Global, regional, and national mortality among young people aged 10-24 years, 1950-2019: a systematic analysis for the Global Burden of Disease Study 2019
- PMID: 34755628
- PMCID: PMC8576274
- DOI: 10.1016/S0140-6736(21)01546-4
Global, regional, and national mortality among young people aged 10-24 years, 1950-2019: a systematic analysis for the Global Burden of Disease Study 2019
Erratum in
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Department of Error.Lancet. 2022 Feb 26;399(10327):802. doi: 10.1016/S0140-6736(22)00320-8. Lancet. 2022. PMID: 35219394 Free PMC article. No abstract available.
Abstract
Background: Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10-24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.
Methods: We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10-24 years by age group (10-14 years, 15-19 years, and 20-24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10-24 years with that in children aged 0-9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10-24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017).
Findings: In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39-1·59) worldwide in people aged 10-24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10-14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15-19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1-4 years (2·4%), and around a third less than in females aged 1-4 years (2·5%). The proportion of global deaths in people aged 0-24 years that occurred in people aged 10-24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%.
Interpretation: Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10-24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group.
Funding: Bill & Melinda Gates Foundation.
Copyright © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.
Conflict of interest statement
Declaration of interests R Ancuceanu reports consulting fees from AbbVie and AstraZeneca; payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing or educational events from Sandoz, AbbVie, and B Braun; and support for attending meetings and/or travel from AbbVie and AstraZeneca, all outside the submitted work. J Ärnlöv reports payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing or educational events from AstraZeneca and Novartis; and payment for expert testimony from AstraZeneca and Boehringer Ingelheim, all outside the submitted work. M Ausloos reports grants or contracts from Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084, outside the submitted work. T Bärnighausen reports research grants from the European Union (Horizon 2020 and EIT Health), German Research Foundation (DFG), US National Institutes of Health, German Ministry of Education and Research, Alexander von Humboldt Foundation, Else-Kröner-Fresenius-Foundation, Wellcome Trust, Bill & Melinda Gates Foundation, KfW, UNAIDS, and WHO; consulting fees for KfW on the OSCAR initiative in Vietnam; and participation on a Data Safety Monitoring Board or Advisory Board through the NIH-funded study “Healthy Options” (PIs: Smith Fawzi, Kaaya), Chair, Data Safety and Monitoring Board (DSMB), German National Committee on the “Future of Public Health Research and Education”, Chair of the scientific advisory board to the EDCTP Evaluation, Member of the UNAIDS Evaluation Expert Advisory Committee, National Institutes of Health Study Section Member on Population and Public Health Approaches to HIV/AIDS (PPAH), US National Academies of Sciences, Engineering, and Medicine's Committee for the “Evaluation of Human Resources for Health in the Republic of Rwanda under the President's Emergency Plan for AIDS Relief (PEPFAR)”, University of Pennsylvania (UPenn) Population Aging Research Center (PARC) External Advisory Board Member; and Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as Co-chair of the Global Health Hub Germany (which was initiated by the German Ministry of Health), all outside the submitted work. M Bell reports research funding and payments to institution from Wellcome Trust, NIH, Yale Climate Change and Health Center, Robert Wood Johnson Foundation, Yale Women Faculty Forum, EPA, and High Tide Foundation; honorarium for proposal review from NIH and Johns Hopkins University; honorarium from mentoring program from University of Montana; and travel expenses to give seminars from University of Illinois at Champaign, Johns Hopkins University, Ohio State University, Royal Society London, Atmospheric Chemistry Gordon Research Conference, New York School of Medicine, and Global Research Laboratory (Seoul), Seoul National University, all outside the submitted work. Z Bhutta reports grants or contracts from the Bill & Melinda Gates foundation, outside the submitted work. I Filip reports financial support from Avicenna Medical and Clinical Research Institute, outside the submitted work. B Hall reports stocks that are unrelated to the paper, outside the submitted work. G Hankey reports consulting fees from Bayer for stroke prevention advisory boards; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the American Heart Association, Medscape, and Bristol Myers Squibb; and participation on a Data Safety Monitoring Board or Advisory Board with AC Immune, all outside the submitted work. C Herteliu reports grants or contracts from Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084, research grant (Oct 2018–Sept 2022) “Understanding and modelling time-space patterns of psychology-related inequalities and polarization”, and project number PN-III-P2-2.1-SOL-2020-2-0351, research grant (June 2021–Oct 2021) “Approaches within public health management in the context of COVID-19 pandemic”, and from the Ministry of Labour and Social Justice Romania, project number 30/PSCD/2018, research grant (Sept 2018–June 2019) “Agenda for skills Romania 2020–2025”, all outside the submitted work. S Islam reports grants or contracts from NHMRC and National Heart Foundation of Australia Fellowships, outside the submitted work. R Ivers reports support for the present manuscript from the National Health and Medical Research Council of NSW through salary funding via a senior research fellowship. V Jha reports grants or contracts from GSK, Baxter Healthcare, and AstraZeneca, outside the submitted work. J Jozwiak reports payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing