Increasing Firearm Deaths in The Youngest Americans: Ecologic Correlation with Firearm Prevalence

Abstract

Background: In the United States (U.S.), the overall death rate in 1-4 year-olds had been steadily declining until 2011, after which it ceased to improve. To understand this trend reversal, we investigated trends in the causes of their deaths.\nMethods: Mortality data were obtained from the U.S. Centers for Disease Control and Institute for Health Metrics and Evaluation, firearm background check data from the National Instant Criminal Background Check System, and civilian firearm prevalence from the Small Arms Survey. \nFindings: In 1-4 year-olds, the rate of fatal firearm accidents during 2002-2017 increased exponentially at an average rate of 6.0%/year (p=0.0003). The rate of increase was the greatest of all evaluable causes of death in the age group. Both the rate increase and most recent absolute rate in firearm accidental deaths in young children were correlated with the concurrent corresponding rate of firearm background checks (p = 0.0002 and 0.003, respectively). Also, the firearm accidental death rate in countries with high civilian firearm prevalence was correlated with the number of guns per civilian population (p=0.002).\nInterpretation: Prior to 2004, the childhood firearm death rate did not increase during the Federal Assault Weapons Ban. Since 2004 when the Ban ended, the steadily increasing rate of sales and concomitant availability of, and access to, firearms in the U.S. has been associated with an increase in fatal firearm accidents in its youngest children. The acceleration of firearm deaths and injuries among young Americans requires urgent, definitive solutions that address firearm prevalence.\nFunding: No external funding.