The American Academy of Pediatrics just published a landmark study on the epidemiology of bullets and our kids, so I thought it would be of interest to share what has been learned.

http://pediatrics.aappublications.org/content/140/1/e20163486

Let me start off by saying that this report should be looked at as separate from the raging controversy in the US over the word “guns.”  Just saying that word tends to make most people experience very strong feelings.

This report is really a piece of good science, what politics does with it is up to the politics.

But as with any event that hurts our children, I think it is essential to start off with the facts.  It was this approach that allowed us to conquer polio, and cure so many infections.

The Problem

The problem is surprisingly simple to state:  Lots of kids in America are killed or injured by bullets.   I would think every American would like to see fewer kids killed and injured by bullets.  That’s it.

Bullets and Epidemiology

Anything that kills and hurts our kids should be understood, just so we can be able to do something to save many children’s lives and protect them from harm, loss of life, and/or disability.

If you don’t know how a harm happens, you cannot do anything about it.

It is from this perspective that many doctors have come to look at bullets like we do anything else that causes harm, we examine patterns of where the harm happens, and then learn how to reduce the chance it will happen.  That’s called epidemiology.

When we did that for germs, we nearly eliminated the chance any of our children would die of an infection.  We should all appreciate that death in child was common throughout all of human history, until now.  And only because we learned what germs were and found ways to prevent infections with them.

We have done that to large extent, not completely yet, but a big degree for childhood cancer.  Four of the five most common now have survival and even, for some cure, rates of nearly 90%.  That only happened because we learned how these childhood cancers worked and found ways to clear them out.

And so it will be with bullets.  They are now the third leading cause of death in childhood in America, we can make all these deaths disappear far more easily than we eliminated deaths from infection and cancer, all it takes is the desire to do so.

The Findings

The findings report the data from the period of 2002-2014.  During this 12 year period, scientists from the CDC studied a national set of data.  It turns out that whenever any American gets a serious illness or suffers a serious injury, it enters into a database, and so we know how many kids fall, get pneumonia.

The CDC found that on average, about 1,300 children in the United States die every year purely as the result of being hit by a bullet.  Another roughly 5,700 children are seen in the ER’s of the US every year for treatment of being hit by a bullet that they survive.

To put the number of needless deaths into perspective, being hit by a bullet is now known to be the third leading cause of death in our children in our country.

The only good news is that childhood is the time, by far, when you are most likely to live.  There are about 2 million deaths a year in the US and only a total of about 18,700 are children ages 1-19.  That is really good news.  It means that our children are the healthiest, most likely to live, generation in the history of humanity.

What many of us don’t really know, however, is that over half of these 18,700 childhood deaths are completely unnecessary.  About 11,000 of the 18,700 childhood deaths in America are due to various types of injury, not disease at all.

Looking at the top three causes of all types of death for children, two of the three are from injury and one does come from a disease.   The #1 cause of death is car-related injury, the #2 is cancer with 1,800 deaths a year, and then being hit by a bullet is #3 at 1,300 deaths a year.

Further information was found in terms of how the bullet hit the child to cause a death.

About half of these tragedies were the result of another person firing the weapon as an intentional act, or homicide.  About 40% of these tragedies were the result of a suicide.  Only 6% of deaths from a bullet were unintentional accidents.  The remaining 3% of these deaths were mainly by police intervention with a very small number of unknown cause.

Looking at the roughly half of all bullet caused deaths due to homicide, it turns out that

In terms of gender, boys are at far greater risk to die from a bullet than girls, accounting for over 4 of 5 such deaths.

In terms of age, older kids (13 and up) were 10 times more likely to be fatally hit by a bullet than younger kids.

In terms of ethnic group, African-American children were ten times more likely to be hit by a bullet via homicide than European- or Asian-American kids, and twice as likely to die by bullet unintentionally.  The pattern reverses with suicide, where the number killed is four times as high for European-American children than African-American children.

One last set of numbers.  The CDC also reported the nature of homicide deaths by bullet.

For the younger children (12 and under) most of the homicides were the result of an adult killing many and themselves.

About half of these homicides were committed by an adult 25 years old or  younger, killing more than one person, including themselves. About 85% of these events took place in the child’s home.

For older children (13 and up) the homicides took place mainly outside the home, by a person close to their age (13-24), and involving only one death during the incident.

The vast majority of bullets causing death in childhood are from one type of tool, the handgun.

Some Thoughts

First of all, this is upsetting data.   All deaths are, and should be, but particularly information about how our children die.

Again, the good news is that the total numbers are small compared to the many times larger numbers of older adults who pass away every year.

The reason to study these numbers and to discuss them, of course, is that is the only way any progress can be made to reduce them.  Can they be reduced?  Of course.

The tackling of deaths from germs was a tremendously complex challenge.   Just think about how smallpox used to be one of the top causes of death in childhood.  It was a scourge so huge that it rose to the level of being a goddess in India.  Now not a single person dies of smallpox on the planet, and haven’t for decades.

So we know we can stop causes of death.  We have done so.

Bullets, like germs, are a cause of death that can be studied, and changed.  In contrast to germs, deaths from bullets are completely the result of choices we make as people.  We as people have chosen to manufacture bullets, and so we are completely responsible for what happens with their use.

Fatalities from infection were never really a choice of any set of people, but bullets are.

Since deaths by bullets are purely from the hands of humanity, there is complexity in those causes.  The pattern of such deaths in younger children includes a large percentage from a young adult killing his family.

And for older children, the large percentage is shootings from other young adults or older kids.  This raises the specter of behavior, a very complex problem to control.  But at the center of all these deaths from human behavior lies the bullet.

However, even given these complexities, if we can do something to stop a germ from killing our children, we clearly are able to do something to stop a bullet.

One last thought, I will again point out my avoidance of the word gun.  It is, as noted above, avoided on purpose.  The word gun excites great passions, for and against.  I am actually not interested in that debate, on whether someone likes or dislikes guns.  My concern is for what causes our children to die, particularly any cause that does not have to be.  I therefore have referred to this cause as by bullet.

There are no known political advocacy groups for or against bullets.  And, I would dearly hope every American is united in wanting to see the number of children killed by bullets drop to zero a year.

It is in that spirit that I am more than pleased the CDC has found the patterns, it is always the first and only step towards dropping or even eliminating a cause of death.

BOTTOM LINES

1. The CDC has issued, in the July 2017 issue of Pediatrics, its findings on the facts of death by bullet for our children in the United States.
2. The number of deaths in childhood is thankfully far, far smaller than for adults.
3. Within that number, deaths by bullet rank as the third leading cause of death, only exceeded by car accidents (#1) and cancer.  All types of injury account for over half of all deaths in childhood.
4. When it comes to bullets, about half of the deaths are from homicide, nearly half from suicide, with about 6% from unintentional injury.
5.   There are patterns relating to ethnicity and age, including the enormously tragic fact that so many of these deaths in young children are at the hand of someone in their home.  And, for older children at the hands of other older children or very young adults.   The huge role of suicide in death by bullet is yet another terrible tragedy.

There is of course plenty of passion to go around when it comes to the word “gun.”  Let’s hope one day, knowing that the third leading cause of death in our children in our country will get the same attention we have offered other leading causes of death, and that we can claim the same level of success we have had in protecting our children from them.

To your health,
Dr. Arthur Lavin