Current causes of death in children and adolescents in the United States (2022) | Hacker News Reader

Current causes of death in children and adolescents in the United States (2022)

nejm.org

89 pointsnetfortius117 comments

Firearm-related deaths increased a lot. As the article mentions, that is a big category that encompasses suicide, homicide, accidents, etc. Clicking through to a supplementary pdf provides a figure that breaks firearm deaths down by subcategory, sex, and race.

https://www.nejm.org/doi/suppl/10.1056/NEJMc2201761/suppl_fi...

For ages 1-19.

That's the age range defined in the article, is it not?

Yes. Just noting. I also wonder how many people would classify 17-19 year olds as children or adolescents.

According to the AAP[0], even up to 21 would count.

[0]https://publications.aap.org/pediatrics/article/140/3/e20172...

If the cutoff was 18 , 21, or even 25 I wouldn't bat an eye. But a cutoff of 19 suggests manipulation of the statistic to achieve a desired outcome.

18 - Old enough to vote, join the army without parental permission.

21 - Old enough to drink and buy cigarettes. Also the age used for numerous firearm purchase/carry laws, when that age isn't 18.

25 - Popularly claimed to be when the human brain reaches maturity, or something like that.

19 - ....has "teen" in the word?

Yes, the standard is 19 because that's when you stop being a teenager. It's a pretty common range.

That's the most arbitrary of those four age ranges, set by a fluke of English terminology and not aligning with any laws or social norms.

It aligns with the WHO definition of adolescence (10-19).

then you would expect the groups to be 1-9 and 10-19

My guess is that 19 is when a cohort is 100% out of school. If you cut off at 18 you'd miss many highschool seniors, and therefore lots of school shooting deaths.

That would require an incredible slant towards exclusively 18-year-olds being killed in school shootings, and an exceptional overestimation of just how many school shooting deaths there are per capita for it to make that kind of difference.

They are likely adopting the WHO definition of adolescence as ages 10-19: https://www.who.int/health-topics/adolescent-health#tab=tab_...

This makes sense for international comparison. The supplemental material of the 2016 version compares with other countries: https://www.nejm.org/doi/suppl/10.1056/NEJMsr1804754/suppl_f...

> 10-19

But that's not the age range they used.

Because they combine children and adolescents (1-19). In their 2018 publication [0], you can see they actually do distinguish between younger children (1-4), older children (5-9), and adolescents (10-19). Your complaint was that 19 is an arbitrary cutoff, or even in bad faith, but it’s actually a common established definition in health contexts.

[0] https://www.nejm.org/doi/full/10.1056/NEJMsr1804754

It got a cocked eyebrow from me when I saw the range too, "children and adolescents" makes me think "up to 15-16". I wonder if there's a breakdown by age range?

You say this like the conclusion I’m supposed to draw is that it doesn’t matter that they died from firearms.

I think the conclusion is that the group definition matters: a group of people age 1-19 is different than 2 groups. 1-17 and 18-19.

If you use 1-19, firearms are the leading cause of death, if you use 1-17 they are not. In almost every other context we consider 18-19 adults.

this looks like something peculiar happens when you age up to 18.

suddenly adult privledges, and expectations are now part of your life, and if you can make it past year one adulthood, this window is passed

That age range would probably make KIA the leading cause of death for “children” during the Vietnam war.

Sure, but we’re not in the middle Of a large scale land wars at the moment.

I guess that includes a lot of young gang members in troubled areas.

Came here to point this out. Unfortunately everything is politics. As another commenter mentioned this includes a lot of gang stuff and suicide when someone is old enough to purchase a gun.

I’ll update this comment when I find the source but I believe if you use the definition of minors that we usually use elsewhere (under 18) firearms are not the leading cause of death.

I'm surprised that by expanding like that it changes the stats that much - are gang members waiting for someone to turn 18th birthday before commencing in gang related murder?

No, but the window of gang-related violence doesn't really start until, say, 14†. Or some other age >> infancy.

So it looks like a tiny change in range when you're going from 0-17 to 0-19, but the peak of the curve already lies near the end of those ranges, so the effect is similar to comparing the range of 14-17 vs. 14-19.

† I chose this somewhat arbitrarily, but the idea is the same. The "natural" bottom of the range isn't 0, it's older.

That's true, I imagine there aren't a lot of 6 year olds doing drive-bys, but given the other major cause of death is motor vehicle accidents I'd expect that too to rise at the same age as inexperienced drivers gain independence behind the wheel for the first time.

It doesn't change the stats that much. Guns and vehicles are both deadly. In rates per 100k, FA=Firearm, MVT=Motor Vehicle Traffic:

           1-17 FA   1-17 MVT | 1-19 FA   1-19 MVT
    2019     2.5       2.8    |   4.3       4.2
    2020     3.3       3.1    |   5.6       4.7

Motor vehicles are also more deadly to 18-19 year olds than younger children, as you might imagine.

