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CHILDHOOD MORTALITY
FROM ACCIDENTS

Tjy age, race, and sex and by type of accident

n
Lo

U
U S. DEPARTMENT OF LABOR

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CHILDREN’S BUREAU

• PUBLICATION 311

C H ILD H O O D M O R T A LIT Y FROM A C C ID E N T S
prepared by

George W olff M. D.

Today accidents are the leading cause of death among children over one
year of age. Medical knowledge in the last decades has greatly reduced the
number of deaths from other causes, such as the acute infectious diseases
and tuberculosis, but in accident prevention we have failed to keep pace
with our increasing industrialization and mechanization.
There is no doubt that the great majority of these accident deaths could be
prevented. If we are to reduce this wastage of child life, we must have
more widespread appreciation of the problem and more precise knowledge
of the types and causes of accidental deaths. For this reason the Children’s
Bureau has made a study of the death rates for specified types of accidents
among children and adolescents, based on data from the Bureau of the
Census for the years 1939, 1940, and 1941. The study was made by Dr.
George Wolff, a member of the Division of Statistical Research of the
Children’s Bureau and formerly Director of Medical Statistics in the Berlin
Health Administration and Lecturer at Berlin University on Social Medicine.
Special emphasis has been put on age, sex, and race differentials for all
kinds of accidents. These reflect the differing risks— due to physiological,
psychological, and environmental differences— of the sexes and races and
suggest methods 'of prevention by special training and education.
Almost 20 thousand boys and girls die from accidents each year. This is
a continuing, peace-time death toll that can and must be reduced. To save
these lives— by education, sanitary engineering, traffic controls, and socio
economic changes— is worth every effort we can make.

Çhieï, CHILDREN’S BUREAU.

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CHILDHOOD MORTALITY
^ F R O M ACCIDENTS
by age, race, and sex, and by type of accident
Since the turn of the century accidents have become relatively more and
more important as a cause of death in childhood. Today they occupy a
place similar to that held in former decades by infectious diseases. To be
sure, the death rate from accidents, including motor-vehicle accidents, has
never equalled and probably never will equal the high rates reached by
tuberculosis, diphtheria, or diarrhea and enteritis, in the past. But at pres
ent accident prevails over most other causes of death in childhood and
therefore forms a new problem in public health and the prevention o f avoid
able deaths. There is no question but that the maj ority o f these deaths from
accident are preventable by one means or another— education, sanitary engi
neering, or socio-economic changes.
For this reason it is of general interest to inquire into the details and dif
ferentials of accident fatalities. Material for such differentiation has been
prepared in the Children’s Bureau for the 3-year period 1939*41, by age, race,
and sex. The average annual death rates are computed for the enumerated
population of the census of 1940 and are based on mortality data from the
United States Bureau of the Census for the single years 1939,1940, and 1941.
The 3-year average has been taken, to diminish chance fluctuations- Stand
ard errors were computed for all rates to test the validity of the finer differ
ences, especially sex and race differences, for different kinds of accidents. In
some instances they are shown and discussed in the text.
Table 1 gives, first, the death rates per 100,000 population for all accidents,
by age and sex, for white and nonwhite children under 20 years of age and,
second, the population numbers on which these rates are based. In addition,
ratios of the death rates, nonwhite to white and male to female, are shown in
the same table.
It is noteworthy that in both racial groups the death rate for accidents is
higher during infancy than in any of the following age groups o f childhood
(1-4, 5-9, 10-14, 15-19 years). In both racial groups the Idwest rate for
boys occurs in the age group 5-9. years, and for girls, in the age group 10-14
years. It should also be mentioned at once that throughout all ages of child
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hood the male exhibits distinctly higher death rates for accidents as a whole
than the female. Finer differences and exceptions will be discussed later.
For the white population under 20 years of age, the average annual
death rates for accidents in the period covered are 56.3 for boys and 25.3
for girls, per 100,000 of each sex. This gives a sex ratio, boys to girls, of
2.2. The absolute numbers corresponding to these rates, 34,129 and 14,916
for boys and girls respectively, give a better idea of the amount of human
life lost through accidents in the promising years of childhood.
For the nonwhite group the death rates are 74.2 and 36.3 for boys and
girls respectively, a sex ratio, boys to girls, of 2.0, with the corresponding
absolute numbers of 5,976 and 2,990. Thus the death rates for accidents are
somewhat higher for the nonwhite group than for the white, while the sex
ratio is somewhat lower. These sex and race differences are, o f course, sta
tistically significant since the rates are based on the huge population of the
total United States, the numbers for children under 20 years being around
20 million for each sex in the white, and 2.7 million for each sex in the non
white population.
A more detailed view of race and sex differentials for accidental deaths is
obtained by computing the race and sex ratios by ages as shown in table 1.
Nonwhite infants of both sexes suffer from fatal accidents more than twice
as often as white infants. In the other age groups the race differences are
not very great, the lowest ratio, nonwhite to white, being 1.1 and the highest
1.4.
The sex difference in both racial groups shows a more consistent trend.
Low in infancy and preschool age, and lower among nonwhite than white
children, the difference between the sexes increases in the age group 5-9
years, when white boys show twice as many fatal accidents as white girls,
and rises appreciably higher in the subsequent groups 10-14 and 15-19 years.
In the last group white hoys suffer nearly four times as many fatal accidents
as white girls, and among nonwhite children the boys have a still higher ratio.
After this short introduction it will be appropriate to consider systemati
cally the details of accidental deaths available in the data. Naturally, the
greatest interest lies in the types and causes of accident dominant in the dif
ferent age groups. In the following tables accident fatalities are grouped
according to the International List of Causes of Death (Fifth Revision of
1 93 8); the numbers of the List associated with the single causes of accidental
death are shown in brackets. As before, death rates are computed for prin
cipal accidents, or accident groups, by age, sex, and race per 100,000 popu
lation; absolute numbers of deaths in the 3-year period 1939-41, and ratios
of the death rates, nonwhite to white, are given in corresponding tables.
(See tables 2,* 3, 4, 5, 6.)
Among white children in all age groups except the infant year, the death
rate for motor-vehicle accidents exceeds the rate for every other type of acci
2
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TABLE

1. — C h i l d h o o d m o r t d l i t y f r o m
Stat es , 1939-41.
Average
each age-sex group.

a c c i d e n t s by â g e , s e x , a n d r ac, e; U n i t e d
annual
rate per 100,000 p o p u l a t i o n
in

Age groups in years
Under 20

Race

Male

White
Nonwhite

____

Female

56.3
74.2

1 -4

Under 1

25.3
36.3

Male

Female

124.0
259.1

97.8
208.1

Male

5 -9

Female

56.6
66.2

41.1
57.9

Male

10-14

Female

20.0
26.7

39.3
42.6

Male

15- 19

Female

Male

Female

40.9
56.2

12.2
14.5

74.1
98.1

19.8
21.1

1.4

1.2

1.3

1.1

R atios : N onw IITE TO W hite

1.3

1.4

2.1

1.4

1.2

1.1

1.3

R ati o s : M al E TO F e IHALE

W h i t e ________ _____
_____
Nonwhite _
_
_____
_______

2.2
2.0

1.3
1.2

1.4
1.1

3.4
3.9

2.0
1.6

3.7
4.6

Population of children under 20 years by age, sex, and race; United States, census of 1940
White

Age groups
(years)

_____
_ _
_

__
________
_________ _______

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Male

Female

20,220,934
906,897
3,794,573
4,744,537
5,259,007
5,515,920

19,654,264
871,336
3,656,699
4,584,414
5,093,688
5,448,127

Male

2,685,179
119,903
533,435
674,286
693,322
•6644233

Female

2,745,227
122,038
536,643
681,385
699^918
705,243

TABLE 1

Under 20 .
Under 1
1-4
$•9
10-14 _
_
15-19
—

Nonwhite

dent. For the nonwhite group automobile accidents do not have the same
relative importance among other accidents. Motor-vehicle accidents consti
tute one of the few causes of death for which nonwhite young children and
adolescents exhibit lower death rates than the white. (See ratios, non white
to white, table 4.) The lower rate o f the nonwhite children ,in this respect
calls to mind the fact that a relatively larger proportion of them live in agricultural parts of the country and for this reason may not be exposed to traf
fic hazards to the same degree that white children are.

