Firearms are now the leading cause of death among children and teenagers in the United States, figures suggest.
More people aged one to 19 died from gun-related injuries in 2020 than in vehicle crashes or drugs overdoses, according to analysis of federal data by researchers at the University of Michigan.
More than 4,300 died of firearm-related injuries that year - a 29% increase from 2019, they found - based on their analysis of mortality data from the Centers for Disease Control (CDC). The figure includes suicides, homicides and unintentional deaths.
An article detailing the researchers' findings has been published in the New England Journal of Medicine.
"In the last 40 years, and almost certainly before that, this is the first time that firearm injuries have surpassed motor vehicle crashes among kids," Jason Goldstick, co-author of the article and a research associate professor at the University of Michigan, told NBC News.
He said homicides made up the majority of gun deaths.
"The increasing rates of firearm mortality are a longer-term trend and demonstrate that we continue to fail to protect our youngest population from a preventable cause of death," he said.
He has called for more action to break the "alarming trend".
There were 3,900 fatalities among children and teenagers due to motor vehicle crashes, which researchers said had "drastically decreased over the last 20 years".
Drug poisoning deaths increased by more than 83% to more than 1,700 - to become the third-leading cause of death in that same age group.
More than 45,000 people in total across the US died from firearm-related injuries in 2020 - over a 13% increase when compared to 2019 - driven largely by firearm homicides, which rose by more than 33%.
"Firearm violence is one of the most critical challenges facing our society, and based on the latest federal data, this crisis is growing more and more intense," said Rebecca Cunningham, co-author of the article and vice president for research at the university.
"As a nation, we turn to scientific evidence to prevent injuries and deaths, and firearms should be no different. Michigan has incredible expertise in this space, and we will continue to use our collective knowledge to create safer and more vibrant communities nationwide."