Despite advances in medicine and vaccines, America’s young people are dying at alarming rates and by preventable causes, according to a recent investigation by a team of U.S. pediatric doctors. The report, published in May in the Journal of the American Medical Association, shows that in particular Blacks are hit hard by gun violence, whites and Hispanics by motor vehicle accidents and Asians and Native Americans by suicide. Most every group saw a recent increase in drug-related deaths.
Most startling: Between 2019 and 2021, death rates in the U.S. among kids ages 1 to 19 increased by 18.3%.
That rate was the “largest such increase in at least half a century,” according to the paper, titled “Racial and Ethnic Disparities in All-Cause and Cause-Specific Mortality Among US Youth.” The paper, which relied heavily on data from the Centers for Disease Control and Prevention, looked at causes of deaths among various ethnic groups between 1999 and 2020, as well as between the Covid years of 2020 and 2021. It found many disturbing trends, such as Black youths were “most likely” to die from gun violence – with nearly 13 out of every 100,000 dying by homicide between 2016 to 2020. Asthma was also a significant killer of Black youth, which were more likely to succumb to several diseases disproportionately than other racial and ethnic groups.
Whites and Hispanics were most likely to die from car accidents or other vehicular crashes, although Hispanics also suffered from disproportionately high rates of gun violence. American Indian, Alaska Native youth and Asian and Pacific Islanders, meanwhile, were seeing high numbers of suicides.
Nearly a half million – or 491,680 – youths died from 1999 to 2020, with the majority, around 65%, boys. More than half of the deaths were among teenagers, and the largest increases in deaths were seen among Blacks, American Indian and Alaska Natives and Whites.
“Disparities in death rates among American Indian or Alaska Native, Black, and White youth have been increasing in the last several years. Between 2014 and 2020, all-cause mortality rates increased 36.7% in Black youth and 22.3% in American Indian or Alaska Native youth while increasing 4.7% in White youth,” reads the report.
Sampan interviewed the paper’s lead author, Dr. Elizabeth Wolf, a pediatrician and researcher at the Virginia Commonwealth University School of Medicine, about the findings.

Sampan: After reading through this investigation, it feels, quite frankly, like we as a society are failing our children on many levels. Is that a fair assumption?
Dr. Wolf: I think you are right to be disappointed. These recent increases in child mortality have offset the medical advances and improvements in injury prevention made over the past 50 years. As a society, we need to do a better job of protecting our children.

Sampan: The trend for Black youth seems most troubling…. Were you surprised by the results, or did they make sense given what you see at the hospital?
Dr. Wolf: I was surprised by a few things: 1) that disparities got worse rather than better over time, 2) that the disparities were so large.

Sampan: If you could, based on these findings, prescribe changes to our society that can’t be remedied in the hospital – as in gun laws or motor vehicle laws or mental health support – what would they be?
Dr. Wolf: I think you are right to focus on interventions that occur outside the hospital. Common sense gun reforms such as child access prevention laws and raising the age limit for firearm purchasing could make a difference in preventing firearm deaths.
Our mental health system is under tremendous strain right now. There is a shortage of mental health providers, especially in rural areas. Every day, we see pediatric patients languishing in emergency departments waiting for psychiatric beds to open. We need to recruit more mental health providers and increase the number of beds for pediatric psychiatric patients. We also need to understand how technology and social media are contributing to the recent mental health crisis.

Sampan: Jumping off that last question, do you ever feel as if we are becoming a society that places too much burden on emergency room care? For example, these gun and other “mechanism” deaths, such as car accidents, would likely be worse if the U.S. did not have such a robust emergency care system. And yet we still see these jumps in deaths among some groups of youth.
Dr. Wolf: I think emergency care is extremely important. Emergency doctors must make lightning-fast decisions that impact whether a patient will live or die. We are seeing a lot of burnout in emergency departments following the pandemic and I worry about whether we will have enough providers in years to come.
On the other hand, the U.S. generally tends to underemphasize prevention efforts relative to acute care. Atul Gawande wrote about this in a wonderful essay for the New Yorker (www.newyorker.com/magazine/2021/08/30/costa-ricans-live-longer-than-we-do-whats-the-secret.)

Sampan: Please help me through the table on total mortality and what it tells you about suicide deaths? What was most striking for you here?
Dr. Wolf: I found the suicide rate in American Indian/Alaska Native youth to be very disturbing. Many of the deaths were by hanging.

Sampan: ….Do you have any concerns that these leading causes of deaths that are preventable, such as by guns or suicide especially, will have a ripple effect of trauma for loved ones and friends of those who died, potentially leading to more injury and death or risky behavior?
Dr. Wolf: I am very concerned about the effects of trauma on the family and community. It is incredibly sad to see so many young people die from preventable causes.