At 18 it's easier to obtain guns/ammo and gang membership is more common in 18-19 year olds than, for example, 5-6 year olds.

> are gang members waiting for someone to turn 18th birthday before commencing in gang related murder?

I wonder how many "undocumented" gang members would claim to be minors to get tried as a child instead of an adult. Remember the fastest 14 years old in Sweden? [0]

[0] https://www.dailymail.co.uk/news/article-3422000/Just-old-th...

This is not true anymore. For ages 1-17, there were 2,571 firearm deaths in 2021. That's now ahead of motor vehicles (2,348).

Source: https://wonder.cdc.gov/controller/saved/D158/D332F520

I'll add some nuance here and its possibly a separate debate on its significance but according to that data, total firearm deaths surpass vehicle deaths but if you look at the split between homicide suicide its like 60-40 homicide-suicide. We would be talking about motor vehicle deaths a lot differently if half that number were kids stealing their parents keys to run into a wall at 100mph.

Here is another bit from the NEJM using CDC data from 2016: https://www.nejm.org/doi/full/10.1056/NEJMsr1804754

Whats interesting is that the gun deaths were higher in 2016 than they are now (roughly 2900). What this suggests is that firearms becoming the leading cause of deaths is not because of a rise in firearm deaths but because the number of vehicle deaths have been dropping off as well - which should be evident based on how little people drove over the last few years.

Edit: also alarming that the per capita rate is increasing as overall gun deaths are still on the decline. That can't be good (if our youth population is declining that rapidly).

Going back in time isn't going to change the more recent figures. Nor are factually incorrect statements about motor vehicle deaths.

From 2018-2021, firearm deaths went up from 2.5 to 3.3 to 3.7 per 100k 1-17 year olds.

During the same time, motor vehicle traffic deaths also went up from 2.8 to 3.1 to 3.4 per 100k 1-17 year olds.

https://wonder.cdc.gov/controller/saved/D158/D332F520

> As another commenter mentioned this includes a lot of gang stuff

I wonder what these stats would look like for legal vs illegal weapons.

The fact that nobody seems to be publishing these figures should be a pretty good indicator of what they would tell us...

... or maybe — just maybe — they are figures that are impossible to determine in any sort of comprehensive or reliable manner.

It's not a conspiracy.

> impossible to determine

Not really. For homicide cases the weapons are often recovered.

Take what you can get reliably, use it as a sample and try and extrapolate out making adjustments if the sample population differs from the overall population.

This is SOP in god knows how many fields.

Which if any fraction of the “illegal” weapon didn’t start out as “legal”? Thus the distinction is pointless.

Depends on which area of the country that you are in but along the southern border a lot of gangs bring in guns.

Then there is the fact that our incompetent government does things like Operation Fast and Furious (https://en.wikipedia.org/wiki/ATF_gunwalking_scandal) and, no, the ATF using private businesses to funnel guns into the hands of people who would not otherwise be able to acquire them is not the same as firearms that were once legal.

Bring in guns? From where

When you see literal shoot outs in the streets between the Sinaloa cartel and the Mexican armed forces, you don't honestly think the cartel members drove to AZ and walked into a Cabela's, do you?

Just like drugs, humans, etc, guns are also trafficked. The vast majority of gun homicides are done with handguns and largely gang related. Not all of those guns weren't at one point legal guns in the US - where the gang member either stole them from a law abiding citizen or walked into a gun store. All handguns in the US require background checks and you have to be 21 years old to buy.

The way the comment was phrased makes it sound like they're bringing in the guns from outside the country.

I think the problem is multi-faceted: - some guns were legally acquired in the US then stolen - the government has done gun running operations from the US into Mexico and then some of the guns have ended up being used in crimes back in the US - some gun running does acquire guns outside of the US and brings them in

The thing I am objecting to is the notion that if an illegally used gun was used in a crime it must have once been a legally possessed gun, and (the implicit policy prescription) that the way to curb illegal gun possession is by limiting legal gun possession. While that last part probably tracks, because of my ideological beliefs, I'd rather we exhaust all other options before limiting legal gun ownership. And even then, again because ideology/convictions, curbing legal gun ownership is probably not a thought I'd entertain at the ballot box.

Or actually enforcing laws on the book to prevent legal guns to becoming illegal guns. Saw this a lot growing up in the south. Jimbo is gonna get charged with some crime that will take away his ability to own a gun, so Jimbo sells/transfers the ownership of the gun to his brother/best friend bob. Bob now legally owns that/those guns, but those guns never actually end up in Bob's ownership. 5 years later, Jimbo still has the guns in his closet.

