The Leading Causes of Death Among Elementary-Age Children

You might have seen this chart recently. It comes from a letter published in the New England Journal of Medicine in April 2022. The data comes directly from the CDC. It shows the leading causes of death for children in the US. You will notice that firearm-related deaths have been rising for much of the past decade, and in 2020 eclipsed car accidents as the leading cause.

Many are sharing this chart in response to the recent elementary school shooting in Nashville. It’s natural to want to study these problems more in the wake of tragedies. After the Uvalde shooting last year, I tried to read as much as I could about the history of homicide and gun violence in the US, and to look at the research on what might work to reduce gun violence, which is summarized in a post I wrote last June.

That being said, I don’t think the chart above accurately characterizes the problem of elementary school shootings. It might accurately describe some broader problem, but it’s misleading with respect to the shooting we all just witnessed. The most important reason is that the definition of “children” here extends to 18- and 19-year-olds. Much of the gun-related homicides for “children” shown here are gang-related violence, not random school shootings at elementary schools. It’s not that we shouldn’t care about these deaths too — we very much should care — but the causes and solutions are entirely different from elementary school mass shootings.

The chart below breaks out the firearm deaths by age (it’s for 2020, but it would look similar for any recent year). Almost half of the firearm deaths between ages 1 and 19 are for ages 18-19 alone, and 75% of the deaths are for ages 16-19.

To further illustrate this point, below is the firearm homicide rate for both 5-10 year olds (elementary school age) and 18-19 year olds. (I’m using firearm homicides only, rather than all gun deaths, which will primarily exclude suicides, but homicides are by far the largest category of gun-related deaths.) Averaged over the entire period, 18-19 year olds have a firearm homicide rate that is 42 times higher than 5-10 year olds. In some years, it is 50 or 60 times higher. This probably doesn’t surprise you, but seeing the data is quite stark.

But perhaps 5-10 year olds are much more likely to die from all causes, so firearm-related deaths could still be the leading cause. This also is not the case. The chart below is my attempt to replicate the first chart in this post, but to limit it to elementary school age kids. Firearm-related deaths are one of the leading causes — ranked somewhere around 4th, 5th, or 6th in recent years — but motor vehicle accidents and cancer kill many more elementary-age children than guns (I’m once again using the broader category of all firearm deaths, not just homicides, and I’ve bolded the line so it stands out). I’ve also added one more year of data beyond the chart from the NEJM letter.

Now, even though firearm deaths aren’t #1, we should still be concerned about them. Firearm deaths are still about 100 deaths per year in recent years, jumping to over 150 deaths per year in 2020 and 2021. And in most years 70-80% of these firearm deaths are homicides. Importantly though, very few of these deaths are from mass shootings, and even fewer are from mass school shootings. Most homicides of young people are by family members. I can’t find this exact data for a recent year, but a 2002 DOJ report suggests that for homicides of children under age 13, two-thirds are committed by family members, with only 8 percent committed by complete strangers (the balance are by friends or acquaintances).

But as an economist, the way we should think about these sorts of numbers it not necessarily which is the largest, but about what sorts of public policies or social activities we could possibly take to impact the deaths, and furthermore how effective these actions would be, and what the tradeoffs are. I tried to do some of this in my post from last June (linked above), by examining the academic research on the topic. I don’t think I have much to add about that today.

As a parent, perhaps there is another way to think about these deaths, which is how much should we worry about different risks of death for our children. In surveys the top 5 things that parents worry about (not just as a cause of death, but worry in general) are: kidnapping, school shootings, terrorists, dangerous strangers, and drugs. Both in terms of deaths, and just general risk, these are clearly not very big risks to young children (drugs are possibly the realest one, but generally this is a worry parents should reserve for older teenagers). And yet, many parents worry about them.

Exactly what actions we should take as a society and as parents to protect children is not always clear. Frustratingly, research does not give us much guidance. As an exercise, compare Emily Oster’s first book (Expecting Better) on pregnancy with her third book (The Family Firm) on raising older kids. For pregnancy, the advice is often crystal clear based on the research (though probably different from what your doctor told you!), while on raising kids after birth and the first few years, the research isn’t helpful. Oster’s third book provides a framework for thinking about decisions, but they aren’t clear cut rules to follow.

Yet despite this lack of guidance on exactly what we should do as a society and parents, somehow we’ve have done pretty well at protecting children over the past several decades. The best evidence is that the mortality rate for children (here defined as under age 15) has been declining consistently as far back as we have data (my chart uses consistent CDC data, so starts in 1968).

4 thoughts on “The Leading Causes of Death Among Elementary-Age Children

  1. Marina March 29, 2023 / 6:50 pm

    So you changing the data to fit YOUR narrative doesn’t change the facts. You are not the CDC or the AMA. You are part of the problem. Congrats You have blood on your hands


    • Matt March 30, 2023 / 1:51 pm

      How were the data changed here? You’re ignoring the fact that the bulk of so-called ‘children’ dying from gunshots are older teens and *adults* involved with or affected by gangs.


  2. Scott Buchanan March 31, 2023 / 9:01 am

    Excellent disentanglement of the facts here. It is helpful to know what are actually the leading threats to younger children, to guide our thinking in how to protect them.


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