The Major Causes of Death in Children and Adolescents in the United States

Abstract

In 2016, children and adolescents (1 to 19 years of age) represented a quarter of the total estimated U.S. population 1 ; reflecting relatively good health, they accounted for less than 2% of all U.S. deaths. 2 By 2016, death among children and adolescents had become a rare event. Declines in deaths from infectious disease or cancer, which had resulted from early diagnosis, vaccinations, antibiotics, and medical and surgical treatment, had given way to increases in deaths from injury-related causes, including motor vehicle crashes, firearm injuries, and the emerging problem of opioid overdoses. Although injury deaths have traditionally been viewed as "accidents," injury-prevention science that evolved during the latter half of the 20th century increasingly shows that such deaths are preventable with evidence-based approaches. In this report, we summarize the leading causes of death in children and adolescents (1 to 19 years of age) in the United States. Unless otherwise indicated, data on deaths were obtained from the Wide-ranging Online Data for Epidemiologic Research (WONDER) system of the Centers for Disease Control and Prevention (CDC), known as CDC WONDER, 2 in which data are derived from U.S. death certificates compiled from 57 vital-statistics jurisdictions. 2 Data are presented for 2016, the most recent year with national data available. 2 Where appropriate, rates are expressed per 100,000 children and adolescents and include the 95% confidence interval. Le ading C auses of Child and Adolescent De ath Burden of Disease In 2016, there were 20,360 deaths among children and adolescents in the United States. More than 60% resulted from injury-related causes, which included 6 of the 10 leading causes of death (Table 1, and Table S1 in the Supplementary Appendix, available with the full text of this article at NEJM.org). Injuries were classified according to underlying mechanism (e.g., motor vehicle crash or firearm-related injury) and intent (e.g., suicide, homicide, unintentional, or undeter-mined), both of which are critical to understanding risk and protective factors and to developing effective prevention strategies. When we examined all deaths among children and adolescents according to intent, unintentional injuries were the most common cause of injury-related death (57%; 7047 of 12,336 deaths), and among intentional injuries, suicide was slightly more common (21%; 2560 of 12,336) than homicide (20%; 2469 of 12,336). Motor vehicle crashes were the leading cause of death for children and adolescents, representing 20% of all deaths; firearm-related injuries were the second leading cause of death, responsible for 15% of deaths. Among firearm deaths, 59% were homicides, 35% were suicides, and 4% were unintentional injuries (e.g., accidental discharge). (The intent was undetermined in 2% of firearm deaths.) In contrast, among U.S. adults (≥20 years of age), 62% of firearm deaths were from suicide and 37% were from homicide. Furthermore , although unintentional firearm deaths were responsible for less than 2% of all U.S. firearm deaths, 26% occurred among children and adolescents. Despite improvements in pediatric cancer care, malignant neoplasms were the third leading cause of death, representing 9% of overall deaths among children and adolescents. The fourth leading cause of death was suffocation, responsible for 7% of all deaths. Suffocation (e.g., due to bed linens, plastic bags, obstruction of the airway, hanging, or strangulation) varies with respect to intent (e.g., homicide, suicide, or unintentional). The remaining six leading causes of The New England Journal of Medicine Downloaded from nejm.org on October 21, 2022. For personal use only. No other uses without permission.