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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 N 1 , Kyu HH 1 , Zoeckler L 1 , Olsen HE 1 , Thomas K 1 Show all authors , Pinho C 1 , Bhutta ZA 2 , Dandona L 1 , Ferrari A 3 , Ghiwot TT 4 , Hay SI 1 , Kinfu Y 5 , Liang X 6 , Lopez A 7 , Malta DC 8 , Mokdad AH 1 , Naghavi M 1 , Patton GC 9 , Salomon J 10 , Sartorius B 11 , Topor-Madry R 12 , Vollset SE 13 , Werdecker A 14 , Whiteford HA 3 , Abate KH 4 , Abbas K 15 , Damtew SA 16 , Ahmed MB 4 , Akseer N 17 , Al-Raddadi R 18 , Alemayohu MA 19 , Altirkawi K 20 , Abajobir AA 3 , Amare AT 21 , Antonio CAT 22 , Arnlov J 23 , Artaman A 24 , Asayesh H 25 , Avokpaho EFGA 26 , Awasthi A 27 , Ayala Quintanilla BP 28 , Bacha U 29 , Betsu BD 19 , Barac A 30 , Bärnighausen TW 10 , Baye E 31 , Bedi N 32 , Bensenor IM 33 , Berhane A 34 , Bernabe E 35 , Bernal OA 36 , Beyene AS 37 , Biadgilign S 38 , Bikbov B 39 , Boyce CA 40 , Brazinova A 41 , Hailu GB 19 , Carter A 1 , Castañeda-Orjuela CA 42 , Catalá-López F 43 , Charlson FJ 3 , Chitheer AA 44 , Choi JJ 45 , Ciobanu LG 21 , Crump J 46 , Dandona R 47 , Dellavalle RP 48 , Deribew A 49 , deVeber G 17 , Dicker D 1 , Ding EL 10 , Dubey M 50 , Endries AY 51 , Erskine HE 52 , Faraon EJA 22 , Faro A 53 , Farzadfar F 54 , Fernandes JC 55 , Fijabi DO 56 , Fitzmaurice C 1 , Fleming TD 1 , Flor LS 57 , Foreman KJ 1 , Franklin RC 58 , Fraser MS 1 , Frostad JJ 1 , Fullman N 1 , Gebregergs GB 19 , Gebru AA 19 , Geleijnse JM 59 , Gibney KB 60 , Gidey Yihdego M 61 , Ginawi IAM 62 , Gishu MD 38 , Gizachew TA 21 , Glaser E 56 , Gold AL 1 , Goldberg E 1 , Gona P 63 , Goto A 64 , Gugnani HC 65 , Jiang G 66 , Gupta R 67 , Tesfay FH 19 , Hankey GJ 68 , Havmoeller R 69 , Hijar M 70 , Horino M 71 , Hosgood HD 72 , Hu G 73 , Jacobsen KH 74 , Jakovljevic MB 75 , Jayaraman SP 76 , Jha V 77 , Jibat T 59 , Johnson CO 1 , Jonas J 78 , Kasaeian A 54 , Kawakami N 79 , Keiyoro PN 80 , Khalil I 1 , Khang YH 45 , Khubchandani J 81 , Ahmad Kiadaliri AA 82 , Kieling C 83 , Kim D 84 , Kissoon N 85 , Knibbs LD 3 , Koyanagi A 86 , Krohn KJ 1 , Kuate Defo B 87 , Kucuk Bicer B 88 , Kulikoff R 1 , Kumar GA 47 , Lal DK 47 , Lam HY 89 , Larson HJ 3 , Larsson A 23 , Laryea DO 90 , Leung J 3 , Lim SS 1 , Lo LT 91 , Lo WD 92 , Looker KJ 93 , Lotufo PA 34 , Magdy Abd El Razek H 94 , Malekzadeh R 54 , Markos Shifti D 95 , Mazidi M 96 , Meaney PA 97 , Meles KG 19 , Memiah P 98 , Mendoza W 99 , Abera Mengistie M 4 , Mengistu GW 19 , Mensah GA 40 , Miller TR 100 , Mock C 101 , Mohammadi A 102 , Mohammed S 103 , Monasta L 104 , Mueller U 14 , Nagata C 105 , Naheed A 106 , Nguyen G 1 , Nguyen QL 107 , Nsoesie E 1 , Oh IH 108 , Okoro A 109 , Olusanya JO 110 , Olusanya BO 111 , Ortiz A 111 , Paudel D 112 , Pereira DM 113 , Perico N 114 , Petzold M 115 , Phillips MR 116 , Polanczyk GV 33 , Pourmalek F 85 , Qorbani M 117 , Rafay A 118 , Rahimi-Movaghar V 54 , Rahman M 119 , Rai RK 120 , Ram U 50 , Rankin Z 1 , Remuzzi G 121 , Renzaho AMN 122 , Roba HS 37 , Rojas-Rueda D 123 , Ronfani L 104 , Sagar R 124 , Sanabria JR 125 , Kedir Mohammed MS 126 , Santos IS 33 , Satpathy M 124 , Sawhney M 125 , Schöttker B 127 , Schwebel DC 128 , Scott JG 129 , Sepanlou SG 54 , Shaheen A 130 , Shaikh MA 131 , She J 132 , Shiri R 133 , Shiue I 134 , Sigfusdottir ID 135 , Singh J 128 , Silpakit N 1 , Smith A 1 , Sreeramareddy C 136 , Stanaway JD 1 , Stein DJ 137 , Steiner C 1 , Sufiyan MB 102 , Swaminathan S 138 , Tabarés-Seisdedos R 43 , Tabb KM 139 , Tadese F 140 , Tavakkoli M 141 , Taye B 142 , Teeple S 1 , Tegegne TK 140 , Temam Shifa G 51 , Terkawi AS 143 , Thomas B 1 , Thomson AJ 144 , Tobe-Gai R 105 , Tonelli M 145 , Tran BX 146 , Troeger C 1 , Ukwaja KN 147 , Uthman O 148 , Vasankari T 149 , Venketasubramanian N 150 , Vlassov VV 151 , Weiderpass E 152 , Weintraub R 153 , Gebrehiwot SW 19 , Westerman R 14 , Williams HC 154 , Wolfe CDA 36 , Woodbrook R 1 , Yano Y 155 , Yonemoto N 156 , Yoon SJ 157 , Younis MZ 158 , Yu C 159 , Zaki MES 94 , Zegeye EA 160 , Zuhlke LJ 161 , Murray CJL 1 , Vos T 1

