For decades, the narrative of gun violence and homicide has been framed as an urban plight disproportionately affecting Black communities in densely populated Northeastern and Midwestern cities. But a new analysis has found that firearm deaths among young Black people in rural locales are on par with — if not higher than — those in cities. 

Since 2013, firearm deaths have quadrupled among Black rural children and teens, primarily because of a rise in homicides, according to a new study led by researchers at the University of Minnesota School of Public Health. The results, published in the New England Journal of Medicine, also put the increasing risk in perspective: Although Black youth make up just 10 percent of the total youth population in rural communities, they comprised 30 percent of firearm homicides among that group in 2022.

The recent study comes in the wake of a 2020 finding by the Centers for Disease Control and Prevention that firearm-related injuries were the leading cause of death for children and adolescents. Allison Lind, a pediatric nurse practitioner who is the study’s lead author, said the data cemented her team’s motivation for analyzing historical patterns of race and rurality.

“I was shocked to find this steep increase in Black rural youth firearm-related deaths,” Lind said. “There hasn’t been a huge narrative about it, but I felt like this was extremely important because it was not something that just happened with the pandemic — this has been happening over a decade.”

The study analyzed youth deaths between 1999 and 2022 using the CDC Wonder database. The researchers defined “youth” as those between the ages of 1 and 19, and “rural” as places with a population of fewer than 50,000 residents. A decade ago, the analysis showed, Black and white rural youth had similar rates of firearm homicide, contributing to 12 percent of the deaths among Black children and teens and 11 percent among white children and teens. By 2022, Black kids and teens in rural communities were dying from firearms at four times the rate of their white counterparts, representing 20 out of every 100,000 such deaths. 

The trajectory shifted most notably in 2018, when deaths among Black children and adolescents in rural communities matched rates in metropolitan areas for the first time. From there, exacerbated by the nationwide rise in gun violence during the COVID-19 pandemic, the gap worsened. The findings show a significant majority of gun deaths among Black youth in rural communities were homicides, and concentrated in the South, where about half of the region’s total population lives in what the CDC considers rural communities. It’s also the region with the largest number of Black residents in the country

As gun violence surges and wanes in communities nationwide, it can be difficult to parse contributing factors, and rural communities are often overlooked by researchers due to overshadowing violence in major cities and lack of resources. An extensive analysis of 10 years of Gun Violence Archive data, conducted earlier this year by The Trace, found an eerily similar trend: Thirteen of the 20 cities with the highest incidences of shootings were in the South. Between 2013 and 2024, the rate of shooting victims in places like Alabama and Mississippi was six times higher than in cities like New York or Los Angeles.

In recent years, rural residents — citing lax gun laws, systemic racism, and healthcare inequities — have demanded that more attention be paid to gun violence in their communities. For many small towns, equitable access to health care is already limited, with hospitals struggling to provide care for sparsely populated areas. 

The collision of these issues is leading to a critical point, said Stacy Grundy, a public health practitioner who grew up in Hodges Park, Illinois, a rural town that sits where the Mississippi and Ohio rivers merge. She has studied the detrimental health effects connected to the erasure of Black rurality, and has lived it. The stakes are higher in rural America, she said. 

“High rates of violence are often a symptom of a larger root cause and I always go back to economic development,” said Grundy. “Most of the kids who are interested in college move away and do not return because there is not an industry to return to, and the economic opportunities for the young people who stay are now foregone. So in these communities you have an aging population and not many opportunities for the young people who stay.”

Rural communities are less dense, and more intimate, so firearm violence can have a compounding effect. “These communities are such close-knit social networks that oftentimes you know the perpetrator’s family, as well as the victims, making it more complicated, and you feel it on different levels,” said Grundy.

The history of racial violence in rural communities is deep. These places are sparsely populated, often with long-standing mistreatment leading to negative health outcomes. “We have to ask how the places where these deaths are occurring changed over time in terms of the population and policies,” said Lind, “and how can we begin to capture the role that firearm prevalence in these areas plays in all this.”