Health Disparities
Inequities in youth mortality in the rural United States: The role of firearms Allison Lind* Allison Lind Susan M Mason Elizabeth Wrigley-Field
Background: Rising mortality in children and adolescents (“youth”) in the United States is driven by an increase in firearm deaths. Black youth have been disproportionately affected, accounting for half of all youth firearm fatalities in 2021. Rural youth have consistently faced an elevated risk of mortality compared to their urban peers. Historically, however, rural residence was advantageous for Black youth.
Objective: To assess the persistence of the “rural advantage” in mortality rates for Black youth amid the recent increase in firearm deaths.
Methods: We leveraged CDC WONDER data for our study. Our outcome of interest is youth mortality, defined as the death of a child or adolescent 1 to 19 years of age. We categorized deaths into firearm and non-firearm-related. We calculated crude mortality rates per 100,000 and stratified by race (non-Hispanic Black & non-Hispanic White) and rurality (population <50,000 rural & ≥ 50,000 urban). We descriptively examined the contribution of firearms to youth mortality and explored time trends.
Results: 4350 youth died by firearms in 2020, comprising 20.3% of all youth deaths that year. Preliminary data for 2022 suggests this trend has remained consistent. In contrast, in 2014, when all-cause child mortality was at its lowest (23.8 deaths per 100,000), firearms accounted for 13.6% of deaths. While there was an overall increase in the proportion of deaths attributed to firearms over time, striking variations were observed across demographic groups (Figure 1). The firearm mortality rate for Black rural youth in 2022 (20.2 deaths per 100,000) was nearly five times the 2012 rate (4.2 deaths per 100,000), playing a substantial role in the simultaneous rise in all-cause mortality. The vast majority of these deaths occurred in the southern United States.
Conclusions: Rising youth mortality in the United States, driven by firearms, is a public health crisis. It profoundly impacts Black youth, including those residing in rural areas.
