Injuries, not illness, kill more young people than anything else. In the United States, the two dominant causes are firearm-related deaths and motor vehicle crashes, with drug overdoses rising fast behind them. Globally, the pattern is similar: the World Health Organization identifies road traffic injuries, drowning, interpersonal violence, and self-harm as the top killers of adolescents and young adults.
Firearms Now Lead in the U.S.
In 2020, firearm-related injuries overtook motor vehicle crashes to become the single leading cause of death among children and adolescents in the United States. That shift had been building for years. The crude rate of firearm deaths jumped 13.5% from 2019 to 2020 alone, reaching a new peak of over 45,000 firearm-related deaths across all ages that year. For young people specifically, firearms now account for more deaths than car crashes, drug poisoning, or cancer.
This ranking holds for the broader age group of 1 to 19. Once you expand the window to include young adults in their early twenties, motor vehicle crashes and overdoses also compete for the top spot depending on the year and demographic group.
Motor Vehicle Crashes Remain a Major Killer
Car crashes have been the traditional leading cause of death for young people in the U.S. for decades, and they still kill thousands every year. In 2023, 2,148 drivers between ages 15 and 20 died in traffic crashes, a 5% increase from the year before. When you count all fatalities in crashes involving a young driver (passengers, pedestrians, and occupants of other vehicles), the number reached 5,588 in 2023, up 25% over the past decade.
Young drivers are overrepresented in fatal crashes relative to how many of them are on the road. The fatal crash involvement rate for 15- to 20-year-olds was 42.4 per 100,000 licensed drivers in 2023, well above the national average. Inexperience, nighttime driving, and passengers in the car all increase risk for teen drivers. Graduated licensing laws, which phase in driving privileges over time, have been one of the most effective policy tools for reducing these numbers.
Drug Overdoses Are Climbing Fast
Overdose deaths among young people rose from 4,652 to 6,723 per year between 2018 and 2022. The rate jumped from about 10.9 to 15.2 per 100,000. The driving force is synthetic opioids, primarily fentanyl, which has infiltrated the drug supply in forms that young people may not recognize as dangerous. Counterfeit pills that look like prescription medications but contain lethal doses of fentanyl are a particular risk.
What changed most dramatically is the type of overdose. Deaths involving synthetic opioids alone (not mixed with other drugs) nearly tripled, going from 1.8 to 4.8 per 100,000. Since 2020, these single-substance fentanyl overdoses have outnumbered polydrug overdoses regardless of the person’s race, ethnicity, or sex. This suggests that many young people who die are not chronic drug users combining multiple substances. Some are encountering fentanyl for the first time in what they believed was something else entirely.
Suicide Rates Have Risen Sharply
Suicide is the second leading cause of death for Americans aged 10 to 24. The rate increased 62% between 2007 and 2021, climbing from 6.8 to 11.0 deaths per 100,000. That trend played out differently across age groups, and the numbers for the youngest are especially striking.
Among 10- to 14-year-olds, the suicide rate tripled from 2007 to 2018, going from 0.9 to 2.9 per 100,000. It then leveled off through 2021 but did not decline. For 15- to 19-year-olds, the rate rose 57% between 2009 and 2017 before plateauing. Among 20- to 24-year-olds, it climbed 63% over two decades, reaching 19.4 per 100,000 in 2021. These increases preceded the pandemic and appear connected to broader trends in mental health among young people, including rising rates of depression and anxiety.
The Pandemic Made Things Worse
Between April 2020 and March 2023, the overall death rate for Americans aged 1 to 24 rose 14.3% compared to the three years before the pandemic. The rate went from 38.2 to 43.7 per 100,000. That increase was not spread evenly. Black youth experienced the largest jump, with a 32.6% increase in death rates. Hispanic youth saw a 23.1% rise. White youth had a much smaller 3.3% increase.
These disparities reflect longstanding inequities in exposure to violence, access to safe transportation and healthcare, and neighborhood conditions. The pandemic disrupted mental health services, increased social isolation, and coincided with a surge in gun purchases and drug supply contamination, all of which hit vulnerable communities hardest.
The Global Picture Looks Different
Outside high-income countries, the leading causes of death for young people shift considerably. For adolescents aged 10 to 14 in low-income settings, infectious diseases still dominate. Diarrheal diseases and pneumonia remain among the top five killers in that age group, particularly in sub-Saharan Africa. A 10-year-old in sub-Saharan Africa is roughly six times more likely to die before age 24 than a 10-year-old in North America or Europe.
As adolescents get older, even in lower-income countries, the pattern starts to resemble what happens in wealthier nations. Road traffic injuries, interpersonal violence, self-harm, and complications from pregnancy and childbirth become the dominant causes of death among older teens and young adults worldwide. Road crashes are the single largest killer of 15- to 29-year-olds globally.
What Actually Reduces These Deaths
The good news is that many of these causes of death respond to straightforward interventions. Motorcycle helmet laws in Vietnam increased helmet use from 27% to 99% and reduced traffic-related head injury deaths by 18%. Bicycle helmet legislation in Canada cut cycling deaths among children by 52%. Graduated driver licensing programs, which restrict nighttime driving and the number of passengers for new teen drivers, have consistently reduced crash fatalities in U.S. states that adopt them.
For violence prevention, school-based programs have shown measurable results. The Safe Dates Program, tested in a randomized trial, reduced rates of physical and sexual violence among adolescents. Secure firearm storage, where guns are locked and stored separately from ammunition, reduces the risk of both youth suicide and unintentional shootings in homes with firearms.
Overdose prevention increasingly focuses on fentanyl test strips, which allow people to check substances before use, and widespread availability of naloxone, the medication that reverses opioid overdoses. Both are now legal and accessible in most U.S. states, though awareness among young people and their families remains uneven.