Global, regional, and national mortality trends in older children and young adolescents (5-14 years) from 1990 to 2016: an analysis of empirical data

Abstract

Background: From 1990 to 2016, the mortality of children younger than 5 years decreased by more than half, and there are plentiful data regarding mortality in this age group through which we can track global progress in reducing the under-5 mortality rate. By contrast, little is known on how the mortality risk among older children (5-9 years) and young adolescents (10-14 years) has changed in this time. We aimed to estimate levels and trends in mortality of children aged 5-14 years in 195 countries from 1990 to 2016.

Methods: In this analysis of empirical data, we expanded the United Nations Inter-agency Group for Child Mortality Estimation database containing data on children younger than 5 years with 5530 data points regarding children aged 5-14 years. Mortality rates from 1990 to 2016 were obtained from nationally representative birth histories, data on household deaths reported in population censuses, and nationwide systems of civil registration and vital statistics. These data were used in a Bayesian B-spline bias-reduction model to generate smoothed trends with 90% uncertainty intervals, to determine the probability of a child aged 5 years dying before reaching age 15 years.

Findings: Globally, the probability of a child dying between the ages 5 years and 15 years was 7·5 deaths (90% uncertainty interval 7·2-8·3) per 1000 children in 2016, which was less than a fifth of the risk of dying between birth and age 5 years, which was 41 deaths (39-44) per 1000 children. The mortality risk in children aged 5-14 years decreased by 51% (46-54) between 1990 and 2016, despite not being specifically targeted by health interventions. The annual number of deaths in this age group decreased from 1·7 million (1·7 million-1·8 million) to 1 million (0·9 million-1·1 million) in 1990-2016. In 1990-2000, mortality rates in children aged 5-14 years decreased faster than among children aged 0-4 years. However, since 2000, mortality rates in children younger than 5 years have decreased faster than mortality rates in children aged 5-14 years. The annual rate of reduction in mortality among children younger than 5 years has been 4·0% (3·6-4·3) since 2000, versus 2·7% (2·3-3·0) in children aged 5-14 years. Older children and young adolescents in sub-Saharan Africa are disproportionately more likely to die than those in other regions; 55% (51-58) of deaths of children of this age occur in sub-Saharan Africa, despite having only 21% of the global population of children aged 5-14 years. In 2016, 98% (98-99) of all deaths of children aged 5-14 years occurred in low-income and middle-income countries, and seven countries alone accounted for more than half of the total number of deaths of these children.

Interpretation: Increased efforts are required to accelerate reductions in mortality among older children and to ensure that they benefit from health policies and interventions as much as younger children.

Funding: UN Children's Fund, Bill & Melinda Gates Foundation, United States Agency for International Development.

Figure 1

Probability of dying among children aged 5–14 years in 2016

Figure 2

Regional trends in the probability of a child aged 5 years dying between ages 5 years and 15 years and the numbers of deaths in children aged 5–14 years, from 1990 to 2016 Data are number of deaths (thousands) and probability (₁₀q₅) of dying per 1000 children, with 90% uncertainty intervals.

Figure 3

Probability of a child aged 5 years dying between ages 5 years and 10 years or 10 years and 15 years in 1990 and 2016 ₅q₅ is the probability of dying between ages 5 years and 10 years, and ₅q₁₀ is the probability of dying between ages 10 years and 15 years. Both are expressed per 1000 children alive, stratified by country. Each bubble represents a country. The size of bubbles represents the number of deaths in each year. Countries for which the B3 model was not used are not shown.

Figure 4

Probability of a child dying younger than 5 years and of a child aged 5 years dying between ages 5 years and 15 years in 1990 and 2016 ₅q₀ is the probability of dying between ages 0 years and 5 years, and ₁₀q₅ is the probability of dying between ages 5 years and 15 years. Both are expressed per 1000 children, stratified by country. Each bubble represents a country. The size of bubbles represents the number of deaths in each year. Countries for which the B3 model was not used are not shown. The solid lines represent the ₁₀q₅ to ₅q₁₀ ratio expected from three different model life tables from the Coale-Demeny system.

Figure 5

Comparison of the annual rate of reduction in ₅q₀ and ₁₀q₅ in 1990–2000 and 2000–16, by region ₅q₀ is the probability of dying before age 5 years, and ₁₀q₅ is the probability of dying between ages 5 years and 15 years.