Firearm-Related Fatalities Among Children and Teenagers -- US, 1982

In 1988, gunshot wounds were the eighth leading cause of unintentional injury deaths among persons in all age groups in the United States and the third leading cause of such deaths among children and teenagers aged 10-19 years (1). From 1982 through 1988, 3607 children and teenagers aged 0-19 years died from unintentional firearm-related injuries, constituting 32% of all unintentional firearm-related deaths. Of those, 81% occurred among 10-19-year-olds. This article describes a case report of an unintentional firearm-related death of a teenager and summarizes an analysis of demographic and regional differences in unintentional firearm-related mortality among children and teenagers from 1982 through 1988. Case Report

In a large metropolitan area in the southern United States, two brothers were playing in their home with two friends while the boys' parents were at work. Initially, they played in the boys' bedroom using the bunk beds and bedspreads to build "forts"; they also engaged in gun play using plastic toy guns. Later, they divided into two teams to play hide-and-seek. One of the boys, a 13-year-old, hid in his parents' bedroom where he found his father's 12-gauge shotgun stored under the bed. The shotgun was kept in the house for protection; the boy did not know it was loaded. When his friend, also aged 13 years, entered the room looking for him, the boy who was hiding inadvertently discharged the gun, killing his friend. Analysis of National Mortality Data

Demographic and regional differences in firearm-related mortality were examined using mortality data compiled by CDC's National Center for Health Statistics. Unintentional firearm-related deaths were identified by the International Classification of Diseases, Ninth Revision, code E922. Classification of counties as metropolitan and nonmetropolitan is based on metropolitan statistical areas designated by the U.S. Office of Management and Budget in 1982.

For males aged 10-19 years, the unintentional firearm-related death rate was 10 times that for females (2.0 per 100,000 versus 0.2 per 100,000 children). Males aged 15-19 years were at higher risk (2.4 per 100,000) than were males in any other age group. The risk for dying from an unintentional gunshot wound was similar for black and white children and teenagers aged 10-19 years.

Children and teenagers living in the South * were at greatest risk for dying from an unintentional gunshot wound; those living in the Northeast ** were at lowest risk (Table 1). Within regions, white males aged 15-19 years were at greatest risk in the South; in all other regions, death rates were highest for black male teenagers. Overall, children and teenagers living in nonmetropolitan regions were more than twice as likely to die from an unintentional gunshot wound as those living in metropolitan areas; however, the rate ratio in nonmetropolitan and metropolitan areas was 1.4 for black males aged 10-14 years and 1.1 for black males aged 15-19 years (Table 2).

Reported by: Unintentional Injuries Section, Epidemiology Br, and Biometrics Br, Div of Injury Control, National Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: Despite recent declines in unintentional firearm-related mortality (1,2), such injuries continue to disproportionately affect youth nationwide. Unintentional firearm-related injuries are also a major cause of morbidity. For example, a recent report by the General Accounting Office (GAO) estimated that, in 10 U.S. cities during 1989 and 1990, the ratio of nonfatal to fatal unintentional gunshot wounds was 105 to 1 for all age groups combined (3). Although the findings of the GAO report cannot be generalized to the entire United States, they underscore the public health impact of unintentional firearm-related injuries.

The high rates of unintentional firearm-related mortality for children and teenagers living in southern and western regions of the country are consistent with the findings of previous reports (1). Although most reports have demonstrated a higher death rate for those living in rural areas (1,4), one study in Cleveland, Ohio, found rates were higher in urban areas than in the suburbs (5).

The findings in this report indicate that, although death rates of unintentional firearm-related injuries were generally higher for children and teenagers living in nonmetropolitan areas, death rates for black males in metropolitan areas approached those in nonmetropolitan areas. Risk factors, such as access to firearms and per capita income, may have a differential impact on unintentional firearm-related mortality. For example, the availability of firearms has been directly associated with unintentional gunshot wounds (5), and the relation between per capita income of the area of residence and unintentional firearm-related mortality varies inversely (1).

Reduction of morbidity and mortality from unintentional firearm-related injuries among children and teenagers must emphasize limiting access to loaded weapons. Specific behavioral characteristics associated with adolescence, such as impulsivity, feelings of invincibility, and curiosity about firearms, place adolescents at particularly high risk for firearm-related injuries (6).

One of the national health objectives for the year 2000 is to reduce by 20% the proportion of households with inappropriately stored weapons (objective 7.11) (7). This objective is consistent with the findings of several studies indicating that most unintentional firearm-related deaths involving children occur at a residence (4,8,9) and involve inappropriately stored weapons (9). Appropriate storage should include locked and separate storage of weapons and ammunition. In Florida and California, legislation has been enacted to make adults legally responsible for inappropriate storage.

Modifying firearms and ammunition to render them less lethal has also been advocated as a prevention strategy (1,10). The addition of child-proof safety devices would prevent children aged less than 6 years from discharging a firearm, and the use of loading indicators could prevent an estimated 23% of all unintentional firearm-related deaths (3). Regulation to control the amount of gunpowder and the shape and jacketing of ammunition may reduce the severity of nonfatal firearm-related injuries (1,10).

References

1. Baker SP, O'Neill B, Ginsburg MJ, Li G. The injury fact book. 2nd ed. New York: Oxford University Press, 1992.

2. Wood NP Jr, Mercy JA. Unintentional firearm-related fatalities, 1970-1984. In: CDC surveillance summaries, February 1988. MMWR 1988;37(no. SS-1):47-52.

3. US General Accounting Office. Accidental shootings: many deaths and injuries caused by firearms could be prevented -- report to the Chairman, Subcommittee on Antitrust, Monopolies, and Business Rights, Committee on the Judiciary, House of Representatives. Washington, DC: US General Accounting Office, 1991; report no. GAO/PEMD-91-9.

4. Keck NJ, Istre GR, Coury DL, Jordan F, Eaton AP. Characteristics of fatal gunshot wounds in the home in Oklahoma: 1982-1983. Am J Dis Child 1988;142:623-6.

5. Rushforth NB, Hirsch CS, Ford AB, Adelson L. Accidental firearm fatalities in a metropolitan county (1958-1973). Am J Epidemiol 1975;100:499-505.

6. Committee on Adolescence, American Academy of Pediatrics. Firearms and adolescents. AAP News 1992;(January):20-1.

7. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives -- full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

8. Wintemute GJ, Kraus JF, Teret SP, Wright MA. Unintentional firearm deaths in California. J Trauma 1989;29:457-61.

9. Beaver BL, Moore VL, Peclet M, Haller JA Jr, Smialek J, Hill JL. Characteristics of pediatric firearm fatalities. J Pediatr Surg 1990;25:97-100.

10. Christoffel KK. Toward reducing pediatric injuries from firearms: charting a legislative and regulatory course. Pediatrics 1991;88:294-305.

• South Atlantic, East South Central, and West South Central regions. ** New England and Middle Atlantic regions.

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