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JAMA Pediatr. 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 Collaboration, Kyu HH1, Pinho C1, Wagner JA1, Brown JC1, Bertozzi-Villa A1, Charlson FJ2, Coffeng LE3, Dandona L4, Erskine HE2, Ferrari AJ2, Fitzmaurice C5, Fleming TD1, Forouzanfar MH1, Graetz N1, Guinovart C1, Haagsma J3, Higashi H1, Kassebaum NJ6, Larson HJ7, Lim SS1, Mokdad AH1, Moradi-Lakeh M8, Odell SV9, Roth GA1, Serina PT1, Stanaway JD1, Misganaw A1, Whiteford HA2, Wolock TM1, Wulf Hanson S1, Abd-Allah F10, Abera SF11, Abu-Raddad LJ12, AlBuhairan FS13, Amare AT14, Antonio CA15, Artaman A16, Barker-Collo SL17, Barrero LH18, Benjet C19, Bensenor IM20, Bhutta ZA21, Bikbov B22, Brazinova A23, Campos-Nonato I24, Castañeda-Orjuela CA25, Catalá-López F26, Chowdhury R27, Cooper C28, Crump JA29, Dandona R30, Degenhardt L31, Dellavalle RP32, Dharmaratne SD33, Faraon EJ34, Feigin VL35, Fürst T36, Geleijnse JM37, Gessner BD38, Gibney KB39, Goto A40, Gunnell D41, Hankey GJ42, Hay RJ43, Hornberger JC44, Hosgood HD45, Hu G46, Jacobsen KH47, Jayaraman SP48, Jeemon P49, Jonas JB50, Karch A51, Kim D52, Kim S53, Kokubo Y54, Kuate Defo B55, Kucuk Bicer B56, Kumar GA30, Larsson A57, Leasher JL58, Leung R59, Li Y60, Lipshultz SE61, Lopez AD62, Lotufo PA20, Lunevicius R63, Lyons RA64, Majdan M65, Malekzadeh R66, Mashal T67, Mason-Jones AJ68, Melaku YA69, Memish ZA70, Mendoza W71, Miller TR72, Mock CN73, Murray J74, Nolte S75, Oh IH76, Olusanya BO77, Ortblad KF78, Park EK79, Paternina Caicedo AJ80, Patten SB81, Patton GC82, Pereira DM83, Perico N84, Piel FB85, Polinder S86, Popova S87, Pourmalek F88, Quistberg DA89, Remuzzi G90, Rodriguez A91, Rojas-Rueda D92, Rothenbacher D93, Rothstein DH94, Sanabria J95, Santos IS96, Schwebel DC97, Sepanlou SG66, Shaheen A98, Shiri R99, Shiue I100, Skirbekk V101, Sliwa K102, Sreeramareddy CT103, Stein DJ104, Steiner TJ105, Stovner LJ106, Sykes BL107, Tabb KM108, Terkawi AS109, Thomson AJ110, Thorne-Lyman AL111, Towbin JA112, Ukwaja KN113, Vasankari T114, Venketasubramanian N115, Vlassov VV116, Vollset SE117, Weiderpass E118, Weintraub RG119, Werdecker A120, Wilkinson JD61, Woldeyohannes SM121, Wolfe CD122, Yano Y123, Yip P124, Yonemoto N125, Yoon SJ126, Younis MZ127, Yu C128, El Sayed Zaki M129, Naghavi M1, Murray CJ1, Vos T1.

