In addition to direct health effects, the COVID-19 pandemic has had indirect effects through the stress and economic hardship imposed by mitigation efforts, such as lockdowns. For children, indirect health outcomes may be comparable to direct effects, because SARS-CoV-2-related morbidity and mortality are concentrated at older ages.
A possible indirect outcome for children’s health is firearm-related deaths due to increased psychological stress on families in combination with school closures, leading to children spending more time at home, where Weapons are often kept. Although studies have documented an increase in gun-related deaths during the pandemic, only a few studies have considered children and those that focused on the early stages of the pandemic.
Methods
This cross-sectional study analyzed gun-related deaths of children between January 1, 2014 and December 31, 2022, from the Gun Violence Archive (GVA), a repository of gun violence collected from more than 7,500 law enforcement officers. public, media, government, and commercial sources. The study used publicly available data and was therefore exempt from human subjects review at Harvard Medical School, and followed the STROBE reporting guideline.
We plot 28-day moving averages of the count of children (ages 0-17) killed, comparing mid-March 2020 onwards to the trend in previous years to account for seasonal variation in shootings.
Additionally, we conducted an event study regression analysis with 2922 daily observations that modeled the daily count of firearm-related child deaths based on a cubic time trend and adjusting for month and day of the week, assuming a pandemic period beginning March 16, 2020.
We conducted subgroup analyzes based on child age, median household income in the census tract where a death occurred (using the 2019 American Community Survey), and the percentage of black or Hispanic population in the census tract (analysis conducted due to the economic and health impact of the pandemic has varied by race). We used a significance threshold of P < .05 using a 2-sided test. Stata version 15.1 (StataCorp) was used for analyzes from March to April 2022.
Results
Overall, 8,044 shootings were analyzed and involved 8,477 children killed . Of these 8477 children, 1888 (22.3%) were aged 0 to 11 years and 6589 (77.7%) were aged 12 to 17 years; 1657 (19.6%) were girls, 6676 (78.8%) were boys, and 144 (1.7%) were of unknown sex; and 4914 (58.0%) were from a high-minority area (defined as having more than 50% black or Hispanic population).
An increase in deaths was observed starting March 16, 2020 (Figure), with an estimated 1.12 (95% CI, 0.70-1.53) additional children killed per day, corresponding to a estimated 733 (95% CI, 462-1003) additional children killed during the study period.
The US Centers for Disease Control and Prevention (CDC) reports that 752 children died from COVID-19 from January 1, 2020 to December 31, 20216 , implying that our estimated increase in firearm-related child deaths was comparable to that of COVID-19 related deaths in children.
Increases in gun-related deaths were concentrated in areas with lower middle incomes or a high percentage of black or Hispanic populations, suggesting that family and neighborhood socioeconomic conditions may be important mediators. They were also higher among children aged 12 to 17 years. Findings were robust to analyzes that modeled linear, quadratic, and quartic time trends.
The figure presents 28-day moving averages. The moving average includes less than 28 but at least 14 days at the beginning and end of the covered period. The children included were between 0 and 17 years old. The vertical line indicates March 16, 2020. Source: Gun Violence Archive.
Discussion
A comparison of firearm-related deaths with COVID-19-related deaths reported by the CDC suggests that the direct mortality effects of SARS-CoV-2 in children may be similar in magnitude to the indirect outcomes mediated by armed violence.
Factors that may have caused the observed increase in gun-related deaths among children are unknown and include psychological and economic strain due to the pandemic, as well as increased time spent at home due to school closures. These findings highlight the potential importance of indirect health outcomes in children during the COVID-19 pandemic.
Limitations of the study include the analysis of a large gun violence database and confounding due to the study’s observational design. Given the coverage of the GVA compared to the CDC data, our numbers may be underestimates .