Fatal Accidents in Infancy
The accident death rate is higher in the first year of life than in any sub
sequent age group of childhood. The average annual rates in 1939-41 were
124.0 and 97.8 per 100,000 for white boys and girls respectively; the cor
responding rates for nonwhite infants being 259.1 and 208.1. Thus it is
obvious that in both sexes the non whites lose relatively more than twice as
many lives as the whites from accidents in the first year of life. The higher
mortality of the male infant is likewise obvious in both racial groups. The
sex difference is significant, even in the nonwhite group, although the abso
lute numbers of infants are comparatively small (around 120,000 of each
sex in the nonwhite and 900,000 of each sex in the white population). An
explanation for this sex difference in early infancy is difficult to find. Per
haps an examination of the single causes of accidental deaths will shed some
light on this striking result of biological statistics.
A glance at. tables 2 and 3 will show that by far the most important cause
of accidental death in infancy is mechanical suffocation. The death rates
for the white infants, 57.7 and 45.0 for male and female respectively, and the
corresponding rates for the nonwhite infants, 112.9 and 98.9 respectively,
constitute almost one-half of the total deaths from accident in both races and
sexes.1 The race differential might be explained by the more favorable en*A similar conclusion regarding the importance of mechanical suffocation as a cause
of accidental death in infancy was reached by William M. Gafafer in his geographicalstatistical studies on fatal accidents for the years 1925-32. The proportion of deaths
from mechanical suffocation among all accidental deaths, though more than one-third,
was still not as high as in the period covered by the present study. According to Gafa
fer, in the United States death registration area mechanical suffocation accounted, in
1932, for 687 deaths out of 1,921 accidental deaths among infants under 1 year, or 36
percent of all accidental deaths. (See U. S. Public Health Reports, Vol. 51, No. 48.
November 27, 1936.) The increasing number of infants who die from this cause of
accidental death has been emphasized by Harold Abramson: Accidental Mechanical
Suffocation in Infants, The Journal of Pediatrics, 25:404-413, 1944. According to the
author the absolute numbers of these deaths increased in the registration States from
692 in 1933 to 1,333 in 1942. The increase holds true even when the birth increase is
considered; the rate per 1,000 live births rose from 0.33 in 1933 to 0.47 in 1942.

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T A B L E

2. — D e a t h r a t e s f o r a c c i d e n t s i n c h i l d h o o d b y a g e , s e x , a n d ' r a c e ; a n d
by t y p e o f a c c i d e n t ; U n i t e d
States, 1939-41. ( A v e r a g e a n n u a l d e a t h
ratées1 per 1 0 0 , 0 0 0 p o p u l a t i o n )
White
Type of accident

(Numbers of International List of Causes of
Death, Fifth Revision of 1938)

Male

Female

Under 1 year
Male

Male

Female

Male

Female

10-14 years
Male

Female

15-19 years
Male

Female

56.3

25.3

124.0

97.8

56.6

41.1

39.3

20.0

40.9

12.2

74.1

19.8

1.1
21.8

0.2
9.7

0.1
7.4

0.0
7.2

0.5
15.6

0.3
11.3

0.6
17.8

0.3
9.3

1.1
14.6

0.3
5.2

2.1
38.6

0.2
13.7

0.5
. 0.3
1.0
0.4
0.4

0.2
0.0
0.1
0.1
0.4

0.1
0.0
0.0
0
2.4

0
0
- 0.0
0
2.3

0.3
0.0
0.8
0.3
0.9

0.2
0
0.3
0.1
1.0

0.4
0.2
0.5
0.2
0.2

0.2
0.0
0.2
0.1
0.1

0.7
0.2
1.1
0.2
0.1

0.2
0.0
0.1
0.0
0.1

0.6
0.8
1.6
0.9
0.1

0.1
0.0
0.0
0.0
0.1

1.2
1.3

1.0
1.1

2.8
4.3

2.3
3.9

4.1
3.4

3.3
2.3

0.3
1.1

0.3
1.2

0.2
0.5

0.6
0.5

0.6
0.4

3.1
2.9
8.8
3.3
2.9
7.3

. 3.7
2.1
2.1
0.5
1.0
3.1

7.6
57.7
1.8
0.2
5.9
33.9

6.4
45.0
1.5
0.0
3.7
25.4

9.2
0.6
9.6
1.0
3.2
7.-1

10.3
0.4
4.2
0.5
2.0
4.6

1.7
0.3
8.1
1.5
2.2
4.2

3.8
0.1
1.3
0.6
0.8
1.8

1.0
0.2
8.9
4.3
2.5
5.3

1.3
0.0
2.0
0.5
0.7
1.3

1.2
0.2
9.8
6.1
3.1
7.8

0.9
0.0
1.4
0.6
0.5
1.1

20.6

15.7

1 Symbol 0 means no death at all; 0.0 death rate less than 0.05.

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Female

5-9 years

1-4 years

TABLE

A ll A ccidental D eaths (169-195)-----Railway accidents (except collisions with
motor-vehicles ) ( 169 )
Motor-vehicle accidents (170a, b, c, d) —
Streetcar and other road-transport acci
dents (171a, 171b)
Accidents in mines and quarries (174) —
Agricultural accidents (175a, b, c ) ____
Other accidents involving machinery (176)
Food poisoning (17 7)_________________
Acute accidental poisoning (except food
poisoning) (178, 179)_______________
Conflagration (180)______________ .____
Accidental bums (except conflagration)
(181) _______________________________
Accidental mechanical suffocation (182)
Accidental drowning (183)_____________
Accidental injury by firearms (184)___
Accidental injury by fall (186a)
Other accidents
Obstruction, suffocation, or puncture by
ingested objects (195d)
.. _

Under 20 years

vironment of the white family. But the fact that both white and nonwhite
boys suffocate by heavy bedclothes or other overlying obstacles more fre
quently than girls do, can hardly be explained by greater risk.
Among nonwhite infants the sex difference is not significant in a strict,
statistical sense and could be due to chance fluctuations; not so among the
white, and both differences lie in the same direction. The only explanation
seems to be a different mental or bodily constitution of the sexes evident from
early infancy, perhaps an inborn tendency in the male to greater activity or
perhaps to lower resistance.2 There may be many factors which combine to
determine the inborn differences of the sexes and which also manifest them
selves in the differentials of accident mortality.
The higher mortality of the male infant also holds for the second most
important cause of accidental death in infancy, obstruction, suffocation, or
puncture by ingested objects.. This classification is contained in the collec
tive group “ other accidents,” which comprises such different causes of death
as cataclysm; injury by animals; hunger or thirst; excessive cold; excessive
heat; obstruction, suffocation, or puncture by ingested objects. The last
subgroup (195d of the International List) is especially large in infancy and
is the main reason why the death rates for “ other accidents” are so much
higher for this age than for any other age group of childhood. The death
rates for obstruction, suffocation, or puncture by ingested objects are isolated
in our tables for the infant year; they are 20.6 and 15.7 for white boys and
girls respectively, and 24.5 and 16.7 for the nonwhite. In both racial groups
this cause of death is second only to mechanical suffocation. The differences
between the races are slight, but the sex differences, pointing in the direction
described above, lie beyond the probable limits of chance fluctuation.
The next leading cause of accidental death in infancy is accidental burns.
The death rates when compared with those for suffocation are rather low
among the white, 7.6 and 6.4 for boys and girls respectively; among the
nonwhite they are 20.6 and 16.4 respectively. For this particular item the
differences between the sexes are not significant from a strictly statistical
point of-view, in either race, but the racial differences are significant and
high, probably due to different environmental hazards in the white and non
white family.
Among white infants, the fourth leading cause of accident fatalities is
m otor-vehicle accidents with 7.4 and 7.2 deaths per 100,000 boys and. girls
respectively; the corresponding rates for nonwhite infants being 6.4 and 6.3
respectively. For this item there is no sex differential of any significance
and the race differential is in favor of the nonwhite group, as mentioned in
the introductory remarks on accidents in general» Among nonwhite infants
the fourth principal causé of accidental deaths is conflagration; the rates,
2For more detailed discussion see Antonio Ciocco, Sex Differences in Morbidity and
Mortality. Quarterly Review of Biology," Vol. 15, Nos., 1 and 2. 1940.

