National Trends and Disparities for Firearm and Motor Vehicle Crash Deaths from U.S. Youth 2011-2021: the Intersection of Age, Sex, Race, and Ethnicity

Lois K. Lee, MD, MPH
Suk-fong S.Tang, PhD
William L. Cull, PhD
Eric Fleegler, MD, MPH
Lynn M. Olson, PhD

Injuries from firearms and motor vehicle crashes are the leading causes of death among U.S. children and youth 0-19 years old. Examining the intersections of age group, sex, race, and ethnicity is essential to focus prevention efforts. The objectives of this study were to examine firearm and motor vehicle crash fatality rates by population subgroups and analyze changes over time.

We conducted a cross-sectional study of firearm and motor vehicle crash deaths among US children and youth 0-19 years old using data from the Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System (WISQARS) database. We reported firearm and motor vehicle collision (MVC) fatality rates by year and over time. To examine changes over time we performed JoinPoint regression analyses reporting average percent change (APC) per year for fatality rates by age, sex, race, and ethnicity.

From 2011-2021 there were 35,684 firearm and 40,735 MVC fatalities among US youth 0-19 years old. For firearms there were 21,332 (59.8%) homicides, 12,113 (33.9%) suicides, and 1,359 (3.8%) unintentional shootings. For all firearm deaths, an overall increase occurred 2014-2021 (APC 8.7%). For firearm homicides no statistically significant increase occurred until 2018-2021 (APC 19.2%). In contrast, firearm suicide had an APC of 5.6% over the entire study period. When considering age group, sex, race and ethnicity, for firearm homicides among youth 15-19 years old the APCs were similar for non-Hispanic Black (21.8%) and Hispanic (22.2%) males from 2018-2021 though with different peak rates (104.22/100,000 and 17.80/100,000, respectively). Non-Hispanic Black females 15-19 years old demonstrated a dramatic APC increase of 40.7% from 2019-2021 (peak rate 14.07/100,000). For firearm suicide in youth 10-19 years old by sex, non-Hispanic Black females had the greatest APC increase of 22.0% from 2016-2021; however, the highest rate occurred among American Indian/Alaska Native males 15-19 years old (18.12/100,000). For MVCs overall no statistical changes occurred overtime. MVC fatalities increased at the highest rate for non-Hispanic Black males 15-19 years (APC 22.9% 2019-2021) with the highest rates in 2021 among non-Hispanic American Indian/Alaska Native males 15-19 years (38.16/100,000) and females (29.31/100,000).

US youth 0-19 years old experienced important disparities in firearm and MVC fatality rates and increases over time when considering the intersectionality by age group, sex, race, and ethnicity. A multi-pronged strategy focused on individual, community and policy level approaches for specific high risk groups for each injury mechanism are necessary to address these leading causes of death in US youth.

1. Compare trends in firearm and motor vehicle collision deaths over time.
2. Describe differences in fatality rates from firearms by intent when considering the intersections of age group, sex, race, and ethnicity.
3. Discuss changes in motor vehicle collision fatality rates by age group, sex, race, and ethnicity.

Safe Sleep

Lois K. Lee, MD, MPH, FACEP, FAAP
Gina S. Lowell, MD, MPH

Climate Change: What’s the Injury Risk?

Monica Cardenas, MD
Cheryl Holder, MD
Lois Lee, MD, MPH
Judy Schaechter, MD, MBA

For many, climate change conjures up images of polar bears adrift, Amazon deforestation and bleached coral reefs. Increasingly, the human health impacts of climate change are demonstrated and directly and powerfully felt, not only in lands far off, but here at home. 2023 was the hottest year ever on record, contributing to premature birth and excess deaths. The once paradise of Maui experienced the deadliest fire in a century. Smoke from Canadian fires crossed borders to pollute states across the US. Precipitation changes are causing both draughts and deluge, with storms such as Hurricane Harvey pouring down 61 inches of rain, the highest of any single storm in recorded history.

This workshop is designed to engage injury prevention experts in the development of a framework to understand climate change as a cause and contributor to injury. Dialogue will include consideration of classic extreme weather injuries (CO, power lines, burns, puncture wounds and lacerations) as well as conditions on the increase (heat stress) or not usually considered injury (birth outcomes, asthma, brain effects). The workshop will explore the disproportionate impact of climate change on children, how climate change exacerbates health inequities and how health inequities impede the ability to adapt to climate change.

Importantly, tools and action steps for providers and families served will be discussed, empowering participants to address climate change at the personal, practice and/or policy level. Throughout the workshop, participants will be invited to share their experiences and to contribute to the shaping of an injury prevention approach to climate change. Interested attendees may elect to join in the drafting of a manuscript on climate change and child injury prevention.

1. Understand the current injury impacts of climate change, as well as the predicted trends affecting children.
2. Describe the climate change inequities (exposure, physiology, adaptation) which disproportionately effect children, adolescents, pregnant persons, people of color and those living with poverty.
3. Applying the Haddon Matrix, consider prevention, adaptation and mitigation means of injury reduction.
4. Commit to 1-2 action steps at the personal, practice or policy level to address climate change and child injury.