Firearms are the number one killer of children and teens in America. This has been the case since 2019, when gun-related deaths surpassed motor vehicle crashes for the first time. Among adolescents aged 15 to 19, roughly 12,777 deaths occur each year, with the top three causes being accidents (unintentional injuries), homicide, and suicide. Firearms cut across two of those categories, making them the single deadliest factor when counted together.
How Firearms Became the Leading Cause
For decades, car crashes held the top spot. That changed as vehicle safety improved and gun deaths climbed. Graduated licensing laws, better crash technology, and teens waiting longer to get their licenses all drove motor vehicle fatalities down over the past 20 years. Meanwhile, firearm deaths moved in the opposite direction, and the two lines crossed in 2019. They haven’t crossed back.
Firearms now account for 20% of all child and teen deaths in the United States. In similarly wealthy nations, firearms account for less than 2% on average. On a per capita basis, the U.S. firearm death rate among people ages 1 to 19 is more than 9.5 times the rate in Canada.
How Firearm Deaths Break Down
Teen firearm deaths fall into three main categories: homicide, suicide, and unintentional shootings. Homicide makes up the largest share, followed by suicide. Unintentional discharges are a smaller but significant piece. Among unintentional firearm deaths in children and adolescents, about 53% were inflicted by another person (often a peer handling a gun), while roughly 38% were self-inflicted, meaning the victim was handling the firearm themselves.
These patterns vary sharply by age. Younger children are more likely to die in unintentional shootings, while older teens face far higher rates of homicide and suicide by firearm.
Racial Disparities in Firearm Deaths
The burden of firearm homicide is not evenly distributed. CDC data from 2019 to 2022 shows the firearm homicide rate among Black Americans was 27.5 per 100,000 in 2022, compared to 5.5 for Hispanic Americans and 2.0 for white Americans. That means Black individuals faced a firearm homicide rate nearly 14 times higher than their white peers. While rates did decrease slightly from 2021 to 2022, they remained far above 2019 levels across all groups.
American Indian and Alaska Native communities also face disproportionate risk, with firearm homicide rates that continued rising through 2022 even as other groups saw modest declines.
Drug Overdoses Are Rising Fast
Drug overdoses and poisonings have climbed to become the third leading cause of death for children and teens, behind firearm injuries and motor vehicle crashes. The rate reached 5.2 deaths per 100,000 adolescents in 2022, a sharp increase driven almost entirely by one substance: illicit fentanyl.
Fentanyl is now involved in at least 75% of adolescent overdose deaths. Most of these deaths don’t involve teens who sought out the drug intentionally. Instead, fentanyl shows up in counterfeit pills designed to look like prescription medications or other recreational drugs. A teen who thinks they’re taking a painkiller or a sedative may be ingesting a lethal dose of fentanyl without knowing it. This has transformed overdose from a problem associated with long-term substance use into one that can kill on a first exposure.
Motor Vehicle Crashes Still Take a Major Toll
Even though they’ve dropped from the top spot, car crashes remain one of the leading killers of American teens. The long-term decline is a genuine public health success story. Multi-stage licensing systems that restrict nighttime driving and the number of passengers for new drivers, combined with advances in airbag and crash-avoidance technology, have saved thousands of lives over the past two decades.
Still, teens remain the highest-risk age group on the road. Inexperience, distraction, and nighttime driving continue to be the primary risk factors. The improvements have been real but incomplete.
How the U.S. Compares Globally
What makes American teen mortality distinctive is not the overall death rate but the composition. In peer countries like Canada, the U.K., Germany, and Australia, firearms barely register as a cause of child and teen death. The U.S. child firearm mortality rate of 3.7 per 100,000 is 5.5 times Canada’s rate of 0.6 per 100,000, and Canada has the second-highest rate among wealthy nations.
This gap exists despite comparable rates of mental health challenges, substance use, and poverty across high-income countries. The difference is access to firearms and the resulting scale of both homicide and suicide by gun. In nations where firearms are less available, teens who experience suicidal crises or interpersonal violence are far less likely to die from those events, because the most lethal means isn’t within reach.