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Racial, ethnic disparities persist in deaths due to firearms, motor vehicle crashes among youths

December 23, 2024

A study co-authored by the AAP Department of Research found racial and ethnic disparities among the two leading causes of death among U.S. youth and calls for a multipronged approach to prevention and more granular research.

Authors examined 35,684 firearm and 40,735 motor vehicle crash (MVC) deaths among youths ages 0-19 from 2011-’21 using data from the Centers for Disease Control and Prevention’s Web-based Injury Statistics and Query Reporting System (WISQARS). Deaths were categorized by mechanism, intent, age group, sex, and race and ethnicity.

“An improved understanding of populations at high risk by mechanism and intent are critical for informing, developing, applying, and evaluating effective prevention strategies with an equitable approach,” the authors wrote.

Firearm deaths

Of the firearm deaths, 59.8% were homicides, 33.9% were self-inflicted, 3.8% were unintentional, 0.77% were by legal enforcement and 1.6% had unknown intents. Using a Joinpoint regression model, authors found that firearm death rates increased from 2014-’21 with an average percent change (APC) of 8.7%.

Significant disparities were found in homicide rates by sex and race and ethnicity. Black males had the highest rate, peaking in 2021 at 30 deaths per 100,000 people — six times the rate of Hispanic males (4.97 deaths per 100,000). Black females had the highest rates among their sex, also peaking in 2021 at 5.37 per 100,000. They also had the highest APC increase (45.5%) from 2019-’21.

Overall, there was an 87% relative increase in youth firearm homicides over the study period.

Firearm suicide deaths saw a 68% relative increase, with the APC increasing 22% among Black females from 2016-’21. The highest suicide rate among all groups came in 2020 among 15- to 19-year-old American Indian/Alaska Native males (24.29 per 100,000).

The study authors recommended the expansion of community- and hospital-based violence intervention programs, mental health screening and treatment and lethal means counseling, and state-level policy reform to address firearm fatalities.

Motor vehicle crash deaths

The APC in MVC death rates decreased by 1.4% from 2011-’19, then shot up 9.2% from 2019-’21. MVC remained the most common cause of death among children ages 0-9 for the study period, with 8,177 deaths.

Again, disparities were observed by sex and race and ethnicity. Black youths ages 0-19 had the highest statistically significant APC increase (20.9%) from 2019-’21. The highest fatality rates came in 2021, among American Indian/Alaska Native males (38.16 per 100,000) and females (29.31 per 100,000) ages 15-19.

“Focused interventions related to child safety seat use, the built environment, and driving behaviors are important strategies, which should be broadly applied to decrease MVC injuries and deaths,” the authors wrote.

Limitations and conclusions

WISQARS added a category in 2021 for people who identify as belonging to more than one race. The 11-year study excluded that data for consistency.

Authors also recognized that death certificate information and race and ethnicity reporting may be inaccurate, and that gender identity is not included in WISQARS data.

Future research should examine pediatric injury trends in the wake of the pandemic, which precipitated changes in pediatric injury epidemiology, the authors said.

“A multipronged approach using established injury prevention strategies, which engage families, the medical and public health community, and policymakers are essential to address these leading preventable causes of death for US children and youth,” they wrote.

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