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An American Childhood Tragedy

Leland Ropp, MD; Paul Visintainer, PhD; Jane Uman, MPH; David Treloar, MD

JAMA. 1992;267(21):2905-2910.

Abstract
Objective.
—To look at trends in mortality and homicide rates in a specific metropolitan area, comparing the urban and suburban mortality trends.

Design.
—Descriptive study of mortality rates. Linear regression determined whether changes in mortality rates over time represented significant trends.

Setting.
—Industrial metropolitan area in the United States, population, 2337891.

Participants.
—Pediatric deaths (1 to 18 years of age) in a 9-year period. Population characteristics: 36% black, 64% white, 50% each urban and suburban.

Main Outcome Measures.
—Pediatric mortality rates for 1980 through 1988, grouped by urban vs suburban, age, gender, and race. Rates calculated using national census figures and plotted over time.

Results.
—There was a 50% increase in all-cause mortality in the urban pediatric population as compared with no change or a slight decline in the suburban and national populations. The increase was found in the black urban population. Homicide showed the largest increase (252%). Firearm-related homicides accounted for the majority of homicide deaths.

Conclusions.
—(1) There were significant differences in mortality between the urban and suburban pediatric populations. (2) The increase in homicides, specifically firearm homicides, in the urban population accounted for the increase in overall mortality rates. (3) The increase in homicide rates was significant only for the 10- to 14-year-old males and the 15- to 18-year-old male and female portions of the black urban population. (4) Firearm homicides have become epidemic in the black urban population we studied.

(JAMA. 1992;267:2905-2910)

Author Affiliations
From the Division of Pediatric Emergency Medicine (Drs Ropp and Treloar) and the Division of Biostatistics and Research Epidemiology (Dr Visintainer and Ms Uman), Henry Ford Hospital, Detroit, Mich.

Footnotes
This article is one of a number of articles on violence that will appear in upcoming issues of The Journal. The reader is referred to the June 10, 1992, issue, which will be dedicated to studies of violence.

Reprint requests to Emergency Department, Henry Ford Hospital, 2799 W Grand Blvd, Detroit, MI 48202 (Dr Ropp).

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