Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study

Research output: Contribution to journalArticle

Abstract

Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.

Objective: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.

Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.

Findings: Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.

Conclusions and Relevance: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

Details

Authors
  • Nicholas Kassebaum
  • Hmwe Kyu
  • Leo Zoeckler
  • Helen Elizabeth Olsen
  • Katie Thomas
  • Christine Pinho
  • Zulfiqar A. Bhutta
  • Lalit Dandona
  • Alize J. Ferrari
  • Tsegaye Tewelde Ghiwot
  • Simon I. Hay
  • Yohannes Kinfu
  • Xiaofeng Liang
  • Alan D. Lopez
  • Deborah Carvalho Malta
  • Ali H. Mokdad
  • Mohsen Naghavi
  • George C. Patton
  • Joshua A. Salomon
  • Benn Sartorius
  • Roman Topor-Madry
  • Stein Emil Vollset
  • Andrea Werdecker
  • Harvey A. Whiteford
  • Kalkidan Hasen Abate
  • Kaja Abbas
  • Solomon Abreha Damtew
  • Muktar Beshir Ahmed
  • Nadia Akseer
  • Rajaa Mohammad Salem Al-Raddadi
  • Mulubirhan Assefa Alemayohu
  • Khalid A Altirkawi
  • Amanuel Alemu Abajobir
  • Azmeraw T. Amare
  • Carl Abelardo T. Antonio
  • Johan Arnlov
  • Al Artaman
  • Hamid Asayesh
  • Euripide Frinel G Arthur Avokpaho
  • Ashish Awasthi
  • Beatriz Paulina Ayala Quintanilla
  • Umar Bacha
  • Dimtsu Balem
  • Aleksandra Barac
  • Till Winfried Bärnighausen
  • Estifanos Baye
  • Neeraj Bedi
  • Isabela M. Bensenor
  • Rasmus Havmoeller
  • Aliasghar A Ahmad Kiadaliri
  • Global Burden of Disease Child and Adolescent Health Collaboration
Organisations
External organisations
  • Norwegian Institute of Public Health
  • Virginia Polytechnic Institute and State University
  • Ministry of Health Saudi Arabia
  • University of Manitoba
  • University of Qom
  • Institut de Recherche Clinique du Bénin
  • Sanjay Gandhi Postgraduate Institute of Medical Sciences
  • University of Management and Technology, Lahore
  • Monash University
  • Jazan University
  • Aga Khan University, Pakistan
  • University of Canberra
  • Federal University of Minas Gerais
  • Jagellonian University
  • King Saud University
  • Dalarna University
  • La Trobe University
  • University of Belgrade
  • Chinese Center for Disease Control and Prevention
  • University of Washington
  • University of Queensland
  • Jimma University
  • University of Oxford
  • University of Melbourne
  • University of Washington, Seattle
  • Harvard University
  • University of KwaZulu-Natal
  • Federal Institute for Population Research
  • Mekelle University
  • Hospital for Sick Children, Toronto
  • University of Adelaide
  • University of the Philippines
  • Uppsala University
  • University of São Paulo
  • Karolinska Institutet
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Public Health, Global Health, Social Medicine and Epidemiology
  • Pediatrics
Original languageEnglish
Pages (from-to)573-592
JournalJAMA Pediatrics
Volume171
Issue number6
Early online date2017 Apr 3
Publication statusPublished - 2017
Publication categoryResearch
Peer-reviewedYes