(CNN) --
Homicide is one of the leading causes of child death in the United States, according to a new study, and the overall rate has risen an average of 4.3% each year for nearly a decade.
Black children died from this cause more than any other group, and firearms were the most common weapon used in child deaths, according to the study, published Monday in the academic journal
JAMA Pediatrics
.
Between 1999 and 2020, 38,362 American children were victims of homicide, the researchers found.
The overall homicide rate saw an especially "precipitous" increase from 2019 to 2020, with rates rising in various demographic groups, the study says.
In that period alone, the number of minors who died in a homicide increased by 27.7%.
The sharp increase may be driven in part by the overall trend in firearm-related juvenile homicides, which increased 47.7% between 2019 and 2020, the study says.
Overall homicide rates increased the most for boys, with an increase of 16.1% between 2018 and 2020. However, there was a decrease in homicides among girls between 1999 and 2020.
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systemic inequalities
The homicide rate among black minors increased by 16.6% between 2018 and 2020. Black and Hispanic minors have experienced a steady increase in homicides since 2012 and 2014, respectively.
American Indian and Alaska Native children had a decline in homicide rates between 1999 and 2020, but it was not statistically significant, the researchers said.
However, in most years, they have had the second highest homicide rates among racial and ethnic groups.
The investigators also noted that these numbers may be underestimates, as the race of some victims may have been misidentified as Hispanic.
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According to the study, homicide rates for Asian, Pacific Islander and White minors have declined steadily since 1999.
Previous studies have shown that racial disparities can be attributed in part to racism and systemic inequities in neighborhoods where many children live, with high concentrations of poverty, few safe places to play, and poor school systems.
These neighborhoods are also run by authority figures who —due to unconscious prejudices— dehumanize these minors and perceive them as "less childish and innocent" and "as more guilty of their acts", with "fewer protections and benefits for children in compared to their white peers," the new study states.
The homicide rate has also increased since 2011 in rural areas that have seen limited employment opportunities and challenges with poverty.
It's a slower climb than in urban areas, but it's a longer period of an upward trend, the study says.
The child homicide rate in the South has also been on the rise since 2013, according to the study.
The researchers also looked at deaths by age group.
Children 10 years of age or younger died more frequently from negligent homicide or abuse, usually by parents or caregivers, particularly by the father's or mother's partner.
Most of the victims 11 and older died in fights, during a crime or at the hands of a friend or acquaintance, the investigators found.
Black boys ages 16 to 17 had a homicide rate 18 times that of white boys and 4.6 times that of Hispanic boys.
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Escaping poverty through education
Homicide rates of infants and children ages 1 to 5 have declined steadily over the past two decades.
The researchers suggest that this decline coincides with medical reform and federal programs such as the Maternal, Child and Early Childhood Home Visiting Program, which supports pregnant women and parents of young children in communities with higher risks and barriers. for positive maternal and child health outcomes, as well as training programs that emphasize positive parenting skills.
Dr. Karen Sheehan, an attending emergency physician at Ann & Robert H. Lurie Children's Hospital of Chicago, agreed that there may be a connection between these programs and the decline in homicides among younger children.
"We've put a lot of resources into this country to help strengthen families, through home visiting programs and also sometimes through programs like the child tax credit, and maybe that's why we're seeing a decline in those categories because of this investment that we've made," said Sheehan, who was not involved in the new research.
Sheehan and other doctors have been working to improve children's health through their Chicago Youth Programs.
"If we wanted to improve their health, it was essential to lift them out of poverty, and for most, education was the shortest path," he said.
The programs offer tutoring, healthcare and leisure activities.
Research shows that these types of youth development programs are effective in improving the economic stability, education, and well-being of children.
Similar programs can also prevent violence against children.
"If we invest strategically and structurally, we can reduce the number of violent deaths," Sheehan said.
a forgotten group
The new study found that homicides among children ages 6 to 10 have been on the rise since 2014.
The researchers say that most school violence intervention programs for this age group focus on talking about sexual abuse and peer violence, such as bullying, rather than parent-child violence, unless the child exhibits specific behavioral problems.
The authors suggest that programs that educate about intimate partner violence may be necessary.
The study also suggests that reducing access to "lethal means" such as weapons could reduce deaths in children ages 6 to 10.
Sheehan said the numbers for this age group were striking.
"I think people often forget about this age group. We think about younger kids with child abuse and older kids with gunshot injuries, but that 6-10 year-old group is something we need to pay attention to. attention".
Why don't the systems work?
For the study, the researchers used Wonder mortality data from the National Vital Statistics System, which uses death certificates for US residents, and the National Violent Death Reporting System.
Although reliable, the records can miss some homicides.
Child deaths can also be misclassified or underreported.
Also, the data comes from only 45 states, so it cannot be fully generalized to the entire country, and the numbers underestimate the true number of child homicides in the United States.
Dr. Elinore Kaufman, an associate professor in the Department of Surgery at the Perelman College of Medicine in Pennsylvania, said the rise in homicides was not surprising, but "that doesn't mean it isn't alarming."
"I think as a society we need to take a hard look at the systems we have in place to protect children and try to come to an understanding of why they aren't working better for these young children," said Kaufman, author of an editorial published alongside to the studio.
The United States needs a multisectoral response to reduce the number of homicides involving children, he said.
For the very young, who die more frequently from abuse or neglect, policy interventions are needed that "create and support services for new parents and families," such as paid family leave and other programs that have been shown to reduce rates of child maltreatment in the community.
For all children, reducing access to firearms can save lives, Kaufman said.
He also believes that more research is needed to better understand the relationship between social inequality and poverty in communities.
"Child homicides are preventable," the study states.
"The decline in homicide rates in some child demographics and geographic groups is encouraging; however, more can be done to protect all children."
The United States has the highest rate of deaths from firearms in more than 25 years, according to CDC data.
Increase in gunshot injuries
Another study published Monday in
JAMA Pediatrics
found that rates of firearm injuries treated at US children's hospitals increased significantly during the first year of the COVID-19 pandemic and remained elevated throughout 2021. .
The researchers compared the number of gunshot injuries treated at children's hospitals between April 2020 and December 2021 with those from April 2018 to December 2019. There were 1,815 gunshot injuries in the prior period and 2,759 during the pandemic. , an increase of 52%.
In each period, a greater proportion of the victims were black children who were covered by public insurance and children up to 5 years of age.
There were no other significant demographic differences between the victims.
"The uneven burden of injuries reflects the disproportionate implications of COVID-19 for minority communities; pandemic conditions exacerbated many structural inequities that contribute to health disparities," the study states.
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Addressing structural racism, poverty, unsafe communities and other contributors to violence, such as homicides, will take effort, but Kaufman is confident that changes can end violence against children.
"These are big problems, and it will take all of us to solve them. But that means that all of us in all of our sectors, be it health, education, social services, and as well as - and indeed I believe - the media of communication play a huge role," he said.
"I believe that all of us in our sectors have a role to play and have an opportunity to make a difference for these children and for our society as a whole."
Children's welfare Homicides