Firearm carriage poses a significant public health challenge, especially for youth (ages 14–24) living in predominantly Black communities that endured racial and economic segregation. Structural racism is a determinant of fatal and nonfatal firearm assaults, but the influence of structural racism on youth firearm carriage has received limited attention. Our study examines whether community violence exposure mediates the association between racialized economic segregation and youth firearm carriage. We analyzed data among 599 youths who sought emergency care and reported drug use within the past six months. Our mediation analysis revealed that increased racialized economic segregation was associated with higher perceived community violence. In turn, a heightened perception of community violence was associated with youth firearm carriage. Our findings advocate for upstream interventions that address the systemic marginalization of Black communities from economic isolation to mitigate community violence and, ultimately, reduce risk for youth firearm carriage.