article · JAMA Pediatrics
This research quantified and described global mortality and nonfatal health outcomes among children and adolescents aged 19 years or younger from 1990 to 2015, aiming to inform policy discussions. Using standardised methods across 195 countries, the study found that global child and adolescent mortality decreased significantly, from 14.18 million deaths in 1990 to 7.26 million in 2015. However, this progress was uneven, with lower Socio-demographic Index (SDI) countries bearing a larger proportion of the mortality burden, particularly in South Asia and sub-Saharan Africa. While deaths from infectious, nutritional, and neonatal disorders declined, noncommunicable diseases and injuries became relatively more important. The absolute burden of disability increased, partly due to population growth and improved survival. The study highlights that mortality drives health loss in low-SDI countries, whereas disability predominates in higher-SDI settings.
Understanding global health trends in children and adolescents is crucial for effective policy development and resource allocation. This study highlights where progress has been made and where disparities persist, guiding targeted interventions to improve health outcomes worldwide. It underscores the need for tailored strategies based on a country's socio-demographic context.
The abstract does not indicate an application pathway for commercialisation, focusing instead on providing a framework for policy discussion and guiding public health strategies. The findings are intended for policymakers, public health organisations, and international bodies to inform programme design and resource allocation for child and adolescent health.
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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.
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DOI: 10.1001/jamapediatrics.2017.0250
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