or educational events from Teva, Amgen, Synexus, Boehringer Ingelheim, ALAB Laboratories, and Zentiva, all outside the submitted work. C Kieling reports grants or contracts from MQ: Transforming Mental Health, UK Academy of Medical Sciences, UK Royal Academy of Engineering, and US National Institute of Mental Health; and royalties or licences from Manole, outside the submitted work. K Krishan reports non-financial support from UGC Centre of Advanced Study, CAS II, Department of Anthropology, Panjab University, Chandigarh, India, outside the submitted work. S Lorkowski reports grants or contracts from Akcea Therapeutics Germany; consulting fees from Danone, Swedish Orphan Biovitrum (SOBI), and Upfield; payment or honoraria for lectures, presentations, speaker's bureaus, manuscript writing or educational events from Akcea Therapeutics Germany, AMARIN Germany, Amedes Holding, AMGEN, Berlin-Chemie, Boehringer Ingelheim Pharma, Daiichi Sankyo Deutschland, Danone, Hubert Burda Media Holding, Lilly Deutschland, Novo Nordisk Pharma, Roche Pharma, Sanofi-Aventis, SYNLAB Holding Deutschland & SYNLAB Akademie; participation on a Data Safety Monitoring Board or Advisory Board with Akcea Therapeutics Germany, AMGEN, Daiichi Sankyo Deutschland, and Sanofi-Aventis, all outside the submitted work. R Maddison reports grants or contracts from NHMRC Ideas Grant and National Heart Foundation of Australia Vanguard Grant, outside the submitted work. M Mahmoudi reports placement as a co-founder and director of the Academic Parity Movement, a non-profit organisation dedicated to addressing academic discrimination, violence and incivility; and receives royalties/honoraria for his published books, plenary lectures, and licensed patents, outside the submitted work. S Nomura reports grant support for the present manuscript from the Ministry of Education, Culture, Sports, Science and Technology (MEXT). C Nowak reports employment with Diamyd Medical AB (Stockholm, Sweden) which develops a treatment for type 1 diabetes, outside the submitted work. A Ortiz reports grants or contracts from Sanofi, Mundipharma, and AstraZeneca; and payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Astellas, Astrazeneca, Amicus, Amgen, Fresenius Medical Care, Bayer, Sanofi-Genzyme, Menarini, Kyowa Kirin, Alexion, Otsuka and Vifor Fresenius Medical Care Renal Pharma. C Panelo reports grants or contracts from USAID Philippines as Chief of Party of USAID's ProtectHealth, a financing policy support project assisting the Philippine Government in implementing universal health care with focus on tuberculosis, family planning and HIV, outside the submitted work. M Postma reports leadership or fiduciary role in other board, society, committee or advocacy group, unpaid as member of UK's JCVI. A Radfar reports financial support from Avicenna Medical and Clinical Research Institute. P Sachdev reports an investigator grant from the National Health and Medical Research Council of Australia, paid to the University; participation on a Data Safety Monitoring Board or Advisory Board with the Advisory Committee for Biogen Australia; and leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as honorary director of International Neuropsychiatric Association and executive member of VASCOG; outside the submitted work. J Singh reports consulting fees from Crealta/Horizon, Medisys, Fidia, Two labs Inc, Adept Field Solutions, Clinical Care options, Clearview healthcare partners, Putnam associates, Focus forward, Navigant consulting, Spherix, MedIQ, UBM LLC, Trio Health, Medscape, WebMD, and Practice Point communications; and the National Institutes of Health and the American College of Rheumatology; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Simply Speaking; support for attending meetings and/or travel from OMERACT, an international organisation that develops measures for clinical trials and receives arm's length funding from 12 pharmaceutical companies, when traveling bi-annually to OMERACT meetings; participation on a Data Safety Monitoring Board or Advisory Board as a member of the FDA Arthritis Advisory Committee; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with OMERACT as a member of the steering committee, with the Veterans Affairs Rheumatology Field Advisory Committee as a member, and with the UAB Cochrane Musculoskeletal Group Satellite Center on Network Meta-analysis as a director and editor; and stock or stock options in TPT Global Tech, Vaxart pharmaceuticals, Charlotte's Web Holdings Inc and previously owned stock options in Amarin, Viking, and Moderna pharmaceuticals, all outside the submitted work. H Slater reports grants or contracts awarded for co-developing a digital platform with young people with musculoskeletal pain to support their care from the Washington Department of Health, 2018–2021. D Stein reports personal fees from Lundbeck, Takeda, Johnson & Johnson and Servier, all outside the submitted work. M Stokes reports payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from the Autism Teaching Institute; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as Vice President of Kidsafe Victoria and Board Member of Australasian Society for Autism Research, all outside the submitted work. S Tadakamadla reports grants or contracts from National Health and Medical Research Council, Australia, Early Career Fellowship. A Tsai reports stipend for work as Editor-in-Chief of Social Science and Medicine: Mental Health from Elsevier, Inc. R Uddin is supported by an Alfred Deakin Postdoctoral Research Fellowship, Deakin University, Australia and reports support for attending meetings and/or travel accommodation reimbursement from Deakin University Institute for Physical Activity and Nutrition, all outside of the submitted work. All other authors declare no competing interests.
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References
-
- Patton GC, Coffey C, Sawyer SM. Global patterns of mortality in young people: a systematic analysis of population health data. Lancet. 2009;374:881–892. - PubMed
-
- Patton GC, Olsson CA, Skirbekk V. Adolescence and the next generation. Nature. 2018;554:458–466. - PubMed
-
- UN . United Nations; New York, NY: 2015. Survive, thrive, transform. The Global Strategy for Women's, Children's and Adolescent's Health.
