Purpose-To compare mortality rates from motor vehicle accidents (MVA), homicide, and suicide across countries, age groups, and time.Methods-The World Health Organization Mortality Database was used to construct age-and gender-specific rates in 26 countries for individuals aged 15 to 34 years during the period 1955 to 1994. The rates were adjusted for differences among countries in the age-and-gender distributions of their populations. Cause-specific rates were compared by country, 4-year age groups, 8-year time blocks, and male/female ratios.Results-The proportion of deaths in 15-34-year-olds owing to MVA, homicide, and suicide increased from 26% to 43% over the 40-year study period. Mortality rates differ by country more than time block, peak at ages 15-29 years, and are higher in males than females. Compared to the United States, 24 countries had lower homicide rates and 23 had lower MVA-death rates.Conclusions-Despite declining rates of death from other causes, the rates of adolescent and young adult death from MVA, homicide, and suicide remain high in countries throughout the world. The proportion of deaths attributable to these causes increased steadily during the latter half of the 20th century. Fatal risk behaviors begin to increase during adolescence but do not peak until age 30 years, suggesting that the target population for prevention extends well beyond the teenage years.
KeywordsAdolescent; Homicide; Injury; Motor vehicle accidents; Suicide; Young adult; Gender differencesThe words "injury," "homicide," and "suicide" have been linked in the adolescent health literature since the 1980s when their contribution to the rising youth mortality rate in the United States was recognized. Adolescent mortality from all causes declined during the 1990s, yet these three causes continue to account for 75% of deaths among individuals aged 15-19 years [1]. Although commonly summed as risk behaviors resulting in death, the rates of fatal unintentional injury (i.e., accident), homicide, and suicide have followed different trajectories over time. In the United States between 1979 and 1998, 15-19-year- Cross-national and time trend analyses of youth death owing to injury, homicide, and suicide have been hampered by reporting bias and failure to recognize that the relative size of a population subgroup may affect individual health and behavior within that subgroup. Analyses that do not adjust crude mortality rates for population age-and-gender proportions cannot conclude that between-country differences or within-country changes over time reflect more than the underlying demographic characteristics of the populations studied [5]. Conversely, variations in adjusted population rates suggest differences in large-scale social or environmental factors that are associated with mortality. Recognizing that variation in these adjusted rates exists and proceeding next to the identification of contextual factors associated with this variation may help guide the development of effective public health strategies for the prev...