Crossing Lines — A Change in the Leading Cause of Death among U.S. Children | NEJM

Injuries are the most common cause of death among children, adolescents, and young adults between 1 and 24 years of age in the United States; indeed, injuries are responsible for more deaths among children and adolescents than all other causes combined. For more than 60 years, motor vehicle crashes were the leading cause of injury-related death among young people. Beginning in 2017, however, firearm-related injuries took their place to become the most common cause of death from injury (see graph).

This change occurred because of both the rising number of firearm-related deaths in this age group and the nearly continuous reduction in deaths from motor vehicle crashes. The crossing of these trend lines demonstrates how a concerted approach to injury prevention can reduce injuries and deaths — and, conversely, how a public health problem can be exacerbated in the absence of such attention. 

Research has shown that most injuries can be prevented by means of the manufacture and appropriate use of safe products and the implementation of policies reducing product-related danger and the occurrence of hazardous situations — the principles of harm reduction.

Since the 1960s, continuous efforts have been directed toward preventing deaths from motor vehicle crashes. As a result, there has been a substantial reduction not just in fatality rates, but in rates of serious nonfatal injuries associated with motor vehicle crashes, among people of all ages.

 In 2000, motor vehicle–related injuries resulted in 13,049 deaths among young people (13.62 per 100,000 persons). Twenty years later, there has been a nearly 40% decrease, with 8234 motor vehicle traffic deaths (8.31 per 100,000 persons) recorded in 2020.