Firearms became the leading cause of deaths for children and adolescents in the United States for the first time in 2020—and the largest increase in gun-related deaths were from suicides, according to two new studies.

Who dies from gunfire in the United States (and how), charted

Guns become the leading cause of death for children

For one study, which was published in the New England Journal of Medicine, researchers analyzed CDC mortality data for gun-related deaths in 2020. In total, 45,222 gun-related deaths occurred in 2020, the highest number on record.

Of these gun-related deaths, 4,368 occurred in children between the ages of one and 19—an almost 30% increase between 2019 and 2020. For the first time, guns overtook motor vehicle crashes, which contributed around 4,000 deaths in 2020, as the leading cause of death in this age group. Overall, two-thirds of these gun-related deaths were homicides, 30% were suicides, 3% were accidental, and 2% were of undetermined intent.

In addition, a Washington Post analysis of CDC's data found that there were significant racial disparities when it came to gun deaths among children and adolescents. In particular, Black children and adolescents were the only group that had higher gun-related deaths than motor vehicle deaths. They also saw the largest increase in gun-related deaths in 2020 at 39%.

"Although the new data are consistent with other evidence that firearm violence has increased during the COVID-19 pandemic, the reasons for the increase are unclear, and it cannot be assumed that firearm-related mortality will later revert to prepandemic levels," the study authors wrote. "Regardless, the increasing firearm-related mortality reflects a longer-term trend and shows that we continue to fail to protect our youth from a preventable cause of death."

Separately, a report from Everytown for Gun Safety found that gun-related suicides among American youth have significantly increased over the last few decades.

According to CDC data, suicide was the third-leading cause of death among young people ages 10 to 24 in 2020, just behind accidents and homicides. In total, 6,643  suicides occurred among young Americans in 2020. On average, more than 3,100 gun-related suicides occur among young people every year. 

In 1999, the overall suicide rate among individuals ages 10 to 24 was 7 deaths per 100,000 people, but by 2020, it had increased to 10.5 per 100,000.

When it comes to gun-related suicides, American Indian and Alaska Native youths had the highest rates at 9.5 per 100,000, followed by white youths (6.2 per 100,000) and Black youths (4.2 per 100,000).

In addition, the report found individuals ages 10 to 24 had the largest increase in gun-related suicides between 2019 and 2020. Although the overall rate of gun-related suicides only increased by 2% during that period, those ages 10 to 24 saw a significantly higher increase at 15%. This rate was even higher among children ages 10 to 14, who saw their rates of gun-related suicides increase 31% between 2019 and 2020.

Overall, the report found that the rate of gun-related suicides among those ages 10 to 24 increased by 53% between 2011 and 2020, with the most significant increase occurring among those ages 10 to 14. In this youngest age group, the rate of gun-related suicides increased by 146% over the past decade.

According to the report, this increased suicide risk among young people may be due to a combination of current life stressors, historical risk factors, and access to lethal means of harm, including guns. In addition, past research has shown that increased access to firearms is also associated with higher rates of youth suicide. For every 10% increase in household gun ownership in a state, there is a more than 25% increase in the youth suicide rate.

Can gun-related deaths among children be prevented?

According to several health experts, improved data collection for gun deaths and injuries could help provide important insights into how gun-related deaths could be prevented going forward.

"Because we have excellent data systems for motor vehicle, and traffic injuries and deaths, we've seen improvements in those areas," said Lois Lee, an associate professor of pediatrics and emergency medicine at Harvard Medical School. "If we can clearly apply the same successful strategies to firearms then that may be a path forward to try and reverse this trend."

In addition, other evidence-based approaches, such as investments in organizations aimed at reducing community violence, campaigns for safe gun storage, and firearm training courses, may help drive down gun fatality rates.

And since "research shows pretty clearly that people who struggle with mental illness are much more likely to be victims than perpetrators of violent crimes," offering young people support and resources for their mental health issues can also be "a huge part of the solution," said Sarah Burd-Sharps, a research director at Everytown. (Keating, Washington Post, 5/25; Bates, TIME, 4/27; Owens, Axios, 5/26; Rothenberg/Kekatos, ABC News, 5/25; Goldstick et al., New England Journal of Medicine, 4/19; DiMartino/Owen, ABC News, 6/2; Cohen, CBS News, 6/2; Everytown for Gun Safety report, 6/2)