Author information

1
Institute for Health Metrics and Evaluation, University of Washington, Seattle.
2
Institute for Health Metrics and Evaluation, University of Washington, Seattle2School of Public Health, University of Queensland, Brisbane, Australia3Queensland Centre for Mental Health Research, Brisbane, Australia.
3
Institute for Health Metrics and Evaluation, University of Washington, Seattle4Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
4
Institute for Health Metrics and Evaluation, University of Washington, Seattle5Public Health Foundation of India, New Delhi, India.
5
Institute for Health Metrics and Evaluation, University of Washington, Seattle6Division of Hematology, Department of Medicine, University of Washington, Seattle7Fred Hutchinson Cancer Research Center, Seattle, Washington.
6
Institute for Health Metrics and Evaluation, University of Washington, Seattle8Department of Anesthesiology and Pain Medicine, Seattle Children's Hospital, Seattle, Washington.
7
Institute for Health Metrics and Evaluation, University of Washington, Seattle9Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, England.
8
Institute for Health Metrics and Evaluation, University of Washington, Seattle10Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran.
9
University of Washington Medical Center, Seattle12Seattle Children's Hospital, Seattle, Washington13Intermountain Healthcare, Salt Lake City, Utah.
10
Department of Neurology, Cairo University, Cairo, Egypt.
11
Kilte Awlaelo Health and Demographic Surveillance Site, Mekelle, Ethiopia16School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia.
12
Infectious Disease Epidemiology Group, Weill Cornell Medical College in Qatar, Doha, Qatar.
13
King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia19King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
14
Department of Epidemiology, University of Groningen, Groningen, the Netherlands21College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia22Discipline of Psychiatry, School of Medicine, University of Adelaide, Adelaide, Australia.
15
Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines.
16
Consultant, Windsor, Ontario, Canada.
17
School of Psychology, University of Auckland, Auckland, New Zealand.
18
Department of Industrial Engineering, School of Engineering, Pontificia Universidad Javeriana, Bogotá, Colombia.
19
National Institute of Psychiatry Ramon de la Fuente, Mexico City, Mexico.
20
University of São Paulo, São Paulo, Brazil.
21
Medical Center, Aga Khan University, Karachi, Pakistan30The Hospital for Sick Children, Toronto, Ontario, Canada.
22
A. I. Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia32Academician V. I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia.
23
International Neurotrama Research Organization, Vienna, Austria34Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia.
24
National Institute of Public Health, Cuernavaca, Mexico36School of Public Health, Harvard University, Boston, Massachusetts.
25
Colombian National Health Observatory, Instituto Nacional de Salud, Bogotá, Colombia38Epidemiology and Public Health Evaluation Group, Public Health Department, Universidad Nacional de Colombia, Bogotá, Colombia.
26
Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada40Department of Medicine, University of Valencia, INCLIVA/CIBERSAM, Valencia, Spain.
27
Department of Public Health and Primary Care, University of Cambridge, Cambridge, England.
28
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, England43National Institute for Health Research Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, S.
29
Centre for International Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
30
Public Health Foundation of India, New Delhi, India.
31
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
32
University of Colorado School of Medicine and the Colorado School of Public Health, Aurora.
33
Department of Community Medicine, Faculty of Medicine, University of Peradeniya, Peradeniya, Sri Lanka.
34
Department of Health Policy and Administration, College of Public Health, University of the Philippines Manila, Manila, Philippines49Office for Technical Services, Department of Health, Manila, Philippines.
35
National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Auckland, New Zealand.
36
Department of Infectious Disease Epidemiology, Imperial College London, London, England.
37
Division of Human Nutrition, Wageningen University, Wageningen, the Netherlands.
38
Agence de Medecine Preventive, Paris, France.
39
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia55Melbourne Health, Parkville, Australia.
40
Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan.
41
School of Social and Community Medicine, University of Bristol, Bristol, England.
42
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia59Harry Perkins Institute of Medical Research, Nedlands, Australia60Western Australian Neuroscience Research Institute, Nedlands, Australia.
43
International Foundation for Dermatology, London, England62King's College London, London, England.
44
Cedar Associates, Menlo Park, California64Stanford University, Stanford, California.
45
Albert Einstein College of Medicine, Bronx, New York.
46
Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, China.
47
George Mason University, Fairfax, Virginia.
48
Department of Surgery, Virginia Commonwealth University, Richmond.
49
Centre for Chronic Disease Control, New Delhi, India70Centre for Control of Chronic Conditions, Public Health Foundation of India, New Delhi, India.
50
Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-Universität Heidelberg, Mannheim, Germany.
51
Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany73Hannover-Braunschweig Site, German Center for Infection Research, Braunschweig, Germany.
52
Department of Health Sciences, Northeastern University, Boston, Massachusetts.
53
Soonchunhyang University, Seoul, South Korea.
54
Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan.
55
Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Québec, Canada78Department of Demography, University of Montreal, Montreal, Québec, Canada79Public Health Research Institute, University of Montreal.
56
Institute of Public Health, Hacettepe University, Ankara, Turkey.
57
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
58
Nova Southeastern University College of Optometry, Fort Lauderdale, Florida.
59
State University of New York at Albany, Rensselaer.
60
Genentech, South San Francisco, California.
61
School of Medicine, Wayne State University, Detroit, Michigan86Children's Hospital of Michigan, Detroit.
62
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
63
Aintree University Hospital National Health Service Foundation Trust, Liverpool, England89School of Medicine, University of Liverpool, Liverpool, England.
64
Farr Institute, Swansea University, Swansea, Wales.
65
Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia.
66
Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
67