6
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T A B L E

3.— D e a t h
r a t e s f or a c c i d e n t s in c h i l d h o o d by a g e , s e x , a n d r a c e /
by t y p e of a c c i d e n t ;
United
States, 1939-41. ( Av e r a g e a nnu al
d e a t h r a t e s 1 per 1 0 0 , 0 0 0 p o p u l a t i o n . )

and

Nonwhite

(Numbers of International List of Causes of
Death, Fifth Revision of 1938)

Under 20 years
Male

Female

5-9 years

Male

Female

Male

259.1

208.1

66.2

57.9

42.6

0.3
6.7

0
6.4

0.3
6.3

0.2
11.0

0.4
7.5

0.8
0.2
0.8
0.6
1.1

0.1
0
0.1 !
0.0
0.8

0
0
0
0
7.2

0.3
0
0.3
0
6.0

0.6
0
0.2
0.3
2.0

2.4
4.2

2.0
4.4

4.7
16.1

3.8
19.1

8.8
20.6
4.5
112.9
1.2
3.3
1.5 Î
1.1
1.3
16.7
4.4
70.1

16.4
98.9
1.4
0.5
7.9
47.0

24.5

16.7

74.2

36.3
I

1.8
18.3

5.9
5.3
13.6
5.3
3.0
10.6

1
1 Symbol 0 means no death at all; 0.0 death rate less than 0.05.

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1-4 years
Female

Male

Female

10-14 years

15-19 years

Male

Female

Male

26.7

56.2

14.5

98.1

21.1

08
15.5

1.3
14.8

0.2
3.9

5.1
32.7

0.4
8.5

0.2
0
0.1
0.1
1.6

06
01
01
0.1
07

01
o
o.i
o
0.4

1.1
0.1
0.9
0.3
0.5

0.1
0
0.0
0.0

1.1
0.7

0.0
0
0.1
0

9.2
9.7

7.1
9.8

09
28

07
2.7

15.9
0.7
3.6
2.6
3.2
7.0

21.8
0.2
1.3
1.6
2.4
3.9

32
01
7.2
28
2.1
54

97
0.1
08
13
08
2.2

Tjj

2.1

Female

0 .2

1.5
0.4

0.2
1.3

0.5
2.2

0.9
2.5

1.8

3.2

2.4
0.4
25.5
9.3
2.4
11.7

2.4

0.1
18.0
6.8

2.0

7.0

0
1.3
1.5
0.5
2.0

0.4

0
1.5

1.6
0.5

2.2

TABLE 3

A ll A ccidental Deaths (169-195)___
Railway accidents (except collisions with
motor-vehicles) (169)
Motor-vehicle accidents (170a, b, c, d )__
Streetcar and other road-transport accidents (171a, 171b)
Accidents in mines and quarries (174)_
Agricultural accidents (175a, b, c)
Other accidents involving machinery (176)
Food poisoning (177)
Acute accidental poisoning (except food
poisoning) (178, 179)
Conflagration (180)
Accidental burns (except conflagration)
(181) _____________________________
Accidental mechanical suffocation (182)
Accidental drowning (183)
Accidental injury by firearms (184)____
Accidental injury by fall (186a)
Other accidents
Obstruction, suffocation, or puncture by
ingested objects (195d)

Under 1 year

16.1 for boys and 19.1 for girls, are about three times as high as those for
motor-vehicle accidents. In contrast, among white infants the death rates
for conflagration are 4.3 and 3.9 respectively, distinctly below the rates for
motor-vehicle accidents. The inverse order of fire and automobile hazards
in the two racial groups reflects differing risks starting in infant life. The
risk of being killed by conflagration (usually as a result of burning houses,
inhalation of smoke, and so on) is four to five times higher for the non white
infant than it is for the white. (See ratios, nonwhite to white, table 4.)
The sex differences for deaths from conflagration are not consistent and
are not statistically significant. This brings up the interesting statistical
fact that where accidents, and the deaths resulting from them, are beyond
personal control (catyclysm, such as floods, earthquake, conflagration, etc.),
there is usually no significant difference between the sexes. In such cases
any constitutional difference in susceptibility between the sexes, as well as
the normal difference in exposure, is outbalanced. This seems to be the
case throughout all the ages of childhood for deaths caused by conflagration,
as shown in table 2 for white children. It is also true for the nonwhite chil
dren, as shown in table 3, in spite of the fact that the latter exhibit far higher
rates than the white. The same holds in both racial groups for motorvehicle accidents during infancy, when the children are only passive suffer
ers; in all following age groups, apparent in the preschool and much more
so in school-age and adolescent groups, the differences between the male and
female rates for motor-vehicle accidents become increasingly significant.
Next in order and still rather high are accidental deaths from injury by
fall. The death rates are 5.9 and 3.7 per 100,000 white boys and girls re
spectively; the corresponding rates for nonwhite infants being 16.7 and 7.9.
Both race differences and sex differences are distinct and beyond mere chance
fluctuations. The explanation can be seen again in the different environ
mental conditions of the races and the greater liability of male infants.
Other principal causes of accidental deaths for which rates are computed
are food poisoning and acute poisoning by gas, solids, or liquids (except
food poisoning). These still play a certain role among all accidental deaths,
especially food poisoning among nonwhite infants, but the rates are becom
ing small and negligible. The absolute figures for deaths from these causes
(see tables 5 and 6) show their relative importance. Among the white popu
lation of the United States under 1 year of age, there occurred 64 male and
61 female deaths from food poisoning in the 3 years 1939-41; and among
the nonwhite population 26 and 22, respectively.

These figures give the

rates 2.4 and 2.3 respectively among the whites, and 7.2 and .6.0 among the
nonwhites.
In conclusion it may be said that the accidental deaths in infancy, though
high when compared with other ages of childhood, lose ,very much in im
portance when compared with the main causes of infant deaths (premature

8
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T A B L E

4. — R a t i o s

death

rates,

nonwhi t e

whi t e;

Uni t ed

States,

1939-41.

