As many as eight children are killed by guns each day in the United States, according to a study revealing firearms are the second biggest cause of death among young people after car crashes.
The latest figures from 2016 released in the New England Journal of Medicine show 20,360 children and teens died in the U.S. that year. Sixty percent of the deaths were caused by preventable injuries, the authors said.
Some 4,074 young people aged 19 or younger died in motor vehicle incidents, amounting to a fifth of total deaths. Meanwhile at 15 percent, 3,140 deaths were caused by a firearm.
Between 2013 and 2016, firearm deaths spiked by 28 percent to four in 100,000 per year among those aged 19 or younger.
Dr. Rebecca Cunningham, Professor of Emergency Medicine at the University of Michigan Medical School and lead author of the study, told Newsweek the 2017 data on gun deaths was released after the study was submitted. But the numbers indicate they have risen again to 4.4 in 100,000.
Of the 2016 total, homicides made up 59 percent of firearm deaths, followed by suicides at 35 percent. Accidents accounted for around four percent of cases, with mass shootings just below one percent. Boys were more than five times more likely to die by gunshot than girls, and twice as likely to drown.
The overall trend of gun deaths among children has been growing since the 1990s, said Cunningham. This may be because one-third of U.S. adults admit to keeping a loaded, unlocked gun at home.
And while the rates of vehicle and cancer-related deaths are dropping, thanks to public health efforts, the same can't be said for firearm incidents, the researchers at the University of Michigan Injury Prevention Center warned. The figure has remained stagnant for around 20 years, and is 36 times higher than in any of the other high-income countries. For instance, only Croatia, Lithuania and Sweden had rates topping 0.20 per 100,000.
The study also revealed cancer was the third biggest killer of children and teenagers, claiming the lives of 1,853. Rates of suffocation (generally due to suicide) were found to have risen and are the fourth highest cause. In fifth place was drug overdoses—with opioids accounting for more than half—followed by birth defects.
To calculate the number of deaths among children and teenagers in the U.S. as well as the leading causes, the researchers pored over public data including death certificates and information provided by the Centers for Disease Control and Prevention.
No single demographic was untouched by gun deaths, highlighted Cunningham. Children faced the same risk whether they lived in rural, urban or suburban settings.
"As an emergency physician I have cared for these children and teens in both suburban and urban areas. This happens in all our neighborhoods," she said,
Cunningham envisions the work informing policies to prevent gun deaths among young people mirror successful campaigns on car crash deaths that have cut rates "substantially" in the past 17 years.
"Firearm deaths are preventable deaths. They are not 'too complex,' and the problem is not too difficult to tackle," she argued. "Scientists have tackled problems as or more complex for ages." This can be achieved by "respecting the rights and culture of our U.S. citizens," she said.
"This is not a topic that we in medicine or emergency medicine can simply look away and not see because it is so uncomfortable or political. It is there every day in hospitals across the country," she said.
In an article accompanying the study, Dr. Edward W. Campion, the online editor of the New England Journal of Medicine and former Chief of the Geriatrics Unit at the Massachusetts General Hospital and Spaulding Rehabilitation Hospital, wrote: "Children in America are dying or being killed at rates that are shameful. The sad fact is that a child or adolescent in the United States is 57 percent more likely to die by the age of 19 years than those in other wealthy nations.
"Car crashes and lethal gunshots are not random results of fate," he continued. "Both individuals and the larger society need to understand that there is much that can be done to reduce the rate of fatal trauma."
Dr. Stephanie Chao, assistant professor of surgery at Stanford School of Medicine and Trauma Medical Director at Stanford Children's Health, who was not involved in the study told Newsweek: "This study is important because it highlights the fact that six of the top 10 causes of pediatric mortality are entirely preventable.
"It also demonstrates how poorly the U.S. compares with other developed nations in terms of mortality from preventable causes like motor vehicle accidents and firearms." She also praised the paper for breaking down mortality disparities according to rurality, race and sex.
"By describing pediatric mortality trends in a more nuanced fashion, the report allows public health officials, policymakers, and the average individual understand how the national data applies to their own community," she said. "That is the first step in devising targeted interventions that will make a difference in each community."
However, she pointed out the study's data do not directly account for why injuries remain a leading cause of pediatric mortality, "but the authors do cite other studies for possible causes."
Dr. Sierra Smucker of Sanford School of Public Policy, Duke University, who did not work on the study, told Newsweek: "The high percentage of children who are killed in firearm homicides may be related to the risk children face in violent domestic contexts.
"We know from extensive research that the presence of a firearm in a domestic violence incident increases the risk of intimate partner homicide, but we also see that these cases are more likely to include multiple deaths and these additional murders are often the children living in the home."
This article has been updated with comment from Dr. Stephanie Chao and Dr. Sierra Smucker.