• What kills kids?

    The CDC has released its National Vital Statistics Report for 2010. For the first time in a long time, homicide is not in the top 15 causes of death for all people in the US. That’s good news. I’m a pediatrician, though, and I want to focus on what kills kids. You may be surprised. Let’s start with 1-4 year olds:

    2Congenital Malformations495
    5Heart Disease156

    Any reader of this blog knows the number one killer of kids is accidents. Car accidents alone killed 444 1-4 year olds, which is still almost enough to earn the #2 spot on its own. But look at #3. The number three killer of children is homicide. It’s assault.

    Here’s 5-14 year olds:

    3Congenital Malformations292

    Accidents, of course, win again. Car accidents in this group killed 895 5-14 year olds, making it – alone – almost the number one killer of children in that age group. Homicide was #5. Suicide was #4.

    I think it’s important to talk about these figures. I work in a children’s hospital, and I know legions of people who work every year to save kids lives. I think it’s one of the most worthy causes there is. But I rarely see massive campaigns and fund-raising drives to prevent assault and homicide. I don’t see many for suicide. I don’t see ribbons for safer cars. Yet these are the things that kill children in droves. More small children were killed in assaults than for all cancers combined. When you get into the 15-24 year old range, accidents (especially cars) are #1, homicide is #2, and suicide is #3.

    While I’m on a rant, influenza and pneumonia was the #6 killer of 1-4 year olds and the #10 killer of 5-14 year olds, so it wouldn’t hurt to try and focus a bit more on better vaccination, either.

    I guess what I’m trying to say is that I would love to see our efforts reflect reality a little bit better. We know what kills kids. We see the results every year. Yet we continue to focus on other things. Here are data. Here are what kill children. We could save more lives by focusing on car accidents, suicide prevention, and homicide prevention than almost anything else. Let’s act on that.

    UPDATE: Fixed some numbers I screwed up when transcribing.

    UPDATE#2: I posted the number of deaths, not the rates. Corrected that.

    • It would be nice to see the cost effectiveness of the current best treatment in each of these areas. Is that what you mean? Or, are you thinking about focusing on developing new treatments for each of these areas? Otherwise, focusing on what might be poor treatments for prevalent incidents seems not altogether ideal. At least, I think an economist may think about it this way.

    • a major risk factor for car accidents is driving (surprising, right). yet a car dependent life style that keeps kids safe from tiny risks of crime condemns many children to road accidents.

    • As the mother of a child who attempted suicide three times between the ages of 14 & 15, I have to write to ask you (and everyone else who talks about suicide prevention) this: do we actually know how to keep distraught/distressed/maturing adolescents from killing themselves?

      When people mention suicide prevention, I just want to put my head in my hands and weep. because what does it mean will be done? What CAN be done? (No, she didn’t die, but she came within a hair’s breadth the last attempt.)

      I think that suicide prevention has got to be more than dark posters of lonely kids sitting on dingy stairwells with captions like “you’re not alone.”

      But does anyone know what works with a frankly suicidal kid?

    • While I agree that keeping kids safe from assault/homicide/domestic violence should be a much greater concern for all of us who care about children, I have to push back against, “I don’t see ribbons for safer cars.” There have been tremendous advances in auto safety over the past decade, including, but not limited to laws requiring children to be seated in the back seat in car seats or booster seats until they reach middle school age, recommendations that carseats be rear-facing until age 2, new restrictions on teen licenses in a dozen states that delay licensing or restrict the passengers in teen-driven cars, massive public campaigns warning of the dangers of cell phone use, texting, and other distracted driving, and a huge change in public attitudes toward drunk driving (though alcohol still contributes to a third of traffic fatalities). Car-related fatalities account for fewer American deaths every year. It may not be enough, and I agree with a previous commenter that we should be doing all we can to move away from car-dependent lifestyles, but you can’t say it isn’t happening. If the laws and campaigns aimed at combating domestic violence were as widespread and successful as the safe car laws and campaigns, that would be a tremendous start.

    • Any reader of this blog knows the number one killer of kids is accidents. Car accidents alone killed 444 per 100,000 1-4 year olds, which is still almost enough to earn the #2 spot on its own. But look at #3. The number three killer of children is homicide. It’s assault.

      It is important to keep this in mind when comparing life expectancy across countries.

      BTW Gov. might get better life expectancy improvements in the USA spending/pushing for cars that drive themselves than pushing for insurance coverage for all.

    • BTW you have an error in the text that could confuse, this:

      More small children were killed in assaults than for all cancers combined.

      I am sure should read:

      More small children were killed in accidents than for all cancers combined.

    • I’m not saying I disagree with you, but I think your analysis is missing an important link: the clear potential to save lives from accidents, homicide, and suicide. It’s not enough to say that a lot of kids die from Problem X. There has to be some plausible potential, a causal chain that starts with advocacy and ends with fewer deaths, for that advocacy to be worth doing, even if Problem X kills a lot of kids.

      I look at the problem of accidents, for example, and I see that cars have gotten a lot safer in recent decades — more seatbelts, more airbags, more crash tests, more safety ratings, more laws, etc. Is there really much more we can do to save lives, or have diminishing returns to advocacy already set in? How much lower can the child mortality rate from driving realistically get, given what we are already doing?

      Again, I don’t disagree with you. I would just like to see you write about what an advocacy campaign to reduce child mortality from accidents/suicide/homicide would actually look like, and why it would potentially work. What’s the theory of change, and what might the marginal product of such a campaign be?

    • You have misread the tables. What you are calling deaths per 100,000 are the total number of deaths; the rate per 100,000 is in the far-right column. It should be 8.4 for accidents, not 1367, etc.

      • You are totally right. Need to fix that. Changes the absolute numbers, not the order or relative significance of each.

    • How about we outlaw stupidity? It would save countless lives…