Format

Send to

Choose Destination
JAMA Pediatr. 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 Collaboration, Kassebaum N1, Kyu HH1, Zoeckler L1, Olsen HE1, Thomas K1, Pinho C1, Bhutta ZA2, Dandona L1,3, Ferrari A4, Ghiwot TT5, Hay SI1,6, Kinfu Y7, Liang X8, Lopez A9, Malta DC10, Mokdad AH1, Naghavi M1, Patton GC11, Salomon J12, Sartorius B13, Topor-Madry R14, Vollset SE15, Werdecker A16, Whiteford HA4, Abate KH5, Abbas K17, Damtew SA18, Ahmed MB5, Akseer N19, Al-Raddadi R20, Alemayohu MA21, Altirkawi K22, Abajobir AA4, Amare AT23, Antonio CAT24, Arnlov J25,26, Artaman A27, Asayesh H28, Avokpaho EFGA29, Awasthi A30, Ayala Quintanilla BP31, Bacha U32, Betsu BD21, Barac A33, Bärnighausen TW12, Baye E34, Bedi N35, Bensenor IM36, Berhane A37, Bernabe E38, Bernal OA39, Beyene AS40, Biadgilign S41, Bikbov B42, Boyce CA43, Brazinova A44, Hailu GB21, Carter A1, Castañeda-Orjuela CA45, Catalá-López F46,47, Charlson FJ4, Chitheer AA48, Choi JJ49, Ciobanu LG23, Crump J50, Dandona R51, Dellavalle RP52, Deribew A53, deVeber G19, Dicker D1, Ding EL12, Dubey M54, Endries AY55, Erskine HE56, Faraon EJA24, Faro A57, Farzadfar F58, Fernandes JC59, Fijabi DO60, Fitzmaurice C1, Fleming TD1, Flor LS61, Foreman KJ1, Franklin RC62, Fraser MS1, Frostad JJ1, Fullman N1, Gebregergs GB21, Gebru AA21, Geleijnse JM63, Gibney KB64, Gidey Yihdego M65,66, Ginawi IAM67, Gishu MD41, Gizachew TA23, Glaser E60, Gold AL1, Goldberg E1, Gona P68, Goto A69, Gugnani HC70, Jiang G71, Gupta R72, Tesfay FH21, Hankey GJ73, Havmoeller R74, Hijar M75, Horino M76, Hosgood HD77, Hu G78, Jacobsen KH79, Jakovljevic MB80, Jayaraman SP81, Jha V82,83, Jibat T63,65, Johnson CO1, Jonas J84, Kasaeian A58, Kawakami N85, Keiyoro PN86, Khalil I1, Khang YH49, Khubchandani J87, Ahmad Kiadaliri AA88, Kieling C89,90, Kim D91, Kissoon N92, Knibbs LD4, Koyanagi A93, Krohn KJ1, Kuate Defo B94, Kucuk Bicer B95, Kulikoff R1, Kumar GA51, Lal DK51, Lam HY96, Larson HJ4,97, Larsson A25, Laryea DO98, Leung J4, Lim SS1, Lo LT99,100, Lo WD101, Looker KJ102, Lotufo PA37, Magdy Abd El Razek H103, Malekzadeh R58, Markos Shifti D104, Mazidi M105, Meaney PA106, Meles KG21, Memiah P107, Mendoza W108, Abera Mengistie M5, Mengistu GW21, Mensah GA43, Miller TR109, Mock C110, Mohammadi A111, Mohammed S112, Monasta L113, Mueller U16, Nagata C114, Naheed A115, Nguyen G1, Nguyen QL116, Nsoesie E1, Oh IH117, Okoro A118, Olusanya JO119, Olusanya BO120, Ortiz A120, Paudel D121, Pereira DM122, Perico N123, Petzold M124, Phillips MR125, Polanczyk GV36, Pourmalek F92, Qorbani M126, Rafay A127, Rahimi-Movaghar V58, Rahman M128, Rai RK129, Ram U54, Rankin Z1, Remuzzi G130, Renzaho AMN131, Roba HS40, Rojas-Rueda D132, Ronfani L113, Sagar R133, Sanabria JR134, Kedir Mohammed MS66, Santos IS36, Satpathy M133, Sawhney M134, Schöttker B135,136, Schwebel DC137, Scott JG138, Sepanlou SG58, Shaheen A139, Shaikh MA140, She J141, Shiri R142, Shiue I143, Sigfusdottir ID144, Singh J137, Silpakit N1, Smith A1, Sreeramareddy C145, Stanaway JD1, Stein DJ146, Steiner C1, Sufiyan MB111, Swaminathan S147, Tabarés-Seisdedos R46, Tabb KM148, Tadese F149, Tavakkoli M150, Taye B151, Teeple S1, Tegegne TK149, Temam Shifa G55, Terkawi AS152, Thomas B1, Thomson AJ153, Tobe-Gai R114, Tonelli M154, Tran BX155, Troeger C1, Ukwaja KN156, Uthman O157, Vasankari T158, Venketasubramanian N159, Vlassov VV160, Weiderpass E161,162, Weintraub R163, Gebrehiwot SW21, Westerman R16, Williams HC164, Wolfe CDA39, Woodbrook R1, Yano Y165, Yonemoto N166, Yoon SJ167, Younis MZ168, Yu C169, Zaki MES103, Zegeye EA170, Zuhlke LJ171, Murray CJL1, Vos T1.

