Trends in US Children's Mortality, Chronic Conditions, Obesity, Functional Status, and Symptoms

Abstract

Importance: Recent scientific and policy statements suggest that child health may be worsening in the US.

Objective: To determine how US children's health has been changing from 2007 to 2023 using multiple data collection methods and a comprehensive set of health indicators.

Design, setting, and participants: Repeated, cross-sectional analyses using mortality statistics from the US and 18 comparator high-income nations from the Organisation for Economic Co-operation and Development (OECD18), 5 nationally representative surveys, and electronic health records from 10 pediatric health systems (PEDSnet). The populations included individuals younger than 20 years old. Unweighted denominator sample size ranges were 1623 to 95 677 across the surveys, 1 026 926 to 2 114 638 for PEDSnet, 81.9 million to 83.2 million in the US, and 118.4 million to 121.1 million in the OECD18 for mortality statistics.

Exposure: Calendar time.

Main outcomes and measures: Rate ratios (RRs) and annual incidence for mortality and prevalence for chronic physical, developmental, and mental health conditions, functional status, and symptoms.

Results: From 2007 to 2022, infants (<1 year old) were 1.78 (95% CI, 1.78-1.79) and 1- to 19-year-old individuals were 1.80 (95% CI, 1.80-1.80) times more likely to die in the US than in the OECD18. The 2 causes of death with the largest net difference between the US and OECD18 were prematurity (RR, 2.22 [95% CI, 2.20-2.24]) and sudden unexpected infant death (RR, 2.39 [95% CI, 2.35-2.43]) for infants 12 months or younger, and firearm-related incidents (RR, 15.34 [95% CI, 14.89-15.80]) and motor vehicle crashes (RR, 2.45 [95% CI, 2.42-2.48]) for 1- to 19-year-old individuals. From 2011 to 2023, the prevalence of 3- to 17-year-old individuals with a chronic condition rose from 39.9% to 45.7% (RR, 1.15 [95% CI, 1.14-1.15]) within PEDSnet, and from 25.8% to 31.0% (RR, 1.20 [95% CI, 1.20-1.20]) within the general population. Rates of obesity, early onset of menstruation, trouble sleeping, limitations in activity, physical symptoms, depressive symptoms, and loneliness all increased during the study period.

Conclusions and relevance: The health of US children has worsened across a wide range of health indicator domains over the past 17 years. The broad scope of this deterioration highlights the need to identify and address the root causes of this fundamental decline in the nation's health.