Ministry of Public Health, Kabul, Afghanistan.
68
Department of Health Sciences, University of York, York, England.
69
School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia94School of Public Health, Mekelle University, Mekelle, Ethiopia95School of Medicine, University of Adelaide, Adelaide, Australia.
70
Saudi Ministry of Health, Riyadh, Saudi Arabia97College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
71
United Nations Population Fund, Lima, Peru.
72
Pacific Institute for Research and Evaluation, Calverton, Maryland100Centre for Population Health Research, Curtin University, Perth, Australia.
73
Harborview Injury Prevention and Research Center, University of Washington, Seattle.
74
Department of Psychiatry, University of Cambridge, Cambridge, England.
75
Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology, Charité Universitätsmedizin, Berlin, Germany104Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Melbourne, Australi.
76
Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea.
77
Center for Healthy Start Initiative, Ikoyi, Nigeria.
78
Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
79
Department of Medical Humanities and Social Medicine, College of Medicine, Kosin University, Busan, South Korea.
80
Universidad de Cartagena, Cartagena, Colombia.
81
Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.
82
Murdoch Childrens Research Institute, University of Melbourne, Melbourne, Australia.
83
REQUIMTE/LAQV, Laboratório de Farmacognosia, Departamento de Química, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal.
84
Istituto di Ricovero e Cura a Carattere Scientifico, Mario Negri Institute for Pharmacological Research, Bergamo, Italy.
85
Department of Zoology, University of Oxford, Oxford, England.
86
Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
87
Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
88
School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
89
Harborview Injury Prevention and Research Center, University of Washington, Seattle117Department of Pediatrics, University of Washington, Seattle.
90
Centro Anna Maria Astori, Istituto di Ricovero e Cura a Carattere Scientifico, Mario Negri Institute for Pharmacological Research, Bergamo, Italy119Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy.
91
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, England121Mid Sweden University, Östersund, Sweden.
92
Centre for Research in Environmental Epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain.
93
Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany.
94
Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, New York125Department of Surgery, University at Buffalo, State University of New York, Buffalo.
95
Case Western Reserve University, Cleveland, Ohio127Chicago Medical School, Rosalind Franklin University of Medicine and Science, Cancer Treatment Centers of America, North Chicago, Illinois.
96
Internal Medicine Department, University of São Paulo, São Paulo, Brazil.
97
University of Alabama at Birmingham, Birmingham.
98
Department of Public Health, An-Najah National University, Nablus, Palestine.
99
Finnish Institute of Occupational Health, Helsinki, Finland132School of Health Sciences, University of Tampere, Tampere, Finland.
100
Health and Life Sciences, Northumbria University, Newcastle upon Tyne, England134Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, Scotland.
101
Columbia University, New York, New York.
102
Faculty of Health Sciences, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, South Africa.
103
Department of Community Medicine, International Medical University, Kuala Lumpur, Malaysia.
104
Department of Psychiatry, University of Cape Town, Cape Town, South Africa139South African Medical Research Council Unit on Anxiety and Stress Disorders, Cape Town, South Africa.
105
Division of Brain Sciences, Imperial College London, London, England141Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
106
Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway142Norwegian Advisory Unit on Headache, St Olavs Hospital, Trondheim, Norway.
107
Department of Criminology, Law and Society, University of California, Irvine144Department of Sociology, University of California, Irvine145Department of Public Health, University of California, Irvine.
108
School of Social Work, University of Illinois at Urbana-Champaign, Champaign.
109
Department of Anesthesiology, University of Virginia, Charlottesville148Outcomes Research Consortium, Cleveland Clinic, Cleveland, Ohio149Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia.
110
Adaptive Knowledge Management, Victoria, British Columbia, Canada.
111
Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts152WorldFish, Penang, Malaysia.
112
Le Bonheur Children's Hospital, Memphis, Tennessee154University of Tennessee Health Science Center, Memphis155St Jude Children's Research Hospital, Memphis, Tennessee.
113
Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria.
114
UKK Institute for Health Promotion Research, Tampere, Finland.
115
Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore.
116
National Research University Higher School of Economics, Moscow, Russia.
117
Norwegian Institute of Public Health, Oslo, Norway161Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
118
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden163Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway164Department of Community Medicine, Faculty of H.
119
University of Melbourne, Melbourne, Australia167Royal Children's Hospital, Melbourne, Australia168Murdoch Childrens Research Institute, Melbourne, Australia.
120
Competence Center Mortality Follow-up of the German National Cohort, Federal Institute for Population Research, Wiesbaden, Germany.
121
Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
122
Division of Health and Social Care Research, King's College London, London, England172National Institute for Health Research Comprehensive Biomedical Research Centre, Guy's and St Thomas' National Health Service Foundation Trust and King's College London.
123
Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
124
Social Work and Social Administration Department, University of Hong Kong, Hong Kong, China175Hong Kong Jockey Club Centre for Suicide Research and Prevention, University of Hong Kong, Hong Kong, China.
125
National Center of Neurology and Psychiatry, Kodaira, Japan.
126
Department of Preventive Medicine, College of Medicine, Korea University, Seoul, South Korea.
127
Jackson State University, Jackson, Mississippi.
128
Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China180Global Health Institute, Wuhan University, Wuhan, China.
129
Mansoura Faculty of Medicine, Mansoura, Egypt.

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.

PMID:
26810619
PMCID:
PMC5076765
DOI:
10.1001/jamapediatrics.2015.4276
[Indexed for MEDLINE]
Free PMC Article

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.

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