Editor’s Note: This brief was updated on March 29, 2023, to make clear that the international comparisons include children and teenagers.

Firearms recently became the number one cause of death for children and teens in the United States, surpassing motor vehicle deaths and those caused by other injuries.

We examine how gun violence and other types of firearm deaths among children and teens in the United States compares to rates in similarly large and wealthy countries. We select comparable large and wealthy countries by identifying Organization for Economic Co-operation and Development (OECD) member nations with above median GDP and above median GDP per capita in at least one year from 2010-2020. Using the Centers for Disease Control and Prevention (CDC) Wonder database and the Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease (GBD) study data, we compare fatality rates and disability estimates for people ages 1 through 19. (Since estimates were not available for children ages 1-17 alone, young adults ages 18 and 19 are grouped with children for the purposes of this brief).

We find that the United States is alone among peer nations in the number of child and teen firearm deaths. In no other similarly large or wealthy country are firearm deaths in the top 4 causes of mortality let alone the number 1 cause of death among children and teens.

In 2020 (the most recent year with available data from the CDC), firearms were the number one cause of death for children and teens ages 1-19 in the United States, taking the lives of 4,357 children and teens. With the exception of Canada, in no other peer country were firearms among the top five leading causes of childhood and teenage deaths. Motor vehicle accidents and cancer are the two most common causes of death for this age group in all other comparable countries.

Combining all child and teen firearm deaths in the U.S. with those in other OECD countries with above median GDP and GDP per capita, the U.S. accounts for 97% of gun-related child and teen deaths, despite representing 46% of the total population in these similarly large and wealthy countries. Combined, the eleven other peer countries account for only 153 of the total 4,510 firearm deaths for children and teens ages 1-19 years in these nations in 2020, and the U.S. accounts for the remainder.

Firearms account for 20% of all child and teen deaths in the U.S., compared to an average of less than 2% of child and teen deaths in similarly large and wealthy nations.

On a per capita basis, the firearm death rate among children and teens in the U.S. is about 7 times the rate of Canada, the country with the second-highest child and teen firearm death rate among similarly large and wealthy nations.

If firearm deaths in the U.S. occurred at rates seen in Canada, we estimate that approximately 26,000 fewer child and teenage lives in the U.S. would have been lost since 2010 (an average of about 2,300 lives per year). This would have reduced the total number of child and teenage deaths from all causes in the U.S. by 12%.

After reaching a recent low (of 3.1 firearm deaths per 100,000 children and teens) in 2013, the U.S. saw an 81% increase (to 5.6 firearm deaths per 100,000 children and teens) by 2020, just seven years later.

The U.S. is the only country among its peers that has seen an increase in the rate of child and teen firearm deaths in the last two decades (42% since 2000). All comparably large and wealthy countries have seen child and teen firearm deaths fall since 2000. These peer nations had an average child and teen firearm death rate of 0.7 per 100,000 children and teens in the year 2000, falling 56% to 0.3 per 100,000 children and teens in 2019.

Not all firearm deaths are a result of violent attacks. In the U.S., in 2020, 30% of child and teen deaths by firearm were ruled suicides, and 5% were unintentional or undetermined accidents. However, the most common type of child and teen firearm death is due to violent assault (65% of all child and teen firearm deaths are assault).

The spike in 2020 child and teen firearm deaths in the U.S. was primarily driven by an increase in gun assault deaths. The child and teen firearm assault mortality rate reached a high in 2020 with a rate of 3.6 per 100,000, a 39% increase from the year before. The firearm suicide mortality rate among children and teenagers in the U.S. increased 13% from 2019 to 2020, 31% since 2000, and 89% since the recent low in 2010.

Not only does the U.S. have by far the highest overall firearm death rate among children and teens, the U.S. also has the highest rates of each type of child and teen firearm deaths — suicides, assaults, and accident or undetermined intent — among similarly large and wealthy countries.

The U.S. also has a higher overall suicide rate (regardless of whether a firearm is involved) among peer nations. In the U.S., the overall child and teen suicide rate is 3.6 per 100,000 children and teens, and 1.7 per 100,000 children and teens died by suicide from firearms. In comparable countries, on average, the overall child and teen suicide rate is 2.8 per 100,000 children and teens, and 0.2 per 100,000 children and teens died by suicide from firearms. If the U.S. child and teen firearm suicide rate was brought down to 0.2 per 100,000 children and teens (the same as the average in peer countries), 1,100 fewer children and teens would have died in 2020 alone.

Exposure and use of firearms also has implications for mental health. Research suggests that adolescents may experience negative mental health impacts, including symptoms of anxiety, in response to gun violence. 

Methods

Data from CDC Wonder 2020 Underlying Cause of Death database and IHME Global Burden of Disease (GBD) 2019 study were used. Underlying cause of death categories are from IHME – GBD Level 3 Causes of Death. Top 20 leading causes of death among children and teens ages 1-19 were ranked for the U.S. and comparable countries. These top 20 causes of death include: firearms, motor vehicle traffic, other injuries, congenital diseases, cancer, substance use disorders, cardiovascular diseases, infectious diseases, chronic respiratory diseases, respiratory infections, neurological disorders, diabetes and kidney diseases, maternal and neonatal complications, digestive diseases, nutritional deficiencies, HIV/AIDS and STIs, musculoskeletal disorders, skin and subcutaneous diseases, other mental disorders, and neglected tropical diseases. Unintentional firearm deaths include undetermined intent firearm deaths. Motor vehicle deaths include motor vehicle, pedestrian, other transport, being struck by or against a vehicle in traffic, and other land transport deaths. Other injuries encompass all injuries that are not from firearms, motor vehicles, or poisonings from substance use disorders, but not from injuries incurred via medical care. Cancer includes both malignant and in situ neoplasms. Congenital diseases include congenital malformations, deformations, and chromosomal disorders, as well as any disease/disorder that could not be identified via laboratory tests or examinations. Other mental disorders (not shown in the tables above but accounted for in analyses) include all deaths from mental health disorders, excluding suicide via firearm or other injury or poisonings via substance use disorder.