Findings Social And Economic Factors | 2024 Health Of Women And Children Report

Executive Brief Introduction National SnapshotFindingsHealth Outcomes Social and Economic Factors Clinical Care Behaviors State RankingsAppendixMeasures Table – Women Measures Table – Children Data Source Descriptions MethodologyState Summaries

US Summary

2024 Health of Women and Children Report 2024 Health of Women and Children Report – Executive Brief 2024 Health of Women and Children Report – State Summaries 2024 Health of Women and Children Report – Concentrated Disadvantage County-Level Maps 2024 Health of Women and Children Report – Measures Table 2024 Health of Women and Children Report – Infographics 2024 Health of Women and Children Report – Report Data (All States)

Social and Economic Factors | Community and Family Safety
Firearm and injury mortality rates increased among women and children.
Firearm Deaths Among Women 
Firearm violence is a severe and deadly public health issue in the U.S. Women in the U.S. are far more likely to die by firearm than women in other high-income countries — the firearm death rate in the U.S. is nearly five times higher than in France, the country with the second-highest rate. 
Changes over time. Nationally, firearm deaths — the number of deaths due to firearm injury of any intent (unintentional, suicide, homicide or undetermined) per 100,000 females ages 20-44 — increased 27%, from 4.8 to 6.1 between 2017-2019 and 2020-2022. In 2020-2022, approximately 10,000 women in the U.S. died by firearm, an increase of more than 2,200 deaths since 2017-2019. Between 2018-2020 and 2020-2022, rates among some racial/ethnic and all age groups significantly increased:
36% among Black (11.0 to 15.0 deaths per 100,000 women ages 20-44), 26% among Hispanic (3.1 to 3.9)​ and 8% among white (4.9 to 5.3) women. ​
23% among women ages 25-34 (5.2 to 6.4)​, 20% among women ages 20-24 (5.4 to 6.5) and 17% among women ages 35-44 (4.8 to 5.6).​
Rates of firearm deaths increased in 14 states between 2017-2019 and 2020-2022. The largest increases were: 90% in Minnesota (2.0 to 3.8 deaths per 100,000 women ages 20-44)​, 70% in Wisconsin (3.7 to 6.3)​ and 60% in New York (1.0 to 1.6)​. 
Disparities. Firearm deaths significantly varied by geography, race/ethnicity and age in 2020-2022. The rate was:
13.4 times higher in Mississippi (16.1 deaths per 100,000 women ages 20-44) than Massachusetts (1.2)​.
10.7 times higher among Black (15.0) compared with Asian (1.4) women.​
1.2 times higher among women ages 20-24 (6.5) than those ages 35-44 (5.6).
Note: The values for women ages 20-24 and those ages 25-34 may not differ significantly based on overlapping 95% confidence intervals.
Related Measure: Injury Deaths Among Women
Nationally, injury deaths — the number of deaths due to injury per 100,000 females ages 20-44 — increased 26%, from 41.2 to 52.0 between 2017-2019 and 2020-2022. In 2020-2022, there were approximately 85,000 injury deaths among women of reproductive age in the U.S., an increase of more than 18,600 deaths since 2017-2019. Rates significantly increased among all age groups between 2017-2019 and 2020-2022: 30% among women ages 35-44 (44.9 to 58.4 deaths per 100,000), 25% among women ages 25-34 (41.8 to 52.4) and 18% among women ages 20-24 (32.8 to 38.6). 
The injury death rate also increased in 35 states and the District of Columbia during this period. The largest increases were: 69% in the District of Columbia (23.6 to 40.0 deaths per 100,000 women ages 20-44), 51% in Louisiana (55.8 to 84.2) and 47% in Mississippi (51.4 to 75.7).
