%0 Journal Article %J JAMA Pediatr %D 2017 %T Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study. %A Kassebaum, Nicholas %A Kyu, Hmwe Hmwe %A Zoeckler, Leo %A Olsen, Helen Elizabeth %A Thomas, Katie %A Pinho, Christine %A Bhutta, Zulfiqar A %A Dandona, Lalit %A Ferrari, Alize %A Ghiwot, Tsegaye Tewelde %A Hay, Simon I %A Kinfu, Yohannes %A Liang, Xiaofeng %A Lopez, Alan %A Malta, Deborah Carvalho %A Mokdad, Ali H %A Naghavi, Mohsen %A Patton, George C %A Salomon, Joshua %A Sartorius, Benn %A Topor-Madry, Roman %A Vollset, Stein Emil %A Werdecker, Andrea %A Whiteford, Harvey A %A Abate, Kalkidan Hasen %A Abbas, Kaja %A Damtew, Solomon Abrha %A Ahmed, Muktar Beshir %A Akseer, Nadia %A Al-Raddadi, Rajaa %A Alemayohu, Mulubirhan Assefa %A Altirkawi, Khalid %A Abajobir, Amanuel Alemu %A Amare, Azmeraw T %A Antonio, Carl A T %A Arnlöv, Johan %A Artaman, Al %A Asayesh, Hamid %A Avokpaho, Euripide Frinel G Arthur %A Awasthi, Ashish %A Ayala Quintanilla, Beatriz Paulina %A Bacha, Umar %A Betsu, Balem Demtsu %A Barac, Aleksandra %A Bärnighausen, Till Winfried %A Baye, Estifanos %A Bedi, Neeraj %A Bensenor, Isabela M %A Berhane, Adugnaw %A Bernabe, Eduardo %A Bernal, Oscar Alberto %A Beyene, Addisu Shunu %A Biadgilign, Sibhatu %A Bikbov, Boris %A Boyce, Cheryl Anne %A Brazinova, Alexandra %A Hailu, Gessessew Bugssa %A Carter, Austin %A Castañeda-Orjuela, Carlos A %A Catalá-López, Ferrán %A Charlson, Fiona J %A Chitheer, Abdulaal A %A Choi, Jee-Young Jasmine %A Ciobanu, Liliana G %A Crump, John %A Dandona, Rakhi %A Dellavalle, Robert P %A Deribew, Amare %A deVeber, Gabrielle %A Dicker, Daniel %A Ding, Eric L %A Dubey, Manisha %A Endries, Amanuel Yesuf %A Erskine, Holly E %A Faraon, Emerito Jose Aquino %A Faro, Andre %A Farzadfar, Farshad %A Fernandes, Joao C %A Fijabi, Daniel Obadare %A Fitzmaurice, Christina %A Fleming, Thomas D %A Flor, Luisa Sorio %A Foreman, Kyle J %A Franklin, Richard C %A Fraser, Maya S %A Frostad, Joseph J %A Fullman, Nancy %A Gebregergs, Gebremedhin Berhe %A Gebru, Alemseged Aregay %A Geleijnse, Johanna M %A Gibney, Katherine B %A Gidey Yihdego, Mahari %A Ginawi, Ibrahim Abdelmageem Mohamed %A Gishu, Melkamu Dedefo %A Gizachew, Tessema Assefa %A Glaser, Elizabeth %A Gold, Audra L %A Goldberg, Ellen %A Gona, Philimon %A Goto, Atsushi %A Gugnani, Harish Chander %A Jiang, Guohong %A Gupta, Rajeev %A Tesfay, Fisaha Haile %A Hankey, Graeme J %A Havmoeller, Rasmus %A Hijar, Martha %A Horino, Masako %A Hosgood, H Dean %A Hu, Guoqing %A Jacobsen, Kathryn H %A Jakovljevic, Mihajlo B %A Jayaraman, Sudha P %A Jha, Vivekanand %A Jibat, Tariku %A Johnson, Catherine O %A Jonas, Jost %A Kasaeian, Amir %A Kawakami, Norito %A Keiyoro, Peter N %A Khalil, Ibrahim %A Khang, Young-Ho %A Khubchandani, Jagdish %A Ahmad Kiadaliri, Aliasghar A %A Kieling, Christian %A Kim, Daniel %A Kissoon, Niranjan %A Knibbs, Luke D %A Koyanagi, Ai %A Krohn, Kristopher