Affiliations 

  • 1 Institute for Health Metrics and Evaluation, University of Washington, Seattle
  • 2 Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan
  • 3 School of Public Health, University of Queensland, Brisbane, Queensland, Australia
  • 4 Jimma University, Jimma, Ethiopia
  • 5 Centre for Research & Action in Public Health, University of Canberra, Canberra, Australia
  • 6 Chinese Center for Disease Control and Prevention, Beijing, China
  • 7 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  • 8 Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
  • 9 Murdoch Childrens Research Institute, University of Melbourne, Victoria, Australia
  • 10 Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
  • 11 School of Nursing and Public Health, University of KwaZulu-Natal, South African Medical Research Council/University of KwaZulu-Natal Gastrointestinal Cancer Research Center, Durban, South Africa
  • 12 Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland
  • 13 Center for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
  • 14 Federal Institute for Population Research, Wiesbaden, Germany
  • 15 Department of Population Health, Virginia Tech, Blacksburg
  • 16 Wolaita Soda University, Wolaita Soda, Ethiopia
  • 17 The Hospital for Sick Children, Centre for Child Health, Toronto, Ontario, Canada
  • 18 Ministry of Health, Jeddah, Saudi Arabia
  • 19 Mekelle University, Mekelle, Ethiopia
  • 20 King Saud University, Riyadh, Saudi Arabia
  • 21 University of Adelaide, Adelaide, Australia
  • 22 Department of Health Policy and Administration, University of Philippines-Manila, Manila, Philippines
  • 23 Department of Medical Services, Uppsala University, Uppsala, Sweden
  • 24 University of Manitoba, Winnipeg, Manitoba, Canada
  • 25 Qom University of Medical Sciences, Qom, Iran
  • 26 Institute de Recherche Clinique du Bénin, Cotonou, Benin
  • 27 Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
  • 28 The Judith Lumley Centre for Mother, Infant, and Family Health Research, La Trobe University, Melbourne, Victoria, Australia
  • 29 School of Health Sciences, University of Management and Technology, Lahore, Pakistan
  • 30 Faculty of Medicine, University of Belgrade, Belgrade, Serbia
  • 31 Monash University, Melbourne, Victoria, Australia
  • 32 College of Public Health and Tropical Medicine, Jazan, Saudi Arabia
  • 33 University of Sao Paulo, Sao Paulo, Brazil
  • 34 College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia
  • 35 King's College London, London, United Kingdom
  • 36 University Andes, Bogota, Columbia
  • 37 Haramaya University, Dire Dawa, Ethiopia
  • 38 Independent Public Health Consultants, Addis Ababa, Ethiopia
  • 39 Department of Nephrology Issues of Transplanted Kidney, V. I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia
  • 40 National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
  • 41 Faculty of Health Sciences and Social Work, Department of Public Health, Trnava University, Trnava, Slovakia
  • 42 Instituto Nacional de Salud, Bogotá, Colombia
  • 43 University of Valencia, Valencia, Spain
  • 44 Ministry of Health, Baghdad, Iraq
  • 45 Seoul National University, Seoul, South Korea
  • 46 Departmentà Centre for International Health, University of Otago, Dunedin, New Zealand
  • 47 Public Health Foundation of India, New Delhi, India
  • 48 School of Medicine, School of Public Health, University of Colorado, Aurora
  • 49 Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
  • 50 International Institute for Population Sciences, Mumbai, India
