‘Pretty shocking’: Child firearm deaths continued to rise in 2021

Key takeaways:

• From 2018 to 2021, pediatric firearm deaths rose by 42%.
• Higher poverty levels correlated with higher gun-related deaths.

Child firearm deaths continued to rise in 2021 after a “huge spike” in the preceding 2 years, according to a study published in Pediatrics.

Last year, the AAP issued a policy statement recommending that firearms — which remain the leading cause of death for children and young adults in the United States — regulate firearms on the level of motor vehicles, with requirements for training, licensing, insurance coverage and registration.

“We were very curious [about] the number of kids killed by guns, particularly as we near post-pandemic years,” Chethan Sathya, MD, MSc, surgical director of pediatric critical care at Cohen Children’s Medical Center and director of the Northwell Health Center for Gun Violence Prevention in New York, told Healio.

“We saw a huge spike in gun deaths in America among children and adults from 2019 to 2020, and many of us figured that that was due to the extenuating circumstances of the COVID-19 pandemic,” Sathya said. “We would have expected that in 2021, maybe that number would have started to plateau or come down. But instead, it went above and beyond those drastic 2020 numbers, which is pretty shocking and really suggests a very dangerous inflection point here.”

Sathya and colleagues studied the CDC’s WONDER data system for firearm-related mortality data and additional injuries among children and adolescents from 2018 through 2021. There were 3,342 deaths in 2018, 3,390 in 2019, 4,368 in 2020 and 4,752 in 2021.

“We also further evaluated [whether or not there is] a correlation across different states and socioeconomic status, just to give a little bit more granularity in that data,” Sathya said.

They also “stratified not only by different age groups within pediatrics but also looked at different types of disparities when it comes to race, age, and so on, as well as all the different types of gun injuries, whether they be suicide, unintentional injury or homicide,” Sathya said.

From 2018 to 2021, the authors found an increase of nearly 42% in the rate of children killed by guns. The 4,752 pediatric firearm deaths in 2021 translated to a rate of 5.8 per 100,000 persons, representing an 8.8% increase in the 2020 rate. Of the 2021 pediatric firearm deaths, 64.3% were homicides, 29.9% were suicides and 3.5% resulted from unintentional injury.

The authors also found that the suicide rate increased among Black children, who also accounted for 67.3% of firearm homicides, and white children, who accounted for 78.4% of suicides. They did note that the suicide rate decreased among American Indian or Alaskan Native children, but that there were worsening clusters of firearm death rates in the South and increasing rates in the Midwest from 2018 to 2021.

“In general, I would say that it was not surprising that firearms are still the leading cause of death among kids in this country,” Sathya said. “We've had good public health approaches to things like car safety, those car-related accidents have been going down, or debt.”

According to Sathya, it is crucial for providers to have conversations about firearm safety with patients and their parents.

“There's a lot you can do as health care professionals, such as conversations with patients about risk — either related to firearm access or gun violence,” Sathya said. “By asking those simple questions, not only do you help reframe this as a public health issue and normalize conversations around gun injury risk mitigation, but you also help to inform patients about the risks and get them thinking about this in a way that promotes the idea that this is a health care issue and something that is at the forefront of most Americans’ minds.”

“This is our one of our main public health crises in this country,” Sathya continued. “We have to consider this a health care issue and a public health issue, not a political one.”