J %A Kuate Defo, Barthelemy %A Kucuk Bicer, Burcu %A Kulikoff, Rachel %A Kumar, G Anil %A Lal, Dharmesh Kumar %A Lam, Hilton Y %A Larson, Heidi J %A Larsson, Anders %A Laryea, Dennis Odai %A Leung, Janni %A Lim, Stephen S %A Lo, Loon-Tzian %A Lo, Warren D %A Looker, Katharine J %A Lotufo, Paulo A %A Magdy Abd El Razek, Hassan %A Malekzadeh, Reza %A Markos Shifti, Desalegn %A Mazidi, Mohsen %A Meaney, Peter A %A Meles, Kidanu Gebremariam %A Memiah, Peter %A Mendoza, Walter %A Abera Mengistie, Mubarek %A Mengistu, Gebremichael Welday %A Mensah, George A %A Miller, Ted R %A Mock, Charles %A Mohammadi, Alireza %A Mohammed, Shafiu %A Monasta, Lorenzo %A Mueller, Ulrich %A Nagata, Chie %A Naheed, Aliya %A Nguyen, Grant %A Nguyen, Quyen Le %A Nsoesie, Elaine %A Oh, In-Hwan %A Okoro, Anselm %A Olusanya, Jacob Olusegun %A Olusanya, Bolajoko O %A Ortiz, Alberto %A Paudel, Deepak %A Pereira, David M %A Perico, Norberto %A Petzold, Max %A Phillips, Michael Robert %A Polanczyk, Guilherme V %A Pourmalek, Farshad %A Qorbani, Mostafa %A Rafay, Anwar %A Rahimi-Movaghar, Vafa %A Rahman, Mahfuzar %A Rai, Rajesh Kumar %A Ram, Usha %A Rankin, Zane %A Remuzzi, Giuseppe %A Renzaho, Andre M N %A Roba, Hirbo Shore %A Rojas-Rueda, David %A Ronfani, Luca %A Sagar, Rajesh %A Sanabria, Juan Ramon %A Kedir Mohammed, Muktar Sano %A Santos, Itamar S %A Satpathy, Maheswar %A Sawhney, Monika %A Schöttker, Ben %A Schwebel, David C %A Scott, James G %A Sepanlou, Sadaf G %A Shaheen, Amira %A Shaikh, Masood Ali %A She, June %A Shiri, Rahman %A Shiue, Ivy %A Sigfusdottir, Inga Dora %A Singh, Jasvinder %A Silpakit, Naris %A Smith, Alison %A Sreeramareddy, Chandrashekhar %A Stanaway, Jeffrey D %A Stein, Dan J %A Steiner, Caitlyn %A Sufiyan, Muawiyyah Babale %A Swaminathan, Soumya %A Tabarés-Seisdedos, Rafael %A Tabb, Karen M %A Tadese, Fentaw %A Tavakkoli, Mohammad %A Taye, Bineyam %A Teeple, Stephanie %A Tegegne, Teketo Kassaw %A Temam Shifa, Girma %A Terkawi, Abdullah Sulieman %A Thomas, Bernadette %A Thomson, Alan J %A Tobe-Gai, Ruoyan %A Tonelli, Marcello %A Tran, Bach Xuan %A Troeger, Christopher %A Ukwaja, Kingsley N %A Uthman, Olalekan %A Vasankari, Tommi %A Venketasubramanian, Narayanaswamy %A Vlassov, Vasiliy Victorovich %A Weiderpass, Elisabete %A Weintraub, Robert %A Gebrehiwot, Solomon Weldemariam %A Westerman, Ronny %A Williams, Hywel C %A Wolfe, Charles D A %A Woodbrook, Rachel %A Yano, Yuichiro %A Yonemoto, Naohiro %A Yoon, Seok-Jun %A Younis, Mustafa Z %A Yu, Chuanhua %A Zaki, Maysaa El Sayed %A Zegeye, Elias Asfaw %A Zuhlke, Liesl Joanna %A Murray, Christopher J L %A Vos, Theo %K Adolescent %K Adolescent Health %K Age Factors %K Cause of Death %K Child %K Child Health %K Child Mortality %K Disabled Children %K Female %K Global Burden of Disease %K Global Health %K Humans %K Male %K Pregnancy %K Pregnancy Complications %K Risk Factors %K Sex Factors %K Wounds and Injuries %X

