Preventable injuries — caused primarily by motor vehicle crashes and guns — are responsible for six out of 10 childhood deaths in the United States, according to a study published Thursday in the New England Journal of Medicine (NEJM).
By comparison, less than 1 in 10 deaths of American children and teens are caused by cancer.
The study’s findings are deeply disturbing, for they underscore how much the country is failing to safeguard the health of its young people.
“Children in America are dying or being killed at rates that are shameful,” writes Dr. Edward Campion, NEJM’s executive editor, in a scathing editorial that accompanies the study. “The sad fact is that 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.”
“America’s children and adolescents are at far higher risk for death than are youth in other developed countries such as England, Sweden, and Australia,” he adds.
For the study, researchers at the University of Michigan’s Injury Prevention Center analyzed national data from U.S. death certificates for 2016, the most recent year for which such data was available. They found that 20,360 young people aged 1 to 19 died in the United States that year. More than 12,000, or 61 percent, of those deaths were injury-related.
Motor vehicle crashes led the list with 4,074 deaths, or about 20 percent of the total.
Young people living in rural areas were at the greatest risk of dying as a result of a motor vehicle-related injury. The rate of such deaths was almost three times higher among children and teens living in rural communities than in urban or suburban areas — even after adjusting for the extra miles traveled by drivers in rural areas, the study found.
There is some positive news in the motor vehicle number, however. The rate at which young people are dying in motor vehicle crashes has decreased dramatically over the past two decades, falling by 38 percent between 2007 and 2016 alone. The study cites many factors for the drop, including various improvements in vehicle safety, graduated driver-licensing programs and public health campaigns aimed specifically at reducing teen drinking and driving.
Yet, as Campion points out, the rate at which America’s youth are dying on our highways is still three times higher that of other developed countries. Also troubling is the fact that motor vehicle-related deaths have begun to increase again in recent years, most likely due to distractions caused by the use of cellphones by both drivers and pedestrians.
The second-leading cause of childhood deaths in the U.S. is firearm injuries, which claimed the lives of 15 percent (3,143) of all the country’s children and teens who died in 2016, according to the study.
That means that guns are involved in the deaths of more than eight young people each day, the study’s authors point out.
Most of those gun-related deaths were homicides (1,865) and suicides (1,102).
The U.S. childhood gun-death rate is lower than at its peak in 1993, but it rose by 28 percent between 2013 and 2016. That increase reflects a 32 percent rise in the rate of gun homicides and a 26 increase in the rate of gun suicides. The rate of unintentional gun deaths, which is the leading cause of firearm death among children aged 1 to 9 years, has remained relatively stable.
Young people in the United States die from gun injuries at a rate that’s about 36 times higher than the average rate for young people living in 12 other high-income countries, the study points out.
“One in three U.S. homes with youth under 18 years of age has a firearm, with 43% of homes reporting that the firearm is kept unlocked and loaded, which increases the risk of firearm injuries,” the study’s authors write. “In addition to differences in availability between the United States and other countries, there is wide variability across countries in laws relating to the purchase of firearms, access to them, and safe storage.”
Teens living in America’s urban areas were about twice as likely to die in gun homicides as their rural counterparts, but rural teens were about twice as likely to die in gun-related suicides. Suburban teens who died from firearm-related injuries in 2016 were about equally likely to have done so as a result of a homicide as of a suicide.
“Firearm deaths of children and adolescents are an ‘everybody’ problem, not a problem for just certain populations,” stresses Dr. Rebecca Cunningham, the study’s lead author and director of the U-M Injury Prevention Center, in a released statement.
The other eight leading causes of childhood deaths in the U.S. in 2016 were cancer (1,853 deaths); suffocation, mostly from suicides (1,430); drowning (995); drug overdoses or poisoning, mostly unintentional (982); congenital anomalies (979); heart disease (599); fire or burns (340); and chronic lower respiratory disease (274).
The cancer death rate (the only non-injury-related one among the top five causes of childhood deaths) fell 32 percent between 1990 and 2016, “which reflects scientific advancements in cancer prevention, detection, and treatment,” the study’s authors write.
Childhood deaths due to drowning fell by 43 percent during that same time period, and deaths due to residential fires fell by nearly 73 percent. Both of these declines are due in large part to public health efforts (such as pool safety and anti-smoking campaigns) and more effective government regulations (including ones that require fencing around pools and stricter building fire codes).
But drug overdoses have climbed in recent years, becoming the sixth-leading cause of death among America’s young people. That rise is largely because of an increase in opioid overdoses among teenagers, the study’s authors report.
‘We ought to be able to agree’
“Devastated families take no comfort from the fact that childhood deaths are now far less common than they were in centuries past,” writes Campion. “In recent decades, there has been progress, but the United States is clearly not effectively protecting its children. The problem is not deficiencies in medical care; it is the high rate of lethal traumatic injury.”
A major barrier to preventing many of these deaths, he adds, “is the sense of helpless inevitability conveyed by the word ‘accident.’ Car crashes and lethal gunshots are not random results of fate. Both individuals and the larger society need to understand that there is much that can be done to reduce the rate of fatal trauma.”
But progress will not be easy, as Campion makes clear:
The approach to this underrecognized public health problem has to be social as well as technological, and the risks are highest in areas of poverty and social isolation. Essential medical care should be guaranteed for every child in the country. That care needs to include access to the social supports and mental health services that promote health and safety and save lives. Such a commitment would be an investment in the next generation that can promote family stability and healthy development while reducing the underlying causes of trauma and violence. Laws and programs are also urgently needed to improve gun safety, and these initiatives need the support of those on all sides of the contentious political debates about guns. The guiding principle should be to save the lives of children.
“We are living in a divisive era in which there are few areas of consensus and agreement,” he adds. “Perhaps one of the few core beliefs that all can agree on is that deaths in childhood and adolescence are tragedies that we must find ways to prevent. Shouldn’t a child in the United States have the same chance to grow up as a child in Germany or Spain or Canada? We ought to be able to agree that in a country with America’s wealth and resources, children should have the opportunity to live, play, and grow to become adults.”
For more information: Abstracts of the study and the editorial can be found on NEJM’s website, but the full papers are behind a paywall.