Global burden of all cause-specific injuries among children and adolescents from 1990 to 2019: a prospective cohort study

Abstract

Background: To assess the burden and change in incidence, death, and disability-adjusted life years (DALYs) for all-cause-specific injuries among children and adolescents in 204 countries and territories between 1990 and 2019.

Materials and methods: Data were extracted from the Global Burden of Disease, Injury, and Risk Factor Study 2019 (GBD 2019). Global, regional, and country-level age-standardized rate (per 100 000) of incidence (ASRI), mortality (ASRM), and DALYs (ASRD) with 95% uncertainty interval (95% UI) of injuries were estimated by age, sex, socio-demographic index (SDI), and all-cause-specific injuries from 1990 to 2019.

Results: Overall, the ASRI, ASRM, and ASRD of injury were 9006.18 (95% UI: 7459.74-10 918.04), 23.04 (20.00-26.50), and 2020.19 (1759.47-2318.64) among children and adolescents worldwide in 2019, respectively. All the above indicators showed a downward trend from 1990 to 2019. In level 2 cause of injury, both the global transport injury and unintentional injury declined during the study years, while self-harm and interpersonal violence-related injury showed an increasing trend. High SDI regions had higher ASRI of injuries, but low SDI regions had higher ASRM and ASRD of injuries globally in 2019. Males had a higher burden of injuries than those in females. The ASRI of injuries is higher in adolescents aged 15-19 years, whereas the mortality and DALYs rate are higher among children under 5 years old. Moreover, adolescents aged 15-19 years and individuals living in Central Asia, Middle East, and Africa had higher ASRI, ASRM, and ASRD of injuries owing to self-harm and interpersonal violence. Generally, falls and road traffic injuries are the leading cause of injury among the population aged 0-19 years worldwide, but self-harm, interpersonal violence, and conflict and terrorism are also leading types of injuries in some regions, particularly in Low-Income Countries and Middle-Income Countries.

Conclusions: Injury remains a major global public health problem among children and adolescents, although its burden at the worldwide level showed a decreasing trend from 1990 to 2019. Of concern, the burden of injuries caused by transport injuries, and unintentional injuries has shown a downward trend in most countries, while the burden caused by self-harm and interpersonal violence has shown an upward trend in most countries. These findings suggest that more targeted and specific strategies to prevent the burden of injuries should be reoriented, and our study provides important findings for decision-makers and healthcare providers to reduce injury burden among children and adolescents.

Figure 1

Age-standardised incidence (A, D), mortality (B, E) and DALYs (C, F) rate of level 2 cause of injuries among children and adolescents in 1990 (A–C) and 2019 (D–F) among GBD regions.

Figure 2

The rank of level 3 cause of injuries for age- standardised rate of incidence (A), mortality (B) and DALYs (C) among children and adolescents by regions in 2019.

Figure 3

Percentage incidence (A, D), mortality (B, E) and DALYs (C, F) rate of level 2 cause of injuries among children and adolescents in 1990 (A–C) and 2019 (D–F) among GBD regions. DALYs, disability-adjusted life years.

Figure 4

Pyramid figure with incidence (A), mortality (B) and DALYs (C) rate by sex, age and level 3 cause of injuries among children and adolescents between 1990 and 2019.

Figure 5

The age-standardised rate of incidence (A), mortality (B) and DALYs (C) of injuries among children and adolescents in 2019, and AAPC of incidence (D), mortality (E) and DALYs (F) of injuries among children and adolescents from 1990 to 2019 in 204 countries and territories.