Guns are the leading cause of death for children in the United States.

Firearms have overtaken automobile accidents as the leading cause of death among American children with official data showing a sharp rise in gun murders such as the massacre at a Texas school that claimed the lives of 19 children.

Overall, 4,368 children and adolescents up to the age of 19 died from gunshots in 2020; a rate of 5.4 per 100,0000, according to data from the Centers for Disease Control and Prevention (CDC).

Nearly two-thirds of the deaths were homicides.

By comparison, there were 4,036 vehicle-related deaths; previously the leading cause of death in that age group.

The gap has been closing since traffic safety measures have been improved in recent decades while deaths from weapons have been growing.

The trend lines crossed in 2020, the latest year for which data is available; a finding was found in a letter published last week in the New England Journal of Medicine (NEJM).

The letter’s authors cautioned that the new data was consistent with other evidence that gun violence increased during the COVID pandemic for reasons that are not yet fully clear. They warned however that “it cannot be assumed that it will revert to pre-pandemic levels.”

Updated data from the CDC shows that almost 30% of deaths were suicides, only 3% were unintentional deaths, and 2% were unexplained attempts.

A small number were categorized as “legal intervention” or self-defense.

The deaths disproportionately impacted black children and adolescents who were four times higher than white children for whom vehicles remain their greatest threat.

The second most affected group was the American Indians. Men are six times more likely than women to die. When it comes to regions, the capital of the United States, Washington, has the highest rate followed by Louisiana and Alaska.

The data serve to highlight that mass shootings, like the one Tuesday at a Texas school, are just a small fraction of the total number of children killed by firearms.

“Since the 1960s, continued efforts have been directed at preventing motor vehicle fatalities,” wrote the authors of another recent letter published in NEJM, contrasting the situation with firearms whose regulations, instead, have been dimmed.

Holden Thorp, editor-in-chief of the influential journal Science, published an editorial on Thursday calling for more research into the public health impact of guns to advance policy changes.

“Scientists should not stand by and watch others fight this,” he wrote.

“Further research into the impact of gun ownership on public health will provide further evidence of its deadly consequences,” he added, arguing that severe mental illness, often thought to be a cause of mass shootings, was prevalent at similar levels in other countries suffer from frequent mass shootings.