Bruno Masquelier1, Lucia Hug2, David Sharrow2, Danzhen You2, Colin Mathers3, Patrick Gerland4, Leontine Alkema5. 1. Catholic University of Louvain, Louvain-la-Neuve, Belgium. Electronic address: bruno.masquelier@uclouvain.be. 2. Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, NY, USA. 3. Technical Advisory Group of the UN Inter-agency Group for Child Mortality Estimation, UN, New York, NY, USA. 4. Population Division, UN, New York, NY, USA. 5. University of Massachusetts Amherst, Amherst, MA, USA.
Abstract
BACKGROUND: The global health community is devoting considerable attention to adolescents and young people, but risk of death in this population is poorly measured. We aimed to reconstruct global, regional, and national mortality trends for youths aged 15-24 years between 1990 and 2019. METHODS: In this systematic analysis, we used all publicly available data on mortality in the age group 15-24 years for 195 countries, as compiled by the UN Inter-agency Group for Child Mortality Estimation. We used nationally representative vital registration data, estimated the completeness of death registration, and extracted mortality rates from surveys with sibling histories, household deaths reported in censuses, and sample registration systems. We used a Bayesian B-spline bias-reduction model to generate trends in 10q15, the probability that an adolescent aged 15 years would die before reaching age 25 years. This model treats observations of the 10q15 probability as the product of the actual risk of death and an error multiplier that varies depending on the data source. The main outcome that we assessed was the levels of and trends in youth mortality and the global and regional mortality rates from 1990 to 2019. FINDINGS: Globally, the probability of an individual dying between age 15 years and 24 years was 11·2 deaths (90% uncertainty interval [UI] 10·7-12·5) per 1000 youths aged 15 in 2019, which is about 2·5 times less than infant mortality (28·2 deaths [27·2-30·0] by age 1 year per 1000 live births) but is higher than the risk of dying from age 1 to 5 (9·7 deaths [9·1-11·1] per 1000 children aged 1 year). The probability of dying between age 15 years and 24 years declined by 1·4% per year (90% UI 1·1-1·8) between 1990 and 2019, from 17·1 deaths (16·5-18·9) per 1000 in 1990; by contrast with this total decrease of 34% (27-41), under-5 mortality declined by 59% (56-61) in this period. The annual number of deaths declined from 1·7 million (90% UI 1·7-1·9) in 1990 to 1·4 million (1·3-1·5) in 2019. In sub-Saharan Africa, the number of deaths increased by 20·8% from 1990 to 2019. Although 18·3% of the population aged 15-24 years were living in sub-Saharan Africa in 2019, the region accounted for 37·9% (90% UI 34·8-41·9) of all worldwide deaths in youth. INTERPRETATION: It is urgent to accelerate progress in reducing youth mortality. Efforts are particularly needed in sub-Saharan Africa, where the burden of mortality is increasingly concentrated. In the future, a growing number of countries will see youth mortality exceeding under-5 mortality if current trends continue. FUNDING: UN Children's Fund, Bill & Melinda Gates Foundation, United States Agency for International Development.
BACKGROUND: The global health community is devoting considerable attention to adolescents and young people, but risk of death in this population is poorly measured. We aimed to reconstruct global, regional, and national mortality trends for youths aged 15-24 years between 1990 and 2019. METHODS: In this systematic analysis, we used all publicly available data on mortality in the age group 15-24 years for 195 countries, as compiled by the UN Inter-agency Group for ChildMortality Estimation. We used nationally representative vital registration data, estimated the completeness of death registration, and extracted mortality rates from surveys with sibling histories, household deaths reported in censuses, and sample registration systems. We used a Bayesian B-spline bias-reduction model to generate trends in 10q15, the probability that an adolescent aged 15 years would die before reaching age 25 years. This model treats observations of the 10q15 probability as the product of the actual risk of death and an error multiplier that varies depending on the data source. The main outcome that we assessed was the levels of and trends in youth mortality and the global and regional mortality rates from 1990 to 2019. FINDINGS: Globally, the probability of an individual dying between age 15 years and 24 years was 11·2 deaths (90% uncertainty interval [UI] 10·7-12·5) per 1000 youths aged 15 in 2019, which is about 2·5 times less than infant mortality (28·2 deaths [27·2-30·0] by age 1 year per 1000 live births) but is higher than the risk of dying from age 1 to 5 (9·7 deaths [9·1-11·1] per 1000 children aged 1 year). The probability of dying between age 15 years and 24 years declined by 1·4% per year (90% UI 1·1-1·8) between 1990 and 2019, from 17·1 deaths (16·5-18·9) per 1000 in 1990; by contrast with this total decrease of 34% (27-41), under-5 mortality declined by 59% (56-61) in this period. The annual number of deaths declined from 1·7 million (90% UI 1·7-1·9) in 1990 to 1·4 million (1·3-1·5) in 2019. In sub-Saharan Africa, the number of deaths increased by 20·8% from 1990 to 2019. Although 18·3% of the population aged 15-24 years were living in sub-Saharan Africa in 2019, the region accounted for 37·9% (90% UI 34·8-41·9) of all worldwide deaths in youth. INTERPRETATION: It is urgent to accelerate progress in reducing youth mortality. Efforts are particularly needed in sub-Saharan Africa, where the burden of mortality is increasingly concentrated. In the future, a growing number of countries will see youth mortality exceeding under-5 mortality if current trends continue. FUNDING: UN Children's Fund, Bill & Melinda Gates Foundation, United States Agency for International Development.
Authors: Robert E Black; Li Liu; Fernando P Hartwig; Francisco Villavicencio; Andrea Rodriguez-Martinez; Luis P Vidaletti; Jamie Perin; Maureen M Black; Hannah Blencowe; Danzhen You; Lucia Hug; Bruno Masquelier; Simon Cousens; Amber Gove; Tyler Vaivada; Diana Yeung; Jere Behrman; Reynaldo Martorell; Clive Osmond; Aryeh D Stein; Linda S Adair; Caroline H D Fall; Bernardo Horta; Ana M B Menezes; Manuel Ramirez-Zea; Linda M Richter; George C Patton; Eran Bendavid; Majid Ezzati; Zulfiqar A Bhutta; Joy E Lawn; Cesar G Victora Journal: Lancet Date: 2022-04-27 Impact factor: 202.731
Authors: Li Liu; Francisco Villavicencio; Diana Yeung; Jamie Perin; Gerard Lopez; Kathleen L Strong; Robert E Black Journal: Lancet Glob Health Date: 2022-03 Impact factor: 26.763