National, regional, and global causes of mortality in 5-19-year-olds from 2000 to 2019: a systematic analysis.
National, regional, and global causes of mortality in 5-19-year-olds from 2000 to 2019: a systematic analysis.
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DOI：
10.1016/s2214-109x(21)00566-0
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发表时间：
2022-03
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影响因子：
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通讯作者：
Black RE
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作者：
Liu L;Villavicencio F;Yeung D;Perin J;Lopez G;Strong KL;Black RE
对年龄较大的儿童和青少年（5-19岁）的生存进行投资，将为现在、他们的未来和下一代带来三重红利。然而，2019年全球该年龄组有150万人死亡，几乎全部死于可预防的原因。为了使国际社会更好地集中注意改善儿童和青少年的生存，并指导有效的政策和方案，可靠和及时的死因数据至关重要，但往往很少。在这一系统分析中，我们提供了2000- 2019年国家、地区和全球5-19岁儿童死亡原因估计的最新时间序列，并按年龄-性别分列。我们根据数据可用性分别估计了高死亡率国家和低死亡率国家以及四个年龄性别组（5-9岁[男女]，10-14岁[男女]，15-19岁女性和15-19岁男性）。只有报告至少两种死亡原因的研究才被纳入我们的分析。我们通过系统性回顾、已知研究者追踪和获取已知国家和次国家死因研究获得了经验性死因数据。我们采用贝叶斯最小绝对收缩和选择算子方法来解决数据稀缺问题，增强协变量选择，产生更稳健的估计，提供更高的灵活性，允许国家随机效应，传播相干不确定性，并提高模型稳定性。我们与联合国儿童死亡率估算机构间小组协调了全因死亡率估算，并根据需要系统地整合了世卫组织和联合国艾滋病规划署的单因估算。2019年，全球主要具体死亡原因是道路交通伤害（115 843例[9 - 5%不确定区间110 672-125 054]死亡; 7.8%[7.5 - 8.1]）;肿瘤（9 - 5 401 [90 744-104 812]; 6.4%[6.1 - 6.8]）;疟疾（81 516 [72 150-94 477]; 5.5%[4.9 - 6.2]）;溺水（77 460 [72 474-85 952]; 5.2%[4.9 - 5.5]）;腹泻（72 679 [66 599-82 002]，4.9%[4.5 - 5.3]）。 各区域的主要原因差别很大。随着年龄的增长，传染病、孕产妇、围产期和营养状况的贡献下降，而与伤害有关的死亡人数增加。主要死因是腹泻（51 630 [47 206-56 235]例死亡; 10.0%[9.5 - 10.5]）5-9岁儿童;疟疾（31 587 [23 940-43 116]; 8.6%[6.6 - 10.4]），10-14岁;自残（32 646 [29 530-36 416]; 13.4%[12.6 - 14.3]）;道路交通伤害（48 757 [45 692-52 625]; 13·9% [13·3-14·3]），15-19岁男性。 据估计，2000- 2019年，各年龄性别组和地区的死因死亡率普遍下降，只有少数例外，如集体暴力。儿童和青少年的生存需要得到重点关注。为了将这一愿景转化为行动，需要对死因保健信息基础设施和相关救生干预措施进行更多投资。比尔及梅林达·盖茨基金会和世卫组织。
Investments in the survival of older children and adolescents (aged 5–19 years) bring triple dividends for now, their future, and the next generation. However, 1·5 million deaths occurred in this age group globally in 2019, nearly all from preventable causes. To better focus the attention of the global community on improving survival of children and adolescents and to guide effective policy and programmes, sound and timely cause of death data are crucial, but often scarce. In this systematic analysis, we provide updated time-series for 2000–19 of national, regional, and global cause of death estimates for 5–19-year-olds with age-sex disaggregation. We estimated separately for countries with high versus low mortality, by data availability, and for four age-sex groups (5–9-year-olds [both sexes], 10–14-year-olds [both sexes], 15–19-year-old females, and 15–19-year-old males). Only studies reporting at least two causes of death were included in our analysis. We obtained empirical cause of death data through systematic review, known investigator tracing, and acquisition of known national and subnational cause of death studies. We adapted the Bayesian Least Absolute Shrinkage and Selection Operator approach to address data scarcity, enhance covariate selection, produce more robust estimates, offer increased flexibility, allow country random effects, propagate coherent uncertainty, and improve model stability. We harmonised all-cause mortality estimates with the UN Inter-agency Group for Child Mortality Estimation and systematically integrated single cause estimates as needed from WHO and UNAIDS. In 2019, the global leading specific causes of death were road traffic injuries (115 843 [95% uncertainty interval 110 672–125 054] deaths; 7·8% [7·5–8·1]); neoplasms (95 401 [90 744–104 812]; 6·4% [6·1–6·8]); malaria (81 516 [72 150–94 477]; 5·5% [4·9–6·2]); drowning (77 460 [72 474–85 952]; 5·2% [4·9–5·5]); and diarrhoea (72 679 [66 599–82 002], 4·9% [4·5–5·3]). The leading causes varied substantially across regions. The contribution of communicable, maternal, perinatal, and nutritional conditions declined with age, whereas the number of deaths associated with injuries increased. The leading causes of death were diarrhoea (51 630 [47 206–56 235] deaths; 10·0% [9·5–10·5]) in 5–9-year-olds; malaria (31 587 [23 940–43 116]; 8·6% [6·6–10·4]) in 10–14-year-olds; self-harm (32 646 [29 530–36 416]; 13·4% [12·6–14·3]) in 15–19-year-old females; and road traffic injuries (48 757 [45 692–52 625]; 13·9% [13·3–14·3]) in 15–19-year-old males. Widespread declines in cause-specific mortality were estimated across age-sex groups and geographies in 2000–19, with few exceptions like collective violence. Child and adolescent survival needs focused attention. To translate the vision into actions, more investments in the health information infrastructure for cause of death and in the related life-saving interventions are needed. Bill & Melinda Gates Foundation and WHO.