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

Nicholas Kassebaum, Hmwe Hmwe Kyu, Leo Zoeckler, Helen Olsen, Katie Thomas, Christine Pinho, Zulfiqar Bhutta, Lalit Dandona, Alize Ferrari, Tsegaye Ghiwot, Simon Hay, Yohannes Kinfu, Xiaofeng Liang, Alan Lopez, Deborah Carvalho Malta, Ali Mokdad, Mohsen Naghavi, George Patton, Joshua Salomon, Benn SartoriusRoman Topor-Madry, Stein Emil Vollset, Andrea Werdecker, Harvey Whiteford, Kalkidan Abate, Kaja Abbas, Solomon Damtew, Muktar Beshir Ahmed, Nadia Akseer, Rajaa Al-Raddadi, Mulubirhan Alemayohu, Khalid Altirkawi, Amanuel Abajobir, Azmeraw Amare, Carl Antonio, Johan Arnlov, Al Artaman, Hamid Asayesh, Euripide Avokpaho, Ashish Awasthi, Beatriz Ayala Quintanilla, Umar Bacha, Balem Demtsu Betsu, Aleksandra Barac, Till Bärnighausen, Estifanos Baye, Neeraj Bedi, Isabela Bensenor, Adugnaw Berhane, Eduardo Bernabé, Oscar Bernal, Addisu Beyene, Sibhatu Biadgilign, Boris Bikbov, Cheryl Anne Boyce, Alexandra Brazinova, Gessessew Hailu, Austin Carter, Carlos Castañeda-Orjuela, Ferrán Catalá-López, Fiona Charlson, Abdulaal Chitheer, Jee-Young Choi, Liliana Ciobanu, John Crump, Rakhi Dandona, Robert Dellavalle, Amare Deribew, Gabrielle deVeber, Daniel Dicker, Eric Ding, Manisha Dubey, Amanuel Yesuf Endries, Holly Erskine, Emerito Faraon, Andre Faro, Farshad Farzadfar, João C. Fernandes, Daniel Obadare Fijabi, Christina Fitzmaurice, Thomas Fleming, Luisa Sorio Flor, Kyle Foreman, Richard Franklin, Maya Fraser, Joseph Frostad, Nancy Fullman, Gebremedhin Gebregergs, Alemseged Aregay Gebru, Johanna Geleijnse, Katherine Gibney, Mahari Gidey Yihdego, Ibrahim Ginawi, Melkamu Dedefo Gishu, Tessema Assefa Gizachew, Elizabeth Glaser, Audra Gold, Ellen Goldberg, Philimon Gona, Atsushi Goto, Harish Chander Gugnani, Guohong Jiang, Rajeev Gupta, Fisaha Haile Tesfay, Graeme Hankey, Rasmus Havmoeller, Martha Hijar, Masako Horino, H. Dean Hosgood, Guoqing Hu, Kathryn Jacobsen, Mihajlo Jakovljevic, Sudha Jayaraman, Vivekanand Jha, Tariku Jibat, Catherine Johnson, Jost Jonas, Amir Kasaeian, Norito Kawakami, Peter Keiyoro, Ibrahim Khalil, Young-Ho Khang, Jagdish Khubchandani, Aliasghar Ahmad Kiadaliri, Christian Kieling, Daniel Kim, Niranjan Kissoon, Luke Knibbs, Ai Koyanagi, Kristopher Krohn, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Rachel Kulikoff, G. Anil Kumar, Dharmesh Kumar Lal, Hilton Lam, Heidi Larson, Anders Larsson, Dennis Odai Laryea, Janni Leung, Stephen Lim, Loon-Tzian Lo, Warren Lo, Katharine Looker, Paulo Lotufo, Hassan Magdy Abd El Razek, Reza Malekzadeh, Desalegn Markos Shifti, Mohsen Mazidi, Peter Meaney, Kidanu Meles, Peter Memiah, Walter Mendoza, Mubarek Abera Mengistie, Gebremichael Mengistu, George Mensah, Ted Miller, Charles Mock, Alireza Mohammadi, Shafiu Mohammed, Lorenzo Monasta, Ulrich Mueller, Chie Nagata, Aliya Naheed, Grant Nguyen, Quyen Le Nguyen, Elaine Nsoesie, In-Hwan Oh, Anselm Okoro, Jacob Olusegun Olusanya, Bolajoko Olusanya, Alberto Ortiz, Deepak Paudel, David Pereira, Norberto Perico, Max Petzold, Michael Robert Phillips, Guilherme Polanczyk, Farshad Pourmalek, Mostafa Qorbani, Anwar Rafay, Vafa Rahimi-Movaghar, Mahfuzar Rahman, Rajesh Kumar Rai, Usha Ram, Zane Rankin, Giuseppe Remuzzi, Andre Renzaho, Hirbo Shore Roba, David Rojas-Rueda, Luca Ronfani, Rajesh Sagar, Juan Ramon Sanabria, Muktar Sano Kedir Mohammed, Itamar Santos, Maheswar Satpathy, Monika Sawhney, Ben Schöttker, David Schwebel, James Scott, Sadaf Sepanlou, Amira Shaheen, Masood Ali Shaikh, June She, Rahman Shiri, Ivy Shiue, Inga Dora Sigfusdottir, Jasvinder Singh, Naris Silpakit, Alison Smith, Chandrashekhar Sreeramareddy, Jeffrey Stanaway, Dan Stein, Caitlyn Steiner, Muawiyyah Babale Sufiyan, Soumya Swaminathan, Rafael Tabarés-Seisdedos, Karen Tabb, Fentaw Tadese, Mohammad Tavakkoli, Bineyam Taye, Stephanie Teeple, Teketo Kassaw Tegegne, Girma Temam Shifa, Abdullah Sulieman Terkawi, Bernadette Thomas, Alan Thomson, Ruoyan Tobe-Gai, Marcello Tonelli, Bach Xuan Tran, Christopher Troeger, Kingsley Nnanna Ukwaja, Olalekan Uthman, Tommi Vasankari, Narayanaswamy Venketasubramanian, Vasiliy Victorovich Vlassov, Elisabete Weiderpass, Robert Weintraub, Solomon Gebrehiwot, Ronny Westerman, Hywel Williams, Charles Wolfe, Rachel Woodbrook, Yuichiro Yano, Naohiro Yonemoto, Seok-Jun Yoon, Mustafa Younis, Chuanhua Yu, Maysaa El Sayed Zaki, Elias Asfaw Zegeye, Liesl Joanna Zuhlke, Christopher Murray, Theo Vos

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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.
Original languageEnglish
Pages (from-to)573-592
JournalJAMA Pediatrics
Volume171
Issue number6
Early online date3 Apr 2017
DOIs
Publication statusPublished - 1 Jun 2017

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