Types of Child Firearm Deaths Different in Rural vs. Urban Areas

Published on in CHOP News

May 25, 2010 — Children in the U.S. are just as likely to die from gunshot wounds if they live in the largest cities or the smallest towns. However, teens living in the most urban counties are more likely to die from gun violence, while children in the most remote areas of the country are more likely to die in gun-related accidents or suicides, according to new research by The Children’s Hospital of Philadelphia.

Gun violence is everyone's problem

Almost 24,000 children and adolescents were killed by guns in the U.S. between 1999 and 2006. The study, which appears in the June issue of the journal Pediatrics, looked at the circumstances of those deaths and found 15,190 were homicides, 7,082 were suicides and 1,377 were classified as unintentional. The most urban counties experienced disproportionately higher rates of firearm homicide, while the most rural counties experienced higher rates of suicide and unintentional firearm deaths. To reduce these deaths, prevention strategies should be tailored to the needs of these distinct geographic areas.

“Gun violence doesn’t just happen in big cities; it is everyone’s problem,” said study author Michael L. Nance, MD, a pediatric surgeon and director of trauma program at The Children’s Hospital of Philadelphia. “Prevention initiatives should take into account these rural-urban differences.”

Gunshot wounds in urban areas more likely to be intentional

Children between the ages of 15 and 19 were more than five times more likely to die from intentional gunshot wounds in the most urban counties than in the most rural counties. On the other hand, the suicide and unintentional firearm mortality rates in the most rural counties were nearly four- to five-fold higher than in the urban counties. During the same eight year period, there were more than 113,000 injury deaths that did not involve firearms and they were more likely to occur in rural areas, according to the study.

First study to look at causes of firearm deaths in children

These findings advance our understanding of firearm-related mortality among children and adolescents in the U.S., the authors said. While past studies have shown similar disparities in the cause of firearm deaths in the adult population, this is the first study to show it exists in the pediatric population as well. By collecting mortality information at the county level, the authors were able to analyze a more geographically specific portrait than past studies.

Firearm injury prevention strategies for children need to be tailored to the environment they live in

“When one looks at the intent associated with the firearm deaths across the rural-urban continuum however, there is significant variation,” Nance said. “Although there is a national need to reduce pediatric firearm injury, specific counties should understand their own distinctive profile of firearm injury and death and tailor their prevention activities according to their specific situation.”

More information

Other study authors are Brendan G. Carr, MD, MS; Michael J. Kallan, MS; Charles C. Branas, PhD and Douglas J. Wiebe, PhD from The University of Pennsylvania.

“Variation in Pediatric and Adolescent Firearm Mortality Between Rural and Urban America,” Pediatrics published online May 24, 2010. Read the abstract.