207 - Firearm-Related Deaths Among Children and Young Adults in a Single Urban Center (2019–2023): A Descriptive Analysis of Social, Behavioral, and Environmental Risk Factors

Publication Number: 2199.207

James Barry, Golisano Children's Hospital at The University of Rochester Medical Center, East Rochester, NY, United States; Marek Falkowski, University of Rochester School of Medicine and Dentistry, Rochester, NY, United States; Elizabeth Murray, University of Rochester, Golisano Children's Hospital, Rochester, NY, United States

Background: Firearm-related deaths became the leading cause of death among U.S. children in 2021, rising sharply during the COVID-19 pandemic. School closures and social disruption disproportionately affected marginalized youth. Adolescents experiencing chronic absenteeism or exclusionary discipline face increased risks of violence and criminal behavior. Mortality exhibits stark racial disparities, with Black adolescents having firearm death rates 11 times higher than White peers.

Objective: By analyzing demographic and biopsychosocial characteristics of youth firearm homicide victims during the COVID-19 pandemic, this study aims to quantify the prevalence of established risk factors and explore how pandemic-related social and structural stressors amplified their impact.

Design/Methods: This descriptive case review analyzed firearm fatalities among youth aged 10–19 years in Rochester, NY, between January 1, 2019, and December 31, 2023, with available electronic medical record data at the University of Rochester Medical Center. Data from local law enforcement provided incident details and gang or criminal involvement. Manual chart abstraction identified Child Protective Services history, school attendance, and substance use.

Results: Subject population included 35 children meeting inclusion criteria. The population was predominantly male (83%) and Black (83%), with a mean age of 17 years. Nearly half (46%) had CPS involvement. Educational challenges were widespread: 57% struggled academically or behaviorally, 31% experienced chronic absenteeism or dropout, and 26% had suspensions. The summer months (June–August) accounted for 43% of deaths. Social factors were highly influential, with 74% having a family member or close friend involved in crime, gangs, or homicide. Two-thirds (66%) had behavioral health conditions, including depression or suicidality, and 54% reported substance use.

Conclusion(s): This study highlights the clustering of vulnerabilities in youth firearm mortality, concentrated among Black adolescent males. High rates of school disengagement, behavioral health concerns, and risky social ties reveal overlapping systems of disadvantage. The inclusion of law enforcement data on incident data and subject relationships strengthened findings, while reliance on medical records likely underestimated educational data. These results emphasize a public health crisis driven by toxic stress and systemic inequity. Reducing exclusionary school discipline and expanding restorative supports are essential to address root causes and reduce future firearm deaths.