Author information

1
Institute for Health Metrics and Evaluation, University of Washington, Seattle.
2
Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
3
Public Health Foundation of India, Gurgaon-122002, National Capital Region, India.
4
School of Public Health, University of Queensland, Brisbane, Queensland, Australia.
5
Jimma University, Jimma, Ethiopia.
6
Oxford Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, United Kingdom.
7
Centre for Research & Action in Public Health, University of Canberra, Canberra, Australia.
8
Chinese Center for Disease Control and Prevention, Beijing, China.
9
Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia.
10
Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
11
Murdoch Childrens Research Institute, University of Melbourne, Victoria, Australia.
12
Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts.
13
School of Nursing and Public Health, University of KwaZulu-Natal, South African Medical Research Council/University of KwaZulu-Natal Gastrointestinal Cancer Research Center, Durban, South Africa.
14
Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Kraków, Poland.
15
Center for Disease Burden, Norwegian Institute of Public Health, Bergen, Norway.
16
Federal Institute for Population Research, Wiesbaden, Germany.
17
Department of Population Health, Virginia Tech, Blacksburg.
18
Wolaita Soda University, Wolaita Soda, Ethiopia.
19
The Hospital for Sick Children, Centre for Child Health, Toronto, Ontario, Canada.
20
Ministry of Health, Jeddah, Saudi Arabia.
21
Mekelle University, Mekelle, Ethiopia.
22
King Saud University, Riyadh, Saudi Arabia.
23
University of Adelaide, Adelaide, Australia.
24
Department of Health Policy and Administration, University of Philippines-Manila, Manila, Philippines.
25
Department of Medical Services, Uppsala University, Uppsala, Sweden.
26
Dalarna University, Uppsala, Sweden.
27
University of Manitoba, Winnipeg, Manitoba, Canada.
28
Qom University of Medical Sciences, Qom, Iran.
29
Institute de Recherche Clinique du Bénin, Cotonou, Benin.
30
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
31
The Judith Lumley Centre for Mother, Infant, and Family Health Research, La Trobe University, Melbourne, Victoria, Australia.
32
School of Health Sciences, University of Management and Technology, Lahore, Pakistan.
33
Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
34
Monash University, Melbourne, Victoria, Australia.
35
College of Public Health and Tropical Medicine, Jazan, Saudi Arabia.
36
University of Sao Paulo, Sao Paulo, Brazil.
37
College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia.
38
King's College London, London, United Kingdom.
39
University Andes, Bogota, Columbia.
40
Haramaya University, Dire Dawa, Ethiopia.
41
Independent Public Health Consultants, Addis Ababa, Ethiopia.
42
Department of Nephrology Issues of Transplanted Kidney, V. I. Shumakov Federal Research Center of Transplantology and Artificial Organs, Moscow, Russia.
43
National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
44
Faculty of Health Sciences and Social Work, Department of Public Health, Trnava University, Trnava, Slovakia.