  • 51 Arba Minch University, Arba Minch, Ethiopia
  • 52 Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia
  • 53 Federal University of Sergipe, Aracaju, Brazil
  • 54 Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • 55 Center for Biotechnology and Fine Chemistry, Catholic University of Portugal, Porto, Portugal
  • 56 Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts
  • 57 Escola Nacional de Saúde Pública Sergio Arouca/Fiocruz, Rio De Janeiro, Brazil
  • 58 James Cook University, Townsville, Queensland, Australia
  • 59 Wageningen University, Wageningen, Netherlands
  • 60 The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia
  • 61 Addis Ababa University, Addis Ababa, Ethiopia
  • 62 College of Medicine, University of Hail, Hail, Saudi Arabia
  • 63 University of Massachusetts-Boston
  • 64 National Cancer Center, Tokyo, Japan
  • 65 Department of Microbiology, Departments of Epidemiology and Biostatistics, St James School of Medicine, the Quarter, Anguilla
  • 66 School of Public Health, Tianjin Medical University, Tianjin, China
  • 67 Eternal Heart Care Centre and Research Institute, Jaipur, India
  • 68 School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
  • 69 Karolinska Institutet, Stockholm, Sweden
  • 70 Fundacion Entornos, Cuernavaca, Morelos, Mexico
  • 71 Nevada Division of Public and Behavioral Health, Carson City, Nevada
  • 72 Albert Einstein College of Medicine, Bronx, New York
  • 73 Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, China
  • 74 Department of Global and Community Health, George Mason University, Fairfax, Virginia
  • 75 University of Kragujevac, Kragujevac, Serbia
  • 76 Virginia Commonwealth University, Richmond
  • 77 George Institute for Global Health, New Delhi, India
  • 78 Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karlas University, Heidelberg, Germany
  • 79 School of Public Health, University of Tokyo, Tokyo, Japan
  • 80 University of Nairobi, Nairobi, Kenya
  • 81 Ball State University, Muncie, Indiana
  • 82 Department of Clinical Sciences, Lund University, Lund, Sweden
  • 83 Federal University of Rio Grande de Sul, Porto Alegre, Brazil
  • 84 Department of Health Sciences, Northeastern University, Boston, Massachusetts
  • 85 University of British Columbia, Vancouver, British Columbia, Canada
  • 86 Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain
  • 87 University of Montreal, Montreal, Quebec, Canada
  • 88 Institute of Public Health, Hacettepe University, Ankara, Turkey
  • 89 Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines
  • 90 Komfo Anokye Teaching Hospital, Kumasi, Ghana
  • 91 UnionHealth Associates LLC, St Louis, Missouri
  • 92 Department of Pediatrics, Department of Neurology, The Ohio State University, Columbus
  • 93 University of Bristol, Bristol, United Kingdom
  • 94 Faculty of Medicine, Mansoura University, Mansoura, Egypt
  • 95 Madda Walabu University, Robe, Ethiopia
  • 96 Institute of Genetics and Developmental Biology, Key State Laboratory of Molecular Developmental Biology, Chinese Academy of Sciences, Beijing, China
  • 97 Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 98 University of West Florida, Pensacola
  • 99 United Nations Population Fund, Lima, Peru
  • 100 Pacific Institute for Research and Evaluation, Calverton, Maryland
  • 101 School of Medicine, School of Global Health, University of Washington, Seattle
  • 102 Baqiyatallah University of Medical Sciences, Tehran, Iran
  • 103 Ahmadu Bello University, Zaria, Kaduna, Nigeria
  • 104 Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
  • 105 National Center for Child Health and Development, Tokyo, Japan
  • 106 International Centre for Diarrheal Disease Research, Dhaka, Bangladesh
  • 107 Institute for Global Health, Duy Tan University, Da Nang, Vietnam
