Injury-related mortality rates, including firearm-related deaths, among children and adolescents increased in almost every state between 2018-2022, according to findings from the University of Michigan.

Researchers from the U-M Institute for Firearm Injury Prevention analyzed mortality data from the U.S. Centers for Disease Control and Prevention’s Wide-ranging Outline Data for Epidemiologic Research and found that nearly 90% of states saw an increase in mortality rates among children and adolescents overall during the study period.

North Dakota’s numbers show the largest increase among states at 65% and Rhode Island saw the largest decrease at 20%. The researchers noted that while mortality rates for children aged 1 to 9 increased, the majority of the overall rate increase was among those ages 10 to 19 years old.

The data also showed that six states saw decreases in injury-related mortality rates and three states reported decreases of more than 10%.

The research defines children and adolescents as ages 1-19. In 2022, institute researchers found that firearms surpassed motor vehicles as the leading cause of death among children and teens in the United States.

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“This study shows that firearm-related deaths among children and adolescents continues to be a critical and geographically diverse issue in the United States,” said Eugenio Weigend Vargas, postdoctoral research fellow at the institute. “These injuries are preventable and by identifying the high priority areas, we can better tailor evidence-based strategies, solutions and policies to save lives.”

The study also found that states with the highest per-capita mortality rates among children and adolescents tended to have firearm injuries as the leading cause. States with the lowest per-capita mortality did not include firearms as a top-two cause. Motor vehicle-related deaths, malignant neoplasms and suffocation were found to be in the top two causes of child and adolescent death in multiple states.

Earlier this summer, in an effort to address these harms, the U.S. surgeon general declared (PDF) firearm violence a public health crisis in a groundbreaking advisory. Multiple projects from the U-M Institute for Firearm Injury Prevention were cited in the advisory.

Co-authors with Weigend Varnas were Philip Stallworth, research analyst at the Institute for Firearm Injury Prevention and U-M’s Injury Prevention Center; Patrick Carter, co-director of the Institute for Firearm Injury Prevention, director of the Injury Prevention Center, associate professor of emergency medicine at the U-M Medical School, and associate professor of health behavior and health equity at the U-M School of Public Health; and Jason Goldstick, co-director of data and methods at the Institute for Firearm Injury Prevention, director of statistics and methods at the U-M Injury Prevention Center, research associate professor of emergency medicine at the U-M Medical School, and research assistant professor of health behavior and health equity at the U-M School of Public Health.