A sobering look at children and gun violence in the United States


Gun violence is an ongoing epidemic in the United States. Gun-related deaths are the second leading cause of death among children and young adults, with nearly a quarter of all deaths among people aged 15 to 24 resulting from guns.1-4 Ninety-one percent of the world’s gun deaths among children aged 0 to 14 occur in the United States.5 The risk of death from unintentional injuries is higher in countries with higher levels of poverty. A survey examines whether living in a county with a higher concentration of poverty was linked to the risk of a child or teenager dying from a gun.6

Investigators conducted a cross-sectional study that analyzed gun deaths in the United States among children and young adults aged 5 to 24 from January 2007 to December 2016. They used data from the Compressed Mortality File of Centers for Disease Control and Prevention as well as annual data. intercensal demographic data from the US Census Bureau. Gun-related deaths included homicides, suicides, unintentional deaths, and deaths with undetermined intent. The concentration of poverty was defined as the population living below the federal poverty line, which was $ 21,027 in 2007 and $ 24,339 in 2016 for a family of 4, and divided into 5 groups: 0% to 4 , 9%, 5% to 9.9%, 10% to 14.9%, 15% to 19.9% ​​and ≥ 20%).

There were 67,905 gun-related deaths from 2007 to 2016 included in the cohort, which was mostly made up of 60,164 males. Of these deaths, 42,512 were homicides; 23,034 were suicides; and 1627 were considered unintentional. Investigators found that there was a gradual increase in the risk of gun-related mortality due to the increasing concentration of poverty in the counties. Compared to counties that had the lowest concentration of poverty, those with the highest concentration of poverty saw an increased rate of total gun-related deaths (adjusted incidence rate ratio [IRR], 2.29; 95% CI, 1.96-2.67), homicides (adjusted IRR, 3.55; 95% CI, 2.80-4.51), suicides (adjusted IRR, 1.45; 95%, 1.20-1.75) and unintentional deaths (adjusted IRR, 9.32; 95% CI: 2.32-37.4). The population attributable fraction was 0.51 (95% CI, 0.43-0.57) for all firearm-related deaths, 0.66 (95% CI, 0.57-0, 73) for homicides, 0.30 (95% CI, 0.17-0.42) for suicides, and 0.86 (95% CI, 0.46-0.97) for unintentional deaths . This means that 34,292 gun deaths would not have occurred if all counties had the same level of risk as those with the lowest concentration of poverty. A total of 3,833,105 years of potential life have been lost.

The researchers noted that there were limitations to their study. The first was that they could only report the association and not the causes. The demographic variables as well as the causes of death noted in the compressed mortality file may have been misclassified. The heterogeneous nature of counties, where neighborhoods can have varying poverty levels, as well as the inability to determine income data for adolescents and young adults themselves mean that investigators were unable to determine. determine the implications of poverty at the individual level versus poverty at the county level. . In addition, investigators were unable to account for the illicit possession of firearms.

Investigators concluded that counties with a higher level of poverty concentration were linked to increased rates of gun deaths, homicides, suicides, and unintentional deaths. Particularly troubling was the fact that over 50% of gun-related deaths as well as over two-thirds of all gun-related homicides in the age group could be linked to living in a county with a higher concentration of poverty. With the trend of increasing income inequality, these data could indicate the potential likelihood of an increased risk of gun deaths due to poverty at the county level.

Comment from Steven Selbst, MD:

This important article shows the dramatic impact of poverty on gun-related deaths in the United States. It’s no surprise that gun violence deaths are linked to poverty, but the numbers reported here and the strong association with a higher concentration of poverty in the counties are staggering.

It is well known that school shootings have increased in the United States in recent years, and these tragic events are naturally gaining national attention. This article takes us a close look at the more subtle epidemic of gun-related deaths that occur on the streets of our country every day.

The authors briefly describe the impact of children living in neighborhoods with a high concentration of poverty. Children in these communities often have inadequate housing, limited access to high-quality schools and increased toxic stress. death. the New York Times reported that Chicago recorded 101 gun-related homicides among residents under the age of 20 in 2021, up from 76 in 2019. In my own city of Philadelphia, 2021 saw a new record of homicides (562) and the vast majority of these deaths have been caused by guns More than 200 teenagers have been caught in the crossfire with the rise of gun violence in Philadelphia and at least 36 have been killed in 2021. The vast majority of these shootings have also took place in areas of the city where poverty is increasingly concentrated.

In 2016, the American Academy of Pediatrics (AAP) noted that nearly half of children in the United States live in or near poverty. They issued a policy statement stating that the AAP is “committed to reducing and ultimately eradicating poverty in the United States.” It is a daunting task, just like the end of the armed violence crisis in our country. The authors of this study in JAMA Pediatrics mention some useful interventions such as the Child Tax Credit, Head Start, the Special Nutritional Supplementation Program for Women, Infants and Children. They also note the importance of gun regulation legislation. Our country seems to be far from it.

We need data to make progress in reducing gun violence. This study provides very valuable data that will at least help us focus our efforts

The references

1. Centers for Disease Control and Prevention. Extensive online data for epidemiological research (WONDER). Accessed March 31, 2021. https://wonder.cdc.gov/

2. LeeLK, MannixR. Increasing death rates from preventable deaths in adolescents and young adults. JAMA. 2018; 320 (6): 543-544. doi: 10.1001 / jama.2018.6566

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3. Centers for Disease Control and Prevention. WISQARS (Web Injury Statistics Query and Reporting System). Choice notice. 2011; 48 (08): 48-4227.

4. Centers for Disease Control and Prevention. Leading causes of death from injury highlighting violence. WISQARS. Accessed March 31, 2021. https://webappa.cdc.gov/sasweb/ncipc/mortrate.html

5. GrinshteynE, HemenwayD. Chapter 6: Gun violence in the pediatric population: an international perspective. In: LeeLK, FleeglerEW, ed.Pediatric Firearm Injury and Death: A Clinician’s Guide to Firearm Damage Prevention Policies and Approachesnm International Springer Publishing; 2021: 75-85. doi: 10.1007 / 978-3-030-62245-9_6

6. Barrett J, Lee L, Monuteaux M, Farrell C, Hoffmann J, Fleegler E. Association of county poverty and inequality with gun-related mortality among American youth. JAMA Pediatrician. Online publication of printed matter. November 22, 2021. doi: 10.1001 / jamapediatrics.2021.4822

NAPNAP urges government to fight gun violence

The day after the November 30, 2021 shooting in Oxford Township, Michigan, the National Association of Pediatric Nurse Practitioners issued a statement1 calling on state and federal leaders to immediately begin addressing the problem of gun violence facing the United States. The organization advocated for several Congressional reforms, including:

Increase funding for gun violence research and monitoring programs

Institute 72-hour waiting periods to allow for in-depth background checks

Set the federal minimum age for the purchase of firearms at 21, with exemptions for the military or law enforcement

Support access to mental health services

Strengthen background checks and remove loopholes that prevent background checks from happening

Constrain the sale and import of high capacity magazines


1. NAPNAP urges the government to fight gun violence. NAPNAP.org. December 1, 2021. Accessed January 10, 2022. https://www.napnap.org/napnap-urges-government-to-address-gun-violence/


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