07 April 2023

Pediatric Mortality Spikes

Pediatric mortality rates in the US rose 20% between 2019 and 2021, the largest increase in at least 50 years. (Though age definitions vary, “pediatric” generally includes infants, children and adolescents).

Welcome back. A recent editorial in the Journal of the American Medical Association (JAMA) Network Open is sad, depressing and important.

Medical researchers affiliated with Virginia Commonwealth and Washington universities and the Seattle Children’s Research Institute examined CDC mortality data for 1999-2020 and provisional data for 2021. They found the all-cause mortality rate for 1 to 19 year olds increased by 10.7% between 2019 and 2020 and by an additional 8.3% between 2020 and 2021.

The increases ended a period of reducing pediatric mortality and were the largest increases in decades. Most deaths were adolescents age 10 to 19, yet all-cause mortality of children age 1 to 9 also increased in 2021 by 8.4%. Infants younger than 1 year were the only age group with no significant increase in mortality.

Research underscores the importance of early crime intervention strategies and mental health services to address pediatric mortality (from news.northwestern.edu/stories/2022/05/we-could-not-have-anticipated-the-high-mortality-rate-of-our-participants/).
Mortality Breakdown
The reversal in the pediatric mortality trajectory was caused by injuries (i.e., all external causes of morbidity and mortality) not by COVID-19. The increase in injury deaths predates and, in 2020, was nearly 12 times higher than COVID. The mortality for causes other than injuries and COVID fell by 0.33 deaths per 100,000.

Suicides of 10 to 19 year olds began to increase in 2007, and homicides in this age group began increasing in 2013. Between those dates and 2019, suicide and homicide rates increased by 69.5% and 32.7%, respectively. Likely contributors to both include increased access to firearms, which accounted for nearly half of the increase in all-cause pediatric mortality in 2020, and a growing mental health crisis. Access to opioids also increased, and overdose deaths began increasing shortly before the pandemic.

Injury mortality of 10 to 19 year olds rose by 22.6% between 2019 and 2020. Much of this surge involved homicides and drug overdoses, which increased by 39.1% and 113.5%, respectively. Transportation-related deaths, which had decreased for decades with improved vehicle safety measures and occupant restraints, increased by 15.6% in 2020. Among children age 1 to 9, injuries accounted for nearly two-thirds of the increase in all-cause mortality in 2021, including a 45.9% increase in deaths involving fires or burns.

Sex, Racial and Ethnic Disparities
The risk of injury deaths was not faced equally by all.

In 2020, the increase in injury deaths involved primarily males, with non-Hispanic Black youths accounting for two-thirds of homicide victims age 10 to 19. In 2021, the homicide rate among non-Hispanic Black youths age 10 to 19 was 6 times that of Hispanic youths and more than 20 times that of Asian-Pacific Islander non-Hispanic and White youths.

All-cause, injury and noninjury mortality rates of males and females, ages 1 to 19, 1999-2021 (from jamanetwork.com/journals/jama/fullarticle/2802602).

Transportation-related death rates of 10 to 19 year olds were highest in the non-Hispanic American Indian/Alaska Native population, but rates among non-Hispanic Black youths increased, surpassing that of non-Hispanic White youths in 2019.

Suicides at age 10 to 19 were more than twice as likely among American Indian/Alaska Native youths and non-Hispanic Black youths than among non-Hispanic White youths.

Although non-Hispanic White youths age 10 to 19 have historically died at higher rates from drug overdoses, non-Hispanic Black and Hispanic populations closed the gap, reaching statistical equivalence in 2020.

Deaths by cause, ages 1 to 19, 1999-2021; deaths from unintentional poisoning, such as those from unintentional drug overdoses or alcohol poisoning, are considered distinct from suicides involving drugs; a large proportion of suicides and homicides are classified as firearm-related deaths (from jamanetwork.com/journals/jama/fullarticle/2802602).
Wrap Up
The researchers conclude that medicine and public health have made remarkable progress in lowering pediatric mortality, yet the lives saved are now endangered by bullets, drugs and automobiles. Without bold action to reverse the trend, the risk of youths not reaching adulthood may increase.

Research and policy to address the underlying causes of pediatric mortality (e.g., depression, suicidality, opioids, systemic racism, widening inequities, societal conflict) are urgently needed; and efforts to understand gun violence, overcome political gridlock and enact firearm policies should progress with the speed that suicides and homicides warrant.

Thanks for stopping by.

Editorial on youth mortality in JAMA Network Open: jamanetwork.com/journals/jama/fullarticle/2802602
Article on editorial on EurekAlert! website: www.eurekalert.org/news-releases/982549
CDC WONDER databases: wonder.cdc.gov/ and wonder.cdc.gov/DataSets.html

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