The major cause of death in children aged 1 to 19 years is not cancer or other another medical condition. It's injury. And by a long shot – 61 percent, versus 9 percent for cancer.
The largest cause of injury was motor vehicle crashes, and next was firearms, according to a study published today in the New England Journal of Medicine. The study sorts through the 20,360 deaths of U.S. children and adolescents in 2016, as counted by the Centers for Disease Control and Prevention.
The authors of the report also found that the U.S. compares poorly to other countries, both rich and poor, in terms of providing a safe environment for kids.
Lead author Rebecca Cunningham of the University of Michigan, who has been an emergency room physician for 20 years, wasn't surprised. "I've been taking care of kids and unfortunately giving bad news to families for several decades," she says.
Cunningham sees some good news in the motor vehicle number. Death rates from crashes have dropped dramatically over the years, from 10 deaths per 100,000 children and adolescents in 1999 to 5.21 deaths per 100,000 in 2016.
"In the U.S. we've invested in decreasing motor vehicle crash deaths and we've been tremendously successful at that," she says. She and her colleagues credit seat belts, car seats for children, safety improvements to cars, the construction of better roads, and growing awareness of the hazards of teen drinking and driving.
But when it comes to firearms there have been no effective interventions to prevent deliberate and accidental gun deaths. While the death rate from guns remained flat from 1999 to 2013, it jumped 28 percent in the next three years, to 4 deaths per 100,000 American kids. "We're seeing increases in both gun homicide and gun suicide" among children and adolescents, Cunningham says.
Cunningham says she's not sure why gun death rates have increased. But she says it should be addressed. "I don't think it's acceptable for firearms to be a preventable cause of death and remain the second cause of death of children and teens," she says. "We're not doing enough to keep kids safe."
Edward W. Campion, the executive editor of the New England Journal of Medicine, pointed out how exceptional the U.S. is when compared to other countries.
"We are way out of line when you compare the trauma deaths in American children compared to what faces children in other developed countries like Germany, Spain and Canada," he says. He points to a study published last January showing that an American child or adolescent is 57 percent more likely to die by age 19 than kids in other wealthy nations.
In an editorial for the Journal accompanying Cunningham's study, Campion called the numbers "shameful." He says the U.S. is clearly not effectively protecting its children.
The World Health Organization had collected data on motor vehicle deaths and firearm deaths in 12 high-income countries and seven low-and-middle-income countries. Cunningham and her colleagues compared that data with their numbers on U.S. deaths.
The rate of firearm deaths in the U.S. far exceeds the rates of the other countries included in the report. It's 36 times the average rate in the 12 high-income countries – that is, 4.02 deaths per 100,000 kids in the U.S., versus 0.11 deaths in the other countries. "It's a gigantic difference," says Cunningham.
And it was five times as high as in the seven low- and middle-income countries studied, where the average rate was 0.8 deaths per 100,000 kids per year.
The U.S. rate of motor vehicle deaths also exceeds the rate of other high-income countries in the report. It was 5.21 deaths per 100,000 children – nearly triple the 1.63 per 100,000 average for other wealthy countries such as England. Sweden in 1997 launched a program to try to eliminate all deaths caused by motor vehicles in the country and in 2016 came in at less than one death per 100,000.
The comparison with motor vehicle deaths in low-and-middle income countries is mixed. Some of the countries, such as Thailand, scored higher, but other countries, such as Romania, scored lower. The researchers say it all depends on economic development – as poorer countries add cars, some are spending money on building safe roads and providing access to emergency health care, and some countries are not.
The overall message of the data to both Cunningham and Campion is that if other countries can have lower rates of death for their children and adolescents, the U.S. can too.
"The U.S. takes great pride in its medical knowledge," Campion says. "People go to all kinds of lengths to try to help a child with a medical need."