Age-Specific Trends in Pediatric and Adult Firearm Homicide After the Onset of the COVID-19 Pandemic

Abstract

This cross-sectional study examines age-specific trends in firearm violence among children and adults in the US after the onset of the COVID-19 pandemic.

The COVID-19 pandemic sparked an unprecedented increase in firearm violence in the US: from 2019 to 2020, firearm homicides increased by over 30%.¹ Children faced severe inequities; in 4 major cities, firearm assaults against children doubled after the onset of the pandemic, and the ratio of disparities between Black and White children exceeded 100 to 1.² There is substantial age specificity in firearm mortality rates; however, prior research on pandemic-era firearm injuries^3,4 has not thoroughly analyzed age-specific trends.

Methods

This cross-sectional study used US Centers for Disease Control and Prevention WONDER data on firearm homicide mortality in the US from 1999 to 2023.¹ We aggregated deaths by calendar year and single-year age. We categorized 1999 to 2019 as the prepandemic period and 2020 to 2023 as the postonset period. We calculated mortality rates per 100 000 for ages 10 to 44 years and compared prepandemic and postonset means (eMethods in Supplement 1). The Boston University Medical Institutional Review Board waived the need for review and informed consent as the study was considered non–human participant research using publicly available data. We followed the STROBE reporting guideline. Data were analyzed from August 6, 2024, to January 21, 2025, using R, version 4.2.2 (R Project for Statistical Computing).

Results

There were 273 514 firearm homicide deaths among individuals aged 10 to 44 years during the study period. The shape of the age and firearm-mortality trajectories were similar across prepandemic years, with rates monotonically increasing until around age 21 years and decreasing gradually thereafter (Figure 1). The postonset years, especially 2022 and 2023, showed the trajectories peaking at a younger age (19 years), with smaller decreases thereafter. Relative to the prepandemic period, firearm homicide rates were higher in the postonset period at every age, though there was variability in the magnitude of increase and magnitudes differed across postonset years (Figure 2). In 2020 and 2021, the increase was concentrated above age 26 years. In 2022 and 2023, age-specific changes were most pronounced, and rates among younger adolescents (ages 10-16 years) doubled prepandemic rates. The smallest relative increases were seen in the highest-risk age group (ages 22-26 years), suggesting a shift in the age vs risk trajectory.

Figure 1. Firearm Homicide Rates in the US by Single-Year Age, 1999 to 2023.

Rates were manually calculated from death counts and population counts for 46 (5%) age-year combinations in which crude rates were reported as unreliable in the US Centers for Disease Control and Prevention WONDER database¹ due to small numerators. Age-year combinations with fewer than 10 deaths (n = 8; 1% of total) were excluded due to data use restrictions.

Figure 2. Firearm Homicide Rates in the US by Single-Year Age, 2020 to 2023, as a Percentage of Prepandemic (1999 to 2019) Rates.

The light blue horizontal line in each graph represents the point at which there is no change from the prepandemic rate.

Discussion

We found a disproportionate spike in firearm homicide among children and adults older than 30 years after the onset of the COVID-19 pandemic, indicating a change in the association between age and firearm victimization risk. This trend moved the peak victimization risk from age 21 to 19 years, and rates for children up to age 16 years were markedly elevated. These age-specific patterns were most pronounced in later postonset years.

This finding could have important implications for prevention. Many community-based programs designed to interrupt firearm violence focus on the traditionally highest-risk age range (ie, 18-29 years). Changes in the age-risk association might require such programs to engage individuals at younger ages and maintain services into later adulthood.

Our pediatric results are especially concerning. Homicides spiked among school-aged children, for whom few evidence-based interventions exist to prevent firearm assaults. Much attention is focused on school shootings, which are tragic but rare. Firearm violence occurs more often outside of school; summer youth employment programs reduce risk,⁵ but additional research on reducing after-school risk is needed. Interventions are also vital for children exposed to firearm violence to mitigate lifelong impacts.⁶

A key study limitation is that we did not examine contributing factors. Our approach yielded granular information about age-specific risk, but additional stratification (eg, by race and ethnicity or geography) would yield sparse counts and unreliable rates. Further work must explore how structural racism, state policies, and other social determinants shape age-specific trends.

The striking rise in firearm homicide among children and adults older than 30 years shows the limits of our knowledge and resources for firearm injury prevention. Accelerated efforts to address these limits are urgently needed.

Supplement 1.

eMethods

Supplement 2.

Data Sharing Statement