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.

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Violence, Guns, and Policy in the United States

The United States is a uniquely violent country among high-income democracies. And by the best available data on homicides, the US has always been more violent. Homicides are useful to look at because we generally have the best data on these (murders are the most likely crime to be reported) and it’s the most serious of all violent crimes.

Just how much more violent is the US than other high-income democracies? As measured by the homicide rate, about 6-7 times as violent. We can see this first by comparing the US to several European countries (and a few groupings of similar countries).

Let me make a few things clear about this chart. First, this is data for homicides, which are typically defined as interpersonal violence. Thus, it excludes deaths on the battlefield, genocides, acts of terrorism (generally speaking), and other deaths of this nature. That’s how it is defined. If we plotted a chart of battlefield deaths, it would look quite different, but there’s not much good reason to combine these different forms of violent death.

On the specifics of the chart, prior to 1990 these data are averages from multiple observations over multi-year timespans (generally 25 or 50 years). The data on European countries comes from a paper by Eisner on long-term crime trends (Table 1). The countries chosen are from this paper, as are the years chosen. Remember that historical data is always imperfect, but these are some of the best estimates available. For the US, I used Figure 5 from this paper by Tcherni-Buzzeo, and did my best to make the timeframes comparable to the Eisner data. The data are not perfect, but I think they are about as close as we can get to long-run comparisons. For the data from 1990 forward, I use the IHME Global Burden of Disease study, and the death rates from interpersonal violence (to match Eisner, I average across grouped countries).

When we average across all the European countries in the first chart and compare the US to Europe, we can see that the US has always been more violent, though the 20th century onwards does seem to show even more violence in the US relative to Europe. (These charts are slightly different from some that I posted on Twitter recently, especially the pre-1990 data as I tried to more carefully use the same periods for the averages — still only take this a rough guide).

And what is the main form by which this violence is carried out? In the US, it is undeniably clear: firearms. Between 1999 and 2020, there were almost 400,000 homicides in the US (using CDC data). Over 275,000 of these, or about 70%, were carried out with firearms. The next largest category is murder with a knife or other sharp object, with about 10% of murders. And homicides have become even more gun-focused in recent years: about 80% of murders in 2020-21 were committed with guns.

So, there’s the data. But the important social scientific question is: Can we do anything about it? Are there any public policies, either about guns or other things, that will reduce gun violence? Could restrictions on gun use actually increase homicides, since no doubt guns are also used defensively?

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