Child mortality rates are higher in the United States than in most European industrialized countries. This excess in mortality is not due to a difference in death rates from all natural causes; rather, all the excess mortality among US children can be attributed to injury (Fig 1). These differences are particularly notable for children 15 to 19 years of age. Suicide rates among 15- to 19-year-olds are higher in the United States than in most other industrialized countries (Fig 2). Excess homicide mortality among 15- to 19-year-olds is particularly striking (Fig 3). In 1985, 1579 homicides occurred among males and females aged 15 to 19 years in the United States. In the same year, only 150 homicides occurred among 15- to 19-year-old males and females in the Federal Republic of Germany, France, England and Wales, Sweden, Canada, and Japan, despite the fact that the combined population of these countries is 1.4 times the populations of the United States.

Our successes in infectious disease control dramatize our failures to control injuries effectively and increase the relative importance of injury. Injury is now the leading cause of childhood mortality and disability and a leading cause of childhood morbidity. In the last 60 years, death rates due to infectious diseases declined 90%, but death rates due to injuries declined only 40%. Since 1968 rates of injury deaths among children declined 25%, but death rates for diseases declined 56% (Fig 4). Deaths from diseases have decreased in the United States, but deaths from injuries have not decreased as much.

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