Alarming Trends in Mortality From Firearms Among US School Children

Firearm mortality in the United States is a continually escalating public health crisis, with nearly 40,000 deaths recorded by the CDC in 2017 alone.¹

Many evidence-based viewpoints and recommendations for reducing firearm mortality in the United States have been published, including a position paper from the American College of Physicians and manuscripts in JAMA and New England Journal of Medicine.^2-4

As work towards solving this crisis continues to be done, of great concern is the impact of firearm deaths among school-aged children. Suicides, unintentional discharge of firearms stored at home, and school shootings–such as Columbine High School in Colorado, Sandy Hook Elementary School in Connecticut, and more recently, Marjory Stoneman Douglas High School in Florida and Santa Fe High School in Texas–have led to thousands of preventable deaths among children for decades.¹

Consultant360 spoke with Charles H. Hennekens, MD, DrPH, senior author of a study recently published in the American Journal of Medicine on firearm mortality trends among US schoolchildren. He shed light on key findings that physicians should note, which could help guide future recommendations for reducing firearm deaths among children in the United States.⁵

Consultant360: What were some of the most concerning trends observed in your study of firearm mortality among US schoolchildren?

Dr Hennekens: From 1999 to 2017, 38,942 firearm-related deaths occurred in children and adolescents aged 5 to 18 years.⁵ This figure included 6464 deaths in children aged 5 to 14 years (average: 340 deaths per year) and 32,478 deaths in children aged 15 to 18 years (average: 2050 deaths per year).⁵

It is sobering that, in 2017, the rate of firearm-associated fatalities among US schoolchildren far surpassed those among law enforcement and military personnel. In 2017, 144 police officers died in the line of duty, and about 1000 active-duty military members throughout the world died, whereas 2462 school-age children were killed by firearms.⁵

C360: What intents were associated with these trends?

Dr Hennekens: Among children and adolescents aged 5 to 14 years, intents associated with firearm fatalities were classified as accidents (830 deaths; 12.8%); suicides (1912 deaths; 29.6%), assaults (3545 deaths; 54.8%) and undetermined causes (177 deaths; 2.7%).⁵

Among adolescents aged 15 to 18 years, causes of death were classified as accidents (1121 deaths; 3.5%), suicides (10,688 deaths, 32.9%) assaults (20,247 62.3%), and undetermined causes (422 deaths; 1.3).5 No deaths were classified as terrorism.⁵

C360: Did the trends suggest certain demographic groups were more affected than others?

Dr Hennekens: Black children and adolescents aged 5 to 14 years experienced statistically significant increases in firearm-related deaths beginning in 2013. Between 2013 and 2017, racial inequalities in firearm-related deaths between black and white children and adolescents had increased significantly among those aged 5 to 14 years, as well as those aged 15 to 18 years.⁵ Black children and adolescents comprised 41% of all deaths, and boys comprised 86% of all deaths.⁵

C360: What key clinical takeaways from your study would you like to leave with our audience?

Dr Hennekens: In the United States, fatalities from firearms in schoolchildren are increasing at alarming rates. This escalating epidemic poses increasing clinical, public health, and policy challenges. My team and I believe there is a need for analytic studies designed a priori to test the hypotheses generated by these descriptive data rather than imposing federal laws and policies that limit these studies. In addition, we believe that failing to address firearms in our efforts to combat the epidemic of mortality from firearms among US schoolchildren is analogous to attempting to solve the epidemic of mortality from lung cancer caused by cigarettes without addressing cigarettes.

Charles H. Hennekens, MD, DrPH, is the first Sir Richard Doll Professor and Senior Academic Advisor to the Dean of the Charles E. Schmidt College of Medicine at Florida Atlantic University.

References:

1. Underlying cause of death 1999-2017 on CDC WONDER Online Database. Centers for Disease Control and Prevention, National Center for Health Statistics. December 2018. https://wonder.cdc.gov/controller/saved/D76/D48F344. Accessed May 1, 2019.

2. Butkus R, Doherty R, Bornstein SS, et al. Reducing firearm injuries and deaths in the United States: a position paper from the American College of Physicians [Published online October 30, 2018]. Ann Intern Med. doi:10.7326/M18-1530.

3. Zeoli AM, Webster DW. Firearm policies that work. JAMA. 2019;321(10):937-938. doi:10.1001/jama.2019.0706.

4. Maa J, Darzi A. Firearm injuries and violence prevention – the potential power of a Surgeon General’s report. N Eng J Med. 2018;379:408-410. doi:10.1056/NEJMp1803295.

5. Rubenstein A, Wood SK, Levine RS, Hennekens CH. Alarming trends in mortality from firearms among United States schoolchildren [Published online March 25, 2019]. Am J Med. https://doi.org/10.1016/j.amjmed.2019.02.012.