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

By H. Kyu, Christine Pinho, J. Wagner, J. Brown, A. Bertozzi-Villa, F. Charlson, Luc E. Coffeng, L. Dandona, H. Erskine, Holly E. Erskine and 154 more. JAMA pediatrics, 2016

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Importance The current literature focuses on mortality among children younger than five years. Comparable information on non-fatal health outcomes among these children is scarce. Moreover, there has been little systematic data collection and reporting on both the fatal and non-fatal burden of diseases and injuries among older children and adolescents. Objective To determine levels and trends in the fatal and non-fatal burden of diseases and injuries among younger children (<5 years), older children (5-9 years) and adolescents (10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study. Design Data from vital registration, verbal autopsy, maternal and child death surveillance, and other sources covering 14,244 site-years (the number of years for which cause of death data were available for a particular geographic area such as a country or demographic surveillance site) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35,620 epidemiological sources (mainly covered from 1990 to 2013) were used to estimate the prevalence of the diseases and sequelae included in the GBD. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble model strategy. For some infectious diseases (e.g., HIV/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 non-fatal health outcomes, DisMod-MR 2.0, a Bayesian meta-regression tool was used to meta-analyze the epidemiological data to generate prevalence and incidence estimates. Results Of the 7.7 (95% uncertainty interval (UI): 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.3 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, lower respiratory infections were the leading cause of death among younger children (905,059 deaths, UI: 810,304 - 998,125 ), diarrheal diseases among older children (38,325 deaths, UI: 30,365 - 47,678), and road injuries among adolescents (115,186 deaths, UI: 105,185 - 124,870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents affecting 619 (UI: 618 - 621) million prevalent cases in 2013. Large between-country variations exist in the trends in mortality from leading causes among children and adolescents. Developing countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in mortality for most leading causes of death during the same period, whereas for countries with the slowest declines in all-cause mortality there was either a stagnant or an increasing trend in most of the leading causes of death. In 2013, Nigeria had about 4% of the world’s children and adolescents but a 12% share of global lower respiratory infections deaths and a 38% share of global malaria deaths. India had nearly 20% of the world’s child and adolescent population but 33% of the world’s neonatal encephalopathy deaths. Half of world’s diarrheal deaths among children and adolescents occurred in just five countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia which together represented 30% of the world’s pediatric population in 2013. Conclusions and Relevance Understanding the levels and trends, as well as geography, 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, and where more attention is needed. Proven interventions exist to prevent diarrheal and respiratory diseases, neonatal conditions, iron deficiency anemia, and road injuries, which are leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these and other available interventions are underutilized and point to where more attention is needed.

Subfields: Health, Pediatrics, Perinatology and Child Health, Public Health, Environmental and Occupational Health

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