Ration : nonwhite to white
Type of accident
(Numbers of International List of Causes of
Death, Fifth Revision of 1938)

Under 20 years
Male

Female

Under 1 year
Male

Female

Male

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Female

Male

Female

10-14 years
Male

Female

15-19 years
Male

Female

2.1

1.2

1.4

1.1

1.3

1.4

1.2

1.3

1.1

0.9

0.4
0.7

1.3
0.7

1.3
0.9

1.0
0.8

1.2
1.0

0.7
0.8

2.4
0.8

2.0
0.6

2.0

1.0
y
0.3
1.0
1.6

1.5
0.5
0.2
0.5
3.5

0.5

1
l
l

0.5

2.0

1.8
0.9
1.3
1.7
4.0

1
1
1
l

4.0

1.6
0.5
0.8
1.5
5.0

1.3

1.4

•2.1

1.6
0.8

1.5
0.7

1
1
1
1

1.6
0.7
0.8
1.5
2.8

l
1
l
1

2.0

3.0

2.6

0.3
1.0
2.2

2.0
3.2

2.0
4.0

1.7
3.7

1.7
4.9

2:2
2.9

2.2
4.3

3.0
2.5

2.3
2.3

1.0
2.6

0.8
4.4

1.5
6.3

1.9
1.8
1.5
1.6
1.0
1.5

2.4 1
2.1
0.6
3.0
1.3
1.4

2.7
2.0
1.8
5.5
2.8
2.1

2.6
2.2
0.9

1.7
1.2
0.4
2.6
ID
1.0

2.1
0.5
0.3
3.2
1.2
0.8

1.9
0.3
0.9
1.9
1.0
1.3

2.6
1.0
0.6
2.2
1.0
1.2

1.8
0.5
2.0
1.6
0.8
1.3

2.5

2.0
2.0
2.6
1.5
0.8
1.5

2.7
1
1.1
2.7
1.0
2.0

1.2

1.1

0.5

1.0

2.1
1.9

1 No deaths, or death rate less than 0.05 per 100,000 among whites or nonwhites.

5-9 years

1-4 years

0.5

0.7
3.0
0.7
1.5

4.0

TABLE 4

A ll A ccidental D eaths (169-195)-----Railway accidents (except collisions with
motor-vehicles) (169) .
Motor-vehicle accidents (170a, b, c, d) —
Streetcar and other road-transport acci
dents (171a, 171b)_
Accidents in mines and quarries (174) —
Agricultural accidents (175a, b, c ) ______
Other accidents involving machinery (176)
Food poisoning (177) ------------------------Acute accidental poisoning (except food
poisoning) (178, 179)-----------------------Conflagration ( 180 )
Accidental bums (except conflagration)
(181)
---------- - - Accidental mechanical suffocation (182) _
Accidental drowning (183)
Accidental injury by firearms (184)------Accidental injury by fall (186a)
Other accidents
Obstruction, suffocation, or puncture by
ingested objects (195d)

birth, pneumonia and influenza, congenital malformations, injury at birth,
diarrhea and enteritis). In 1939-41 accident fatalities constituted only a
little more than 2 percent of all deaths in infancy and were not, therefore,
among the leading causes of death in this age group.

Fatal Accidents in the Preschool Age
During 1939-41, for the preschool child 1-4 years of age, the average an
nual death rates for accidents were 56.6 and 41.1 per 100,000 white boys
and girls respectively. The distinct sex difference of 15.5 is beyond doubt
significant in a strictly statistical sense. If standard errors are computed
for the 3-year average on the basis of the huge population of white children
of these ages, numbering in the census year of 1940 nearly 4 million of each
sex, the difference is almost 17 times its standard error of .934. The corres
ponding death rates for nonv^hite boys and girls are 66.2 and 57.9 respec
tively, and are based on a population of somewhat above one-half million in
each sex. The sex difference among the* nonwhite children, 8 .3 ± 2 .7 8 , is
much smaller and not as significant as among white children, but is still be
yond the usual limits of chance fluctuations, being 3 times its standard error.
The death rates for accidents are somewhat higher for nonwhite children
than for white, especially for the girls, but both racial differences, 9 .6 ± 2 .1 5
for the boys and 1 6.8 ±2 .00 for the girls, are obviously significant.
The absolute numbers of accident fatalities, given in tables 5 and 6, also
deserve attention since they show in a vivid and realistic manner the lives lost
by accidents, which must be called preventable deaths. In this age group
during the 3 years 1939-41, there were 6,445 white boys who lost their lives
through accident, 4,511 white girls, 1,060 nonwhite boys, and 932 nonwhite
girls; altogether practically 13,000 fatal accidents among children 1-4 years
of age. Among the white population these deaths constitute 20 percent of all
deaths among boys of this age and 17 percent of all deaths among girls; in
the nonwhite population they constitute 12 percent of all deaths among both
boys and girls. Thus the relative importance of fatal accidents, or their
weight among all causes of death, is much greater in the preschool age than
in infancy, although the death rates themselves are appreciably lower.
Accident fatalities, one of the leading causes of death among children
of preschool age, have gained in importance in recent years principally be
cause other preventable causes of death, the infectious diseases in particular,
have decreased at a much faster rate. As a matter of fact, in the 1939-41
period under scrutiny, the death rate for all accidents among white boys
(56.6) was almost the same as for pneumonia and influenza (56.7), the
10

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leading cause of death for this age group since the beginning of the century ;
among white girls the death rate for accidents (41.1) was second only to
that for pneumonia and influenza (51.4). Among nonwhite boys the acci
dent death rate (66.2) occupied third place, being exceeded greatly by pneu
monia and influenza (140.5), and only slightly by diarrhea and enteritis
(66.9) ; among nonwhite girls the accident death rate (57.9) was second
only to pneumonia and influenza (116.9), and exceeded the death rate from
diarrhea and enteritis (56.5).
Turning again to the principal causes of fatal accidents, it will be seen
from the rate tables 2 and 3 that the rank order for the preschool child is
very different from that for the infant. Mechanical suffocation, the prin
cipal -cause of accidental death in infancy, has almost disappeared. The lead
is now taken, among white boys and girls, by m otor-vehicle accidents, with
15.6 and 11.3 deaths per 100,000 respectively. Among nonwhite boys and
girls these rates are lower, 11.0 and 7.5 respectively, and the lead is taken
by accidental burns with rates of 15.9 and 21.8 respectively. The corres
ponding rates for accidental burns among white children are 9.2 and 10.3,
making this cause of accidental death second highest in the rank order for
girls, and third highest for boys.
Accidental burns are practically the only type of accident for which female
children have a higher death rate than male. Since this holds true in both
racial groups and, as will be seen later, in the following age groups of the
school child, the statistical trend must be taken as significant even though
the sex differences are not always beyond possible chance fluctuations. That
girls of preschool and school age have higher ratés for burns than boys may
be due to the fact that girls spend more time around the kitchen and laundry
than boys do, and for this reason are more exposed to environmental hazards
such as boiling water.8
Another outstanding accident in this age is conflagration. The rates show
no consistent sex difference in either race, but they are distinctly higher for
the nonwhite than for the white, with 9.7 and 9.8 deaths per 100,000 for
nonwhite boys and girls respectively and 3.4 and 2.3 for white respectively.
The high rates for the nonwhite, almost three times as high for the boys and
more than four times as high for the girls (see ratios, table 4) reflect again,
as in the infant year and the following age groups, the greater risk of the
nonwhite people from burning houses, smoke inhalation, and so on. These
hazards hardly observe any sex distinction.
In almost every other type of accidental death the little boys, 1-4 years of
3Collins found very similar results for mortality from burns among white school
children in the registration States of 1920 during the period 1921-1927. See: The
Health of the School Child. U. S. Public Health Bulletin No. 200, pp ÏÜ7-109. Dub
lin and Lotka attribute the greater mortality of girls of preschool age, which they ob
served among Metropolitan industrial policyholders, more to additional hazards of
feminine clothing. See Twenty-five Years of Health Progress, Metropolitan Life Insur
ance Co., N. Y., 1937, p. 485.

