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Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study

GBD 2017 Child and Adolescent Health Collaborators , Reiner RC 1 , Olsen HE 1 , Ikeda CT 1 , Echko MM 1 , Ballestreros KE 1 Show all authors , Manguerra H 1 , Martopullo I 1 , Millear A 1 , Shields C 1 , Smith A 1 , Strub B 1 , Abebe M 2 , Abebe Z 3 , Adhena BM 4 , Adhikari TB 5 , Akibu M 6 , Al-Raddadi RM 7 , Alvis-Guzman N 8 , Antonio CAT 9 , Aremu O 10 , Asgedom SW 11 , Asseffa NA 12 , Avila-Burgos L 13 , Barac A 14 , Bärnighausen TW 15 , Bassat Q 16 , Bensenor IM 17 , Bhutta ZA 18 , Bijani A 19 , Bililign N 20 , Cahuana-Hurtado L 13 , Malta DC 21 , Chang JC 22 , Charlson FJ 23 , Dharmaratne SD 1 , Doku DT 24 , Edessa D 25 , El-Khatib Z 26 , Erskine HE 23 , Ferrari AJ 23 , Fullman N 1 , Gupta R 27 , Hassen HY 28 , Hay SI 1 , Ilesanmi OS 29 , Jacobsen KH 30 , Kahsay A 31 , Kasaeian A 32 , Kassa TD 33 , Kebede S 34 , Khader YS 35 , Khan EA 36 , Khan MN 37 , Khang YH 38 , Khubchandani J 39 , Kinfu Y 40 , Kochhar S 41 , Kokubo Y 42 , Koyanagi A 43 , Defo BK 44 , Lal DK 45 , Kumsa FA 46 , Larson HJ 1 , Leung J 47 , Mamun AA 48 , Mehata S 49 , Melku M 50 , Mendoza W 51 , Mezgebe HB 52 , Miller TR 53 , Moges NA 54 , Mohammed S 15 , Mokdad AH 1 , Monasta L 55 , Neupane S 56 , Nguyen HLT 57 , Ningrum DNA 58 , Nirayo YL 33 , Nong VM 57 , Ogbo FA 59 , Olagunju AT 60 , Olusanya BO 61 , Olusanya JO 61 , Patton GC 62 , Pereira DM 63 , Pourmalek F 64 , Qorbani M 65 , Rafay A 66 , Rai RK 67 , Ram U 68 , Ranabhat CL 69 , Renzaho AMN 70 , Rezai MS 71 , Ronfani L 55 , Roth GA 1 , Safiri S 72 , Sartorius B 73 , Scott JG 23 , Shackelford KA 1 , Sliwa K 74 , Sreeramareddy C 75 , Sufiyan MB 76 , Terkawi AS 77 , Topor-Madry R 78 , Tran BX 79 , Ukwaja KN 80 , Uthman OA 81 , Vollset SE 1 , Weldegwergs KG 33 , Werdecker A 82 , Whiteford HA 1 , Wijeratne T 83 , Yonemoto N 84 , Yotebieng M 85 , Zuhlke LJ 74 , Kyu HH 1 , Naghavi M 1 , Vos T 1 , Murray CJL 1 , Kassebaum NJ 1