Nearly all guns used for crime in the US were once legally owned

https://archive.md/qymWJ

> I’ll update this comment when I find the source

So... you gonna update your beliefs in light of the changing landscape? We have the source; you probably heard it when it was true, but things have gotten worse. Or are you just going to seek alternative ways of supporting your pre-existing beliefs?

Everything is politics, indeed.

> that is a big category that encompasses suicide, homicide, accidents

according to the document, there were more than twice as many homicides as suicides, and other causes (including accidents) were vanishingly few.

So, the news here is that gun deaths are now the leading cause of death for teens (ages 13-19), but for kids 1-12, cars remain the leading cause of death in the US.

Per https://nyc.streetsblog.org/2022/12/28/fact-check-many-more-...

> Through age 12, more than 500 more U.S. kids died in vehicle crashes in 2020 than were killed with firearms. But the numbers flip beginning with age 13, and emphatically. For ages 13 through 19, firearms killed more than 1,000 more teens than did traffic crashes.

Historically, car crashes are the leading cause of death for both groups combined.

Firearms, motor vehicles, and overdose all jumped large % amounts from 2019 to 2020. One has to wonder how much of this is mental-health related, given that 2020 had a, uh, significant impact on many people's mental health.

> This change is largely explained by the 110.6% increase in unintentional poisonings from 2019 to 2020.

That's the only days about circumstance I could find in the article. Everything else is about the direct cause of death.

So are they counting fentanyl deaths ("hey somebody put drugs in my drugs") as a drug overdose, or as an accidental poisoning?

It's almost certainly driven by the cause of death on the death certificate.

Suicide rates in teens has been trending upward long before COVID. Look at the rates over time with the release of the smartphone and popularization of social media.

In 2013 motor vehicle crashes and firearm-related injuries both trended upwards, and seemed to track each other; in 2019 firearm-related injuries and drug overdoses both increased sharply. Something happened in those two years. I wonder what.

Is that what you were looking for in the data before seeing those "trends"?

The pandemic changed a lot of things, more and more people purchased guns for protection, and fentanyl drug abuse is a massive issue right now and has been for years.

2019 in generally considered pre-pandemic, the US at least.

More and more guns were bought. NI am not aware of anything that would mply they are actually bought "for protection".

I'm sure we'll see a upward trend in 'accidents in the workplace' with all the regulations on child work age being lowered.

Starting around 2019 there was a huge increase in accidental fentanyl poisonings due to Mexican drug cartels manufacturing counterfeit prescription opioid pills.

https://peterattiamd.com/anthonyhipolito/

I figured firearms and ODing would be on the rise, but suffocation surprised me. It's still low, but also one of the few that's trending upward. What could be the cause of that?

Stupid TikTok/social media challenges?

Drowning, if it's not covered elsewhere, would be my guess. Possibly infants with improper bedding and smothering hazards in their bed.

The most proximate cause of death in a typical opioid overdose is respiratory depression; they stop breathing.

Also, the popularization of autoerotic asphyxiation may play a role. The article's statistics do include teens up to 19 after all.

Suicide by hanging is still a thing in the 21st century.

Firearm related injuries went up accross all ages post pandemic.

Is there any info on how many of them were school shootings? how many of them were gang violence related death?

the FBI has a very thorough crime database, I am sure you can make a public request

afaik school shootings are a tiny fraction of youth gun homicides

similarly, "assault rifles" represent a tiny fraction of all gun homicides

in the ghetto cities nearby, only a small number of murders and overall firearm incidents are solved. I cannot imagine that they are accurately captured at the national scale. On the 4th of July night or New Years night, literally hundreds of firearms go off for hours in crowded, urban areas.. completely illegal.

FBI does indeed track unsolved homicides, as does your local PD

Solving a murder and determining whether a murder was committed with a rifle are two completely different things; you don't need to know who the culprit was to determine how they did it. There is no reason to believe that murders committed with rifles go unsolved more frequently than those committed with handguns.

FBI has only published their UCRs up through 2019

> Is there any info on how many of them were school shootings? how many of them were gang violence related death?

If by school shootings you mean the type of random killings that make the news, then that data is published as a part of the FBI active shooter datasets every year (lagging by a few years now).

Here's a 20 year summary

https://www.fbi.gov/file-repository/active-shooter-incidents...

Averaging about 5 per year, including adults at schools.

---

If by school shooting you include shootings by rival gangs, then the numbers go way, way, way up.

For numerical context, according to the NHTSA study from last decade, >25 kids die every year just commuting to school (vehicle accident, or hit by vehicle walking to school, etc).

Striking that the top 3 causes are from human inventions (cars/guns/drugs). Makes me wonder what new causes of death have yet to be invented.

