More Americans dying in childhood
Guns, drugs nip progress from medical advances
Child and teen deaths surged during the COVID-19 pandemic, driven by fatal injuries, in a dramatic change after decades of progress from medical advancements in pediatric diseases, according to an editorial published this week in the Journal of the American Medical Association.
Researchers analyzed death certificate data from the Centers for Disease Control and Prevention and found pediatric mortality increased by 20% from 2019 to 2021 – the largest increase in 50 years.
For decades, the overall death rate among Americans 19 and younger has been steadily decreasing because of breakthroughs in prevention and treatment for conditions like premature births, pediatric cancer and birth defects, said lead author Dr. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University.
But the new findings represent a reversal in this trend, “meaning that our children are now less likely to reach adulthood.”
“It’s very tragic,” he said. “The progress that we’ve made in reducing death rates in children is the product of decades of research ... and to see all of that progress be reversed by a handful of factors is really troubling.”
What the report found: Spike driven by injuries
Researchers found this spike is largely driven by an increase in injury-related deaths, such as suicide, homicide, overdose deaths and car accidents, which all began climbing before the COVID-19 pandemic.
● Suicide rates began rising in 2007 and increased by 70% by 2019.
● Homicide rates began rising in 2013 and increased by 33% by 2019.
● Overdose deaths began rising in 2019, shortly before the pandemic.
The study also showed most of the deaths were among those ages 10 to 19. But deaths among younger children – 1
to 9 years old – had also increased by 8.4% in 2021. The only age group that didn’t experience a significant increase was infants.
The new analysis also highlighted stark disparities:
● In 2021, Black people ages 10 to 19 were 20 times more likely to die by homicide than white youths and six times more likely than Hispanic youths.
● Death by suicide was also twice as likely among Black and American Indian/Alaska Native youths compared to white youths.
● American Indian/Alaska Native youths also faced the greatest risk of dying in a motor vehicle accident.
What’s behind the rise in deaths?
Although COVID-19 did not start these trends, study authors said the pandemic may have “poured fuel on the fire” as access to firearms and opioids increased, alongside a “deepening mental health crisis.”
The pandemic also may have further impeded trauma care and emergency services as the health care system was overwhelmed by COVID-19 patients, said Dr. Henry Xiang, professor of medicine and epidemiology and director of the Center for Pediatric Trauma Research at Nationwide Children’s Hospital, who is not affiliated with the study.
“This is not a surprise,” he said. “Based on my research in this field for over 20 years, I’ve noticed significant changes in pediatric mortality rates, particularly caused by suicide, violence and opioid abuses in the past five to 10 years.”
Previous research has documented the steady increase of injury-related deaths among younger Americans,
Woolf said. But for the first time, the trend has offset reductions in deaths caused by childhood diseases and tipped the scales in all-cause mortality.
“When you look at all-cause mortality rates – or deaths from anything – you’re looking at a balance between progress in lowering mortality and conditions that are increasing mortality,” he said. “When we see all-cause mortality increasing ... it just speaks to how massive the death toll is.”
How do we protect our children?
More research into injury-related deaths is needed to identify trends and inform policies, experts say.
Xiang co-wrote a study published August 2022 showing injury-related deaths among those younger than 70 decreased between 1981 and 1993 but saw a significant increase from 1994 to 2019. Despite the concerning trend, the study found the National Institutes of Health severely underfunded research in suicide, homicide and unintentional injuries.
“We don’t do enough research on this topic,” Woolf said. “We need to fund research in proportion to the death toll.”
In the meantime, experts say it’s important to address the growing mental health crisis and gun safety.
It’s important for parents and families to have conversations about mental health and substance use at home with their children, said Anthony Estreet, CEO of the National Association of Social Workers. But schools play a “critical role” in identifying students who may be exhibiting early warning signs, he said.
Although gun policies won’t change overnight, experts say gun safety can be practiced at home. This includes keeping guns and ammunition separate from each other and locking up firearms to prevent children from accessing them.
“That goes hand in hand with responsible gun ownership,” Estreet said. “The more we have those conversations and we push legislation, we might see a reversal of that trend.”
“To see all of that progress (in reducing death rates) be reversed by a handful of factors is really troubling.” Dr. Steven Woolf
Lead author of the study