Children living in high-risk neighborhoods are disproportionately affected by gun violence, even in states with relatively strict firearm regulations, according to a U.S. study.

Death rates from gunshots among young Americans were 11 times higher in "socially vulnerable” communities compared to those in low-risk areas, according to research published Wednesday in the Journal of the American Medical Association. The authors used data tracking U.S. communities’ vulnerability to public-health emergencies to determine which were at risk.

Guns are the leading cause of death for U.S. children, accounting for one in five child and teen fatalities, with most classified as violent assaults. Accidents account for about a third of gun deaths among small children.