45
Instituto Nacional de Salud, Bogotá, Colombia.
46
University of Valencia, Valencia, Spain.
47
Health Research Institute and CIBERSAM, Valencia, Spain.
48
Ministry of Health, Baghdad, Iraq.
49
Seoul National University, Seoul, South Korea.
50
Departmentà Centre for International Health, University of Otago, Dunedin, New Zealand.
51
Public Health Foundation of India, New Delhi, India.
52
School of Medicine, School of Public Health, University of Colorado, Aurora.
53
Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom.
54
International Institute for Population Sciences, Mumbai, India.
55
Arba Minch University, Arba Minch, Ethiopia.
56
Queensland Centre for Mental Health Research, Brisbane, Queensland, Australia.
57
Federal University of Sergipe, Aracaju, Brazil.
58
Non-Communicable Diseases Research Center, Tehran University of Medical Sciences, Tehran, Iran.
59
Center for Biotechnology and Fine Chemistry, Catholic University of Portugal, Porto, Portugal.
60
Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts.
61
Escola Nacional de Saúde Pública Sergio Arouca/Fiocruz, Rio De Janeiro, Brazil.
62
James Cook University, Townsville, Queensland, Australia.
63
Wageningen University, Wageningen, Netherlands.
64
The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria, Australia.
65
Addis Ababa University, Addis Ababa, Ethiopia.
66
Department of Public Health, Mizan-Tepi University, Ethiopia.
67
College of Medicine, University of Hail, Hail, Saudi Arabia.
68
University of Massachusetts-Boston.
69
National Cancer Center, Tokyo, Japan.
70
Department of Microbiology, Departments of Epidemiology and Biostatistics, St James School of Medicine, the Quarter, Anguilla.
71
School of Public Health, Tianjin Medical University, Tianjin, China.
72
Eternal Heart Care Centre and Research Institute, Jaipur, India.
73
School of Medicine and Pharmacology, University of Western Australia, Perth, Australia.
74
Karolinska Institutet, Stockholm, Sweden.
75
Fundacion Entornos, Cuernavaca, Morelos, Mexico.
76
Nevada Division of Public and Behavioral Health, Carson City, Nevada.
77
Albert Einstein College of Medicine, Bronx, New York.
78
Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, China.
79
Department of Global and Community Health, George Mason University, Fairfax, Virginia.
80
University of Kragujevac, Kragujevac, Serbia.
81
Virginia Commonwealth University, Richmond.
82
George Institute for Global Health, New Delhi, India.
83
University of Oxford, Oxford, United Kingdom.
84
Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karlas University, Heidelberg, Germany.
85
School of Public Health, University of Tokyo, Tokyo, Japan.
86
University of Nairobi, Nairobi, Kenya.
87
Ball State University, Muncie, Indiana.
88
Department of Clinical Sciences, Lund University, Lund, Sweden.
89
Federal University of Rio Grande de Sul, Porto Alegre, Brazil.
90
Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
91
Department of Health Sciences, Northeastern University, Boston, Massachusetts.
92
University of British Columbia, Vancouver, British Columbia, Canada.
93
Research and Development Unit, Parc Sanitari Sant Joan de Deu, Barcelona, Spain.
94
University of Montreal, Montreal, Quebec, Canada.
95
Institute of Public Health, Hacettepe University, Ankara, Turkey.
96
Institute of Health Policy and Development Studies, National Institutes of Health, Manila, Philippines.
97
Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom.
98
Komfo Anokye Teaching Hospital, Kumasi, Ghana.
99
UnionHealth Associates LLC, St Louis, Missouri.
100
Alton Mental Health Center, Alton, Illinois.
101
Department of Pediatrics, Department of Neurology, The Ohio State University, Columbus.
102
University of Bristol, Bristol, United Kingdom.
103
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
104
Madda Walabu University, Robe, Ethiopia.
105
Institute of Genetics and Developmental Biology, Key State Laboratory of Molecular Developmental Biology, Chinese Academy of Sciences, Beijing, China.
106
Perelman School of Medicine, University of Pennsylvania, Philadelphia.
107
University of West Florida, Pensacola.
108
United Nations Population Fund, Lima, Peru.
109
Pacific Institute for Research and Evaluation, Calverton, Maryland.
