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.
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.
复制标题
DOI：
10.1016/s0140-6736(21)01546-4
复制
发表时间：
2021-10-30
期刊：
影响因子：
--
通讯作者：
GBD 2019 Adolescent Mortality Collaborators
中科院分区：
文献类型：
--
作者：
GBD 2019 Adolescent Mortality Collaborators
记录青年死亡率的模式和长期趋势，反映了青少年健康的人口和社会决定因素的巨大变化，有助于确定这一年龄组的全球投资优先事项。我们的目标是利用2019年全球疾病、伤害和风险因素负担研究(GBD)的估计数据，分析从1950年到2019年204个国家和地区10-24岁人口的死亡人数、寿命损失年数和按性别和年龄组划分的死亡率。我们报告了1950年至2019年期间和1980年至2019年期间按年龄组(10-14岁、15-19岁和20-24岁)和性别划分的204个国家和地区所有死因的估计总死亡人数和每10万 000人口死亡率的趋势。我们按地区、年龄组和性别分析结果的差异，并比较从1990年到2019年10-24岁年轻人和0-9岁儿童死亡率的年变化率。然后，我们使用GBD社会人口指数(SDI)分析了10-24岁人口死亡率与社会经济发展之间的关系，SDI是基于15岁以上人口的平均国民教育程度、25岁以下人口的总生育率和人均收入的综合衡量标准。我们评估了SDI与2019年全因死亡率之间的关联，并使用最新发布的可用数据(2017)分析了SDI观察到的死亡率与预期死亡率的比率。2019年，全球10-24岁人群中有149万人死亡(95%的不确定区间1·39-1·59)，其中61%为男性。32.7%的青少年死亡是由于交通伤害、意外伤害或人际暴力和冲突；32.1%是由于传染病、营养或母体原因；27.0%是因为非传染性疾病；8.2%是由于自我伤害。自1950年以来，这一年龄段的死亡率女性下降了30.0%，男性下降了15.3%，在世界大多数地区，基于性别的死亡率差异越来越大。地域差异也在增加，特别是在10-14岁的人群中。自1980年以来，在大多数GBD超区域，传染病和孕产妇死因占总死亡人数的比例大幅下降，但在撒哈拉以南非洲和南亚仍然是最常见的死因，超过一半的青少年死亡发生在这些地区。自1990年以来，15-19岁青少年全因死亡率每年下降的百分比男性为1.3%，女性为1.6%，几乎是1-4岁男性(2.4%)的一半，比1-4岁女性(2.5%)低约三分之一。从1950年到2019年，全球0-24岁人口中发生在10-24岁人口中的死亡比例翻了一番多，从9.5%上升到21.6%。由于在减少男性和大龄青少年死亡方面进展缓慢，各国之间和按性别划分的青少年死亡率差异正在扩大。改善全球青少年死亡率将需要采取行动来解决这一年龄段的具体脆弱性，而这些脆弱性正被忽视。此外，新冠肺炎大流行的间接影响可能危及改善健康结果的努力，包括10-24岁年轻人的死亡率。迫切需要对不断变化的全球青少年死亡率负担作出反应，解决发生不平等现象的问题，并提高这一年龄段初级死亡率数据的可得性和质量。比尔和梅琳达·盖茨基金会。
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. 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). 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%. 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. Bill & Melinda Gates Foundation.