Importance: Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health.

Objective: To quantify and describe levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion.

Evidence Review: Cause-specific mortality and nonfatal health outcomes were analyzed for 195 countries and territories by age group, sex, and year from 1990 to 2015 using standardized approaches for data processing and statistical modeling, with subsequent analysis of the findings to describe levels and trends across geography and time among children and adolescents 19 years or younger. A composite indicator of income, education, and fertility was developed (Socio-demographic Index [SDI]) for each geographic unit and year, which evaluates the historical association between SDI and health loss.

Findings: Global child and adolescent mortality decreased from 14.18 million (95% uncertainty interval [UI], 14.09 million to 14.28 million) deaths in 1990 to 7.26 million (95% UI, 7.14 million to 7.39 million) deaths in 2015, but progress has been unevenly distributed. Countries with a lower SDI had a larger proportion of mortality burden (75%) in 2015 than was the case in 1990 (61%). Most deaths in 2015 occurred in South Asia and sub-Saharan Africa. Global trends were driven by reductions in mortality owing to infectious, nutritional, and neonatal disorders, which in the aggregate led to a relative increase in the importance of noncommunicable diseases and injuries in explaining global disease burden. The absolute burden of disability in children and adolescents increased 4.3% (95% UI, 3.1%-5.6%) from 1990 to 2015, with much of the increase owing to population growth and improved survival for children and adolescents to older ages. Other than infectious conditions, many top causes of disability are associated with long-term sequelae of conditions present at birth (eg, neonatal disorders, congenital birth defects, and hemoglobinopathies) and complications of a variety of infections and nutritional deficiencies. Anemia, developmental intellectual disability, hearing loss, epilepsy, and vision loss are important contributors to childhood disability that can arise from multiple causes. Maternal and reproductive health remains a key cause of disease burden in adolescent females, especially in lower-SDI countries. In low-SDI countries, mortality is the primary driver of health loss for children and adolescents, whereas disability predominates in higher-SDI locations; the specific pattern of epidemiological transition varies across diseases and injuries.

Conclusions and Relevance: Consistent international attention and investment have led to sustained improvements in causes of health loss among children and adolescents in many countries, although progress has been uneven. The persistence of infectious diseases in some countries, coupled with ongoing epidemiologic transition to injuries and noncommunicable diseases, require all countries to carefully evaluate and implement appropriate strategies to maximize the health of their children and adolescents and for the international community to carefully consider which elements of child and adolescent health should be monitored.

%B JAMA Pediatr %V 171 %P 573-592 %8 2017 Jun 01 %G eng %N 6 %1 http://www.ncbi.nlm.nih.gov/pubmed/28384795?dopt=Abstract %R 10.1001/jamapediatrics.2017.0250 %0 Journal Article %J Lancet %D 2015 %T Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. %A Forouzanfar, Mohammad H %A Alexander, Lily %A Anderson, H Ross %A Bachman, Victoria F %A Biryukov, Stan %A Brauer, Michael %A Burnett, Richard %A Casey, Daniel %A Coates, Matthew M %A Cohen, Aaron %A Delwiche, Kristen %A Estep, Kara %A Frostad, Joseph J %A Astha, K C %A Kyu, Hmwe H %A Moradi-Lakeh, Maziar %A Ng, Marie %A Slepak, Erica Leigh %A Thomas, Bernadette A %A Wagner, Joseph %A Aasvang, Gunn Marit %A Abbafati, Cristiana %A Abbasoglu Ozgoren, Ayse %A Abd-Allah, Foad %A Abera, Semaw F %A Aboyans, Victor %A Abraham, Biju %A Abraham, Jerry Puthenpurakal %A Abubakar, Ibrahim %A Abu-Rmeileh, Niveen M E %A Aburto, Tania C %A Achoki, Tom %A Adelekan, Ademola %A Adofo, Koranteng %A Adou, Arsène K %A Adsuar, José C %A Afshin, Ashkan %A Agardh, Emilie E %A Al Khabouri, Mazin J %A Al Lami, Faris H %A Alam, Sayed Saidul %A Alasfoor, Deena %A Albittar, Mohammed I %A Alegretti, Miguel A %A Aleman, Alicia V %A Alemu, Zewdie A %A Alfonso-Cristancho, Rafael %A Alhabib, Samia %A Ali, Raghib %A Ali, Mohammed K %A Alla, François %A Allebeck, Peter %A Allen, Peter J %A Alsharif, Ubai %A Alvarez, Elena %A Alvis-Guzmán, Nelson %A Amankwaa, Adansi A %A Amare, Azmeraw T %A Ameh, Emmanuel A %A Ameli, Omid %A Amini, Heresh %A Ammar, Walid %A Anderson, Benjamin O %A Antonio, Carl Abelardo T %A Anwari, Palwasha %A Argeseanu Cunningham, Solveig %A Arnlöv, Johan %A Arsenijevic, Valentina S Arsic %A Artaman, Al %A Asghar, Rana J %A Assadi, Reza %A Atkins, Lydia S %A Atkinson, Charles %A Avila, Marco A %A Awuah, Baffour %A Badawi, Alaa %A Bahit, 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R %A Lopez, Alan D %A Vos, Theo %A Murray, Christopher J %X

BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution.

METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol.

FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa.

INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks.

FUNDING: Bill & Melinda Gates Foundation.

%B Lancet %V 386 %P 2287-323 %8 2015 Dec 5 %G eng %N 10010 %1 http://www.ncbi.nlm.nih.gov/pubmed/26364544?dopt=Abstract %R 10.1016/S0140-6736(15)00128-2