Youth Experiencing Parental Death Due to Drug Poisoning and Firearm Violence in the US, 1999-2020

Abstract

Importance: Youth (those aged <18 years) parental death has been associated with negative health outcomes. Understanding the burden of parental death due to drug poisoning (herein, drugs) and firearms is essential for informing interventions.

Objective: To estimate the incidence of youth parental death due to drugs, firearms, and all other causes.

Design, setting, and participants: This cross-sectional observational study was conducted using vital registration, including all US decedents, and census data from January 1990 through December 2020. Data were analyzed from May 30, 2023, to March 28, 2024.

Exposures: Parental death due to drug poisoning or firearms.

Main outcomes and measures: A demographic matrix projection model was used to estimate the number and incidence of youth experiencing parental death, defined as the death of 1 or more parents, per 1000 population aged less than 18 years. Analyses evaluated parental deaths by drugs, firearms, and all other causes from 1999 through 2020 by race and ethnicity.

Results: Between 1999 and 2020, there were 931 785 drug poisoning deaths and 736 779 firearm-related deaths with a mean (SD) age of 42.6 (16.3) years. Most deaths occurred among males (73.8%) and White decedents (70.8%) followed by Black (17.5%) and Hispanic (9.5%) decedents. An estimated 759 000 (95% CI, 722 000-800 000) youth experienced parental death due to drugs and an estimated 434 000 (95% CI, 409 000-460 000) youth experienced parental death due to firearms, accounting for 17% of all parental deaths. From 1999 to 2020, the estimated number of youth who experienced parental death increased 345% (95% CI, 334%-361%) due to drugs and 39% (95% CI, 37%-41%) due to firearms compared with 24% (95% CI, 23%-25%) due to all other causes. Black youth experienced a disproportionate burden of parental deaths, based primarily on firearm deaths among fathers. In 2020, drugs and firearms accounted for 23% of all parental deaths, double the proportion in 1999 (12%).

Conclusions and relevance: Results of this modeling study suggest that US youth are at high and increasing risk of experiencing parental death by drugs or firearms. Efforts to stem this problem should prioritize averting drug overdoses and firearm violence, especially among structurally marginalized groups.

Figure 1.. Estimated Number of Youth Affected by Parental Death Due to Drug Poisoning

A, Estimated number of youth affected by parental death due to drug poisoning by race and ethnicity, 1999-2020. B, Youth affected by parental death due to drug poisoning per 1000 population by race and ethnicity, 1999-2020. Numbers in thousands of youth less than age 18 years by race and ethnicity, 1999-2020, are listed at the bottom.

Figure 2.. Number of Youth Affected by Parental Death Due to Firearms

A, Estimated number of youth affected by parental death due to firearms by race and ethnicity, 1999-2020. B, Youth affected by parental death due to firearms per 1000 population by race and ethnicity, 1999-2020. Numbers in thousands of youth less than age 18 years by race and ethnicity, 1999-2020, are listed at the bottom.

Figure 3.. Youth Affected by the Death of a Father and Mother Due to Drug Poisoning and Firearms

A, Youth affected by the death of a father due to drug poisoning per 1000 population by race and ethnicity, 1999-2020. B, Youth affected by the death of a mother due to drugs per 1000 population by race and ethnicity, 1999-2020. C, Youth affected by the death of a father due to firearms per 1000 population by race and ethnicity, 1999-2020. D, Youth affected by the death of a mother due to firearms per 1000 population by race and ethnicity, 1999-2020.