No Exaggeration: Too Many Children Are Dying in the U.S.

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A recent report (RM Cunningham et al. NEJM 2018; 379: 2468-75; editorial 2466-7) highlights the poor outcomes for children in the U.S. based mainly on the CDC WONDER (Wide-ranging Online Data for Epidemiologic Research) database.

Key findings:

  • “The sad fact is that a child or adolescent in the United States is 57% more likely to die by the age of 19 years than those in other wealthy nations.”
  • Motor vehicle accidents (MVA) are the number one cause of deaths in children/adolescents, accounting for 20% of such deaths.  The U.S. rate of death from MVAs is “triple that in other developed countries.”  Overall, MVA deaths had dropped in half from 1999-2013 but have increased in last few years; this increase is thought to be related to distracted driving/walking due to cellphones.
  • Firearm-related deaths accounted for 15% of deaths in children/adolescents in U.S.  In U.S., children/adolescents are “36 times as likely to be killed by gunshots.”  Unlike adults in U.S., the majority of these gunshots are homicides (59%) rather than suicides (35%); unintentional firearm deaths accounted for 4% (2% undetermined firearm-related death).  Among U.S. adults, 62% of deaths from firearms were from suicide.
  • Malignant neoplasms were the third leading mortality cause in children/adolescents, 9%. This rate is similar to other countries.

The figures in the study are very helpful:

  • Figure 2: Deaths from MVAs for the U.S. pediatric population are more similar to low-to-middle income countries (Figure 2A) whereas firearm-related deaths are much greater than all of the countries shown in Figure 2B (including Sweden, England, Hungary, Australia, Austria, Thailand, Tajikistan, Romania, Mongolia).
  • Figure 3. Deaths in U.S. rural areas are roughly double from MVAs than from the average of urban/suburban areas.  Deaths from firearms are similar in all three areas.  There are several factors which could explain the high rate of fatal MVAs in rural areas: longer time to get medical attention, faster speeds in less populous areas, less seat belts, lower enforcement of traffic laws, and impaired driving.

My take: The increased risk of death from MVAs and firearms identified in this study should not be considered “accidents” but failures.  Is it too much to expect that a child born in the U.S. could have the same chance to reach adulthood as a child in Canada or a child in Europe?

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