Key Points:

Question What causes of death are associated with the widening disparities in mortality among US youth of different races and ethnicities in recent years?

Findings In this cross-sectional study of mortality in youth aged 1 to 19 years in the US, injuries, especially firearm injuries, were associated with worsening disparities between Black and American Indian or Alaska Native and White youth. Between 2016 and 2020, the homicide rate in Black youth was 12.81 per 100 000 youth (rate ratio with White youth, 10.20), and the suicide rate for American Indian or Alaska Native youth was 11.37 per 100 000 youth (rate ratio with White youth, 2.60).

Meaning In this study, racial and ethnic disparities were observed for almost all leading causes of injury and disease and were associated with recent increases in US mortality rates.

Between 2019 and 2021, all-cause pediatric mortality rates in the US increased by 18.3%, the largest such increase in at least half a century.1 The increase was based on homicides, suicides, motor vehicle crashes (MVCs), and drug overdoses, while COVID-19 played a minor role.1 Previously, all-cause mortality had been decreasing among youth of all races and ethnicities due to advances in health care, expanded insurance coverage, and progress in injury prevention,2-4 but that trend reached a nadir in 2014.

Disparities in death rates among American Indian or Alaska Native, Black, and White youth have been increasing in the last several years. Between 2014 and 2020, all-cause mortality rates increased 36.7% in Black youth and 22.3% in American Indian or Alaska Native youth while increasing 4.7% in White youth.5 However, a knowledge gap exists regarding causes of death and the widening inequalities among racial and ethnic groups.

Although previous studies have examined disparities in pediatric all-cause mortality within a region6 or by cause of death,7-9 few have disaggregated national data by race and ethnicity across leading causes of death.10,11 Disaggregating analyses of recent data is important to clarify which causes of death are associated with the widening disparities and current increases in all-cause mortality, identify the populations at greatest risk, and evaluate public health progress aimed at reducing disparities in specific causes of death...