Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study.
Child and Adolescent Health From 1990 to 2015: Findings From the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study.
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DOI：
10.1001/jamapediatrics.2017.0250
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发表时间：
2017-06-01
期刊：
影响因子：
26.1
通讯作者：
Vos T
中科院分区：
文献类型：
--
作者：
Global Burden of Disease Child and Adolescent Health Collaboration;Kassebaum N;Kyu HH;Zoeckler L;Olsen HE;Thomas K;Pinho C;Bhutta ZA;Dandona L;Ferrari A;Ghiwot TT;Hay SI;Kinfu Y;Liang X;Lopez A;Malta DC;Mokdad AH;Naghavi M;Patton GC;Salomon J;Sartorius B;Topor-Madry R;Vollset SE;Werdecker A;Whiteford HA;Abate KH;Abbas K;Damtew SA;Ahmed MB;Akseer N;Al-Raddadi R;Alemayohu MA;Altirkawi K;Abajobir AA;Amare AT;Antonio CAT;Arnlov J;Artaman A;Asayesh H;Avokpaho EFGA;Awasthi A;Ayala Quintanilla BP;Bacha U;Betsu BD;Barac A;Bärnighausen TW;Baye E;Bedi N;Bensenor IM;Berhane A;Bernabe E;Bernal OA;Beyene AS;Biadgilign S;Bikbov B;Boyce CA;Brazinova A;Hailu GB;Carter A;Castañeda-Orjuela CA;Catalá-López F;Charlson FJ;Chitheer AA;Choi JJ;Ciobanu LG;Crump J;Dandona R;Dellavalle RP;Deribew A;deVeber G;Dicker D;Ding EL;Dubey M;Endries AY;Erskine HE;Faraon EJA;Faro A;Farzadfar F;Fernandes JC;Fijabi DO;Fitzmaurice C;Fleming TD;Flor LS;Foreman KJ;Franklin RC;Fraser MS;Frostad JJ;Fullman N;Gebregergs GB;Gebru AA;Geleijnse JM;Gibney KB;Gidey Yihdego M;Ginawi IAM;Gishu MD;Gizachew TA;Glaser E;Gold AL;Goldberg E;Gona P;Goto A;Gugnani HC;Jiang G;Gupta R;Tesfay FH;Hankey GJ;Havmoeller R;Hijar M;Horino M;Hosgood HD;Hu G;Jacobsen KH;Jakovljevic MB;Jayaraman SP;Jha V;Jibat T;Johnson CO;Jonas J;Kasaeian A;Kawakami N;Keiyoro PN;Khalil I;Khang YH;Khubchandani J;Ahmad Kiadaliri AA;Kieling C;Kim D;Kissoon N;Knibbs LD;Koyanagi A;Krohn KJ;Kuate Defo B;Kucuk Bicer B;Kulikoff R;Kumar GA;Lal DK;Lam HY;Larson HJ;Larsson A;Laryea DO;Leung J;Lim SS;Lo LT;Lo WD;Looker KJ;Lotufo PA;Magdy Abd El Razek H;Malekzadeh R;Markos Shifti D;Mazidi M;Meaney PA;Meles KG;Memiah P;Mendoza W;Abera Mengistie M;Mengistu GW;Mensah GA;Miller TR;Mock C;Mohammadi A;Mohammed S;Monasta L;Mueller U;Nagata C;Naheed A;Nguyen G;Nguyen QL;Nsoesie E;Oh IH;Okoro A;Olusanya JO;Olusanya BO;Ortiz A;Paudel D;Pereira DM;Perico N;Petzold M;Phillips MR;Polanczyk GV;Pourmalek F;Qorbani M;Rafay A;Rahimi-Movaghar V;Rahman M;Rai RK;Ram U;Rankin Z;Remuzzi G;Renzaho AMN;Roba HS;Rojas-Rueda D;Ronfani L;Sagar R;Sanabria JR;Kedir Mohammed MS;Santos IS;Satpathy M;Sawhney M;Schöttker B;Schwebel DC;Scott JG;Sepanlou SG;Shaheen A;Shaikh MA;She J;Shiri R;Shiue I;Sigfusdottir ID;Singh J;Silpakit N;Smith A;Sreeramareddy C;Stanaway JD;Stein DJ;Steiner C;Sufiyan MB;Swaminathan S;Tabarés-Seisdedos R;Tabb KM;Tadese F;Tavakkoli M;Taye B;Teeple S;Tegegne TK;Temam Shifa G;Terkawi AS;Thomas B;Thomson AJ;Tobe-Gai R;Tonelli M;Tran BX;Troeger C;Ukwaja KN;Uthman O;Vasankari T;Venketasubramanian N;Vlassov VV;Weiderpass E;Weintraub R;Gebrehiwot SW;Westerman R;Williams HC;Wolfe CDA;Woodbrook R;Yano Y;Yonemoto N;Yoon SJ;Younis MZ;Yu C;Zaki MES;Zegeye EA;Zuhlke LJ;Murray CJL;Vos T
