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JAMA Pediatr. 2017 Apr 3. doi: 10.1001/jamapediatrics.2017.0250. [Epub ahead of print]
Child and Adolescent Health from 1990 to 2015: Findings from the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study
Global Burden of Disease Child and Adolescent Health Collaboration, Kassebaum N1, Kyu HH1, Zoeckler L1, Olsen HE1, Thomas K1, Pinho C1, Bhutta ZA2, Dandona L3, Ferrari A4, Ghiwot TT5, Hay SI6, Kinfu Y7, Liang X8, Lopez A9, Malta DC10, Mokdad AH1, Naghavi M1, Patton GC11, Salomon J12, Sartorius B13, Topor-Madry R14, Vollset SE15, Werdecker A16, Whiteford HA4, Abate KH5, Abbas K17, Abreha Damtew S18, Ahmed MB5, Akseer N19, Al-Raddadi R20, Alemayohu MA18, Altirkawi K21, Abajobir AA4, Amare AT22, Antonio CA23, Arnlov J24, Artaman A25, Asayesh H26, Avokpaho EF27, Awasthi A28, Ayala Quintanilla BP29, Bacha U30, Balem D18, Barac A31, Bärnighausen TW12, Baye E32, Bedi N33, Bensenor IM34, Berhane A35, Bernabe E36, Bernal OA37, Beyene AS38, Biadgilign S39, Bikbov B40, Boyce CA41, Brazinova A42, Hailu GB18, Carter A1, Castañeda-Orjuela CA43, Catalá-López F44, Charlson FJ4, Chitheer AA45, Choi JJ46, Ciobanu LG22, Crump J47, Dandona R48, Dellavalle RP49, Deribew A50, deVeber G19, Dicker D1, Betsu BB18, Ding EL12, Dubey M51, Endries AY52, Erskine HE53, Faraon EJ23, Faro A54, Farzadfar F55, Fernandes JC56, Fijabi DO57, Fitzmaurice C1, Fleming TD1, Flor LS58, Foreman KJ1, Franklin RC59, Fraser MS1, Frostad JJ1, Fullman N1, Gebregergs GB18, Gebru AA18, Geleijnse JM60, Gibney KB61, Gidey Yihdego M62, Ginawi IA63, Gishu MD39, Gizachew TA22, Glaser E57, Gold AL1, Goldberg E1, Gona P64, Goto A65, Gugnani HC66, Jiang G67, Gupta R68, Tesfay FH18, Hankey GJ69, Havmoeller R70, Hijar M71, Horino M72, Hosgood HD73, Hu G74, Jacobsen KH75, Jakovljevic MB76, Jayaraman SP77, Jha V78, Jibat T79, Johnson CO1, Jonas J80, Kasaeian A55, Kawakami N81, Keiyoro PN82, Khalil I1, Khang YH46, Khubchandani J83, Ahmad Kiadaliri AA84, Kieling C85, Kim D86, Kissoon N87, Knibbs LD4, Koyanagi A88, Krohn KJ1, Kuate Defo B89, Kucuk Bicer B90, Kulikoff R1, Kumar GA48, Lal DK48, Lam HY91, Larson HJ92, Larsson A93, Laryea DO94, Leung J4, Lim SS1, Lo LT95, Lo WD96, Looker KJ97, Lotufo PA35, Magdy Abd H, El Razek98, Malekzadeh R55, Markos Shifti D99, Mazidi M100, Meaney PA101, Meles KG18, Memiah P102, Mendoza W103, Abera Mengistie M5, Mengistu GW18, Mensah GA41, Miller TR104, Mock C105, Mohammadi A106, Mohammed S107, Monasta L43, Mueller U16, Nagata C108, Naheed A109, Nguyen G1, Nguyen QL110, Nsoesie E1, Oh IH111, Okoro A112, Olusanya JO113, Olusanya BO113, Ortiz A114, Paudel D115, Pereira DM116, Perico N117, Petzold M118, Phillips MR119, Polanczyk GV34, Pourmalek F87, Qorbani M120, Rafay A121, Rahimi-Movaghar V55, Rahman M122, Rai RK123, Ram U51, Rankin Z1, Remuzzi G124, Renzaho AM125, Roba HS38, Rojas-Rueda D126, Ronfani L127, Sagar R128, Sanabria JR129, Kedir Mohammed MS130, Santos IS34, Satpathy M128, Sawhney M129, Schöttker B131, Schwebel DC132, Scott JG133, Sepanlou SG55, Shaheen A134, Shaikh MA135, She J136, Shiri R137, Shiue I138, Sigfusdottir ID139, Singh J134, Slipakit N1, Smith A1, Sreeramareddy C140, Stanaway JD1, Stein DJ141, Steiner C1, Sufiyan MB107, Swaminathan S142, Tabarés-Seisdedos R143, Tabb KM144, Tadese F145, Tavakkoli M146, Taye B147, Teeple S1, Tegegne TK145, Temam Shifa G52, Terkawi AS148, Thomas B1, Thomson AJ149, Tobe-Gai R108, Tonelli M150, Tran BX151, Troeger C1, Ukwaja KN152, Uthman O153, Vasankari T154, Venketasubramanian N155, Vlassov VV156, Weiderpass E157, Weintraub R158, Gebrehiwot SW18, Westerman R16, Williams HC159, Wolfe CD37, Woodbrook R1, Yano Y160, Yonemoto N161, Yoon SJ162, Younis MZ163, Yu C164, Zaki ME98, Zegeye EA165, Zuhlke LJ166, Murray CJ1, Vos T1.
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.