Guns kill more US children than other causes

More American children and teens die from firearms than any other cause, but there are more deaths — and wider racial disparities — in states with more permissive gun policies, according to a new study. The study, published in the medical journal JAMA Pediatrics on June 9, analyses trends in state firearm policies and kids’ deaths since 2010, after the landmark US Supreme Court decision in McDonald v. City of Chicago.

The ruling struck down the city’s handgun ban, clearing the way for many states to make it easier for people to buy and carry guns. The study authors split states into three groups: “most permissive,” “permissive” and “strict,” based on the stringency of their firearm policies.

Those policies include safe storage laws, background checks and so-called Stand Your Ground laws. The researchers analysed homicide and suicide rates and the children’s race. Using statistical methods, the researchers calculated 6,029 excess deaths in the most permissive states between 2011 and 2023, compared with the number of deaths that would have been expected under the states’ pre-McDonald rules. There were 1,424 excess deaths in the states in the middle category.

In total, about 17,000 deaths were expected in the post-decision period, but 23,000 occurred, said lead author Dr. Jeremy Faust, an emergency physician at Brigham and Women’s Hospital in Boston, in an interview.

Among the eight states with the strictest laws, four — California, Maryland, New York and Rhode Island — saw statistically significant decreases in their pediatric firearm death rates. Illinois, which was directly affected by the court’s decision in the McDonald case, and Connecticut saw increases in their rates. In Massachusetts and New Jersey, the changes were not statistically significant. The rate increased in all but four (Alaska, Arizona, Nebraska and South Dakota) of the 41 states in the two permissive categories. (Hawaii was not included in the study due its low rates of firearm deaths.) Non-Hispanic Black children and teens saw the largest increase in firearm deaths in the 41 states with looser gun laws. Those youths’ mortality rates increased, but by a much smaller amount, in the states with strict laws.

Experts say the study underscores the power of policy to help prevent firearm deaths among children and teens. The analysis comes less than a month after the release of a federal report on children’s health that purported to highlight the drivers of poor health in America’s children but failed to include anything on firearm injuries — the leading cause of death for children and teens in 2020 and 2021, according to the federal Centers for Disease Control and Prevention.

Trauma surgeon Dr. Marie Crandall, chair of surgery at MetroHealth medical center and a professor at Case Western Reserve University School of Medicine in Cleveland, researches gun violence. She previously practiced at a Jacksonville, Florida, urban trauma unit, where she frequently saw children and teens caught in gun violence. “When I see children come in with 10 holes in them that I can’t save — that is a loss. That is a completely preventable death, and it is deeply emotionally scarring to have to have those conversations with families when we know, as a society, there are things we could do to de-escalate,” said Crandall, who wasn’t involved in the new study.

In her state of Ohio, firearm death rates among children and teens increased from 1.6 per 100,000 kids in the decade before the McDonald decision to 2.8 after it, according to the study. Ohio was categorised in the group with the most permissive laws. The study adds to previous research that shows state laws around child access to firearms, such as safe storage and background checks, tend to be associated with fewer child firearm deaths. “We know that child access prevention decreases unintentional injuries and suicides of children. So having your firearms locked, unloaded, stored separately from ammunition, decreases the likelihood of childhood injuries,” Crandall said.

“More stringent regulation of those things also decreases childhood injuries.” But she said it’s hard to be optimistic about more stringent regulation when the current administration dismisses gun violence as a public health emergency. The Trump administration earlier this year took down an advisory from the former US surgeon general, issued last year, that emphasised gun violence as a public health crisis.

Faust, the lead author of the new study, stressed that firearm injuries and deaths were notably missing from the Make America Healthy Again Commission report on children’s health. He said the failure to include them illustrates the politicisation of a major public health emergency for America’s kids. “It’s hard to take them seriously if they’re omitting the leading cause of death,”

Faust said. “They’re whiffing, they’re shanking. They’re deciding on a political basis not to do it. I would say by omitting it, they’re politicising it.” Faust and pediatric trauma surgeon Dr. Chethan Sathya, who directs the Center for Gun Violence Prevention at the Northwell Health system in New York, each pointed to the development of car seat laws and public health education, as examples of preventive strategies that helped reduce childhood fatalities. They support a similar approach to curbing youth gun deaths.

“We really have to apply a public health framework to this issue, not a political one, and we’ve done that with other issues in the past,” said Sathya, who wasn’t involved in the study and oversees his hospital’s firearm injury prevention programmes. “There’s no question that this is a public health issue.” In Louisiana, which the study categorised as one of the 30 most permissive states, the child firearm mortality rate increased from 4.1 per 100,000 kids in the pre-McDonald period to 5.7 after it — the nation’s highest rate. The study period only goes to 2023, but the state last year enacted a permitless carry law, allowing people to carry guns in public without undergoing background checks. And just last month, Louisiana legislators defeated a bill that would have created the crime of improper firearm storage.

Louisiana Democratic state Rep. Matthew Willard, who sponsored the safe storage legislation, said during the floor debate that its purpose was to protect children. Louisiana had the highest rate of unintentional shootings by children between 2015 to 2022, according to the research arm of Everytown for Gun Safety, which advocates for stricter gun access.

Willard cited that statistic on the floor. But Republican opponents said Willard’s proposal would infringe on residents’ gun rights and make it more difficult for them to use guns in self-defense. “Nobody needs to come in our houses and tell us what to do with our guns. I think this is ridiculous,” Republican state Rep. R. Dewith Carrier said during the debate. Another Republican opponent, state Rep. Troy Romero, said he was concerned that having a firearm locked away would make it harder for an adult to quickly access it.

“If it’s behind a locked drawer, how in the world are you going, at 2 or 3 in the morning, going to be able to protect your family if somebody intrudes or comes into your home?” Romero said.