Some context: A scary trend on closer inspection.

Researchers at Virginia Commonwealth University and Children’s Hospital of Richmond had previously revealed that mortality rates among children and adolescents had increased 18 percent between 2019 and 2021. Injury-related deaths had increased so dramatically that they eclipsed all gains in public health.

The group, seeking to delve deeper into this troubling trend, obtained death certificate data from the Centers for Disease Control and Prevention’s public database WONDER and stratified it by race, ethnicity and cause for children ages 1 to 19. years. They found that black and American Indian/Alaska Native children were not only dying at significantly higher rates than white children, but that disparities, which had been improving until 2013, were widening.

The data also revealed that while overall infant mortality rates worsened around 2020, rates for Black, Native American and Hispanic children had begun to rise much earlier, around 2014.

Between 2014 and 2020, mortality rates for Black children and adolescents increased by about 37 percent, and for Native American youth by about 22 percent, compared to less than 5 percent for white youth.

“We knew we would find disparities, but certainly not this large,” said Dr. Steven Woolf, a professor of family medicine at the VCU School of Medicine, who worked on the research. “We were shocked.”

The numbers: Injuries, particularly from firearms, are driving disparities.

Racial and ethnic disparities were most dramatic when injuries were isolated from other causes of death. For example, Black children died from homicide at a rate 10 times that of white children between 2016 and 2020. When the study’s lead author, Dr. Elizabeth Wolf, associate professor of pediatrics at VCU School of Medicine, , compared accidents to intentional injuries, The sobering realities of the mental health crisis came to light.

Native American children died by suicide at more than twice the rate of white children, whose rate was already high.

“As a pediatrician, that really took my breath away,” she said.

Firearm-related deaths, including accidents, homicides, and suicides, were two to four times higher among black and Native American youth than among white youth, and the risk of dying from a firearm-related injury was more than doubled among black and Native American youth. between 2013 and 2020.

The researchers also drew attention to disparities in other causes of death: Native American children died of pneumonia and flu at a rate three times higher than white children, for example, and black children died of asthma at a rate nearly eight times higher than white children. times higher than white children.

What happens next: Deeper research and policy changes.

This particular study did not examine all the variables that contribute to the causes of childhood illnesses, injuries, and deaths. Dr. Wolf said she hoped the paper would serve as a “wake-up call” and spur researchers to examine the underlying factors.

Understanding the reasons for the increase in car accident deaths, for example, could determine whether redesigned intersections or targeted seat belt campaigns would be the most effective intervention for a specific group.

For other childhood deaths, access to care is a likely factor, given that black children with circulatory diseases are less likely to be referred for transplants and less likely to have a successful procedure compared to white children. Asthma-related illnesses and deaths are likely to be affected by access to interventions such as inhalers, as well as socioeconomic and environmental factors such as air pollution.

At the same time, Dr. Woolf said, policymakers should not “wait for more research to identify obvious next steps,” including supporting children’s mental health and stricter gun laws. Public perception of gun violence among children often focuses on school shootings, she said, but statistically speaking, “the vast majority occur in communities across our country, day by day, one by one.”