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age, exhibit higher rates than the girls. Surprisingly high in the white race
are accidental deaths from drowning, with 9.6 and 4.2 per 100,000 boys and
girls respectively, as compared with 3.6 and 1.3 for the nonwhite group.
Since these rates are based on huge population figures for a 3-year period,
there is no doubt about their statistical significance; the race differences as
well as the sex differences far surpass chance fluctuations. This still holds
for the next age group, 5-9 years (see ratios, nonwhite to white, table 4 ).
While greater exposure suggests itself as an explanation for the higher death
rates of the male in both racial groups, it is difficult to find any explanation
for the higher rates for drowning among white children compared with non
white. Of course, for this cause as for some of the others, the statistical
results depend on the reliability of the original material, i.e., the medical
diagnoses on the death certificates, which cannot be corrected by mathemat
ical methods.
Other important types of accident fatalities in the preschool age are
acute poisoning by gases, solids, or liquids (except food poisoning), and
injury by fall.- Deaths from food poisoning are not as frequent as in in
fancy. Fatal accidents from acute poisoning by gases, liquids, or solids
occur among non white boys and girls (9.2 and 7.1 deaths per 100,000 re
spectively) more than twice as often as among white (4.1 and 3.3 respec
tively). For fatalities from falls the preschool children in both races exhibit
almost the same rates; for white boys and girls 3.2 and 2.0 respectively,
and for nonwhite, 3.2 and 2.4. The sex differences are rather distinct in all
these rates and show again the greater liability or exposure of the male child.
This is also the case in most of the rarer accidents, the rates for which may
be seen in the tables. Thus the only significant exceptions are accidental
burns in the preschool and school age. Here, undoubtedly, we see the effect
of the different environment of boys and girls.

Fatal Accidents in the School-Age Groups
School age comprises two age groups in our tabulation, 5-9 and 10-14
years. Here the death rates for accidents as a whole* 1939-41, were the
lowest of all the ages of childhood. In the age group 5-9 years, there were
39.3 and 20.0 accidental deaths per 100,000 white boys and girls respec
tively, and 42.6 and 26.7 per 100,000 nonwhite boys and girls. The race
differences are not significant in this age, but the sex differences are seen to
be significant beyond doubt in both races, when standard errors are com
puted. The sex difference is still more distinct among the older school chil
dren, 10-14 years of age, whose death rates were 40.9 and 12.2 for the white

12
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TABLE

5. — D e a t h s f r o m a c c i d e n t s i n c h i l d h o o d b y a g e , s e x , a n d
t y p e of a c c i d e n t ; U n i t e d S t a t e s , 1 9 3 9 - 4 1 . ( A b s o l u t e
three years.)
White

Type of accident
(Numbers of International List of Causes of
Death, Fifth Revision of 1938)

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Under 20 years

Under 1 year

Male

Femali

Male

34,129

14,916

671
13,198

1-4 years

5-9 years

10-14 years

15-19 years

Female

Male

Female

Male

Female

Male

Female

Male

Female

. 3,373

2,556

6,445

4,511

5,595

2,745

6,457

1,869

12,259

3,235

136
5,745

2
200

1
187

62
1,772

28
1,245

88
2,538

37
1,283

175
2,299

41
789

344
6,389

29
2,241

315
211
600
252
230

106
14
72
32
213

2
1
1
0
64

0
0
1
0
61

39
4
88
34
103

26
0
31
15
108

57
27
72
34
30

24
6
23
7
19

111
39
173
37
16

34
4
11
4
8

106
140
266
147
17

22
4
6
6
17

716
813

594
656

75
116

60
101

462
386

367
256

39
156

40
159

37
77

23
75

103
78

104
65

1,857
1,740
5,318
2,024
1,743
4,441

2,158
1,243
1,225
301
616
1,805

206
1,570
48
5
161
922

167
1,177
39
1
96
665

1,052
70
1,097
109
363
804

1,132
47
463
60
223
510

249
36
1,149
212
314
594

518
8
181
76
110
254

157
27
1,398
684
395
832

194
5
313
71
101
196

193
37
1,626
1,014
510
1,289

147
6
229
93
86
180

560

411

TABLE 5

A ll A ccidental D eaths (169-195)____
Railway accidents (except collisions with
motor-vehicles) (169)
Motor-vehicle accidents (170a, b, c, d ) __
Streetcar and other road-transport acci
dents (171a, 171b)
Accidents in mines and quarries (174)_
Agricultural accidents (175a, b, c)
Other accidents involving machinery (176)
Food poisoning (177)
Acute accidental poisoning (except food
poisoning) (178, 179)
Conflagration (180)
Accidental burns (except conflagration)
(181)
Accidental mechanical suffocation (182) _
Accidental drowning (183)
Accidental injury by firearms (184)____
Accidental injury hy fall (186a)
Other accidents
Obstruction, suffocation, or puncture by
ingested objects (195d)

race, a n d by
numbers for

boys and girls respectively, and 56.2 and 14.5 for the nonwhite. Apart from
the wide sex difference in both racial groups in this age, 10-14, nonwhite
boys show a distinctly higher rate than the whites while nonwhite girls do
f
not. One might suppose that the nonwhite boys, 10-14 years old, are already |
engaged with the laboring forces and thus suffer relatively more than the
whites from occupational hazards. But an analysis of the single types and
causes of accidental deaths throws a different light upon the race differential
of the male.
Although at school age the death rates for accidents as a whole are lower
than at any other age, accident fatalities represent by far the most important
cause of death among school children at the present time.

Other leading

causes of death, acute infectious diseases and tuberculosis, have decreased
substantially during the last decade, but fatal accidents only very little for
this age group.4
The total number of deaths from accidents, 1939-41, for children 5-9 years
of age amounted, among the whites, to 5,595 boys and 2,745 girls and,
among the nonwhites, to 861 boys and 546 girls; altogether 9,747 fatal acci
dents.

In the following age group, 10-14 years, the corresponding figures

are 6,457 and 1,869 white boys and girls and 1,169 and 304 nonwhite; alto
gether 9,799 fatal accidents.

Thus nearly 20,000 deaths from accidents oc

curred among children of school age in the 3 years 1939-41.

These accident

fatalities constitute, in the 5-9 year group, one-third of all deaths among
white boys and more than one-fourth among nonwhite boys; almost 4onefourth among white girls and one-fifth among nonwhite girls.

In the 10-14

year group, the corresponding proportions are somewhat higher for the
boys in both races, but distinctly lower for the girls, especially the nonwhite
girls.

(See table 7.)

Accidents represent the leading cause of death among school children and
hence constitute a public-health problem of the first rank.

This becomes still

more apparent when we compare the other leading causes of death with fatal
accidents. The death rates for pneumonia and influenza, second leading
cause of death among children 5-9 years old, for the same period are 10.2
and 9.0 for white boys and girls respectively, as compared with accident
rates of 39.3 and 20.0.

In the white group, the third leading cause of death

is appendicitis with the respective rates 8.2 and 6.7.

Among nonwhite boys

and girls of this age the respective death rates for pneumonia and influenza
are 21.2 and 18.1, as compared with 42.6 and 26.7 for accidents.

In this

group the third leading cause of death is tuberculosis with the rates 16.4 for
boys and 14.7 for girls.
4The decrease in the leading causes of death, from 1900 to 1940, has been discussed
in a former paper. See George Wolff: Deaths From Accidents Among Children and
Adolescents. The Child, 9:84-86, 1944.