Disparities. The injury death rate significantly varied by race/ethnicity, geography and age. The rate was: 
12.7 times higher among American Indian/Alaska Native (152.0 deaths per 100,000 women ages 20-44) than Asian (12.0) women.​
4.3 times higher in West Virginia (120.0) than Hawaii (27.9).​
1.5 times higher among women ages 35-44 (58.4) than those ages 20-24 (38.6).
Firearm Deaths Among Children 
The U.S. is the only nation among Organization for Economic Co-operation and Development (OECD) countries similar in size and wealth where firearms are the leading cause of child mortality. In 2020, firearm deaths among children surpassed deaths due to motor vehicles, which had previously been the leading cause of death for children.
Changes over time. Nationally, firearm deaths — the number of deaths due to firearm injury of any intent (unintentional, suicide, homicide or undetermined) per 100,000 children ages 1-19 — increased 37%, from 4.3 to 5.9 between 2017-2019 and 2020-2022. This is a larger increase than the 26% increase cited in the 2023 Health of Women and Children Report. In 2020-2022, approximately 14,000 children in the U.S. died by firearm injury, about 3,500 more deaths than in 2017-2019. Between 2017-2019 and 2020-2022, the rate significantly increased in 23 states. The largest increases were: 84% in both North Carolina (4.3 to 7.9 deaths per 100,000 children ages 1-19) and Montana (5.5 to 10.1), and 70% in Wisconsin (3.3 to 5.6). Rates increased among all age and some race/ethnicity groups between 2018-2020 and 2020-2022:
50% among children ages 1-4 (0.6 to 0.9 deaths per 100,000 children), 25% among children ages 5-14 (1.2 to 1.5) and 20% among children ages 15-19 (14.7 to 17.7).
38% among Black (14.9 to 20.6) and 31% among Hispanic (3.2 to 4.2) children.
Disparities. The rate of firearm deaths among children varied significantly by age and race/ethnicity in 2020-2022. The rate was:
19.7 times higher among children ages 15-19 (17.7 deaths per 100,000 children) than those ages 1-4 (0.9).
15.8 times higher among Black (20.6) compared with Asian (1.3) children.
Note: The 2018-2020 and 2020-2022 comparison contains an overlapping data year (2020). Thus, the comparison is mainly between the non-overlapping years (2018-2019 and 2021-2022). 
Related Measure: Injury Deaths Among Children 
Nationally, injury deaths — the number of deaths due to injury per 100,000 children ages 1-19 — increased 20%, from 15.5 to 18.6 between 2017-2019 and 2020-2022. Approximately 43,000 children in the U.S. died due to fatal injury in 2020-2022, an increase of roughly 7,000 deaths compared with 2017-2019. The rate of injury deaths among children increased in 23 states between 2017-2019 and 2020-2022. The largest increases were: 41% in Montana (24.3 to 34.3 deaths per 100,000 children ages 1-19), 37% in North Carolina (16.1 to 22.1) and 33% in Louisiana (24.7 to 32.9). Rates of injury death also increased 22% among adolescents ages 15-19 (38.1 to 46.6), 13% among children ages 5-14 (6.0 to 6.8), 10% among children ages 1-4 (10.0 to 11.0), 21% among boys (21.5 to 26.1) and 16% among girls (9.2 to 10.7) during the same period.
Disparities. Injury deaths among children significantly varied by age, race/ethnicity, geography and gender in 2020-2022. The rate was:
6.9 times higher among children ages 15-19 (46.6 deaths per 100,000 children ages 1-19) than those ages 5-14 (6.8).​
6.4 times higher among American Indian/Alaska Native (44.5) than Asian (6.9) children.​
4.1 times higher in Montana (34.3) than Massachusetts (8.3).
2.4 times higher among boys (26.1) than girls (10.7).

