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Distinctive patterns in child homicide: A retrospective study in Maryland
Samuel E Okum1, Drew M Bidmead, Jordyn A Hurly
1Department of Surgery, School of Medicine (S.O., D.B., J.H., E.R.), Johns Hopkins University, Baltimore, MD (S.O.), Department of Medicine, The University of Pittsburgh Medical Center, Pittsburgh, PA, (J.H.), Department of Surgery, The Johns Hopkins University School of Medicine; Department of Surgery (N.L.), Department of Surgery, University of Texas Southwestern, Dallas, TX; (A.J.K., E.R.H., J.V.S.), Johns Hopkins Hospital, Baltimore, MD; R Adams Cowley Shock Trauma Center (D.T.E.), University of Maryland Medical Center, Baltimore, MD.
Introduction:
Homicide is a leading cause of childhood death, yet few studies distinguish child homicide from adolescent and adult patterns, challenging the development of prevention strategies. We sought to define how child homicide epidemiology differs from that of older age groups in Maryland.
Methods:
In this cross-sectional study, we analyzed all homicide decedents in Maryland (2005-2017) using Office of the Chief Medical Examiner data. Age groups were defined per American Academy of Pediatrics: child/early adolescent (0-14), adolescent (15-22), young adult (23-30), and adult (31+). Descriptive statistics were calculated, and multinomial logistic regression (children as reference) assessed associations with sex, race, mechanism, site, and geography. Two interactions (race×sex and mechanism×site) were retained.
Results:
Among 6,508 homicide decedents, 217 were children, 1,242 adolescents, 2,226 young adults, and 2,823 adults. Children were more often female (44% vs. 9%-19%) and less likely to die in Baltimore (25% vs. 40%-46%) than all older groups, and more likely to die at home (21% vs. 5%-7%) than adolescents and young adults. Firearm deaths were less common in children (28% vs. 65%-84%) while blunt trauma was more common (36% vs. 2%-9%). In regression, older groups were less likely than children to be female (OR, 0.6-0.8), die at home (OR, 0.1-0.5, p<0.05) if killed by firearms, or die outside Baltimore (OR, 0.5-0.6, p<0.01). Significant race × sex interactions were observed for Black female decedents across older age groups (interaction ORs, 0.2-0.4; all p<0.05). Significant mechanism × site interactions were also observed, including Blunt × Home (interaction OR, 32.7; p<0.001) and Strangulation × Home (interaction OR, 48.4; p=0.001) among adults.
Conclusions:
Child homicide differs markedly from older groups, with victims more often female, killed by non-firearm mechanisms, at home, and outside Baltimore. By adolescence, decedents reflect a more "adult" profile in sex, mechanism, site, and geography. Homicide prevention strategies for children may need to diverge from those targeting community gun violence in older groups. (J Trauma Acute Care Surg. 2026;00: 000-000. Copyright © 2026 Wolters Kluwer Health, LLC. All rights reserved.).
Level Of Evidence:
Cross-Sectional; Level IV.
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