Firearms have surpassed motor vehicles as the leading cause of death among children and adolescents in the United States, according to new federal data analyzed by researchers at the University of Michigan.

U-M researchers Jason Goldstick, Rebecca Cunningham and Patrick Carter co-authored an article published in The New England Journal of Medicine that quantifies the leading causes of death nationwide for individuals ages 1 to 19. Based on their analysis of data from the Centers for Disease Control and Prevention, firearm-related deaths among children and adolescents increased by 29% from 2019 to 2020.

“The increasing rates of firearm mortality are a longer-term trend and demonstrate that we continue to fail to protect our youngest population from a preventable cause of death,” said Goldstick, research associate professor of emergency medicine at Michigan Medicine and of health behavior and health education at the U-M School of Public Health.

“Recent investments in firearm injury prevention research by the CDC and National Institutes of Health, in addition to community violence prevention funding in the federal budget, are a step in the right direction, but this momentum must continue if we truly want to break this alarming trend.”

Goldstick and colleagues at the U-M Institute for Firearm Injury Prevention are working to maintain momentum in this space through its new Data and Methods Core, where researchers analyze national datasets to identify key trends in firearm violence. The institute launched last year as part of a $10 million university commitment to generate new knowledge and advance innovative solutions to reduce firearm injuries and deaths, while respecting the rights of law-abiding citizens to legally own firearms.

U-M researchers’ latest analysis on major causes of death in children and adolescents signals an upward trend in firearm violence nationwide, and can help policymakers and community groups identify potential solutions to address this national crisis.

More than 4,300 individuals ages 1-19 across the U.S. died as the result of firearms in 2020, which includes suicides, homicides and unintentional deaths. Motor vehicles caused about 3,900 fatalities among children and adolescents in 2020, while drug poisoning deaths increased by more than 83%—to more than 1,700 total deaths—to become the third-leading cause of death in this group.

Pediatric deaths from 1999 to 2020 in the United States.

“Motor vehicle crashes were consistently the leading cause of death for children and adolescents by a fairly wide margin, but by making vehicles and their drivers safer, these types of fatalities have drastically decreased over the past 20 years,” said Carter, co-director of the institute and associate professor of emergency medicine and of health behavior and health education.

“Injury prevention science played a crucial role in reducing automobile deaths without taking cars off the road, and we have a real opportunity here to generate a similar impact for reducing firearm deaths through the application of rigorous injury prevention science.”

More than 45,000 people across the U.S. died as the result of firearms in 2020, regardless of age—a more than 13% increase when compared to 2019. The national increase was driven largely by firearm homicide, which jumped more than 33% from 2019 to 2020. Firearm suicides increased by about 1%, according to data analyzed by U-M researchers.

“Firearm violence is one of the most critical challenges facing our society, and based on the latest federal data, this crisis is growing more and more intense,” said Cunningham, U-M vice president for research and the William G. Barsan Collegiate Professor of Emergency Medicine.

“As a nation, we turn to scientific evidence to prevent injuries and deaths, and firearms should be no different. Michigan has incredible expertise in this space, and we will continue to use our collective knowledge to create safer and more vibrant communities nationwide.”