Accidents, officially called unintentional injuries, are the number one killer of teenagers in the United States. According to CDC mortality data, the top three causes of death for adolescents ages 15 to 19 are accidents, homicide, and suicide. What surprises many people is that the vast majority of these deaths are preventable, and the specific threats vary dramatically depending on a teenager’s age, sex, and race.
Motor Vehicle Crashes and Firearms Lead the Way
Within that broad “accidents” category, two causes dominate: motor vehicle crashes and firearms. For decades, car crashes were the single deadliest event for American teenagers. That changed in 2019, when firearm-related deaths overtook motor vehicles as the leading cause of death among children and adolescents overall. Both remain far ahead of any disease as a killer of young people.
The U.S. stands out internationally on both fronts. American teenagers die in car crashes at more than triple the rate of teens in other high-income countries. The gap is even more striking for firearms: the U.S. firearm death rate among children and adolescents is 36.5 times higher than in other wealthy nations, and five times higher than in lower-income countries with available data. Cancer rates, by comparison, are nearly identical across high-income countries, which underscores that the difference in teen mortality is driven almost entirely by injury.
Drug Overdoses Are Now a Top-Three Threat
Drug overdoses and poisonings have climbed to the third leading cause of death among young people in the U.S., behind only firearms and motor vehicle crashes. In 2022, an average of 22 adolescents died of overdoses every week, a rate of 5.2 deaths per 100,000. That’s roughly one high school classroom’s worth of students lost every seven days.
The primary driver is counterfeit pills laced with fentanyl. Illicit fentanyl is now involved in at least 75% of adolescent overdose deaths. Many of these teens are not chronic drug users. They may take what they believe is a prescription pill purchased through social media or from a peer, unaware it contains a lethal dose of a synthetic opioid.
Suicide Rates Have Risen Sharply
Suicide is the third leading cause of death for teens ages 15 to 19, and the second leading cause for younger adolescents ages 10 to 14. Between 1999 and 2020, suicide rates increased across every method studied. Firearm suicides rose especially fast, climbing roughly 5% per year among male adolescents and nearly 8% per year among female adolescents from 2007 to 2020. Suicide by poisoning among teenage girls accelerated dramatically after 2011, increasing at roughly 13% per year through 2020.
Suicide and homicide rates among young Americans followed different trajectories for years. Suicide surpassed homicide as early as 2010, but a sharp spike in homicides between 2019 and 2020 brought the two rates nearly even again.
Race, Sex, and Age Change the Picture
National averages mask huge differences in what actually kills specific groups of teenagers. The leading cause of death shifts depending on who you’re looking at.
For Black teenage boys ages 15 to 19, homicide has been the number one cause of death consistently, before, during, and after the COVID-19 pandemic. For Black teenage girls in the same age range, homicide also ranks as the top threat when injuries are categorized by type rather than grouped under “accidents.”
For white teenage boys ages 15 to 19, suicide and transportation crashes compete for the top spot. For Asian American teenage boys and girls in that age range, suicide has been the leading cause in most recent periods studied. Hispanic teenagers of both sexes are most likely to die in transportation crashes.
These patterns matter because they point to different solutions for different communities. A prevention strategy focused on car crashes may address the biggest risk for Hispanic teens but miss the most urgent threat facing Black or Asian American teens entirely.
Why Most Teen Deaths Are Preventable
The striking thing about the leading causes of teenage death is that almost none of them are diseases. They are injuries, violence, and poisoning. That means they respond to policy changes and safety interventions in ways that cancer or genetic conditions do not.
Motor vehicle deaths, for example, have dropped significantly over the past two decades thanks to graduated driver’s license laws, which restrict nighttime driving and the number of passengers new teen drivers can carry. Seatbelt laws and enforcement of drunk driving statutes have also contributed to declines. States with stricter graduated licensing programs see measurably fewer teen crash deaths than states with weaker ones.
For drug overdoses, the widespread availability of naloxone (a medication that reverses opioid overdoses) and fentanyl test strips gives families and schools tools that can prevent deaths in the moment. Education about the prevalence of counterfeit pills is also critical, since many adolescents do not realize that a single pill bought outside a pharmacy could be fatal.
Reducing firearm deaths involves a different set of interventions, from secure storage practices in homes with guns to community violence intervention programs in neighborhoods with high rates of youth homicide. The specific approach depends heavily on whether the firearm deaths in a community are primarily suicides, homicides, or accidents, which circles back to the demographic differences described above.