(CNN) -- Death by gunshot was the second-highest cause of death in the United States in 2016 among children and adolescents ages 1 to 19, according to a study released Thursday in the New England Journal of Medicine.
The study analyzed data from US death certificates from 57 jurisdictions. Comparing the data with that of previous years, the study authors found a 28% relative increase in the rate of firearm deaths from 2013. Over those three years, firearm homicide rose by 32% and firearm suicide rose by 26%, while unintentional firearm deaths remained relatively stable.
Globally, the United States led the world in the rate of firearm deaths in youth among countries with available data in 2016. The rate in the US was 36.5 times higher than in a dozen comparable high-income countries around the world; the rate of firearm deaths was five times as high compared with a sampling of low- to middle -ncome countries.
The results mimic data released by the US Centers for Disease Control and Prevention in June, which showed a decline in overall childhood deaths from illness but a starling rise in accidental deaths, homicides and suicides. Many of those were attributed to traffic accidents, drugs and firearms.
"This is a wake-up call that we need to pay attention to the health and well-being of our children," Dr. Tina Cheng, director of the Department of Pediatrics at Johns Hopkins Medicine, said at that time.
Dr. Thomas Weiser, a trauma surgeon at Stanford University Medical Center, said that "without a doubt, easy access to guns drives the homicide rate in the United States. This is such a fundamental issue to address through gun safety programs that are effective and widespread."
The new analysis, done by the University of Michigan, found that 20,360 children died in 2016, the most recent year in which national data was available. More than 12,000 deaths, or 60%,were from injury-related causes. Motor vehicle injuries led the list at 4,074, but firearms injuries were close behind at 3,143 deaths, or 15% of the total deaths among children.
Homicides accounted for 1,865 of children and adolescent deaths by firearm, suicide for 1,102, and unintentional or undetermined accounted for 126 deaths. That last number may appear small until put into context: Unintentional deaths among adults accounted for only 2% of the year's total. Among children and adolescents, unintentional firearm injuries that led to death were 26% of the total.
Other causes of children's deaths, in order, were a form of cancer called malignant neoplasm (1,853); suffocation, mostly from suicide (1,430); drowning (975); drug overdose or poisoning, most unintentional (982); congenital anomalies (979); heart disease (599); fire or burns (340) and chronic lower respiratory disease (274).
Solving this problem will require a "shift in public perceptions so that injury deaths are viewed not as 'accidents,' " the study concluded, but as deaths that can be prevented by changes in public health approaches.