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. 2017 Jun 1;171(6):573-592.
doi: 10.1001/jamapediatrics.2017.0250.

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 CollaborationNicholas Kassebaum  1 Hmwe Hmwe Kyu  1 Leo Zoeckler  1 Helen Elizabeth Olsen  1 Katie Thomas  1 Christine Pinho  1 Zulfiqar A Bhutta  2 Lalit Dandona  1   3 Alize Ferrari  4 Tsegaye Tewelde Ghiwot  5 Simon I Hay  1   6 Yohannes Kinfu  7 Xiaofeng Liang  8 Alan Lopez  9 Deborah Carvalho Malta  10 Ali H Mokdad  1 Mohsen Naghavi  1 George C Patton  11 Joshua Salomon  12 Benn Sartorius  13 Roman Topor-Madry  14 Stein Emil Vollset  15 Andrea Werdecker  16 Harvey A Whiteford  4 Kalkidan Hasen Abate  5 Kaja Abbas  17 Solomon Abrha Damtew  18 Muktar Beshir Ahmed  5 Nadia Akseer  19 Rajaa Al-Raddadi  20 Mulubirhan Assefa Alemayohu  21 Khalid Altirkawi  22 Amanuel Alemu Abajobir  4 Azmeraw T Amare  23 Carl A T Antonio  24 Johan Arnlov  25   26 Al Artaman  27 Hamid Asayesh  28 Euripide Frinel G Arthur Avokpaho  29 Ashish Awasthi  30 Beatriz Paulina Ayala Quintanilla  31 Umar Bacha  32 Balem Demtsu Betsu  21 Aleksandra Barac  33 Till Winfried Bärnighausen  12 Estifanos Baye  34 Neeraj Bedi  35 Isabela M Bensenor  36 Adugnaw Berhane  37 Eduardo Bernabe  38 Oscar Alberto Bernal  39 Addisu Shunu Beyene  40 Sibhatu Biadgilign  41 Boris Bikbov  42 Cheryl Anne Boyce  43 Alexandra Brazinova  44 Gessessew Bugssa Hailu  21 Austin Carter  1 Carlos A Castañeda-Orjuela  45 Ferrán Catalá-López  46   47 Fiona J Charlson  4 Abdulaal A Chitheer  48 Jee-Young Jasmine Choi  49 Liliana G Ciobanu  23 John Crump  50 Rakhi Dandona  51 Robert P Dellavalle  52 Amare Deribew  53 Gabrielle deVeber  19 Daniel Dicker  1 Eric L Ding  12 Manisha Dubey  54 Amanuel Yesuf Endries  55 Holly E Erskine  56 Emerito Jose Aquino Faraon  24 Andre Faro  57 Farshad Farzadfar  58 Joao C Fernandes  59 Daniel Obadare Fijabi  60 Christina Fitzmaurice  1 Thomas D Fleming  1 Luisa Sorio Flor  61 Kyle J Foreman  1 Richard C Franklin  62 Maya S Fraser  1 Joseph J Frostad  1 Nancy Fullman  1 Gebremedhin Berhe Gebregergs  21 Alemseged Aregay Gebru  21 Johanna M Geleijnse  63 Katherine B Gibney  64 Mahari Gidey Yihdego  65   66 Ibrahim Abdelmageem Mohamed Ginawi  67 Melkamu Dedefo Gishu  41 Tessema Assefa Gizachew  23 Elizabeth Glaser  60 Audra L Gold  1 Ellen Goldberg  1 Philimon Gona  68 Atsushi Goto  69 Harish Chander Gugnani  70 Guohong Jiang  71 Rajeev Gupta  72 Fisaha Haile Tesfay  21 Graeme J Hankey  73 Rasmus Havmoeller  74 Martha Hijar  75 Masako Horino  76 H Dean Hosgood  77 Guoqing Hu  78 Kathryn H Jacobsen  79 Mihajlo B Jakovljevic  80 Sudha P Jayaraman  81 Vivekanand Jha  82   83 Tariku Jibat  63   65 Catherine O Johnson  1 Jost Jonas  84 Amir Kasaeian  58 Norito Kawakami  85 Peter N Keiyoro  86 Ibrahim Khalil  1 Young-Ho Khang  49 Jagdish Khubchandani  87 Aliasghar A Ahmad Kiadaliri  88 Christian Kieling  89   90 Daniel Kim  91 Niranjan Kissoon  92 Luke D Knibbs  4 Ai Koyanagi  93 Kristopher J Krohn  1 Barthelemy Kuate Defo  94 Burcu Kucuk Bicer  95 Rachel Kulikoff  1 G Anil Kumar  51 Dharmesh Kumar Lal  51 Hilton Y Lam  96 Heidi J Larson  4   97 Anders Larsson  25 Dennis Odai Laryea  98 Janni Leung  4 Stephen S Lim  1 Loon-Tzian Lo  99   100 Warren D Lo  101 Katharine J Looker  102 Paulo A Lotufo  37 Hassan Magdy Abd El Razek  103 Reza Malekzadeh  58 Desalegn Markos Shifti  104 Mohsen Mazidi  105 Peter A Meaney  106 Kidanu Gebremariam Meles  21 Peter Memiah  107 Walter Mendoza  108 Mubarek Abera Mengistie  5 Gebremichael Welday Mengistu  21 George A Mensah  43 Ted R Miller  109 Charles Mock  110 Alireza Mohammadi  111 Shafiu Mohammed  112 Lorenzo Monasta  113 Ulrich Mueller  16 Chie Nagata  114 Aliya Naheed  115 Grant Nguyen  1 Quyen Le Nguyen  116 Elaine Nsoesie  1 In-Hwan Oh  117 Anselm Okoro  118 Jacob Olusegun Olusanya  119 Bolajoko O Olusanya  120 Alberto Ortiz  120 Deepak Paudel  121 David M Pereira  122 Norberto Perico  123 Max Petzold  124 Michael Robert Phillips  125 Guilherme V Polanczyk  36 Farshad Pourmalek  92 Mostafa Qorbani  126 Anwar Rafay  127 Vafa Rahimi-Movaghar  58 Mahfuzar Rahman  128 Rajesh Kumar Rai  129 Usha Ram  54 Zane Rankin  1 Giuseppe Remuzzi  130 Andre M N Renzaho  131 Hirbo Shore Roba  40 David Rojas-Rueda  132 Luca Ronfani  113 Rajesh Sagar  133 Juan Ramon Sanabria  134 Muktar Sano Kedir Mohammed  66 Itamar S Santos  36 Maheswar Satpathy  133 Monika Sawhney  134 Ben Schöttker  135   136 David C Schwebel  137 James G Scott  138 Sadaf G Sepanlou  58 Amira Shaheen  139 Masood Ali Shaikh  140 June She  141 Rahman Shiri  142 Ivy Shiue  143 Inga Dora Sigfusdottir  144 Jasvinder Singh  137 Naris Silpakit  1 Alison Smith  1 Chandrashekhar Sreeramareddy  145 Jeffrey D Stanaway  1 Dan J Stein  146 Caitlyn Steiner  1 Muawiyyah Babale Sufiyan  111 Soumya Swaminathan  147 Rafael Tabarés-Seisdedos  46 Karen M Tabb  148 Fentaw Tadese  149 Mohammad Tavakkoli  150 Bineyam Taye  151 Stephanie Teeple  1 Teketo Kassaw Tegegne  149 Girma Temam Shifa  55 Abdullah Sulieman Terkawi  152 Bernadette Thomas  1 Alan J Thomson  153 Ruoyan Tobe-Gai  114 Marcello Tonelli  154 Bach Xuan Tran  155 Christopher Troeger  1 Kingsley N Ukwaja  156 Olalekan Uthman  157 Tommi Vasankari  158 Narayanaswamy Venketasubramanian  159 Vasiliy Victorovich Vlassov  160 Elisabete Weiderpass  161   162 Robert Weintraub  163 Solomon Weldemariam Gebrehiwot  21 Ronny Westerman  16 Hywel C Williams  164 Charles D A Wolfe  39 Rachel Woodbrook  1 Yuichiro Yano  165 Naohiro Yonemoto  166 Seok-Jun Yoon  167 Mustafa Z Younis  168 Chuanhua Yu  169 Maysaa El Sayed Zaki  103 Elias Asfaw Zegeye  170 Liesl Joanna Zuhlke  171 Christopher J L Murray  1 Theo Vos  1
Affiliations
Free PMC article

