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. 2016 Mar;170(3):267-87.
doi: 10.1001/jamapediatrics.2015.4276.

Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013: Findings From the Global Burden of Disease 2013 Study

Global Burden of Disease Pediatrics CollaborationHmwe H Kyu  1 Christine Pinho  1 Joseph A Wagner  1 Jonathan C Brown  1 Amelia Bertozzi-Villa  1 Fiona J Charlson  2 Luc Edgar Coffeng  3 Lalit Dandona  4 Holly E Erskine  2 Alize J Ferrari  2 Christina Fitzmaurice  5 Thomas D Fleming  1 Mohammad H Forouzanfar  1 Nicholas Graetz  1 Caterina Guinovart  1 Juanita Haagsma  3 Hideki Higashi  1 Nicholas J Kassebaum  6 Heidi J Larson  7 Stephen S Lim  1 Ali H Mokdad  1 Maziar Moradi-Lakeh  8 Shaun V Odell  9 Gregory A Roth  1 Peter T Serina  1 Jeffrey D Stanaway  1 Awoke Misganaw  1 Harvey A Whiteford  2 Timothy M Wolock  1 Sarah Wulf Hanson  1 Foad Abd-Allah  10 Semaw Ferede Abera  11 Laith J Abu-Raddad  12 Fadia S AlBuhairan  13 Azmeraw T Amare  14 Carl Abelardo T Antonio  15 Al Artaman  16 Suzanne L Barker-Collo  17 Lope H Barrero  18 Corina Benjet  19 Isabela M Bensenor  20 Zulfiqar A Bhutta  21 Boris Bikbov  22 Alexandra Brazinova  23 Ismael Campos-Nonato  24 Carlos A Castañeda-Orjuela  25 Ferrán Catalá-López  26 Rajiv Chowdhury  27 Cyrus Cooper  28 John A Crump  29 Rakhi Dandona  30 Louisa Degenhardt  31 Robert P Dellavalle  32 Samath D Dharmaratne  33 Emerito Jose A Faraon  34 Valery L Feigin  35 Thomas Fürst  36 Johanna M Geleijnse  37 Bradford D Gessner  38 Katherine B Gibney  39 Atsushi Goto  40 David Gunnell  41 Graeme J Hankey  42 Roderick J Hay  43 John C Hornberger  44 H Dean Hosgood  45 Guoqing Hu  46 Kathryn H Jacobsen  47 Sudha P Jayaraman  48 Panniyammakal Jeemon  49 Jost B Jonas  50 André Karch  51 Daniel Kim  52 Sungroul Kim  53 Yoshihiro Kokubo  54 Barthelemy Kuate Defo  55 Burcu Kucuk Bicer  56 G Anil Kumar  30 Anders Larsson  57 Janet L Leasher  58 Ricky Leung  59 Yongmei Li  60 Steven E Lipshultz  61 Alan D Lopez  62 Paulo A Lotufo  20 Raimundas Lunevicius  63 Ronan A Lyons  64 Marek Majdan  65 Reza Malekzadeh  66 Taufiq Mashal  67 Amanda J Mason-Jones  68 Yohannes Adama Melaku  69 Ziad A Memish  70 Walter Mendoza  71 Ted R Miller  72 Charles N Mock  73 Joseph Murray  74 Sandra Nolte  75 In-Hwan Oh  76 Bolajoko Olubukunola Olusanya  77 Katrina F Ortblad  78 Eun-Kee Park  79 Angel J Paternina Caicedo  80 Scott B Patten  81 George C Patton  82 David M Pereira  83 Norberto Perico  84 Frédéric B Piel  85 Suzanne Polinder  86 Svetlana Popova  87 Farshad Pourmalek  88 D Alex Quistberg  89 Giuseppe Remuzzi  90 Alina Rodriguez  91 David Rojas-Rueda  92 Dietrich Rothenbacher  93 David H Rothstein  94 Juan Sanabria  95 Itamar S Santos  96 David C Schwebel  97 Sadaf G Sepanlou  66 Amira Shaheen  98 Rahman Shiri  99 Ivy Shiue  100 Vegard Skirbekk  101 Karen Sliwa  102 Chandrashekhar T Sreeramareddy  103 Dan J Stein  104 Timothy J Steiner  105 Lars Jacob Stovner  106 Bryan L Sykes  107 Karen M Tabb  108 Abdullah Sulieman Terkawi  109 Alan J Thomson  110 Andrew L Thorne-Lyman  111 Jeffrey Allen Towbin  112 Kingsley Nnanna Ukwaja  113 Tommi Vasankari  114 Narayanaswamy Venketasubramanian  115 Vasiliy Victorovich Vlassov  116 Stein Emil Vollset  117 Elisabete Weiderpass  118 Robert G Weintraub  119 Andrea Werdecker  120 James D Wilkinson  61 Solomon Meseret Woldeyohannes  121 Charles D A Wolfe  122 Yuichiro Yano  123 Paul Yip  124 Naohiro Yonemoto  125 Seok-Jun Yoon  126 Mustafa Z Younis  127 Chuanhua Yu  128 Maysaa El Sayed Zaki  129 Mohsen Naghavi  1 Christopher J L Murray  1 Theo Vos  1
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Free PMC article

Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013: Findings From the Global Burden of Disease 2013 Study

Global Burden of Disease Pediatrics Collaboration et al. JAMA Pediatr. .
Free PMC article

Abstract

Importance: The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce.

Objective: To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study.

Evidence review: Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14,244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35,620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates.

Findings: Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905.059 deaths; 95% UI, 810,304-998,125), diarrheal diseases among older children (38,325 deaths; 95% UI, 30,365-47,678), and road injuries among adolescents (115,186 deaths; 95% UI, 105,185-124,870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world's deaths from neonatal encephalopathy. Half of the world's diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia.

Conclusions and relevance: Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed.

Conflict of interest statement

Conflict of Interest Disclosures: Dr. Kassebaum reports personal fees and non-financial support from Vifor Pharmaceuticals, Axon Communications LLC and Merck & Co outside the submitted work. KPG was awarded the NHMRC-Gustav Nossal Postgraduate Award sponsored by CSL; this award is peer reviewed and CSL had no part in selecting the awardee. Prof. Lotufo reports honoraria (modest) from Abbvie for one lecture. Walter Mendoza is program analyst at the UNFPA country office in Peru, which not necessarily endorses the study. Prof. Santos reports receiving a grant from São Paulo Research Foundation/FAPESP (Brazilian governmental research agency) for research purposes. In the past 3 years, Dr. Stein has received research grants and/or consultancy honoraria from AMBRF, Biocodex, Cipla, Lundbeck, National Responsible Gambling Foundation, Novartis, Servier, and Sun. No other conflicts are reported.

Figures

Figure 1a
Figure 1a. Top 25 Global Causes of Death for the Largest 50 Countries by Child and Adolescent Population, Both Sexes, Ages 0 to 19, 2013
Footnote (Figure 1a): Colors correspond to the ranking of the leading causes of death, with dark red as the most common cause and dark green as the least common cause for the location indicated. The numbers inside each box indicate the ranking.
Figure 1b
Figure 1b. Top 25 Global Causes of Death for the Largest 50 Countries by Child and Adolescent Population, Under 5, Both Sexes, 2013
Footnote (Figure 1b): Colors correspond to the ranking of the leading causes of death, with dark red as the most common cause and dark green as the least common cause for the location indicated. The numbers inside each box indicate the ranking.
Figure 2
Figure 2. Top cause of death by country for ages 0 to 19, both sexes, 2013
Footnote (Figure 2): “Foreign Body” refers to “foreign body in lung and pulmonary aspiration”. “Neonatal Encephalopathy” refers to “neonatal encephalopathy following birth trauma and asphyxia”.
Figure 3
Figure 3. Age-standardized DALY rate (per 100,000), ages 0 to 19, 2013
Figure 4a
Figure 4a. Top 25 global causes of DALYs, ages 0 to 19, both sexes, 1990 and 2013
Footnote 1 (Figure 4a): Causes connecting with lines show changes in ranks between 1990 and 2013. The second column on the right-hand side shows the mean DALY counts. The third and fourth columns on the right-hand side show the median percent changes (calculated at the 1000 draw level) in the number and rates of global DALYs. Footnote 2 (Figure 4a): *Changes that are statistically significant.
Figure 4b
Figure 4b. Top 25 global causes of DALYs, under 5, both sexes, 1990 and 2013
Footnote 1 (Figure 4b): Causes connecting with lines show changes in ranks between 1990 and 2013. The second column on the right-hand side shows the mean DALY counts. The third and fourth columns on the right-hand side show the median percent changes (calculated at the 1000 draw level) in the number and rates of global DALYs. Footnote 2 (Figure 4b): *Changes that are statistically significant.

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