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Firearm deaths in children and young adults were vastly more common in the poorest versus richest U.S. counties, researchers said.

Analysis of CDC data on 67,905 firearm deaths in people age 5-24 during 2007-2016 showed the risk of dying by a firearm was more than twice as high for those living in counties with the greatest versus lowest poverty concentration after controlling for demographic variables, urbanicity, and gun prevalence by state (incidence rate ratio 2.29, 95% CI 1.96-2.67), reported Jefferson T. Barrett, MD, MPH, of Boston Children's Hospital in Massachusetts.

The association between poverty and youth firearm deaths was strongest for unintentional deaths (IRR 9.3, 95% CI 2.31-37.3), followed by homicides (IRR 3.55, 95% CI 2.81-4.54), and suicides (IRR 1.45, 95% CI 1.2-1.75), Barrett said at the virtual American Academy of Pediatrics (AAP) meeting.

"We can target the most impoverished counties with public health interventions knowing that is where the highest risk is," Barrett told MedPage Today. "Whether it's with gun control, buybacks, community policing, or implementing community programs, these can be directed at the highest impoverished counties because they are at the highest risk."

The toxic stressors associated with living in poverty affect adolescent health in many ways, and poverty has been associated with increased child abuse, youth suicides, and unintentional injuries, Barrett said.

Gun violence is also tied with economic instability. During the pandemic, as the nation faces the worst economic crisis since the Great Depression.

If the recession continues, disparities in the rate at which poverty-stricken counties are experiencing youth firearm deaths will potentially worsen, Barrett said.

However, the most predominant factor in firearm morbidity and mortality is access to firearms, commented Eric Sigel, MD, of Children's Hospital Colorado in Aurora, who was not involved in this research.

Negligence laws, in which caregivers are held criminally liable if a child accesses and uses a firearm, have been associated with a reduction in youth firearm fatalities.

"If kids don't have access to firearms, then firearm injury would not happen, unless they are victimized by an adult who has a gun," Sigel told MedPage Today.

The but if there are firearms in the home, it is recommended that families keep them stored in a locked location unloaded, and separate from ammunition. The also encourages pediatricians to directly ask whether there are guns in the places where their children play.

For this study, researchers analyzed deaths among people 5-24 years old reported to the CDC, and obtained county-level poverty concentrations from the U.S. Census Bureau. In 2016, the federal poverty line was $24,339 for a family of four, Barrett said. Poverty concentrations were divided into quintiles, with the highest poverty concentration involving counties with at least 20% of households below the federal poverty line and the lowest poverty concentration counties having less than 5% of households below the poverty line.

Overall, 34,292 pediatric firearm deaths could have been prevented if all counties had the highest income quintile analyzed in this study, the authors calculated. That translates to 27,932 homicides, 6,910 suicides, and 1,404 unintentional deaths, Barrett reported.

The rate of firearm homicides increased over time from 8.5 per 100,000 youth in 2007, to 9.2 per 100,000 youth in 2016, Barrett noted. There was an uptick in firearm fatalities, particularly among poverty-stricken counties, in years 2008-2010 and 2015-2016.

Black children had 4.8-fold the risk of dying from a firearm compared to white youth, although the risk of dying from a firearm-related suicide was higher among white children than Black children, Barrett said. Hispanic children had 1.8-fold the risk of dying from firearms compared to white youth in 2007, but that disparity narrowed by 2016, Barrett said. Native American children were also at a higher risk of firearm-related suicide compared to white youth, he added.

The county-level analysis could be viewed as a limitation, since it didn't distinguish among municipalities or neighborhoods within a county, in which poverty and firearm deaths may vary dramatically.

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