State Gun Laws and Pediatric Firearm-Related Mortality

Pediatrics. 2019 Aug;144(2):e20183283. doi: 10.1542/peds.2018-3283. Epub 2019 Jul 15.


Background: Firearms are the second leading cause of pediatric death in the United States. There is significant variation in firearm legislation at the state level. Recently, 3 state laws were associated with a reduction in overall deaths from firearms: universal background checks for firearm purchases, universal background checks for ammunition purchases, and identification requirement for firearms. We sought to determine if stricter firearm legislation at the state level is associated with lower pediatric firearm-related mortality.

Methods: This was a cross-sectional study in which we used 2011-2015 Web-based Injury Statistics Query and Reporting System and Census data. We measured the association of the (1) strictness of firearm legislation (gun law score) and (2) presence of the 3 aforementioned gun laws with pediatric firearm-related mortality. We performed negative binomial regression accounting for differences in state-level characteristics (population-based race and ethnicity, education, income, and gun ownership) to derive mortality rate ratios associated with a 10-point change in each predictor and predicted mortality rates.

Results: A total of 21 241 children died of firearm-related injuries during the 5-year period. States with stricter gun laws had lower rates of firearm-related pediatric mortality (adjusted incident rate ratio 0.96 [0.93-0.99]). States with laws requiring universal background checks for firearm purchase in effect for ≥5 years had lower pediatric firearm-related mortality rates (adjusted incident rate ratio 0.65 [0.46-0.90]).

Conclusions: In this 5-year analysis, states with stricter gun laws and laws requiring universal background checks for firearm purchase had lower firearm-related pediatric mortality rates. These findings support the need for further investigation to understand the impact of firearm legislation on pediatric mortality.

MeSH terms

  • Adolescent
  • Child
  • Cross-Sectional Studies
  • Female
  • Firearms / legislation & jurisprudence*
  • Homicide / legislation & jurisprudence
  • Homicide / trends
  • Humans
  • Male
  • Mortality / trends
  • Suicide / legislation & jurisprudence
  • Suicide / trends
  • United States / epidemiology
  • Wounds, Gunshot / diagnosis
  • Wounds, Gunshot / mortality*
  • Young Adult