Nicholas J. Kassebaum, Robert C. Reiner, Helen Elizabeth Olsen, Chad Thomas Ikeda, Michelle M. Echko, Katherine E. Ballestreros, Helen Manguerra, Ira Martopullo, Anoushka Millear, Chloe Shields, Alison Smith, Bryan Strub, Molla Abebe, Zegeye Abebe, Beyene Meressa Adhena, Tara Ballav Adhikari, Mohammed Akibu, Rajaa M. Al-Raddadi, Nelson Alvis-Guzman, Carl Abelardo T. Antonio, Olatunde Aremu, Solomon Weldegebreal Asgedom, Netsanet Abera Asseffa, Leticia Avila-Burgos, Aleksandra Barac, Till W. Bärnighausen, Quique Bassat, Isabela M. Bensenor, Zulfiqar A. Bhutta, Ali Bijani, Nigus Bililign, Lucero Cahuana-Hurtado, Deborah Carvalho Malta, Jung-Chen Chang, Fiona J. Charlson, Samath Dhamminda Dharmaratne, David Teye Doku, Dumessa Edessa, Ziad El-Khatib, Holly E. Erskine, Alize J. Ferrari, Nancy Fullman, Rahul Gupta, Hamid Yimam Hassen, Simon I. Hay, Olayinka Stephen Ilesanmi, Kathryn H. Jacobsen, Amaha Kahsay, Amir Kasaeian, Tesfaye Dessale Kassa, Seifu Kebede, Yousef Saleh Khader, Ejaz Ahmad Khan, Mohammed Nuruzzaman Khan, Young-Ho Khang, Jagdish Khubchandani, Yohannes Kinfu, Sonali Kochhar, Yoshihiro Kokubo, Ai Koyanagi, Barthelemy Kuate Defo, Dharmesh Kumar Lal, Fekede Asefa Kumsa, Heidi J. Larson, Janni Leung, Abdullah A. Mamun, Suresh Mehata, Mulugeta Melku, Walter Mendoza, Haftay Berhane Mezgebe, Ted R. Miller, Nurilign Abebe Moges, Shafiu Mohammed, Ali H. Mokdad, Lorenzo Monasta, Subas Neupane, Huong Lan Thi Nguyen, Dina Nur Anggraini Ningrum, Yirga Legesse Nirayo, Vuong Minh Nong, Felix Akpojene Ogbo, Andrew T. Olagunju, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, George C. Patton, David M. Pereira, Farshad Pourmalek, Mostafa Qorbani, Anwar Rafay, Rajesh Kumar Rai, Usha Ram, Chhabi Lal Ranabhat, Andre M. N. Renzaho, Mohammad Sadegh Rezai, Luca Ronfani, Gregory A. Roth, Saeid Safiri, Benn Sartorius, James G. Scott, Katya Anne Shackelford, Karen Sliwa, Chandrashekhar Sreeramareddy, Mu'awiyyah Bable Sufiyan, Abdullah Sulieman Terkawi, Roman Topor-Madry, Bach Xuan Tran, Kingsley Nnanna Ukwaja, Olalekan A. Uthman, Stein Emil Vollset, Kidu Gidey Weldegwergs, Andrea Werdecker, Harvey A. Whiteford, Tissa Wijeratne, Naohiro Yonemoto, Marcel Yotebieng, Liesl J. Zuhlke, Hmwe Hmwe Kyu, Mohsen Naghavi, Theo Vos, Christopher J. L. Murray
Importance: Understanding causes and correlates of health loss among children and adolescents can identify areas of success, stagnation, and emerging threats and thereby facilitate effective improvement strategies. Objective: To estimate mortality and morbidity in children and adolescents from 1990 to 2017 by age and sex in 195 countries and territories. Design, Setting, and Participants: This study examined levels, trends, and spatiotemporal patterns of cause-specific mortality and nonfatal health outcomes using standardized approaches to data processing and statistical analysis. It also describes epidemiologic transitions by evaluating historical associations between disease indicators and the Socio-Demographic Index (SDI), a composite indicator of income, educational attainment, and fertility. Data collected from 1990 to 2017 on children and adolescents from birth through 19 years of age in 195 countries and territories were assessed. Data analysis occurred from January 2018 to August 2018. Exposures: Being under the age of 20 years between 1990 and 2017. Main Outcomes and Measures: Death and disability. All-cause and cause-specific deaths, disability-adjusted life years, years of life lost, and years of life lived with disability. Results: Child and adolescent deaths decreased 51.7% from 13.77 million (95% uncertainty interval [UI], 13.60-13.93 million) in 1990 to 6.64 million (95% UI, 6.44-6.87 million) in 2017, but in 2017, aggregate disability increased 4.7% to a total of 145 million (95% UI, 107-190 million) years lived with disability globally. Progress was uneven, and inequity increased, with low-SDI and low-middle-SDI locations experiencing 82.2% (95% UI, 81.6%-82.9%) of deaths, up from 70.9% (95% UI, 70.4%-71.4%) in 1990. The leading disaggregated causes of disability-adjusted life years in 2017 in the low-SDI quintile were neonatal disorders, lower respiratory infections, diarrhea, malaria, and congenital birth defects, whereas neonatal disorders, congenital birth defects, headache, dermatitis, and anxiety were highest-ranked in the high-SDI quintile. Conclusions and Relevance: Mortality reductions over this 27-year period mean that children are more likely than ever to reach their 20th birthdays. The concomitant expansion of nonfatal health loss and epidemiological transition in children and adolescents, especially in low-SDI and middle-SDI countries, has the potential to increase already overburdened health systems, will affect the human capital potential of societies, and may influence the trajectory of socioeconomic development. Continued monitoring of child and adolescent health loss is crucial to sustain the progress of the past 27 years. © 2019 American Medical Association. All rights reserved.