  • 108 Department of Preventive Medicine, College of Medicine, Kyung Hee University, Seoul, South Korea
  • 109 Society for Family Health, Abuja, Nigeria
  • 110 Center for Healthy Start Initiative, Lagos, Nigeria
  • 111 IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain
  • 112 UK Department for International Development, Lalitpur, Nepal
  • 113 Universidade do Porto, Porto, Portugal
  • 114 Istituto di Richerche Farmacologiche Mario Negri, Bergamo, Italy
  • 115 Health Metrics Unit, University of Gothenburg, Gothenburg, Sweden
  • 116 School of Medicine, Shanghai Jiao Tong University, Shanghai, China
  • 117 School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
  • 118 Contect International Health Consultants, Lahore, Punjab, Pakistan
  • 119 Research and Evaluation Division, Building Resources Access Communities, Dhaka, Bangladesh
  • 120 Society for Health and Demographic Surveillance, Suri, India
  • 121 International Society of Nephrology, Brussels, Belgium
  • 122 Western Sydney University, Penrith, Australia
  • 123 ISGlobal Instituto de Salud Global de Barcelona, Barcelona, Spain
  • 124 All India Institute of Medical Sciences, New Delhi, India
  • 125 Marshall University, Huntington, West Virginia
  • 126 Department of Public Health, Mizan-Tepi University, Ethiopia
  • 127 Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
  • 128 University of Alabama at Birmingham
  • 129 Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
  • 130 Department of Public Health, An-Najah University, Nablus, Palestine
  • 131 Independent Consultant, Karachi, Pakistan
  • 132 Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
  • 133 Finnish Institute of Occupational Health, Work Organizations, Disability Program, University of Helsinki, Helsinki, Finland
  • 134 Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom
  • 135 Reykjavik University, Reykjavik, Iceland
  • 136 Department of Community Medicine, International Medical University, Kuala Lumpur, Selangor, Malaysia
  • 137 Department of Psychiatry, University of Cape Town, Cape Town, South Africa
  • 138 Indian Council of Medical Research, Chennai, India
  • 139 University of Illinois at Urbana-Champaign, Champaign
  • 140 Debre Markos University, Debre Markos, Ethiopia
  • 141 New York Medical Center, Valhalla
  • 142 Department of Biology, Colgate University, Hamilton, New York
  • 143 University of Virginia, Charlottesville
  • 144 Adaptive Knowledge Management, Victoria, British Columbia, Canada
  • 145 University of Calgary, Calgary, Alberta, Canada
  • 146 The Johns Hopkins University, Baltimore, Maryland
  • 147 Federal Teaching Hospital, Abakaliki, Nigeria
  • 148 University of Warwick, Coventry, United Kingdom
  • 149 Institute for Health Promotion Research, Tampere, Finland
  • 150 Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
  • 151 National Research University Higher School of Economics, Moscow, Russia
  • 152 Department of Medical Epidemiology and Biostatistics, Karolinska Insitutet, Stockholm, Sweden
  • 153 Royal Children's Hospital, Melbourne, Victoria, Australia
  • 154 University of Nottingham, Nottingham, United Kingdom
  • 155 Department of Preventive Medicine, Northwestern University, Chicago, Illinois
  • 156 Kyoto University, Kyoto, Japan
  • 157 Department of Preventive Medicine, School of Medicine, Korea University, Seoul, South Korea
  • 158 Jackson State University, Jackson, Missouri
  • 159 Wuhan University, Wuhan, China
  • 160 University of KwaZulu-Natal, Durban, South Africa
  • 161 Red Cross War Memorial Children's Hospital, Cape Town, South Africa
JAMA Pediatr, 2017 Jun 01;171(6):573-592.
PMID: 28384795 DOI: 10.1001/jamapediatrics.2017.0250

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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