Child and adolescent deaths decreased by half worldwide since 1990

 
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April 29, 2019

Child and adolescent deaths have decreased 51.7% worldwide from 1990 to 2017. But inequality between poor and rich countries has increased, with wealthier nations accounting for an increasingly smaller proportion of deaths overall, according to new research in JAMA Pediatrics.

“Childhood and adolescence are vulnerable periods and a crucial window for adult health determination,” the authors write. “While improvements in the mortality rate of children younger than 5 years (the population often called under-5) have been undeniably dramatic and positive, the full story of child and adolescent health is more nuanced and heterogeneous, with a notably broader range of characteristics than can be told with a single summary statistic.”

To home in on more detailed information about child and adolescent health, this study looks at data collected between 1990 and 2017 on those under the age of 20 living in 195 countries and territories. The researchers compiled data from thousands of sources, which they have made accessible to the public through the Global Health Data Exchange.

The authors note the limitation that data availability poses on their analysis. Estimates might be out-of-date due to time lags in reporting data; estimates might not be accurate for countries in conflict, like Syria, Iraq and South Sudan, which might suffer “data deficiencies.”

The researchers were interested in changes in mortality rates over time, as well as trends in nonfatal illness and disability. They analyzed at 359 diseases and injuries as causes of death and disability.

Here’s what they found:

  • In 1990, there were 13.77 million child and adolescent deaths. In 2017 there were 6.64 million.
  • Over half of all child and adolescent deaths — 60.1% — occurred in babies less than one year old. Nearly half of these infants — 46.6% — were less than one week old.
  • During the period studied, deaths decreased most rapidly for children between the ages of 1 and 4. This age group had a 61% reduction in premature mortality.
  • In less-developed regions, decreases in deaths were attributed mostly to reductions in mortality due to infectious diseases, neonatal disorders and unintentional injuries. The authors write that these decreases are linked to gains in development and “improvements in vaccination, early childhood nutrition, sanitation, clean water, and targeted interventions for HIV/AIDS and malaria.”
  • In more-developed regions, mortality decreased primarily because of reductions in mortality due to non-communicable diseases, such as birth defects and blood disorders.
  • While the largest absolute declines in mortality occurred in African, low- and low-middle income countries still had relatively higher percentages of the global share of premature mortality — 82.2% of deaths in 2017, an increase from 70.9% in 1990.
  • Overall, the countries that had the greatest improvements in child and adolescent mortality also had the greatest improvements in maternal mortality, too.
  • However, eight countries had divergent trends between maternal mortality and child and adolescent health. American Samoa, Canada, Greece, Jamaica, St. Vincent and the Grenadines, the United States and Zimbabwe had increases in maternal mortality and decreases in child and adolescent mortality and disability rates.
  • Total disability-adjusted life years (DALYs), which are the sum of years lived with a disability and years of life lost due to premature mortality, decreased by 46% from 1.31 billion in 1990 to 709 million in 2017.
  • Globally, the top ten contributors to premature death and disability were anemia, neonatal disorders, lower respiratory infection, diarrhea, congenital birth defects, malaria, meningitis, road injuries, malnutrition and HIV/AIDS.
  • In total, disability rates increased 4.7% from 1990 to 2017. The authors explain that the decline in premature mortality, coupled with the increase in years lived with a disability show that global health trends are shifting towards nonfatal health issues.

“Continued monitoring of the drivers of child and adolescent health loss is crucial to sustain the progress of the past 26 years,” the authors conclude. “Only then will we be able to accelerate progress to 2030 and beyond.”

 

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Citation: GBD 2017 Child and Adolescent Health Collaborators. "Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study," JAMA Pediatrics, April 2019. doi: 10.1001/jamapediatrics.2019.0337.