Only a few low-to-middle-income countries such as Thailand, Romania and Mongolia had more children dying from motor vehicle crashes per capita than the U.S.

The odds of a child dying before age 18 are far higher in the U.S. than in other high-income countries, with firearms and motor vehicle accidents accounting for much of the exceptionally high mortality, a new analysis shows.

The odds that a child will be killed by a gun is 36 times higher in the U.S. than in other high-income countries. Suicide by firearm makes up more than one-third of those gunshot deaths among adolescents.

Homicides accounted for nearly two-thirds of firearm-related deaths and gun-related accidents another 4 percent, researchers report in The New England Journal of Medicine

“Guns are killing more children than cancer,” said lead author Dr. Rebecca Cunningham, who directs the Injury Prevention Center at the University of Michigan in Ann Arbor.

Motor vehicle crashes are the deadliest category, responsible for 20 percent of child and adolescent deaths. Use of cell phones by young drivers and pedestrians appears to be the chief contributor to the fatality rate in this category that’s more than three times higher than in other high-income countries, the researchers found.

Cancer caused 9 percent of deaths; suffocation caused 7 percent. Next most common were drowning, drug overdose and poisoning.

“Devastated families take no comfort from the fact that childhood deaths are now far less common than they were in centuries past,” the Journal’s executive editor Dr. Edward Campion writes in an accompanying commentary.

It is wrong to refer to these deaths as accidents, he argues. “Car crashes and lethal gunshots are not random results of fate. Both individuals and the larger society need to understand that there is much that can be done to reduce the rate of fatal trauma.”

The study used data from the U.S. Centers for Disease Control and Prevention for 2016, the most recent year with complete statistics, and from the World Health Organization.

While the rate of firearm deaths among kids in the United States is 4 per 100,000, in a dozen other high-income countries it averages 0.11 per 100,000, the study found.

“For firearm deaths, there’s really no comparison,” Cunningham said in a telephone interview. “We have substantially more firearm deaths across all the high-, low- and middle-income deaths we examined.” And 2017 data released last week show the trend is continuing, she noted. “Firearm injuries continue to go up.”

“One in three U.S. homes with youth under 18 years of age has a firearm, with 43 percent of homes reporting that the firearm is kept unlocked and loaded, which increases the risk of firearm injuries,” the researchers write.

The scope of childhood firearm deaths will be news to most people, Cunningham said. “We’ve invested billions of dollars to decrease motor vehicle crashes from the late 1990s to now. The same with cancer. The public accepts that as something we should be investing in to keep our children safe. But we’ve invested virtually nothing in firearm-related prevention. We’ve done virtually no research. Yet we can do things that do not affect our Second Amendment rights at all.”

Some good news: Cancer deaths dropped 32 percent from 1990 to 2016, drowning deaths declined 46 percent and death from home fires plummeted by nearly 73 percent, probably because fewer people were smoking, more homes had smoke detectors and building codes improved.

“We are living in a divisive era in which there are few areas of consensus and agreement. Perhaps one of the few core beliefs that all can agree on is that deaths in childhood and adolescence are tragedies that we must find ways to prevent,” Campion writes. “Shouldn’t a child in the United States have the same chance to grow up as a child in Germany or Spain or Canada?”