More than 20 years of child and teen mortality data revealed that the pediatric death rate in the United States rose sharply between 2019 and 2021.
The 20 percent increase offsets years of progress in medicine and public health in the nation, and represents the largest increase in 50 years, according to an editorial published in the Journal of the American Medical Association today.
Homicides, accidental drug overdoses, motor vehicle accidents and suicide among ages 10 to 19 are attributed to the mortality rate increase. New research is based on detailed examination of death certificate data from the Centers for Disease Control and Prevention. Analysis revealed that the mortality rate of Americans age 19 years and under rose by 11 percent between 2019 and 2020, and an additional 8 percent between 2020 and 2021.
“I have not seen this in my career,” lead author Dr. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University, said. “For decades, the overall death rate among U.S. children has fallen steadily, thanks to breakthroughs in prevention and treatment of diseases like premature births, pediatric cancer and birth defects. We now see a dramatic reversal of this trajectory, meaning that our children are now less likely to reach adulthood. This is a red flashing light. We need to understand the causes and address them immediately to protect our children.”
The recent increase in “all-cause mortality” among children began before the COVID-pandemic. Researchers found that suicide rates among ages 10 to 19 began increasing in 2007 and climbed by 70 percent by 2019. Increasing homicide rates began in 2013 and rose by 13 percent by 2019. Deaths by overdoes began to rise in 2019 and deaths by car accidents jumped dramatically in 2020 and 2021.
“We’ve now reached a tipping point where the number of injury-related deaths is so high that it is offsetting many of the gains we’ve made in treating other diseases,” Dr. Elizabeth Wolf, an assistant professor in the Department of Pediatrics at the VCU School of Medicine and pediatrician at the Children’s Hospital of Richmond at VCU. The study was co-authored by Dr. Frederick Rivara, a professor of pediatrics at the University of Washington and Seattle Children’s Research Institute and acclaimed expert on pediatric injury prevention.
COVID-19 contributed to the recent increase in child mortality in the U.S., but was overshadowed by deaths caused by injuries.
“A large proportion of these deaths involve firearms, the method most commonly used by teens to die by suicide or commit homicides. Firearm ownership has increased, guns are more available to young people, and the weapons are more lethal,” Woolf, a professor in the Department of Family Medicine and Population Health at the VCU School of Medicine, said. “Mass shootings at schools receive a lot of national attention, but what adds up to a much larger death toll are the shootings of children, one by one, that we hear about on our local nightly news.”
Mental health crisis is worsening and affecting young people, according to Wolf.
“There is a severe shortage of mental health providers who care for children and adolescents, especially in rural areas,” Wolf said. “It’s estimated that only half of children with a treatable mental health condition have access to a mental health professional.”
The pandemic did not initiate the trends, but may have poured fuel on the fire, researchers said.
“Children and teens were impacted by the pandemic in so many indirect ways, whether from the death of a caregiver or extended school closings,” Wolf said. “The pandemic also upended health care delivery, making it harder for children to attend routine checkups and receive important vaccinations.”
Injury-related death risk varies significantly by race and ethnicity. Black youths ages 10 to 19 were 20 times more likely to die by homicide than white or Asian American youths in 2021, and six times more likely than Hispanic youths. Death by suicide is more than twice as likely among Black and American Indian/Alaskan Native than white youths.
“These disparities have a history. They reflect the social and health consequences of policies that, for generations, have marginalized people of color, segregated neighborhoods, and choked off resources for economic development,” Woolf said. “The legacy of this history is that communities of color are at much higher risk of economic stress and social conflict.”
The country needs bold research and policy actions to reverse the trend.
“The need to address policies on firearms and mental health is obvious, but we must also address the root causes of these deaths by expanding opportunities for education, well-paying jobs, good housing, and other living conditions. More research is also needed to better understand and address the increase in injury deaths,” Woolf said. “Modern medicine has fought the battle against pediatric diseases, but the threats to our children are now manmade. Without action, bullets, drugs and automobiles will continue to claim the lives of our most cherished population.”