Does it help if you consider how many causes of death we've invented away from? People don't die from a host of diseases because we have vaccines now, a whole host of things improved in the medical side of things so that people don't die in childbirth, inventions in agriculture allow people to starve an awful lot less than they used to, etc.

Lots of people trying to make polio prevalent again...

Gun advocates tend to add insult to injury by vilifying gun violence victims and their families. I suppose its because those victims manifest the inconvenient truth that the cost of America's gun obsession is paid with the blood of innocents.

So if you're a gun owner, please be sure to thank those victims and donate to their families. They died so that you can own your loud shiny tools of effortless assassination.

Anyone has an idea what caused the decline in Motor Vehicle Deaths from ~2004-2014?

I’m curious if it could be safety technology improvements and child car seats?

Highly likely a lot of it is simply older cars without safety features we consider basic these days (like side air bags) being phased out. Very few people driving cars from the 80s or earlier these days.

You can probably thank Ralph Nader for a lot of it, honestly.

> You can probably thank Ralph Nader for a lot of it, honestly.

https://news.ycombinator.com/item?id=35341056

Vehicles became a lot safer because of Ralph Nader.

Google “unsafe at any speed”.

did you look at the graph? has he been active in auto safety since the 1920s?

Also encompasses the "cash for clunkers" program and period of low interest rates, both of which accelerated the retirement of older cars for newer (and generally, safer) cars

motor vehicle deaths have always trended down, cars just keep getting safer

https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in...

Yet in a lot of countries they don't anymore. Here mostly due to pedestrian and cyclist deaths being counted as motor vehicle deaths due to increasing car size and more km driven per capita.

Strange you don't link to the table which tells a different story:

https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in...

the deaths per 100,000 population has got worse across the last 10 years.

Car were safer and safer, ABS and stuff helped, Also the whole world started doing crash tests to help protect the drivers and passengers.

Note that the trend continued past 2014 in Europe (stabilizing now). Two differences:

- Less SUVs/light truck on the road in Europe (it's changing)

- crash tests in Europe test small cars against SUVs, SUVs against trucks... All different combinations. If your utility vehicle / SUV doesn't perform well on those crash tests, you can't sell it (hence no F-150).

A lot of improvements in vehicle safety were made between 1990ish and 2005ish. Around 2004-14 period the older cars that teenagers drive would have started being models with airbags and ABS. Neither of these have much impact on fatalities among "average drivers" but young driver's propensity to crash into things at very high speed and propensity to load more people than seat-belts into vehicles plays right into the use cases where these technologies will save the most lives. Cars from the mid '00s on up will also have much stiffer cabins because of a bunch of rollover and side impact rule changes that took effect around then.

Rate of fatal car accidents in US is about twice as that in Germany and Germans have autobahn with no speed limits drinking beer and then driving is part of their culture.

What happened to the US official statistics? There was one for 2019, do we have for 2020 and 2021?

As others have pointed out, the choice of the age range has a significant impact on the conclusions one is able to draw. In particular, this paper defines "Children and Adolescents" as 1 to 19 years old, which captures a lot of firearms related deaths due to gang violence.

Unfortunately, politics and culture war are infused in everything. But, if you want to be informed so that you can make better, persuasive arguments, I suggest looking at the CDC Child Health data here: https://www.cdc.gov/nchs/fastats/child-health.htm

TLDR: non-accidental deaths are weighted heavily towards 15-19 year olds, and due to that cohort's fraction of the 1-19 year population, when 15-19 year olds are lumped together with 1-14 yos, it allows someone to present data that homicides are the leading cause of death for 1 to 19 year olds. The further refinement from homicides -> firearms is presumably disambiguated in the referenced paper.

While the authors are obviously free to frame the data and discussion however they please, this strikes me as a paper designed to serve a policy position or perhaps guide political action more so than an even handed look at childhood deaths. Add to it the emotional impact that we're talking about children here, and I find it verging into the emotionally manipulative.

**************************

CDC data

Children aged 1-4 years: https://wonder.cdc.gov/controller/saved/D158/D321F178

- Accidents (unintentional injuries); 8.5 deaths/100k

- Congenital malformations, deformations, and chromosomal abnormalities; 2.7/100k

- Assaults (homicide) - not broken down by assault weapon; 2.0/100k

Children aged 5-9 years: https://wonder.cdc.gov/controller/saved/D158/D321F179

- Accidents (unintentional injuries); 4.1/100k

- Cancer; 1.7/100k

- Assaults (homicide) - not broken down by assault weapon; 0.9/100k

Children aged 10-14 years: https://wonder.cdc.gov/controller/saved/D158/D321F180

- Accidents (unintentional injuries); 4.3/100k