In 2016, 3,143 children and adolescents died of a gunshot wound in the United States, a new tally of childhood deaths finds. These children accounted for 15.4 percent of all those Americans between 1 and 19 who died in 2016, and a quarter of all those killed by injury rather than disease.
As they inch their way back to rates last seen in 1999, childhood deaths attributed to firearms generated 70 percent more grieving families than those produced by pediatric cancer (1,853) in 2016. Guns also created more than three times as many bereft families than did childhood drownings (995).
A child's poisoning death or fatal drug overdose broke the hearts of 982 families in 2016. A gun devastated three times as many families by taking a child's life.
The figures _ the latest and most comprehensive accounting of childhood deaths available _ were published Wednesday in the New England Journal of Medicine. They were compiled by a team from the University of Michigan.
The number of children who died of a gunshot wound intentionally inflicted by someone else in 2016 _ 1,865 _ came in just ahead of the total number of childhood deaths attributed to birth defects, heart disease and chronic respiratory diseases such as asthma combined:1,852. The number of children or adolescents who took their own lives with a gun _ 1,102 _ represents half of all children and adolescents who died by suicide in 2016.
Childhood deaths caused by a firearm in 2016 were exceeded only by those caused by motor vehicle crashes (4,074). Although there's been a worrisome rise in such fatalities since 2013, safety improvements and drunken driving initiatives have steadily driven the pediatric toll of vehicle accidents to roughly half their 1999 rate.
At 4.02 per 100,000 children, the 2016 rate of childhood firearms deaths stands at half the rate of pediatric gun deaths (8.12 per 100,000) seen at their most recent peak, in 1993.
But the decline has since stalled: The 2016 rate represents a reduction of less than 10 percent from rates seen in 1999. Between 2013 and 2016, the rate of gun-related deaths among kids in the U.S. grew 28 percent. That upward trend in firearm mortality reflected a 32 percent increase in the rates of firearm homicide and a 26 percent increase in the rate of youth suicides carried out with a gun.
The relatively steady toll of firearms stands in contrast, too, to trends in children's cancer deaths: By 2016, improved detection and treatment of pediatric cancer had helped drive down such deaths by almost one-third since 1999. Over four decades, a child diagnosed with cancer has seen her odds of surviving rise from 10 percent to nearly 90 percent.
"Children in America are dying or being killed at rates that are shameful," wrote Dr. Edward W. Campion in an editorial published alongside the new report on childhood causes of death. Campion, the executive editor of NEJM, called the death of a child "a crime against nature" and "the most stressful thing that can happen to parents and siblings."
Despite progress is some areas, he wrote, "the United States is clearly not effectively protecting its children."
The authors of the new report, as well as Campion, are rigorously even-handed about the various causes of children's deaths in the United States. They noted the role of cellphone distraction in driving up motor vehicle deaths in recent years. They lauded the effects of pool fencing in reducing drownings, and smoke detectors in preventing children's deaths in house fires. They cited the impact of longer transport times to hospitals to help explain why rural children were more likely to die of injuries than were kids in cities or suburbs.
In short, the authors made no effort to distinguish firearms as a cause of pediatric death different from any other.
The facts they cite do that, and they jump off the page:
_ The rate of childhood deaths caused by guns in the United States was more than 36 times as high as the rate seen in 12 other high-income countries. The affluent countries that had the next closest rate of childhood deaths due to guns _ Croatia, Lithuania and Sweden _ had rates about 20 times lower than those in the United States.
_ One in three U.S. homes with children under 18 has a firearm, with 43 percent of homes reporting that the firearm is kept unlocked and loaded, which increases the risk of firearm injuries.
_ Firearms in 2016 were the leading cause of death among African-American children and adolescents, occurring at a rate 3.7 times the rate of gun-related deaths among white youth. African-American children are also much more likely than white children to drown, or die in house fires, or of asthma. But as a statistical matter, the gun-related death rates among African-American kids do much more to drive a shocking racial disparity in the United States: That while white kids died at a rate of 24.2 per 100,000, black youth died at a rate of 38.2 per 100,000.
_ Firearm violence in schools accounts for less than 1 percent of all suicides and homicides among school-age children and adolescents, the authors wrote. But they cited a recent review noting an upward trend in school shooting incidents, with 35 school shootings in 2013, 55 in 2014, and 64 in 2015.
_ Finally, gun "accidents" claimed the lives of 126 children in 2016. These unintentional causes represented 26 percent of all firearm deaths among children between the ages of 1 and 9 years old and 3 percent of firearm deaths among adolescents between 10 and 19 years of age.
The authors of the new report weren't keen on the use of the term "accidents" in any context, whether they referred to the unintentional discharge of a gun, a poisoning or a skateboard crash.
It's time for Americans to start thinking about kids' injuries "not as 'accidents,' but rather as social ecologic phenomena that are amenable to prevention," the authors advised. Underpinned by solid scientific research, public health campaigns have helped drive down kids' deaths and injuries in vehicle crashes, drowning and home fires, they wrote. Those approaches should be expanded to "all leading causes of death," they added.
