Guns are the second leading killer of U.S. kids, after car crashes, according to a new report published Wednesday.

Nearly twice as many kids died from gun injuries in 2016 as died from cancer, the study by a team at the University of Michigan found. The gun fatality rate for U.S. children is 36 times higher than the rate in other developed nations, according to the analysis.

And it’s getting worse. “Between 2013 and 2016, there was a 28 percent relative increase in the rate of firearm deaths,” Dr. Rebecca Cunningham of the University of Michigan Injury Prevention Center and colleagues wrote.

“The rate in the United States was 36.5 times as high as the overall rate observed in 12 other high-income countries.”

The executive editor of the New England Journal of Medicine, which published the analysis, said the United States is failing to protect children.

“Children in America are dying or being killed at rates that are shameful,” Dr. Edward Campion wrote in an editorial that ran alongside the report. “The sad fact is that a child or adolescent in the United States is 57 percent more likely to die by the age of 19 years than those in other wealthy nations.”

Cunningham and colleagues used a Centers for Disease Control and Prevention database called WONDER to analyze all causes of death of U.S. children aged 18 and younger.

Recent searches of that database have also shown that 40,000 people overall died from firearms injuries in the U.S. last year.

Mortality rates for the 10 leading causes of death in children and adolescents in the United States. The New England Journal of Medicine

Cunningham’s team found that just over 20,000 children died in the U.S. last year, most of them from injuries of some sort. They found 4,074 children died in road deaths, 3,143 from firearms and 1,853 from cancer.

“Motor vehicle crashes were the leading cause of death for children and adolescents, representing 20 percent of all deaths; firearm-related injuries were the second leading cause of death, responsible for 15 percent of deaths,” they wrote.

“Among firearm deaths, 59 percent were homicides, 35 percent were suicides, and 4 percent were unintentional injuries.”

The U.S. is an outlier both in terms of road deaths and gun deaths, the analysis shows.

“The rate of death from motor vehicle crashes among U.S. children and adolescents was the highest observed among high-income countries; the U.S. rate was more than triple the overall rate observed in 12 other developed countries,” the researchers wrote. The rate of kids killed in car crashes was much higher than in Britain, Sweden or Australia and close to the rate of road deaths in Mongolia.

That’s even though the rate of car deaths fell 38 percent between 2007 and 2016.

“This has been attributed to the widespread adoption of seat belts and appropriate child safety seats, the production of cars with improved safety standards, better constructed roads, graduated driver-licensing programs, and a focus on reducing teen drinking and driving,” the researchers wrote.

There’s plenty of good news. Deaths from house fires have fallen by 73 percent since 1990, because fewer people smoke, plus better building codes and wider use of smoke detectors.

“Shouldn’t a child in the United States have the same chance to grow up as a child in Germany or Spain or Canada?”

Cancer deaths also fell. The number of children who die from cancer has fallen by 32 percent since 1990, the researchers wrote. Cancer prevention and treatment has improved, and doctors are better at spotting cancer earlier, when it is easier to cure.

Few kids drowned, also; 995 children drowned in 2016. “Drowning deaths declined by 46 percent during that time period because of public health efforts, including mandatory fencing around pools and a greater focus on pool safety,” the researchers wrote.

But over the 2013-2016 period, gun deaths rose by 28 percent. Kids in the U.S. are far more likely to be killed by gunshots than kids in any other developed country.

The rate of children killed by firearms is 4.02 per 100,000 kids in the U.S., compared to an average of one in a million in 11 other rich countries: Britain, Sweden, the Netherlands, Lithuania, Iceland, Hungary, the Czech Republic, Cyprus, Croatia, Austria and Australia.

The U.S. simply has more guns around than other countries do, the researchers noted. “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,” they wrote.

“In addition to differences in availability between the United States and other countries, there is wide variability across countries in laws relating to the purchase of firearms, access to them, and safe storage.”

While it’s true that children no longer die of infectious diseases at the same rates as they did 100 years ago, the deaths from car crashes and by gun are nonetheless tragedies, Campion said.

“In recent decades, there has been progress, but the United States is clearly not effectively protecting its children,” he wrote. “Firearm injury, the second leading cause of death, is only a minor contributor to childhood mortality in other developed countries.”

Politics is dividing Americans, he said. “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 wrote.

“Shouldn’t a child in the United States have the same chance to grow up as a child in Germany or Spain or Canada?”