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

Across middle and high school ages combined (i.e., 11 to 18 years old), the leading causes of injury-related death from 2001 to 2022 included firearm-related causes, motor vehicle collisions, drug poisoning, suffocation, and drowning (Fig. 1A). In 2017, firearms injuries surpassed motor vehicle collisions as the leading cause, with firearm-related deaths increasing by 60.1% and motor vehicle deaths decreasing by 51.6% from 2001 to 2022. See Supplementary Tables 1–3 for crude rates corresponding to Fig. 1.

Firearm deaths among adolescents, by intent, age group, and metro area, 2001-2022. Panel of crude rates per 100,000 persons for firearm injury death among adolescents from 2001-2022 including (A) all 11-18 year olds, (B) 11-13 year olds in metro areas, (C) 11-13 year olds in non-metro areas, (D) 14 −18 year olds in metro areas, and (E) 14 −18 year olds in non-metro areas. Data points not plotted were due to suppressed values

For metro middle school adolescents (i.e., 11–13 year olds), motor vehicle collisions were the leading cause of mortality until surpassed by suffocation in 2017, with firearm injuries surpassing both as the leading cause of death in 2021 (Fig. 1B). For middle school adolescents in non-metro areas, motor vehicle collision deaths decreased by 42.8% but remained the leading cause of death until 2018, when firearms injuries briefly became the leading cause (Fig. 1C).

For metro high school adolescents (i.e., 14–18 year olds), firearm injuries became the leading cause of death in 2012, with a 47.9% increase from 2001 to 2022, five years earlier than 11-18-year-olds regardless of rurality (Fig. 1D). For non-metro high school adolescents, motor vehicle collisions remained the leading cause of death despite a 52.4% decrease and alongside a 97.4% increase in firearm injury deaths (Fig. 1E).

When looking at firearm-related fatal injuries among adolescents aged 11–18 years old, firearm homicides consistently outpaced firearm suicides and unintentional deaths. Starting in 2018, there was a sharp rise in firearm homicides, resulting in a 79.3% increase to 2022 (Fig. A). See Supplementary Tables 4–6 for crude rates corresponding to Fig. 2.

Among middle school adolescents in metro areas, firearm homicide and suicide rates were comparable (Fig. 2B). In non-metro areas, firearm suicide surpassed firearm homicide in 2014, remaining higher since (Fig. 2C; some data were suppressed due to small sample sizes and not available).

For metro high school adolescents, firearm homicides increased by 61.2% from 2001 to 2022, surging by 127.3% from the 2013 low, and remained higher than firearm suicides (Fig. 2D). In non-metro areas, firearm suicides consistently remained higher than firearm homicides, though the crude rate of homicides increased by 362.9% compared to the crude rate of suicides (44.2%) (Fig. 2E).