110
School of Medicine, School of Global Health, University of Washington, Seattle.
111
Baqiyatallah University of Medical Sciences, Tehran, Iran.
112
Ahmadu Bello University, Zaria, Kaduna, Nigeria.
113
Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy.
114
National Center for Child Health and Development, Tokyo, Japan.
115
International Centre for Diarrheal Disease Research, Dhaka, Bangladesh.
116
Institute for Global Health, Duy Tan University, Da Nang, Vietnam.
117
Department of Preventive Medicine, College of Medicine, Kyung Hee University, Seoul, South Korea.
118
Society for Family Health, Abuja, Nigeria.
119
Center for Healthy Start Initiative, Lagos, Nigeria.
120
IIS-Fundacion Jimenez Diaz-UAM, Madrid, Spain.
121
UK Department for International Development, Lalitpur, Nepal.
122
Universidade do Porto, Porto, Portugal.
123
Istituto di Richerche Farmacologiche Mario Negri, Bergamo, Italy.
124
Health Metrics Unit, University of Gothenburg, Gothenburg, Sweden.
125
School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
126
School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
127
Contect International Health Consultants, Lahore, Punjab, Pakistan.
128
Research and Evaluation Division, Building Resources Access Communities, Dhaka, Bangladesh.
129
Society for Health and Demographic Surveillance, Suri, India.
130
International Society of Nephrology, Brussels, Belgium.
131
Western Sydney University, Penrith, Australia.
132
ISGlobal Instituto de Salud Global de Barcelona, Barcelona, Spain.
133
All India Institute of Medical Sciences, New Delhi, India.
134
Marshall University, Huntington, West Virginia.
135
Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany.
136
Institute of Health Care and Social Sciences, FOM University, Essen, Germany.
137
University of Alabama at Birmingham.
138
Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia.
139
Department of Public Health, An-Najah University, Nablus, Palestine.
140
Independent Consultant, Karachi, Pakistan.
141
Department of Pulmonary Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
142
Finnish Institute of Occupational Health, Work Organizations, Disability Program, University of Helsinki, Helsinki, Finland.
143
Faculty of Health and Life Sciences, Northumbria University, Newcastle Upon Tyne, United Kingdom.
144
Reykjavik University, Reykjavik, Iceland.
145
Department of Community Medicine, International Medical University, Kuala Lumpur, Selangor, Malaysia.
146
Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
147
Indian Council of Medical Research, Chennai, India.
148
University of Illinois at Urbana-Champaign, Champaign.
149
Debre Markos University, Debre Markos, Ethiopia.
150
New York Medical Center, Valhalla.
151
Department of Biology, Colgate University, Hamilton, New York.
152
University of Virginia, Charlottesville.
153
Adaptive Knowledge Management, Victoria, British Columbia, Canada.
154
University of Calgary, Calgary, Alberta, Canada.
155
The Johns Hopkins University, Baltimore, Maryland.
156
Federal Teaching Hospital, Abakaliki, Nigeria.
157
University of Warwick, Coventry, United Kingdom.
158
Institute for Health Promotion Research, Tampere, Finland.
159
Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore.
160
National Research University Higher School of Economics, Moscow, Russia.
161
Department of Medical Epidemiology and Biostatistics, Karolinska Insitutet, Stockholm, Sweden.
162
Institute of Population-based Cancer Research, Cancer Registry of Norway, Oslo, Norway.
163
Royal Children's Hospital, Melbourne, Victoria, Australia.
164
University of Nottingham, Nottingham, United Kingdom.
165
Department of Preventive Medicine, Northwestern University, Chicago, Illinois.
166
Kyoto University, Kyoto, Japan.
167
Department of Preventive Medicine, School of Medicine, Korea University, Seoul, South Korea.
168
Jackson State University, Jackson, Missouri.
169
Wuhan University, Wuhan, China.
170
University of KwaZulu-Natal, Durban, South Africa.
171
Red Cross War Memorial Children's Hospital, Cape Town, South Africa.

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.

PMID:
28384795
PMCID:
PMC5540012
DOI:
10.1001/jamapediatrics.2017.0250
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Silverchair Information Systems Icon for PubMed Central
Loading ...
Support Center