In this issue of JAMA, Wolf et al found that during the period from 2019 to 2021, the US experienced the greatest increase in all-cause pediatric fatalities (aged 1-19 years) in more than 50 years, with increased mortality disproportionately resulting from preventable injuries. Importantly, the authors identified widening racial and ethnic disparities across these preventable health outcomes, particularly for American Indian or Alaska Native and Black populations. The most stark differences were observed for homicide and suicide, with Black youth 10 times more likely to die by homicide and American Indian or Alaska Native youth almost 3 times more like to die by suicide compared with White youth. Among both populations, firearms remain the dominant mechanism of injury underlying homicide and suicide deaths, and firearm fatalities were identified by Wolf et al as one of the largest factors in observed disparities. Such findings are consistent with the trends that have been observed in the US throughout the past decade, where the firearm injury epidemic has continued to advance unabated and has now superseded motor vehicle crash deaths as the leading cause of death for US children and teens.

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