Black children were 100 times more likely to be shot than white children during the first 21.5 months of the coronavirus pandemic, according to a study published last week in the Journal of the American Medical Association.

“This study shows how important it is to bring a health disparity lens to research,” said Jonathan Jay, a professor at the Boston University School of Public Health and one of the study’s authors. “It shows how structural racism, including the inequitable distribution of resources, residential racial segregation, and distribution of opportunities not only harms children of color, but privileges white children.”

Firearm homicide rates rose dramatically in the first months of the COVID-19 pandemic, and research has linked the spike to poverty. Initial scholarship focused on gun violence affecting adults or the general public, but emerging work is revealing that children were particularly affected. A recent study of pandemic-era pediatric firearm assaults in St. Louis found that the monthly gun injury rate among children increased by almost 52 percent compared to the five years before the pandemic, while the death rate among children increased by 29 percent. Black boys averaging 13 years old were the most likely victims.

The study analyzed data from Philadelphia, which has the highest firearm homicide rate nationwide, and the three most populous cities in the U.S: New York, Los Angeles, and Chicago.  

The researchers, who used standard practices of statistical modeling, found that firearm assaults among people 18 and younger nearly doubled from 2015 to 2021, from nearly nine children per 100,000 to nearly 17 children per 100,000. The dataset included both fatal and nonfatal shootings for every city except Chicago (for which data on nonfatal injuries among children was not available).

Among non-Hispanic white children, there was no increase in shootings. Black children saw the most significant increase, from 27 children per 100,000 to 34. The Black-white disparity grew from a relative risk of 25 percent to 100 percent; the Hispanic-white disparity tripled; and the disparity between Asian and white children nearly tripled.

“These stats are astonishing, but not surprising. The number is quite high, but it is very consistent with what we see on the frontlines,” said Dr. Chethan Sathya, a pediatric trauma surgeon at Northwell Health in New York. “Last year, we saw a 350 percent increase at our children’s hospital of kids coming in with bullet wounds. The majority of those children are Black children.” 

Dr. Sathya, who also serves as the director for Northwell Health’s Center for Gun Violence Prevention, said that solutions to address these issues have to directly combat firearm violence among marginalized communities. Standardized hospital-based violence intervention programs, for example, must be paired with community programs including mentorships and faith-based organizations. “The elephant in the room that we don’t discuss as much — probably because we don’t know how to combat it yet — is that we also have to address the availability of illegal firearms in the country.”

Researchers involved in the BU study explained that it focused on the quantitative toll, hoping that the numerical data could propel future studies examining root causes. COVID-19’s exacerbation of health, employment, and educational disparities all played significant roles in the increases in violence among different racial and ethnic groups, the authors explain, but further research is needed to untangle their effects on the firearm disparities seen during the pandemic.

“The concentration of firearm victimization among Black, Hispanic, and Asian children must be addressed at the individual, community, and societal levels,” the researchers wrote. “It is critical to focus community safety and mental health interventions in the most affected communities and to target structural racism as a fundamental driver of the U.S. firearm violence epidemic.”

According to the study, New York City saw the biggest increase in violence, but the researchers said this was likely because of a low starting baseline. Prior to the pandemic, New York pediatric firearm assault data hovered around five children per 100,000; by 2021, it increased to nearly nine children per 100,000.

“We might tend to expect bigger proportional increases in places with a lower baseline because there is more room to move,” said Jay, one of the study’s authors. “But the important direction for this work to go is to understand what these disparities look like across different communities and identify the drivers, particularly modifiable drivers.” 

Editor’s note: A previous version of this story incorrectly listed the duration of the study. The researchers observed rates of violence over a 21.5-month period.