For the first time since automobiles became widespread, Americans have started losing more years of life to guns than car accidents, making the former the leading cause of death from physical trauma in the US. The calculation, published in Trauma Surgery and Acute Care Open is based not only on the number of deaths but how long people who died in these ways could have expected to live otherwise.

Dr Joshua Klein of the Westchester Medical Center and co-authors used data from the CDC's National Vital Statistics Reports for 2009-2018, considering the ages of those who died from gunshot and motor vehicle crashes. Based on estimates of typical lifespan, these were used to calculate years of potential life lost (YPLL) for different causes of death.

For the majority of the period studied YPLL was higher for car accidents than guns, but this shifted in 2017 and 2018. For example, in 2018 the YPLL was 1.34 million from motor vehicle accidents, and 1.42 million from guns. Data for subsequent years was not available when the study was done.

In the pre-COVID-19 times when the data was collected, cancer and heart disease dominated the number of deaths in the United States. However, traumatic injuries represented the largest cause of death for people under the age of 46, and therefore made up a much larger proportion of YPLL than raw deaths.

Within the traumatic injury category, car accidents have been the leading component for a long time, but gun deaths had been catching up, so the 2017 switch was not a complete surprise.

The study's methodology is open to question at the margins, since the YPLL was calculated by subtracting an individual's age at death from 80. This not only rounds up the current American life expectancy of 78.7 years but ignores demographic differences, such as women having longer lifespans than men. Men are more likely to die of both gunshots and car accidents in the United States than women, but the skew is heavier for gunshots. A method that took gender and other influences on lifespan into account might therefore produce a somewhat different comparison. The authors note their method is the CDC standard.

Moreover, the continuing upward trend of death by firearm, while car deaths remain relatively stable, indicates guns will probably cost more YPLL than cars soon, even on other accounting methods.

Breaking the firearm data down further the authors found suicides took 741,869 YPLL in 2018, predominantly in older white men, having increased every year through the decade. Firearm homicide rates (including both murders and accidents) had been more even, other than a 2014-2016 surge, and accounted for 633,656 YPLL in 2018. The majority of these were in young Black men.

As the paper notes, “it is not realistic that all suicides are preventable.” Nevertheless, they point out most suicide attempts are impulsive and “are typically made after less than 3 hours of contemplation”. With guns having almost 90 percent effectiveness for suicides, much higher than any other method, their widespread availability leads to many completed suicides that would otherwise have been avoided.

The authors hopefully advocate for more resources to be redirected and allocated to most at-risk populations. However, while America has made great strides in making cars safer, the recent release of a semi-automatic weapon specifically marketed to children shows how difficult it is finding it to make even modest headway against the tide of guns.