Current causes of death for children and adolescents in the United States

To the editor:

The Centers for Disease Control and Prevention (CDC) recently released updated official death data that showed 45,222 firearm-related deaths in the United States in 2020 — a new peak.1 Although previous analyzes have shown increases in firearm-related deaths in recent years (2015 to 2019), compared to relatively stable rates from previous years (1999 to 2014),2,3 This new data shows a sharp 13.5% increase in the crude gun-related death rate from 2019 to 2020.1 This change was largely driven by firearm homicides, which saw a 33.4% increase in the crude rate from 2019 to 2020, while the crude rate of firearm suicides increased by 1.1%.1 Given that firearm homicides disproportionately affect young adults in the United States,3 These data require an update of the results of Cunningham et al. Regarding the leading causes of death among children and adolescents in the United States.4

Leading causes of death for children and adolescents in the United States, 1999 through 2020.

Children and adolescents are defined as persons between the ages of 1 and 19 years.

The previous analysis, which examined data up to 2016, showed that firearm-related injuries were second only to motor vehicle accidents (both traffic-related and non-traffic-related) as the leading cause of death among children and adolescents, defined as people 1 to 19 years old. of age.4 Since 2016, this gap has narrowed, and in 2020, firearm-related injuries become the leading cause of death in that age group (shape 1). From 2019 to 2020, the relative increase in firearm-related deaths of all types (suicide, homicide, unintentional, and unspecified homicide) among children and adolescents was 29.5%—more than double the relative increase in the general population. . The increase was observed across most demographics and types of firearm-related deaths (Figure S1 in the Supplementary Appendix, available with the full text of this letter at

Additionally, drug overdose and poisoning increased by 83.6% from 2019 to 2020 among children and adolescents, becoming the third leading cause of death in that age group. This change can largely be explained by the 110.6% increase in unintentional poisonings from 2019 to 2020. Rates for other major causes of death have remained relatively stable since the previous analysis, indicating that changes in mortality trends among children and adolescents during early COVID-19 a pandemic that was specific to firearm-related injuries and drug poisoning; Covid-19 itself resulted in 0.2 deaths per 100,000 children and adolescents in 2020.1

Although the new data is consistent with other evidence that gun violence has increased during the Covid-19 pandemic,5 The reasons for the increase are unclear, and it cannot be assumed that firearm-related deaths will subsequently return to pre-pandemic levels. Regardless, the increasing death rate associated with firearms reflects a long-standing trend and shows that we are still failing to protect our young people from a preventable cause of death. Generational investments in gun violence prevention are being made, including new funding opportunities from the Centers for Disease Control and Prevention and the National Institutes of Health, and funding for community violence prevention has been proposed in federal infrastructure legislation. This financing momentum must be maintained.

Jason E. Goldstick, Ph.D.
Rebecca M. Cunningham, MD
Patrick Carter, MD
University of Michigan, Ann Arbor, Michigan
[email protected]

Disclosure forms provided by the authors are available with the full text of this letter at

This message was posted on April 20, 2022, at

  1. 1. Centers for Disease Control and Prevention. CDC Wonder. 2021 (

  2. 2. Goldstick JAnd ZioliAnd MerciAnd Cunningham RM. Firearms-related deaths in the United States: national, state, and population trends, 1999–2017. Department of Health (Millwood) 2019; 38:16461652.

  3. 3. Goldstick JAnd Carter PMAnd Cunningham RM. Current epidemiological trends of firearm deaths in the United States. Gamma Psychiatry 2021; 78:241242.

  4. 4. Cunningham RMAnd Walton MasterAnd Carter PM. The leading causes of death in children and adolescents in the United States. In Angel J Med 2018; 379:24682475.

  5. 5. Schleimer GBAnd McCourt CDAnd chef dad, and others. Firearms procurement and gun violence during the coronavirus pandemic in the United States: a cross-sectional study. Eng Epidimol 2021; 8:4343.

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