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 et al. JAMA Pediatr. .
Free PMC article

Erratum in

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.

Conflict of interest statement

Conflict of Interest Disclosures: Dr Larson reported that her research group at the London School of Hygiene and Tropical Medicine has received funding from GlaxoSmithKline and Merck to convene research symposia, that she has received funding from GlaxoSmithKline for advising on issues related to vaccine hesitancy, and that she has have served on the Merck Vaccines Strategy Advisory Board. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Ranking of the Top 25 Global Causes of Death in 2015 by 5 Socio-demographic Index (SDI) Quintiles and 21 Regions in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD)
Ranking of causes of death in females and males. Global causes, SDI quintiles, and GBD regions appear in columns, sorted in order of decreasing SDI status. The causes are sorted according to their ranking at the global level. The color coding indicates the relative ranking of each cause, with red the highest and green the lowest. The numbers appearing in each column indicate the geography-specific ranking of that cause in 2015. Blanks indicate causes that were not contracted in that geographical area. HIV indicates human immunodeficiency virus.
Figure 2.
Figure 2.. Leading Level 3 Causes of Global Disability-Adjusted Life Years (DALYs) in the Global Burden of Diseases, Injuries, and Risk Factors Study
This figure shows the rankings for the top 25 causes of global disability-adjusted life years among children and adolescents 19 years or younger at the global level in 1990, 2005, and 2015. Lines connecting the boxes illustrate changes in ranking. Any cause that appears in the top 25 in any year is listed, along with its ranking during each year. Group I causes (infectious, neonatal, nutritional, and maternal) are shown in gray, noncommunicable diseases in red, and injuries in green. Changes in total DALYs are in the first column next to 2005, followed by changes in all-ages rates of DALYs, and age-standardized rates of DALYs. Statistically significant differences appear in bold. HIV indicates human immunodeficiency virus, and STI, sexually transmitted infection.
Figure 3.
Figure 3.. Expected Association Between Rates of Years of Life Lost (YLL) and Years Lived With Disability (YLD) Rates With Socio-demographic Index (SDI) for 21 Level 2 Causes in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD)
A, Expected association between rates of YLL and YLD with SDI for the 21 GBD level 2 causes in children and adolescents 19 years or younger, both sexes, 1990-2015. Each geography is assigned an SDI value for each year, and nonlinear spline regressions are used to find the average relationship between SDI and cause-specific burden rates. B, Expected association between rates of YLL and YLD and SDI for the 21 GBD level 2 causes as a proportion of total rates of YLL and YLD in children and adolescents 19 years or younger, both sexes, 1990-2015. Each geographical area is assigned an SDI value for each year, and nonlinear spline regressions are used to find the mean association between SDI and cause-specific rates of disease burden. HIV indicates human immunodeficiency virus.

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