Citation

Reiner RC, Olsen HE, Ikeda CT, Echko MM, Ballestreros KE, Manguerra H, Martopullo I, Millear A, Shields C, Smith A, Strub B, Abebe M, Abebe Z, Adhena BM, Adhikari TB, Akibu M, Al-Raddadi RM, Alvis-Guzmán N, Antonio CAT, Aremu O, Asgedom SW, Asseffa NA, Avila-Burgos L, Barac A, Bärnighausen TW, Bassat Q, Benseñor IM, Bhutta ZA, Bijani A, Bililign N, Cahuana-Hurtado L, Malta DC, Chang JC, Charlson FJ, Dharmaratne SD, Doku DT, Edessa D, El-Khatib Z, Erskine HE, Ferrari AJ, Fullman N, Gupta R, Hassen HY, Hay SI, Ilesanmi OS, Jacobsen KH, Kahsay A, Kasaeian A, Kassa TD, Kebede S, Khader YS, Khan EA, Khan MN, Khang YH, Khubchandani J, Kinfu Y, Kochhar S, Kokubo Y, Koyanagi A, Defo BK, Lal DK, Kumsa FA, Larson HJ, Leung J, Mamun AA, Mehata S, Melku M, Mendoza W, Mezgebe HB, Miller TR, Moges NA, Mohammed S, Mokdad AH, Monasta L, Neupane S, Nguyen HLT, Ningrum DNA, Nirayo YL, Nong VM, Ogbo FA, Olagunju AT, Olusanya BO, Olusanya JO, Patton GC, Pereira DM, Pourmalek F, Qorbani M, Rafay A, Rai RK, Ram U, Ranabhat CL, Renzaho AMN, Rezai MS, Ronfani L, Roth GA, Safiri S, Sartorius B, Scott JG, Shackelford KA, Sliwa K, Sreeramareddy C, Sufiyan MB, Terkawi AS, Topór-Madry R, Tran BX, Ukwaja KN, Uthman OA, Vollset SE, Weldegwergs KG, Werdecker A, Whiteford HA, Wijeratne T, Yonemoto N, Yotebieng M, Zuhlke LJ, Kyu HH, Naghavi M, Vos T, Murray CJL, Kassebaum NJ. JAMA Pediatr. 2019; 173(6): e190337.

Affiliation

Department of Anesthesiology and Pain Medicine, University of Washington, Seattle.

Copyright

(Copyright © 2019, American Medical Association)

DOI

10.1001/jamapediatrics.2019.0337

PMID

31034019

Abstract

IMPORTANCE: Understanding causes and correlates of health loss among children and adolescents can identify areas of success, stagnation, and emerging threats and thereby facilitate effective improvement strategies.

OBJECTIVE: To estimate mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories.

DESIGN, SETTING, AND PARTICIPANTS: This study examined levels, trends, and spatiotemporal patterns of cause-specific mortality and nonfatal health outcomes using standardized approaches to data processing and statistical analysis. It also describes epidemiologic transitions by evaluating historical associations between disease indicators and the Socio-Demographic Index (SDI), a composite indicator of income, educational attainment, and fertility. Data collected from 1990 to 2017 on children and adolescents from birth through 19 years of age in 195 countries and territories were assessed. Data analysis occurred from January 2018 to August 2018.

EXPOSURES: Being under the age of 20 years between 1990 and 2017.

MAIN OUTCOMES AND MEASURES: Death and disability. All-cause and cause-specific deaths, disability-adjusted life years, years of life lost, and years of life lived with disability.

RESULTS: Child and adolescent deaths decreased 51.7% from 13.77 million (95% uncertainty interval [UI], 13.60-13.93 million) in 1990 to 6.64 million (95% UI, 6.44-6.87 million) in 2017, but in 2017, but aggregate disability increased 4.7% to a total of 145 million (95% UI, 107-190 million) years lived with disability globally. Progress was uneven, and inequity increased, with low-SDI and low-middle-SDI locations experiencing 82.2% (95% UI, 81.6%-82.9%) of deaths, up from 70.9% (95% UI, 70.4%-71.4%) in 1990. The leading disaggregated causes of disability-adjusted life years in 2017 in the low-SDI quintile were neonatal disorders, lower respiratory infections, diarrhea, malaria, and congenital birth defects, whereas neonatal disorders, congenital birth defects, headache, dermatitis, and anxiety were highest-ranked in the high-SDI quintile.

CONCLUSIONS AND RELEVANCE: Mortality reductions over this 27-year period mean that children are more likely than ever to reach their 20th birthdays. The concomitant expansion of nonfatal health loss and epidemiological transition in children and adolescents, especially in low-SDI and middle-SDI countries, has the potential to increase already overburdened health systems, will affect the human capital potential of societies, and may influence the trajectory of socioeconomic development. Continued monitoring of child and adolescent health loss is crucial to sustain the progress of the past 27 years.

Language: en