14
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TABLE

6. — D e a t h s f r o m a c c i d e n t s i n c h i l d h o o d
by a g e , s e x , a n d r a c e , a n d
t y p e o f a c c i d e n t ; U n i t e d S t a t e s , 1 93 9 - 4 1. ( A b s o l u t e n u m b e r s f o r
three years.)
Nonwhite

Type of accident
(Numbers of International List of Causes of
Death, Fifth Revision of 1938)

Under 20 years
Male

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’ Female

Under 1 year
Male

2,990

932

28
554
10
0
8
2
68

1-4 years

Female

Male

5-9 years

Female

10-14 years

Male

Female

Male

15-19 years

Female

Male

Female

762

1,060

932

861

546

1,169

304

1,954

446

3
176

7
120

16
314

7'
150

28
307

4
81

101
652

9
180

0
0
0,
26

1
0
1
0
22

10
0
3
5
32

3
0
1
1
25

12
3
3
3
14

2
0
3
0
8

23
3
18
7
11

3
0
1
1
5

22 .
14
-42
30
8

168
363

17
58

14
70

147
155

115
157

18
56

15
56

5
26

4
27

10
44

20
53

728
368
102
120
106
365

' 74
406
12
4
60
252

60
362
5
2
29
172

255
11
58
41
52
112

351
4
21
26
■ 39
62

65
3
146
56
43
109

199
2
17
27
16
44

37
2
374
141 41
146

68
0
27
31
11
41

48
7
509
186
47
234

50
0
32
34
11
46

1
0
2
0
8

TABLE 6

A ll A ccidental D eaths (169-195)____ 5,976
Railway accidents (except collisions with
motor-vehicles) (16 9)_______ ________
148
Motor-vehicle accidents (170a, b, c, d ) ___ 1,472
Streetcar and other road-transport acci
dents (171a, 171b)_______________ =__
67
Accidents in mines and quarries (174)_
20
Agricultural accidents (175a, b, c ) ______
66
Other accidents involving machinery (176)
45
Food poisoning (177) ____________
91
Acute accidental poisoning (except food
poisoning) (178, 179)__________ _____
197
Conflagration (180) __________________
339
Accidental burns (except conflagration)
(181) _______________________ _______ _
479
Accidental mechanical suffocation (182)
429
Accidental drowning (183)__________
1,099
Accidental injury by firearms (184)____
428
Accidental injury by fall (186a)________
243
Other accidents ___ ^ _______________
853
Obstruction, suffocation, or puncture by
ingested objects (195d)________!___ ;

Among older school children, 10-14 years of age, the accident death rate
for white boys (40.9) is many times higher than the next most important
causes of death; appendicitis (9 .0 ), diseases of the heart (8 .8 ), and pneu
monia and influenza (7 .0 ).

Among the white girls accidents remain

the

leading cause of death but the excess over other causes is relatively small
owing to the low accident death rate of 12.2.

This is followed by heart dis

eases (9 .2 ), pneumonia and influenza (7 .1 ), and appendicitis (6 .9 ). Among
nonwhite children of this age, the difference between accident fatalities and
other leading causes of death is again large for the boys, though not quite
so enormous as for the white boys, the death rate for accidents (56.2) being
two and one-half times as high as that for tuberculosis (22.3), and more
than three times as high as that for pneumonia and influenza (17.4).

(The

death rates for heart diseases and appendicitis are appreciably smaller than
any of these.)

Among nonwhite girls of this age the story is quite different.

Here tuberculosis is by far the main cause of death, with a rate of 39.0
(higher than the rate for nonwhite boys, 22.3), followed at a great distance
by pneumonia and influenza (16.3) and only then by accidents (14.5).
This is a very characteristic difference in the mortality patterns of the two
racial groups.

Tuberculosis today still takes a high toll among the non

white people, especially among maturing and adolescent girls, while among
the white children tuberculosis, with the rates 2.9 and 4.3 for boys and girls
respectively, has almost ceased to be a serious threat.
Details about the principal causes of accidental death among school chil
dren can be obtained from the tables.
be reviewed here.

Some of the outstanding facts may

In both age groups o f white school children m otor-vehicle

fatalities leads with rates of 17.8 and 9.3 for boys and girls respectively, in
the lower age group, and 14.6 and 5.2 respectively, in the higher.

The next

jnost important cause of accidental death is drowning the rates for which
are 8.1 and 1.3 in the 5-9 year group and 8.9 and 2.0 in the 10-14, for white
boys and girls respectively.

The low rates of the girls for accidental drown

ing are especially conspicuous and bring to mind the different attitudes of
the sexes towards outdoor life in early childhood and the resulting different
environmental hazards.
cant in every sense.

These large sex differences are, of course, signifi

The figures show how many school children’s lives

could be saved by better educational and supervisional measures.

The abso

lute figures for drowning are quite impressive. Among white children, in the
period under observation 1,149 boys and 181 girls died by drowning, in the
5-9 year group, and 1,398 boys and 313 girls in the 10-14 group.

The cor

responding figures for nonwhite children are 146 boys and 17 girls in the
5-9 year group, and 374 boys and 27 girls in the 10-14.

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Altogether more

than 3,600 school children lost their lives by drowning during 1939-41.
(See tables 5 and 6.)
In regard to the race differential for drowning, there is one striking point
which should be mentioned. Among the preschool and younger school chil
dren the nonwhite show lower death rates than the whites in both sexes, but
in the 10-14 year group (and still more so in the following age group)
nonwhite boys pay a definitely higher toll fo r drowning than white boys of
the same age (see ratios, table 4 ). Their death rate of 18.0 per 100,000 is
more than twice that of the white boys and, in fact, the principal cause of
accident deaths in this group, exceeding even the motor-vehicle death rate
o 14.8. This high race differential for drowning is also the main reason
why nonwhite boys of this age have a higher total death rate for accidents
t an w ite boys. Race differences for the other single causes are small and
mostly within the boundaries of chance fluctuation. It appears, therefore,
that the increased rate for accidental death among nonwhite boys at these
ages may be due chiefly to their choice of recreation (fishing, swimming,
boating) or to their places of recreation.
Other more or less characteristic causes of fatal accidents among children
are accidental burns, conflagration, injury by fall, and, among the older
children, injury by firearms.

For these and for some other causes (agricul

tural accidents, other accidents involving machinery, etc.) the tabulated rates
are not very high and may be found in tables 2 and 3. With few excep
tions, in both age divisions the females of both racial groups incur fewer
risks than the males, the one outstanding exception being accidental burns.
For this latter cause of accident fatality, the rate for white girls, 5-9 years of
age, is 3.8 per 100,000, more than twice that for white boys (1 .7 ); the rate
for non white girls is 9.7, more than three times that for nonwhite boys, (3.2 ).
Among the older school children, 10-14 years, the sex difference is in the
same direction though less marked.

The rates in the white group are 1.0

and 1.3, and in the nonwhite 1.8 and 3.2, for boys and girls respectively.
The explanation is obviously the same as that given for preschool children
and suggests a need for more specific education and care on the part of
mothers regarding this avoidable cause of death.

As the children grow older

the rates for accidental burns decrease considerably and the unfavorable dif
ferential of the girls diminishes.

Among adolescents, 15-19 years of age,

girls do not suffer more than boys from fatal burns; this holds true for both
racial groups.
•_
It should also be mentioned that among older school children, injury by
firearms becomes a relatively important cause of fatal accidents. Among
white children 10-14 years of age, the death rates are 4.3 and 0.5 for boys
and girls respectively; and among nonwhites of the same age, 6.8 and 1.5
respectively.

This significant sex difference, of course, needs no special

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explanation; it is the expression of the greater self-exposure of the male to
firearms, which starts in childhood and continues throughout life.

