The Effect of Firearm Laws on Pediatric Mortality in the United States

Introduction Firearms are the leading cause of death in US children and adolescents, but little is known about whether legal policies may be responsible. Methods We conducted difference-in-differences analysis on CDC WONDER data before and after McDonald v. Chicago , the landmark 2010 Supreme Court decision on firearms regulation. States were divided into three groups, based on legal actions taken before and since 2010, most permissive, permissive, and restricted. Firearm mortality trends before (1999-2010) and after (2010-2023) were determined and compared across the three groups for all intents and by intent (homicide and suicide). Within the most permissive state grouping, pediatric firearm mortality by 2013 urbanicity and by observed race and ethnicity were conducted. For each US state, pre-and- post 2010 all-intent pediatric firearm mortality incident rates were compared. Results There were 7130 excess pediatric firearms deaths in states with more permissive regulatory regimes than those with stricter frameworks, as well as higher rates of homicide and suicide. Non-Hispanic Black populations were disproportionately affected by these trends. Four states (California, Maryland, New York, and Rhode Island) had decreased pediatric firearm mortality after 2010, all of which were in the restrictive firearms law group. Conclusion States with more permissive firearm laws have experienced greater pediatric firearm mortality during the post- McDonald v. Chicago era. KEY POINTS Question Did states enacting permissive firearm laws after 2010—when McDonald v. Chicago was decided by the United States Supreme Court—subsequently experience higher rates of pediatric firearm mortality? Findings Difference-in-difference analysis found that state groups that enacted more permissive firearm laws after 2010 experienced >7,100 firearm deaths in children and adolescents ages 0-17 between 2010-2023 compared to restrictive law-enacting states, of which most (77.5%) were homicides. In the permissive states groups, increases occurred in all urbanicities. The largest increase occurred in non-Hispanic Black children and adolescents. Four states had statistical decreases in pediatric firearm mortality during the study period, all of which were in states which enacted restrictive firearm policies. Meaning Permissive firearm laws contributed thousands of excess firearm deaths among children living in states with permissive policies. Future work should focus on determining which types of laws conferred the most harm and which the most protection.