Trends in firearm death among middle and high-school aged rural and urban adolescents from 2001 to 2022.

Background: Youth are at high risk for firearm-related injury and death. However, research combining children and adolescents into one homogeneous group ignores distinct developmental stages and associated risks. Addressing firearm mortality as a public health crisis requires strategies tailored to developmental stage, injury intent, setting, and cultural context. Given this, the purpose of the current study was to identify changes over time in injury mortality and specifically firearm-related mortality, among middle (11-13 year olds) and high school-aged (14-18 year olds) adolescents in metro and non-metro areas of the United States.

Findings: Crude death rate data were pulled from the United States Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System Fatal Injury Data from 2001 to 2022. Across all fatal injury causes among 11-18 year olds, firearms surpassed motor vehicle collisions as the leading cause of death in 2017. When looking specifically at fatal firearm injuries, rates of homicide were consistently higher than those of suicide and unintentional death, with a 79.3% increase from 2018 to 2022. In non-metro areas, suicide was the leading cause of death for the 11-13 year olds. Among the 14-18 year old group suicide remained the leading cause of death despite a 362.9% increase in homicide. In metro areas, homicides among 14-18 year olds surged 127.3% from a 2013 low and remained higher than rates of suicide.

Conclusions: Findings suggest developmental differences influence risk and combining children and adolescents together obscures distinct trends within critical developmental stages. Prevention strategies should be informed by developmental stage and include violence and injury prevention efforts in all areas as well as developmentally and culturally appropriate suicide prevention approaches in rural areas.