(CNN) — The mortality rate for children and teens in the United States surged in 2020 and 2021, driven not by deaths from Covid-19 but from fatal injuries from things like firearms, drugs and cars, according to a study published Monday in JAMA.

The pandemic years brought a marked shift to the trends in pediatric mortality, which had previously seen a "period of great progress," according to the study authors. Pediatric deaths had been ticking up, but the latest annual increases — nearly 11 percent in 2020 and more than 8 percent in 2021 — were the largest in decades.

"Medicine and public health have made remarkable progress in lowering pediatric mortality rates, but the lives they have saved are now endangered by man-made pathogens," the authors, from Virginia Commonwealth University School of Medicine and the University of Washington, wrote.

When Covid-19 and injuries are excluded, pediatric mortality actually decreased.

Covid-19 mortality rates doubled among children between 2020 and 2021, but still only explained about a fifth of the total increase in mortality in 2021, according to the study.

Instead, firearms "play a central role," the authors said — accounting for nearly half of the increase in mortality in 2020.

"Current efforts to understand gun violence, overcome political gridlock, and enact sensible firearm policies are not progressing with the speed that pediatric suicides and homicides require," they wrote.

Infants are the only age group that did not see a significant increase in mortality, but most of the surge was due to deaths among older children.

For those ages 10 to 19, injury mortality increased 23 percent between 2019 and 2020 — including homicides that jumped 39 percent and drug overdoses that more than doubled.

But even among younger children between 1 and 9, injuries explained nearly two-thirds of the increase in mortality between 2020 and 2021, according to the study.

"Research and policy efforts to address the underlying causes — eg, depression, suicidality, opioid use, systemic racism, widening inequities, societal conflict — are urgently needed, as is system redesign to provide help for people affected by these conditions," the study authors wrote.

"A nation that begins losing its most cherished population — its children — faces a crisis like no other."

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