全面和及时地监测包括儿童和青少年在内的所有年龄段的疾病负担，对于改善人口健康至关重要。量化和描述1990年至2015年儿童和青少年死亡率和非致命性健康后果的水平和趋势，为政策讨论提供框架。使用数据处理和统计建模的标准化方法，分析了195个国家和地区从1990年到2015年的死因特定死亡率和非致命性健康结果，按年龄组、性别和年份进行了分析，随后对结果进行了分析，以描述19岁或19岁以下儿童和青少年的地理和时间水平和趋势。为每个地理单位和年份制定了收入、教育和生育率的综合指标(社会人口指数[SDI])，评估了SDI和健康损失之间的历史联系。全球儿童和青少年死亡率从1990年的1418万(95%不确定区间[UI]，1409万降至1428万)下降到2015年的726万(95%UI，714万至739万)，但进展分布不均。2015年，SDI较低的国家的死亡负担比例(75%)高于1990年(61%)。2015年，大多数死亡病例发生在南亚和撒哈拉以南非洲地区。全球趋势是由感染性、营养性和新生儿疾病引起的死亡率下降推动的，这总体上导致非传染性疾病和伤害在解释全球疾病负担方面的重要性相对增加。从1990年到2015年，儿童和青少年的残疾绝对负担增加了4.3%(95%UI，3.1%-5.6%)，其中很大一部分增加是由于人口增长和儿童和青少年到老年的存活率提高。除感染性疾病外，许多导致残疾的主要原因与出生时的长期后遗症(如新生儿疾病、先天性出生缺陷和血红蛋白病)以及各种感染和营养不足的并发症有关。贫血、发育性智力残疾、听力损失、癫痫和视力丧失是导致儿童残疾的重要因素，这些残疾可能由多种原因引起。产妇和生殖健康仍然是造成青春期女性疾病负担的主要原因，特别是在SDI较低的国家。在SDI低的国家，死亡率是儿童和青少年健康损失的主要驱动力，而在SDI较高的地区，残疾占主导地位；流行病学转变的具体模式因疾病和伤害而异。持续的国际关注和投资使许多国家儿童和青少年健康损失的原因得到持续改善，尽管进展参差不齐。一些国家的传染病持续存在，加上向伤害和非传染性疾病的流行病学过渡，要求所有国家认真评估和执行适当的战略，以最大限度地保护其儿童和青少年的健康，并要求国际社会认真考虑应监测儿童和青少年健康的哪些方面。这项研究量化并描述了1990年至2015年儿童和青少年的死亡率和非致命性健康后果的水平和趋势，为政策讨论提供了一个框架。从1990年到2015年，儿童和青少年的死亡率和非致命性健康损失的水平和趋势是什么？这项研究发现，从1990年到2015年，各种原因导致的儿童和青少年死亡率在全球范围内显著下降，但全球不平等日益加剧。在社会人口指数(SDI)低的国家，死亡率是儿童和青少年健康损失的主要驱动因素，主要是由于传染病、营养、孕产妇和新生儿原因，而在SDI较高的地区，非致命性健康损失占主导地位。各国应评估造成儿童和青少年疾病负担的驱动因素，以协助执行适当的战略，最大限度地保护人民的健康。
Comprehensive and timely monitoring of disease burden in all age groups, including children and adolescents, is essential for improving population health. 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. 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. 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. 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. This study quantifies and describes levels and trends of mortality and nonfatal health outcomes among children and adolescents from 1990 to 2015 to provide a framework for policy discussion. What are the levels and trends of mortality and nonfatal health loss among children and adolescents from 1990 to 2015? This study found significant global decreases in all-cause child and adolescent mortality from 1990 to 2015, but with increasing global inequality. In countries with a low Socio-demographic Index (SDI), mortality is the primary driver of health loss in children and adolescents, largely owing to infectious, nutritional, maternal, and neonatal causes, while nonfatal health loss prevails in locations with a higher SDI. Nations should evaluate drivers of disease burden among children and adolescents to aid implementation of appropriate strategies to maximize the health of populations.
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