Fatal Accidents in Adolescence
Among adolescent males, 15-19 years, the death rate for accidents as a
whole is higher than in any preceding age of childhood except infancy.
Not so for the young women. This is in all probability due to the fact that
boys are exposed to greater occupational and recreational accident hazards
than girls. Although both boys and girls are working during this age
period, boys tend to enter occupations where the hazards are greater.
In both racial groups the accident death rates of girls 15-19 exceed only those
of the older school girls, 10-14 years of age. The death rates are, among the
whites, 74.1 and 19.8 for boys and girls respectively and among the non
whites, 98.1 and 21.1. In this group the racial differences are not very im
pressive for accidents as a whole although there are some finer and more
significant differences for single types of accidents. (See table 4, ratios,
nonwhite to white.) Much more impressive at this age are the sex differen
tials, reflecting the different habits of the sexes when reaching puberty and
entering the hazards of occupational life. The white males suffer almost
four times, and the nonwhite nearly five times, as many fatal accidents as
the respective females; these are the highest sex differences dealt with in this
study.
Accident fatalities today represent the leading cause of death among white
youths 15-19 years of age, and particularly among the boys; among the non
white,' deaths from tuberculosis still rank much higher than deaths from
accidents for the females, while for males the rates for fatal accidents and
for tuberculosis are about equal. During 1939-41, there occurred among
white males 12,259 deaths from accidents, or 43 percent of all deaths in this
group; among white females 3,235 deaths from accidents were reported, or
17 percent of all deaths, with tuberculosis following closely. The corres
ponding numbers of accidental deaths among the nonwhite were *1,954 male
and 446 female, or 26 and 5 percent, respectively, of all deaths. The total
in both races and both sexes amounted to almost 18,000 deaths from acci
dents.
The rank of the leading causes of death will be seen best from the follow
ing summarizing table where the death rates per 100,000 are shown by race
and sex in the order of the male rates. The rank order for the females is
shown in brackets.
This table brings out clearly the tremendous weight that accident carries
among causes of death for the white male 15-19 years old. The death rate

is
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(74.1) covers more than two-fifths of all deaths in this group and is nearly
six times that of the second most important cause, heart disease, with a rate
of 12.7. Among nonwhite boys the accident death rate (98.1) is higher
but does not constitute much above one-fourth of all deaths, tuberculosis
with a rate of 97.2 having almost the same weight.

In the white group the

tuberculosis rate is only 10.7 for boys and 18.9 for girls.

It is worth men

tioning, in a sociographic picture of the causes of death among the races and
sexes, that in the nonwhite group homicide, with a rate of 36.4, enters as the
third leading cause of death among boys. Compared with this the corres
ponding rate among the whites (2.1) is negligible. •

RdnJc of 6 leading causes of death for white and nonwhite youths, 15-19 years of age
Average annual death rate by sex per 100,000 population, United States, 1939-41

Leading causes of
death in order of
the rates for the
white male
(rank of female
rates in brackets)

A ccid en ts_____
Heart diseases__
Appendicitis___
Tuberculosis *.__
Pneumonia &
influenza____
Diseases of
pregnancy __

White

Male

Female

74.1
1 2.7
11.2
10.7

1 9.8
11.2
6 .6
18.9

10 .4

Leading causes of
death in order of
the rates for the
nonwhite male
(rank of female
rates in brackets)

(1 )
(4 )
(6 )
(2 )

7.5 (5 )

—

11.3 (3 )

A ccid en ts____
Tuberculosis _
H om icid e____
Pneumonia &
in flu en za __
Heart diseases.
Diseases of
pregnancy _

Non white

Male

Female

98.1
9 7 .2
3 6 .4

21.1 (5 )
L59.7 (1 )
15.2 (6 )

3 0 .0
15.7

3 0 .9 (3 )
2 1 .6 (4 )

—

6 2 .3 (2 )

In the nonwhite group, the death rate from homicide is high at this age
even among girls (15.2) and enters the leading causes of death at the sixth
place.

The corresponding rate for white girls is only 1.0.

The total acci

dent death rate is slightly higher among nonwhite girls (21.1) than among
the white (19.8).

However, the relative importance of accidents among all

causes of death at this age is very much greater among the whites.

Among

white females, 15-19 years old, 1 death out of 6 is caused by accident, in con
trast to 1 out of 20 among the nonwhite females.

Other causes of death

Ijplay a greater role among the nonwhite than among the white, as can be seen
Trom the above rank.

By far the greatest killer among nonwhite young

women is still tuberculosis, probably augmented by childbearing.

The

tuberculosis death rate (159.7) is nearly eight times the accident rate
in the same racial group (21.1), and more than eight times the tuberculosis
rate among young white females (18.9).

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Therefore the main public-health

problem among nonwhite girls entering the childbearing age is still tubercu
losis, while among white girls and even more so among white boys, accident
is the leading cause of death.
Turning again to the single types of accidents, it will be seen from tables
2 and 3 that by far the most important type at this age is m otor-vehicle acci
dents, especially in the white group. More than one-half the accidental
deaths among white boys result from this cause, and among white girls, more
than two-thirds. For 1939-41 the death rates are 38.6 and 13.7 respec
tively. Among the nonwhites the corresponding rates are 32.7 and 8.5;
appreciably lower than the rates among the whites. (See ratios, table 4.)
In both racial groups the large sex difference is very significant. Another
traffic hazard, death from railway accidents, is also noticeable in this age.
To be sure, the rates are Iqw in comparison with motor-vehicle accidents, but
are much higher than in any preceding age of childhood. It should also be
noticed that for this type of accident the death rates for the nonwhite, 5.1
for males and 0.4 for females, exceed those for the whites, 2.1 and 0.2 re
spectively. This is especially true for the male and may be due to the
greater occupational exposure of the nonwhite laborers in railroad jobs.
Second in rank among the principal causes of accident fatalities for male
youths is drowning, the death rates among the white group, 9.8 and 1.4 for
boys and girls respectively, being far behind those for motor-vehicle acci
dents. In the nonwhite group, the rate for boys (25.5) is rather close to
the leading cause, motor-vehicle accidents, while the rate for girls (1.5) is
as low as among the whites. The sex differences are obvious and easily
understood. But why at this age, as in the preceding age, nonwhite boys
should incur a much higher risk of accidental drowning than white boys
is not so easily explained, especially since in the preschool and early school
age the reverse was true, namely a higher death rate for drowning among
the white children.
The third cause of fatal accidents among adolescent males is injury by
firearms.

The death rates among the whites are 6.1 and 0.6 for boys and

girls respectively, and among the nonwhites 9.3 and 1.6.

The sex differences

are high as is to be expected since it is especially the growing boy who plays
with his father’s unprotected firearms and often enough causes minor or
major accidents.

The actual numbers of persons 15-19 years old killed this

way during 1939-41 are 1,014 white boys and 93 white girls, and 186 and
34 nonwhite boys and girls respectively. For all ages under 20 years, the
numbers killed by firearm accidents during 1939-41 total 2,452 boys and 421
girls.

(For more detailed figures by age and race see tables 5 and 6.)

This

loss of young human life under peacetime conditions is considerable arid
could have been prevented in the great majority of cases by proper education
and better care on the part of parents and the youngsters.
edies reflected here cannot be evaluated by figures.

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The human trag

TABLE

D e a t h s and death rates from
all
causes
and
from
accidents
per
1 0 0 , 0 0 0 p o p u l a t i o n , a n d p e r c e n t a g e of a c c i d e n t a l d e a t h s a m o n g a l l
d e a t h s in c h i l d h o o d by a g e , s e x , a n d r a c e ; U n i t e d S t a t e s , 1 9 3 9 - 4 1 .
White male

White female

Age groups
(Years)

Total deaths
Number in
3 years

Under 20.
Under 1_.
1-4__ 1___
5-9______
10-14____
15-19

248,623
153,744
32,645
16,702
17,048
28,484

Accidental deaths

Average
Number in
annual rate 3 years
409.8
5,650.9
286.8
117.3
108.1
172.1

Average
annual rate

34,129
3,373
6,445
5,595
6,457
12,259

56.3
124.0
56.6
39.3
40.9
74.1

Percentage
of
accidental
deaths
13.7
2.2
19.7
33.5
37.9
43.0

Total deaths
Number in
3 years
183,843
114,377
26,906
12,102
11,328
19,130

Average
Number in
annual rate 3 years
311.8
4,375.5
245.3
88.0
74.1
117.0

Nonwhite male

Under 20Under 1_.
l-4______

5-9___
10-14____
15-19__ _

59,785
36,785
8,669
3,236
3,651
7,444

742.2
10,226.3
541.7
160.0
175.5
373.6

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Percentage
of
accidental
Average
deaths
annual rate