Social and Economic Factors | Economic Resources
Food sufficiency among children worsened.
Food Sufficiency Among Children 
Children should consume a variety of nutrients to maintain a healthy lifestyle. Consistent access to nutritious food is essential to promote health throughout development and prevent diet-related chronic diseases in adulthood. Healthy eating patterns during childhood development look different at each stage of life and can change based on activity level. 
Changes over time. Nationally, food sufficiency — the percentage of children ages 0-17 whose household could always afford to eat good nutritious meals in the past 12 months — decreased 6%, from 71.9% to 67.3% between 2020-2021 and 2022-2023. The prevalence among children in most caregiver educational attainment and some racial/ethnic groups significantly decreased:
​15% among children with a caregiver who has some post-high school education (60.8% to 51.9%), 10% among children with a caregiver who graduated from high school (54.4% to 48.7%) and 4% among children with a caregiver who graduated from college (84.9% to 81.2%).​ 
9% among Hispanic (65.1% to 59.3%) and 6% among white (77.6% to 73.1%) children.​
Disparities. The prevalence of food sufficiency varied significantly by caregiver educational attainment, race/ethnicity and geography in 2022-2023. It was: 
1.7 times higher among children with a caregiver who graduated from college (81.2%) compared with those with a caregiver who graduated from high school (48.7%).​
1.6 times higher among Asian (81.1%) compared with Hawaiian/Pacific Islander (51.6%) children.
1.5 times higher in Massachusetts (79.2%) than Mississippi (54.6%).
Note: The values for Hawaiian/Pacific Islander, American Indian/Alaska Native, Black and Hispanic children may not differ significantly based on overlapping 95% confidence intervals.​

Social and Economic Factors | Education
The percentage of women ages 25-44 who graduated from college improved, and early childhood education enrollment started to return to the pre-pandemic rate.
College Graduate Among Women 
Income differences between college graduates and those with a high school diploma in the U.S. have widened since 1965, persisting into 2024. People who earn a college degree have access to a wider variety of employment opportunities and are compensated more on average than those without a college degree.
Changes over time. Nationally, college graduates — the percentage of women ages 25-44 who graduated from a college or technical school — increased 6%, from 35.6% to 37.7% between 2019-2020 and 2021-2022. In 2021-2022, there were approximately 16.5 million women of reproductive age who were college graduates in the U.S., an increase of more than 1.4 million women since 2019-2020. The percentage increased among both age groups and women living in metropolitan areas:
6% among women ages 25-34 (34.1% to 36.0%) and women ages 35-44 (37.1% to 39.2%).
5% among women living in metropolitan areas (37.7% to 39.4%). 
On the other hand, college graduates decreased 9% among women with an annual household income of $25,000-$49,999 (23.4% to 21.2%). 
The percentage increased 26% in Rhode Island (34.4% to 43.2%), 21% in Louisiana (26.6% to 32.3%), 12% in the District of Columbia (62.9% to 70.5%) and 10% in Colorado (43.5% to 48.0%). 
Disparities. The percentage of women ages 25-44 who graduated from college significantly varied by income, race/ethnicity, disability and geography in 2021-2022. The percentage was:
6.1 times higher among women with an annual household income of $75,000 or more (63.1%) than those with incomes less than $25,000 (10.4%).
2.9 times higher among Asian (65.7%) compared with Hispanic (22.9%) women.​
2.7 times higher among women without a disability (42.6%) than those who have difficulty with self-care (15.6%).​
1.9 times higher in Massachusetts (49.4%) than Nevada (26.0%). 
Note: The values for women who have difficulty with self-care and those with independent living difficulty, difficulty with mobility, difficulty seeing and difficulty hearing may not differ significantly based on overlapping 95% confidence intervals.

Early Childhood Education 
Evidence shows that early childhood education leads to higher educational attainment, improves health and promotes health equity. Typically, children who attend early childhood education programs have reduced special education use, lower rates of teen births and crime, improved standardized test scores and increased high school graduation rates compared with those who did not have an early childhood education.
Changes over time. Nationally, the percentage of children ages 3-4 enrolled in nursery school, preschool or kindergarten increased 16%, from 40.2% to 46.7% between 2021 and 2022. Despite this improvement, the rate is still lower than in 2019 (48.9%) before enrollment dropped during the COVID-19 pandemic.
The rate of early childhood education increased in 19 states between 2021 and 2022, led by: 46% in New Mexico (25.6% to 37.5%), 43% in Oregon (31.9% to 45.6%) and 40% in New Hampshire (40.1% to 56.0%).
Disparities. The percentage of early childhood education among children ages 3-4 significantly varied by geography in 2022. It was 2.3 times higher in New Jersey (67.0%) than North Dakota (29.1%).