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Motor vehicle crashes, firearm deaths, and pediatric cancer were the top three leading causes of death among children and adolescents in 2016, researchers found.

Overall, motor vehicle crashes comprised 20% of all deaths, firearm-related injuries comprised 15% of all deaths, and malignant neoplasms among pediatric patients made up 9% of deaths, reported Rebecca M. Cunningham, MD of the University of Michigan Firearm Injury Prevention Center in Ann Arbor, and colleagues.

Over two-thirds of youth who died did so during adolescence, but causes of death varied between older and younger children, the authors wrote in a special report in the .

However, there was a 38% decrease in deaths from motor vehicle crashes in children and adolescents from 2007 to 2016, and this was the most notable change over time, the authors noted.

Researchers examined data from the CDC's (WONDER), which is comprised of death certificates from 57 vital-statistics jurisdictions.

They also found the rate of firearm-related mortality was lower in 2016 among this population than the most recent peak mortality in 1993. The authors said that "rates remained stable between 2007 and 2016 without improvement." But they also found a 28% relative increase in the rate of firearm deaths, which was likely driven by both 32% increases in firearm homicide and 26% increases in firearm suicide, they noted.

An by Edward W. Campion, MD, NEJM executive editor, called out the large discrepancy between the U.S. and other developed nations in terms of the top two causes of death in this population. He said that the U.S. rate of death from motor vehicle crashes was more than triple that of other developed countries.

Campion also added that firearm injury is only a "minor contributor" to childhood mortality in other developed countries.

"Children and adolescents in the United States were more than 36 times as likely to be killed by gunshots as their counterparts in other high-income countries," he wrote. "The grim statistics include suicides, which occur mainly in adolescents and which accounted for 35% of firearm-related deaths and 13% of all deaths among children and adolescents in 2016."

When examining the third leading cause of death in this population, Cunningham and colleagues found that death from malignant neoplasm declined 32% from 1990 to 2016, which the authors said "reflects scientific advancements in cancer prevention, detection, and treatment."

In the same time period, deaths from drowning declined 46% and deaths from residential fires were down 73%. However, the authors found that drug overdoses or poisonings rose to the sixth leading cause of death, mainly due to an increase in opioid overdoses, which were responsible for "well over half of all drug overdoses among adolescents."

Not surprisingly, drowning was the most common cause of death among the youngest children (ages 1-4), while the authors found that in school-age children, malignant neoplasm was the leading cause of death. For adolescents (ages 10-19), injury deaths from motor vehicle crashes, firearm injuries, and suffocation were the three leading causes of death, they said.

They also noted the importance of intent for injury-related causes of death, with unintentional causes comprising 78% of all suffocation deaths among children compared with 7% of suffocation deaths among adolescents.

The authors concluded that mortality among this population remains "overwhelmingly related to preventable injury-related causes of death." A shift in public perception of injury deaths as "accidents" instead of "social ecologic phenomena that are amenable to prevention" is needed to help make further progress towards reducing these deaths, they said.