Affiliations 

  • 1 Institute for Health Metrics and Evaluation, Seattle, Washington
  • 2 Department of Clinical Chemistry, University of Gondar, Gondar, Ethiopia
  • 3 Department of Human Nutrition, University of Gondar, Gondar, Ethiopia
  • 4 School of Public Health, Mekelle University, Tigray, Ethiopia
  • 5 Nepal Health Research Environment, Center for Social Science and Public Health Research Nepal, Lalitpur, Nepal
  • 6 Department of Midwifery, Debre Berhan University, Debre Berhan, Ethiopia
  • 7 Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
  • 8 Research Group on Health Economics, University of Cartagena, Cartagena, Colombia
  • 9 Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines
  • 10 School of Health Sciences, Birmingham City University, Birmingham, United Kingdom
  • 11 School of Pharmacy, Mekelle University, Mekelle, Ethiopia
  • 12 School of Public Health, Wolaita Sodo University, Wolaita Dofo, Ethiopia
  • 13 Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
  • 14 Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia
  • 15 Institute of Public Health, Heidelberg University, Heidelberg, Germany
  • 16 Barcelona Institute for Global Health, Barcelona, Spain
  • 17 Department of Internal Medicine, University of São Paulo, São Paulo, Brazil
  • 18 The Centre for Global Child Health, University of Toronto, Toronto, Canada
  • 19 Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran
  • 20 Woldia University, Woldia, Ethiopia
  • 21 Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Minas Gerais, Brazil
  • 22 College of Medicine, National Taiwan University, Taipei, Taiwan
  • 23 School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
  • 24 Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
  • 25 School of Pharmacy, Haramaya University, Harar, Ethiopia
  • 26 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
  • 27 West Virginia Bureau for Public Health, Charleston, West Virginia
  • 28 Public Health Department, Mizan-Tepi University, Teppi, Ethiopia
  • 29 Department of Public Health and Community Medicine, University of Liberia, Monrovia, Liberia
  • 30 Department of Global and Community Health, George Mason University, Fairfax, Virginia
  • 31 Department of Nutrition and Dietetics, Mekelle University, Tigray, Ethiopia
  • 32 Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
  • 33 Clinical Pharmacy Unit, Mekelle University, Mekelle, Ethiopia
  • 34 Midwifery Program, Salale University, Fiche, Ethiopia
  • 35 Department of Public Health and Community Medicine, Jordan University of Science and Technology, Ramtha, Jordan
  • 36 Department of Epidemiology and Biostatistics, Health Services Academy, Islamabad, Pakistan
  • 37 School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
  • 38 Department of Health Policy and Management, Seoul National University, Seoul, South Korea
  • 39 Department of Nutrition and Health Science, Ball State University, Muncie, Indiana
  • 40 Faculty of Health, University of Canberra, Canberra, Australian Capital Territory, Australia
  • 41 Department of Global Health, University of Washington, Seattle
  • 42 Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan
  • 43 Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Barcelona
  • 44 Department of Demography, University of Montreal, Montreal, Quebec, Canada
  • 45 Public Health Foundation of India, Gurugram, India
  • 46 Center for Midwifery, Child, and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
  • 47 Center for Youth Substance Abuse Research, The University of Queensland, St Lucia, Queensland, Australia
  • 48 Institute for Social Science Research, The University of Queensland, Brisbane, Queensland, Australia
  • 49 Research, Monitoring, and Evaluation, Ipas Nepal, Kathmandu, Nepal
  • 50 Institute of Public Health, University of Gondar, Gondar, Ethiopia
  • 51 Peru Country Office, United Nations Population Fund, Lima, Peru
  • 52 Department of Pharmacy, Ethiopian Academy of Medical Science, Tigray, Ethiopia
  • 53 Pacific Institute for Research and Evaluation, Calverton, Maryland
  • 54 Department of Public Health, Debre Markos University, Debre Markos, Ethiopia
  • 55 Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy
  • 56 Faculty of Health Sciences, University of Tampere, Tampere, Finland
  • 57 Institute for Global Health Innovations, Duy Tan University, Hanoi, Vietnam
  • 58 Department of Public Health Science, State University of Semarang, Kota Semarang, Indonesia
  • 59 Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
  • 60 Department of Psychiatry,University of Adelaide, Adelaide, South Australia, Australia
  • 61 Centre for Healthy Start Initiative, Lagos, Nigeria
  • 62 Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
  • 63 Rede de Química e Tecnologia/Laboratório Asociado do Química Verde, University of Porto, Oporto, Portugal
  • 64 School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
  • 65 Noncommunicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
  • 66 Department of Epidemiology and Biostatistics, Contech School of Public Health, Lahore, Pakistan
  • 67 Society for Health and Demographic Surveillance, Suri, India
  • 68 Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India
  • 69 Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea
  • 70 School of Social Sciences and Psychology, Western Sydney University, Penrith, New South Wales, Australia
  • 71 Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, Iran
  • 72 Managerial Epidemiology Research Center, Maragheh University of Medical Sciences, Maragheh, Iran
  • 73 Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa
  • 74 Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa
  • 75 Division of Community Medicine, International Medical University, Kuala Lumpur, Malaysia
  • 76 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
  • 77 Department of Anesthesiology, University of Virginia, Charlottesville
  • 78 Institute for Public Health, Jagiellonian University Medical College, Krakow, Poland
  • 79 Department of Health Economics, Hanoi Medical University, Hanoi, Vietnam
  • 80 Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria
  • 81 Division of Health Sciences, University of Warwick, Coventry, United Kingdom
  • 82 Demographic Change and Ageing Research Area, Federal Institute for Population Research, Wiesbaden, Germany
  • 83 Department of Medicine, University of Melbourne, St Albans, Victoria, Australia
  • 84 Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan
  • 85 College of Public Health, The Ohio State University, Columbus
JAMA Pediatr, 2019 06 01;173(6):e190337.
PMID: 31034019 DOI: 10.1001/jamapediatrics.2019.0337

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, 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.

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

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