in Firearm Deaths among Children,” (Roberts BK, et al. Pediatrics. Aug. 21, 2023).

The team analyzed 2018-’21 data from a Centers for Disease Control and Prevention database, analyzing firearm deaths for children 19 years and younger.

In 2021, 4,752 children and teens were killed by firearms, a rate of almost 6 per 100,000 youths. The rate is up 9% from 2020 and 42% from 2018, according to the study.

About 85% of youths killed by firearms in 2021 were male, and 83% were ages 15-19 years. Half of the deaths were among Black youths, and the rate for this group rose from 11 per 100,000 in 2018 to 19 per 100,000 in 2021.

The highest firearm death rates were in Louisiana, Mississippi and Alabama. Researchers also found links between high poverty levels and high firearm death rates.

“These findings highlight the necessity and urgency of real-time epidemiological surveillance of this epidemic and implantation of evidence-informed strategies to prevent pediatric firearm fatalities among children and adolescents at highest risk,” authors wrote.


About 64% of the pediatric firearm deaths in 2021 were homicides, and rates increased from 2.2 per 100,000 in 2018 to 3.7 per 100,000 youths in 2021. Rates increased for all pediatric age groups.

Roughly 84% of pediatric firearm homicides were among males, and 67% were Black. The homicide firearm death rate among Black youths was 11 times higher than White youths.

“Addressing these widening racial disparities requires dedicated strategies that dismantle drivers of structural violence,” authors wrote.


About 30% of the pediatric firearm deaths in 2021 were suicides, and rates increased from 1.6 per 100,000 in 2018 to 1.7 per 100,000 in 2021.

Roughly 86% of those who died by suicide were male, and 78% were White. American Indian/Alaska Native children had the highest firearm suicide rate at 2 per 100,000 in 2021, although it was down from 2.6 the year before. Meanwhile, rates rose for Black and White children.

“It is critical that ample attention be given to preventing firearm suicides among children across racial groups,” authors wrote.

AAP efforts

Keeping children safe from firearms has been a priority for the AAP. Efforts this year have included calling for more federal funding of research, holding a town hall with nearly 200 pediatricians and forming a new Firearm Injury Prevention Special Interest Group. Earlier this month, leaders from around the country chose two firearm-related resolutions to be among their top 10 priorities for the Academy.

“Pediatricians have been and continue to be at the forefront of overcoming partisan politics to call for progress and change on this important issue,” Lois K. Lee, M.D., M.P.H., FAAP, chair of the AAP Council on Injury, Violence and Poison Prevention Executive Committee, said at the town hall.



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