14,916
2,556
4,511
2,745
1,869
3,235

25.3
97.8
41.1
20.0
12.2
19.8

8.1
2.2
16.8
22.7
16.5
16.9

36.3
208.1
57.9
26.7
14.5
21.1

5.8
2.6
12.2
19.6
9.4
5.0

Nonwhite female
74.2
259.1
66.2
42.6
56.2
98.1

10.0
2.5
12.2
26.6
32.0
26.2

51,444
28,873
7,647
2,789
3,218
8,917

624.6
7,886.3
475.0
136.4
153.3
421.5

2,990
762
932
546
304
446

TABLE 7

5,976
932
1,060
861
1,169
1,954

Accidental deaths

Other important, causes of accidental death in the 15-19 year group
are injury by fall, agricultural accidents, accidental burns, and among the
nonwhites, conflagration. The death rates for these accidents, and for the
other types specified in the tables, are comparatively low. It may be men
tioned that in this age group, for the first time since infancy, the girls do not
show higher death rates for accidental burns than the boys. They seem to
have learned how to avoid these hazards of the home environment which in
early childhood destroyed quite a few human lives. For white females,
15-19 years old, the death rate for burns is only 0.9, which is distinctly lower
than that for the males (1 .2 ); for nonwhite females the rate (2.4) is exactly
the same as for males. Regarding death from conflagration, no significant
or consistent difference between the sexes is apparent in our figures, in this
or in any other age group of childhood, as we have already stated in dis
cussing the preceding ages. Where the hazards are more or less beyond
immediate control different sex susceptibilities or behaviors do not essen
tially influence the fatal results of a catastrophe, such as a huge fire— the
1944 circus fire at Hartford may be recalled— a flood cataclysm, or an
earthquake.
In the final table, number 7, are given total deaths and death rates, acci
dent deaths and rates, and the proportions of accident fatalities among all
deaths by age, sex, and race. These show in summary form the loss of life
through accidents in childhood. These losses are preventable in most part
by proper education of adults regarding safety measures at home and at
work, close supervision of children at play, public attention and sanitary
engineering, better control of water roads and traffic highways, and by strict
enforcement of child-labor laws and other necessary regulations. All these
arguments and possibly others make the campaign against accidents a publichealth problem of the first rank.

SUMMARY
1. A g e d i f f e r e n t i a l o f a c c i d e n t a l d e a t h s
and r e l a t i v e i m p o r t a n c e of a c c i d e n t s
as c a u s e of d e a t h a m o n g
different
age

groups

childhood.

The death rates for accident are highest in infancy, lower in the preschool,
and lowest in the elementary-school age; they rise again in adolescence with
the beginning of occupational life. The high rates in the first year of life
are due largely to mechanical suffocation which hardly plays any part in the

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following ages of childhood; another important cause of fatal accidents in
infancy is obstruction, suffocation, or puncture by ingested objects. Al
though the total death rate for accidents is high in infancy when compared
with other age groups, it loses much of its significance through the greater
prevalence of other causes of death at this age (especially premature birth,
pneumonia and influenza, congenital malformations, injury at birth, and
diarrhea and enteritis).
In preschool age, school age, and adolescence accidents become increasingly predominant because of the great decline in deaths from tuberculosis
and acute infectious diseases in the last decades, during which time accident
fatalities as a whole have decreased relatively little. After infancy the most
important single causes of accidental deaths in childhood are motorvehicle accidents, drowning, burns, injuries by firearms, and injuries by fall.

Race

differential

in a c c i d e n t

fatalities.

The difference between the accident death rates for white and nonwhite
children is not very conspicuous, unlike some other causes of death (tubercu
losis, syphilis, malaria, pneumonia and influenza) which are much more
prevalent in the nonwhite races. It is only in the infant year that nonwhite
children suffer twice as high death rates from accident as white children; in
all other age groups of childhood the ratios, nonwhite to white, range between
a minimum of 1.1 and a maximum of 1.4. However, there are quite a few
race differentials of varying degrees and in different directions, for single
types of accidents. Motor-vehicle accidents, for instance, occur consistently
more often among white children of all ages. The same is true for acciden
tal drowning among the preschool and younger school children. Nonwhite
children of this age suffer only a little more than one-half the death rates of
the white children for drowning, while nonwhite boys of 10-14 and 15-19
years of age experience more than twice as many deaths from this cause as
do white boys. A consistently higher death toll is paid by nonwhite chil
dren in all ages for food poisoning, conflagration, and accidental burns, and,
to a lesser degree, for other accidental poisoning and for injuries by firearms.
The ratios of the death rates, nonwhite to white, are shown in a special tabu
lation corresponding to the death-rate tables of the two racial groups.

3. S e x

differentials

accident

fatalities.

Differences between the sexes for fatal accidents are more outstanding
than those between the races. These reflect differing risks, behaviors, and
susceptibilities of the sexes that may be inborn or acquired. The boys are
more daring and even foolhardy; the girls are more timid and approach
maturity earlier, both physically and mentally. The greater mortality of the
male starts in infancy. For most causes of accident the boys exhibit signifi
cantly higher death rates than the girls, as is the case for most other causes

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of death. There is one characteristic exception, reflecting the greater envi
ronmental risk of the girls at home during the preschool and school age, and
that is accidental burns. Only in a few types of accidents are the rates
about equal.
According to the sex differences accidents may be grouped as follows:
a

Accidents showing a higher death rate for the male (motor-vehicle
and other traffic accidents except in the first year of life, drowning,
injury by firearms, injury by fall, mechanical suffocation, agricul
tural accidents).

Accidents showing a higher death rate for the female (accidental
burns).

Accidents showing no significant sex differential (food poisoning,
other accidental poisonings, conflagration, motor-vehicle accidents
in infancy when the children are passive participants on ly ). In all
these types the accident represents more or less an event of ‘ ‘force
majeure” transcending the inborn differences of the sexes as well
as different exposures at work and at play.

Such grouping of accidental fatalities according to the physiological and
psychological behavior of the sexes suggests methods of prevention by special
training and education. The general importance of accident prevention in
all walks of life, domestic and industrial, has been stressed by numerous and
illuminating publications of the National Safety Council. In this investiga
tion additional emphasis has been put on accident fatalities of children by
age, race, and sex. The increasing weight of accidents as a leading cause
of death in childhood, from 1 through 19 years of age, has been demon
strated by large figures for a 3-year period, and the more significant race and
sex differences, beyond the probable limits of chance fluctuations, for the
principal types and causes of accidental death have been underlined.

SOURCE
Abramson, Harold:
American

MATERIAL

Collins, Selwyn D,:

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REFERENCES

Accidental Mechanical Suffocation in Infants.
Journal of Pediatrics 25: 404-413, 1944.

Association

Ciocco, Antonio:

AND

The

of School* Administrators: Safety Education.
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Sex Differences in Morbidity and Mortality. Quarterly
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The Health of the School Child. U. S. Public Health
Bulletin No. 200. Washington, 1931.

Dublin, Louis I. and Alfred J. Lotka:

External Causes of Death, Chapter

X II; Twenty-five Years of Health Progress. Metro
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Gafafer, William M .: Mortality from Automobile Accidents Among Children
in Different Geographic Regions of the United States,
1930; Time Changes in the Relative Mortality from
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Geographic Regions of the United States, 1925*32;
Time Changes in the Relative Mortality from Acci
dental Burns Among Children in Different Geo
graphic Regions of the United States, 1925r32; Time
Changes in the Mortality from Accidental Mechani
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in Different Geographic Regions of the United
States, 1925-32. Studies on the Fatal Accidents of
Childhood, Nos. 1, 2, 3, 4. U. S. Public Health
Reports, Vol. 51, Nos. 32, 35, 38, 48, 1936.
National Safety Council, Chicago:

Accident Facts, 1943 and 1944 Edition.

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Monthly.

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Mortality Summary, The Infant; The Preschool
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Deaths from Accidents Among Children and Adolescents.
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Accident Statistics of the Federal Government.
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Washing

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