Thursday, December 20, 2018

Rising U.S. Youth Firearm, Motor Vehicle Crash Deaths Called ‘Shameful’

There was a 28% increase in the rate of firearm deaths among U.S. children between 2013 and 2016, according to a report published today in the New England Journal of Medicine.

In all, there were more than 20,000 deaths among children and adolescents in the United States in 2016, and the majority—60%—resulted from injury-related causes. Motor vehicle crashes were the leading cause of death for children and adolescents, representing 20% of all deaths, followed by firearm-related injuries (15%), and malignant neoplasm, or cancer (9%).

Declines in deaths from infectious disease or cancer have been eclipsed by increases in deaths from injury-related causes, including motor vehicle crashes, firearm injuries, and the emerging problem of opioid overdoses, wrote Rebecca M. Cunningham, M.D., a professor of emergency medicine and director of the Injury Prevention Center at the University of Michigan Medical School, and colleagues. “Although viewed as ‘accidents,’ injury prevention science increasingly shows that such deaths are preventable with evidence-based approaches,” the authors noted.

Between 2013 and 2016, the firearm homicide rate and suicide rate jumped 32% and 26%, respectively. The U.S. rate of death from firearms among youth was more than 36 times as high as that in 12 other high-income countries in 2016, authors noted. Meanwhile, the rate of suicide by other means increased 15%.

Among youth firearm deaths, 59% were homicides and 35% were suicides. The researchers also found drug overdoses or poisoning made up nearly 5 percent of youth deaths in 2016, and the vast majority (78%) were unintentional.

When viewed by racial or ethnic group, youth mortality was highest among blacks (38 per 100,000) and American Indian or Alaska natives (28 per 100,000) than among whites (24 per 100,000). The disparities were most pronounced for firearm-related deaths, which were the leading cause of death among black youth and occurred at a rate nearly four times higher than the rate among white youth.

An accompanying editorial by Edward W. Campion, M.D., pointed out a child or adolescent in the United States is 57% more likely to die by the age of 19 years than those in other wealthy nations. “Children in America are dying or being killed at rates that are shameful,” Campion wrote. “Both individuals and the larger society need to understand that there is much that can be done to reduce the rate of fatal trauma. Strong leadership by the medical and public health communities is needed. Education, awareness, and very feasible interventions can help protect children and adolescents.”

Over the past decade, the rate of youth death from motor vehicle crashes showed the most notable improvement, dropping 38%, in part to widespread adoption of seat belts and car safety seats, the authors noted. However, since 2013 there has been a reversal of this trend with the rate of youth motor vehicle crash deaths on the rise due to unknown causes, possibly increases in distracted driving by teens because of peer passengers or cell-phone use, the authors wrote.

The report summarizes the leading causes of death for children and adolescents aged 1 to 19 years using ICD-10 codes and causes of death on U.S. death certificates. Data were obtained from the Wide-ranging Online Data for Epidemiologic Research system of the Centers for Disease Control and Prevention (CDC WONDER) in 2016, the most recent year with national data available.

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