Institute for Health Metrics and Evaluation, Harborview Medical Center, Ste 600, 2301 5th Ave, Seattle, 98121, WA, United States; Department of Health Metrics Sciences, University of Washington, Seattle, United States; Department of Clinical Chemistry, University of Gondar, Gondar, Ethiopia; Department of Human Nutrition, University of Gondar, Gondar, Ethiopia; School of Public Health, Mekelle University, Tigray, Ethiopia; Nepal Health Research Environment, Center for Social Science and Public Health Research Nepal, Lalitpur, Nepal; Unit for Health Promotion Research, University of Southern Denmark, Esbjerg, Denmark; Department of Midwifery, Debre Berhan University, Debre Berhan, Ethiopia; Department of Family and Community Medicine, King Abdulaziz University, Jeddah, Saudi Arabia; Research Group on Health Economics, University of Cartagena, Cartagena, Colombia; Research Group on Hospital Management and Health Policies, University of the Coast, Barranquilla, Colombia; Department of Health Policy and Administration, University of the Philippines Manila, Manila, Philippines; Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong; School of Health Sciences, Birmingham City University, Birmingham, United Kingdom; School of Pharmacy, Mekelle University, Mekelle, Ethiopia; School of Public Health, Wolaita Sodo University, Wolaita Dofo, Ethiopia; Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico; Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia; Faculty of Medicine, University of Belgrade, Belgrade, Serbia; Institute of Public Health, Heidelberg University, Heidelberg, Germany; Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States; Barcelona Institute for Global Health, Barcelona, Spain; Catalan Institution for Research and Advanced Studies, Manhiça Health Research Center, Manhiça, Mozambique; Department of Internal Medicine, University of São Paulo, São Paulo, Brazil; Centre for Global Child Health, University of Toronto, Toronto, Canada; Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan; Social Determinants of Health Research Center, Babol University of Medical Sciences, Babol, Iran; Woldia University, Woldia, Ethiopia; Department of Maternal and Child Nursing and Public Health, Federal University of Minas Gerais, Minas Gerais, Brazil; College of Medicine, National Taiwan University, Taipei, Taiwan; School of Public Health, University of Queensland, Brisbane, QLD, Australia; Department of Global Health, University of Washington, Seattle, United States; Department of Community Medicine, University of Peradeniya, Peradeniya, Sri Lanka; Department of Population and Health, University of Cape Coast, Cape Coast, Ghana; Faculty of Social Sciences, Health Sciences, University of Tampere, Tampere, Finland; School of Pharmacy, Haramaya University, Harar, Ethiopia; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; West Virginia Bureau for Public Health, Charleston, WV, United States; Department of Health Policy, Management, and Leadership, West Virginia University, Morgantown, United States; Public Health Department, Mizan-Tepi University, Teppi, Ethiopia; Unit of Epidemiology and Social Medicine, University Hospital Antwerp, Antwerp, Belgium; Department of Public Health and Community Medicine, University of Liberia, Monrovia, Liberia; Department of Global and Community Health, George Mason University, Fairfax, VA, United States; Department of Nutrition and Dietetics, Mekelle University, Tigray, Ethiopia; Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran; Hematologic Malignancies Research Center, Tehran University of Medical Sciences, Tehran, Iran; Clinical Pharmacy Unit, Mekelle University, Mekelle, Ethiopia; Midwifery Program, Salale University, Fiche, Ethiopia; Department of Public Health and Community Medicine, Jordan University of Science and Technology, Ramtha, Jordan; Department of Epidemiology and Biostatistics, Health Services Academy, Islamabad, Pakistan; School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia; Department of Population Sciences, Jatiya Kabi Kazi Nazrul Islam University, Mymensingh, Bangladesh; Department of Health Policy and Management, Seoul National University, Seoul, South Korea; Institute of Health Policy and Management, Seoul National University, Seoul, South Korea; Department of Nutrition and Health Science, Ball State University, Muncie, IN, United States; Faculty of Health, University of Canberra, Canberra, ACT, Australia; Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Department of Public Health, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Suita, Japan; Research and Development Unit, San Juan de Dios Sanitary Park, Sant Boi de Llobregat, Barcelona, Spain; Department of Demography, University