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
progr...