Growing racial disparities are driving the rise in childhood deaths in the United States

Researchers at Virginia Commonwealth University and Children's Hospital in Richmond previously revealed that death rates among children and adolescents increased 18% between 2019 and 2021. Injury-related deaths grew so dramatically that they eclipsed all improvements in terms of public health.

The team, seeking to delve deeper into this troubling trend, obtained death certificate data from the Centers for Disease Control and Prevention's public WONDER database and stratified it by race, ethnicity, and cause for children aged 1 and 19 years old. They found that Black and American Indian/Alaska Native children were not only dying at significantly higher rates than white children, but the disparities – which had been improving through 2013 – were widening.

The data also revealed that while infant mortality rates overall worsened around 2020, rates for Black, Native American and Hispanic children had begun to increase much earlier, around 2014.

Between 2014 and 2020, death rates for Black children and adolescents increased by about 37%, and for Native American youth by about 22%, compared to less than 5% for white youth.

“We knew we would find disparities, but certainly not that large,” said Dr. Steven Woolf, a professor of family medicine at the VCU School of Medicine, who worked on the research. “We were shocked.”

Racial and ethnic disparities were more dramatic when injuries were isolated from other causes of death. For example, Black children died from homicide at a rate 10 times higher than White children between 2016 and 2020. When the study's lead author, Dr. Elizabeth Wolf, an associate professor of pediatrics at the VCU School of Medicine, compared accidents to intentional injuries, sobering realities about the mental health crisis emerged.

Native American children died by suicide at more than double the rate of white children, whose rate was already high.

“As a pediatrician, this really blew me away,” she said.

Gun-related deaths, including accidents, homicides, and suicides, were two to four times higher among Black and Native American youth than white youth, and the risk of dying from gun-related injuries was more than doubled among youth blacks and Native Americans. between 2013 and 2020.

The researchers also drew attention to disparities in other causes of death: Native American children died of pneumonia and influenza at three times the rate of white children, for example, and black children died of asthma at a rate nearly eight times higher than that of white children.

This particular study did not examine all of the variables that contribute to the causes of childhood illness, injury, and death. Dr. Wolf hopes the paper will serve as a “wake-up call” and spur researchers to examine the underlying factors.

Understanding the reasons for the increase in traffic deaths, for example, could determine whether redesigned intersections or campaigns targeting seat belt use would be the most effective intervention for a specific group.

For other child deaths, access to care is a likely factor, as black children with circulatory diseases are less likely to receive transplants and less likely to have a successful procedure than white children. Asthma-related illnesses and deaths are likely to be influenced by access to interventions such as inhalers, as well as socioeconomic and environmental factors such as air pollution.

At the same time, Dr. Woolf said, policymakers should not “wait for further research to identify obvious next steps,” including support for children's mental health and tougher gun laws. Public perceptions of gun violence among children are often focused on school shootings, he said, but statistically speaking, “the vast majority occur in communities across our country – day by day, one by one.”

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