of Montreal, Montreal, QC, Canada; Department of Social and Preventive Medicine, University of Montreal, Montreal, QC, Canada; Public Health Foundation of India, Gurugram, India; Center for Midwifery, Child, and Family Health, University of Technology Sydney, Sydney, NSW, Australia; School of Public Health, Haramaya University, Harar, Ethiopia; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom; Center for Youth Substance Abuse Research, University of Queensland, St Lucia, QLD, Australia; Institute for Social Science Research, University of Queensland, Brisbane, QLD, Australia; Research, Monitoring, and Evaluation, Ipas Nepal, Kathmandu, Nepal; Institute of Public Health, University of Gondar, Gondar, Ethiopia; Peru Country Office, United Nations Population Fund, Lima, Peru; Department of Pharmacy, Ethiopian Academy of Medical Science, Tigray, Ethiopia; Pacific Institute for Research and Evaluation, Calverton, MD, United States; School of Public Health, Curtin University, Perth, WA, Australia; Department of Public Health, Debre Markos University, Debre Markos, Ethiopia; Health Systems and Policy Research Unit, Ahmadu Bello University, Zaria, Nigeria; Clinical Epidemiology and Public Health Research Unit, Burlo Garofolo Institute for Maternal and Child Health, Trieste, Italy; Faculty of Health Sciences, University of Tampere, Tampere, Finland; Institute for Global Health Innovations, Duy Tan University, Hanoi, Viet Nam; Department of Public Health Science, State University of Semarang, Kota Semarang, Indonesia; Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei, Taiwan; Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia; Department of Psychiatry, University of Adelaide, Adelaide, SA, Australia; Department of Psychiatry, University of Lagos, Lagos, Nigeria; Centre for Healthy Start Initiative, Lagos, Nigeria; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Population Health Group, Murdoch Childrens Research Institute, Melbourne, VIC, Australia; Rede de Química e Tecnologia/Laboratório Asociado Do Química Verde, University of Porto, Oporto, Portugal; Cartagena University, Cartagena, Colombia; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Noncommunicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran; Department of Epidemiology and Biostatistics, Contech School of Public Health, Lahore, Pakistan; Society for Health and Demographic Surveillance, Suri, India; Department of Economics, University of Göttingen, Göttingen, Germany; Department of Public Health and Mortality Studies, International Institute for Population Sciences, Mumbai, India; Institute for Poverty Alleviation and International Development, Yonsei University, Wonju, South Korea; School of Social Sciences and Psychology, Western Sydney University, Penrith, NSW, Australia; Department of Pediatrics, Mazandaran University of Medical Sciences, Sari, Iran; Division of Cardiology, University of Washington, Seattle, United States; Managerial Epidemiology Research Center, Maragheh University of Medical Sciences, Maragheh, Iran; Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa; Child and Youth Mental Health, Queensland Centre for Mental Health Research, Brisbane, QLD, Australia; Department of Medicine, University of Cape Town, Cape Town, Western Cape, South Africa; Division of Community Medicine, International Medical University, Kuala Lumpur, Malaysia; Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria; Department of Anesthesiology, University of Virginia, Charlottesville, United States; Syrian Expatriate Medical Association, Charlottesville, VA, United States; Institute for Public Health, Jagiellonian University Medical College, Krakow, Poland; Agency for Health Technology Assessment and Tariff System, Warszawa, Poland; Department of Health Economics, Hanoi Medical University, Hanoi, Viet Nam; Department of Internal Medicine, Federal Teaching Hospital, Abakaliki, Nigeria; Division of Health Sciences, University of Warwick, Coventry, United Kingdom; Demographic Change and Ageing Research Area, Federal Institute for Population Research, Wiesbaden, Germany; Independent Consultant, Staufenberg, Germany; University of Queensland, Brisbane, QLD, Australia; Department of Medicine, University of Melbourne, St Albans, VIC, Australia; Department of Psychology, La Trobe University, Melbourne, VIC, Australia; Department of Psychopharmacology, National Center of Neurology and Psychiatry, Tokyo, Japan; College of Public Health, Ohio State University, Columbus, United States; School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic Congo; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, Western Cape, South Africa; Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, United States
