I always look forward to the holiday issue of BMJ, one of the foremost medical journals in the world, which typically includes light-hearted and satirical articles such as the recent randomized controlled trial of parachutes to prevent death from jumping out of airplanes, and my all-time favorite article about comparing apples and oranges. However, this year my enjoyment was overshadowed by an anything-but-satirical article in the holiday week New England Journal of Medicine. (Thanks to my colleague Yoav Messinger for alerting me to it.)
Researchers at the University of Michigan published a study of the major causes of death in US children and adolescents over the past 20 years. Given the omnipresent collection boxes to support St. Jude’s Research Hospital, you’d be tempted to think that cancer is at the top of the list. Not so much. In 2016, the most recent year for which data are available, it came in a distant third, accounting for 9% of deaths in children age 1-19 years. Leading the list are motor vehicle crashes and firearms. All injuries, both intentional and unintentional, make up over 60% of all childhood deaths. Moreover, among injuries, unintentional injuries were most common (57%), but almost half of injured kids were victims of suicide (21%) or homicide (20%).
Let that sink in for a minute. In 2016, 2560 children took their own lives, and 2469 were killed by someone else. That’s 97 dead kids each week, or one every 104 minutes. Each year in this country we lose some 750,000 person-years of life due to childhood injuries alone. If we really want to save lives, you would think gas stations would have those little plastic coin boxes with pictures of shot up or strangled children. I haven’t found one of those yet.
Reading the article, it’s hard to know what is most upsetting: how much worse we in the US are compared with other wealthy countries (and many poor ones), or the enormous disparities within our own nation, or the notable lack of progress in reducing these deaths over the past two decades. Motor vehicle crashes are a major exception, with the death rate in 2016 just about half that in 1999. However, for both motor vehicles and firearms, death rates have actually increased in the past 3 years.
An accompanying editorial points out that the problem is not about deficiencies in medical care. It is about the sickening prevalence of nearly universally preventable traumatic injuries. I recently wrote about firearms specifically, but the notion that we need to pay more attention to preventing injuries if we want to save children’s lives is clearly broader (suicide by suffocation, for example, is slightly more common than suicide by gun).
Now, I have nothing against St. Jude’s or any other children’s charity. But when it comes to causes of death, we need to focus efforts and resources where they will have the greatest impact. In this context, comparing cancer to injuries is like comparing walnuts and elephants.