In 2017, Firearms Surpassed Motor Vehicle Collisions as the Leading Cause of Death Among American Adolescents Aged 11 to 18. June is National Gun Violence Awareness Month.

Children are not supposed to die from gunshots. That sentence should not need to be written in a peer-reviewed publication, and yet the data in this paper from researchers at Washington State University, the University of Washington, and the University of Michigan demands that it be said plainly. Firearm injury is now the leading cause of death among American adolescents. Not cancer. Not car crashes. Not drowning. Firearms. This study, published in Injury Epidemiology in 2025, is one of the most granular analyses of adolescent firearm mortality in the recent literature, separating middle school-aged children from high school-aged adolescents, distinguishing metro from non-metro populations, and stratifying by intent across homicide, suicide, and unintentional death. What it finds is not a single story. It is several stories layered on top of each other, each one demanding a different response. June is National Gun Violence Awareness Month, and there is no better moment to read this data carefully and sit with what it says.

Weybright et al. analyzed crude death rate data from the United States Centers for Disease Control and Prevention (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS) Fatal Injury Data from 2001 to 2022. Adolescents were stratified into two developmental groups: middle school age (11 to 13 years old, reflecting 6th to 8th grade) and high school age (14 to 18 years old, reflecting 9th to 12th grade). Each group was further stratified by metro and non-metro classification using the National Center for Health Statistics designation. Cause-specific crude death rates were calculated for firearm homicide, firearm suicide, and unintentional firearm death, and percent change over time was calculated as the difference between crude death rates in 2022 and 2001 divided by the crude death rate in 2001 multiplied by 100. The five leading causes of fatal injury were tracked annually across all subgroups.

Across all adolescents aged 11 to 18, firearms surpassed motor vehicle collisions as the leading cause of injury death in 2017. Firearm-related deaths increased by 60.1% from 2001 to 2022, while motor vehicle deaths decreased by 51.6% over the same period. These two trends crossed in 2017 and have not recrossed since.

Among middle school adolescents in metro areas, firearm injuries surpassed all other causes of death in 2021. In non-metro areas, firearms briefly became the leading cause in 2018 before motor vehicle collisions reclaimed that position.

For high school adolescents in metro areas, firearms became the leading cause of death as early as 2012, five years earlier than the combined 11 to 18 age group analysis would suggest. Firearm injury deaths in this subgroup increased by 47.9% from 2001 to 2022.

On the question of intent, firearm homicides consistently outpaced firearm suicides across the full 11 to 18 age group. Starting in 2018, firearm homicides surged sharply, resulting in a 79.3% increase from 2018 to 2022. The rural and urban split reveals the full complexity. In metro areas among high school adolescents, homicides increased by 127.3% from a 2013 low and remained higher than suicides. In non-metro areas, firearm suicides among high school adolescents were consistently higher than homicides throughout the study period, though homicides increased by 362.9% compared to a 44.2% increase in suicides. Among non-metro middle school adolescents, firearm suicide surpassed firearm homicide in 2014 and remained higher thereafter.

• —The study uses crude death rates rather than age-adjusted rates, which limits direct comparability across subgroups with different age distributions within the 11 to 18 range.
• —WISQARS data is dependent on accurate ICD-10 coding of death certificates, which can introduce misclassification particularly for intent, with some suicides potentially coded as unintentional deaths.
• —Some data points were suppressed due to small sample sizes in specific subgroup and year combinations, particularly for non-metro middle school adolescents, which limits the precision of trend estimates in that group.
• —The study covers 2001 to 2022 and does not capture 2023 or 2024 data, which would reflect the post-pandemic stabilization or continuation of the homicide surge.

American children are dying from gunshots at a rate that now exceeds every other cause of injury death in their age group. The trend is not static. It has been worsening for over a decade. The data shows two distinct crises: one in cities, driven by homicide; one in rural communities, driven by suicide. Both are preventable. Both require investments in safety, access to care, and evidence-based intervention that are proportional to the scale of the loss. June is National Gun Violence Awareness Month. These children had names. They had futures. The data is not abstract.