With thanks to The Lancet
The
first international study to quantify the causes and patterns of death in
children over 5 years old from 50 countries over the second half of the 20th
century shows that, in a reversal of historical mortality patterns, death rates
in young people (15–24 years) are now higher than in children (1–4 years)
across most high- and low-income countries. In particular, death rates in young
men (15–24 years) are now two to three times higher than in boys (1–4 years).
The majority of deaths in young people are now due to injury, limiting
improvements in mortality in this age-group over the past 50 years to just half
that of children.
These
and many other findings, published in an Article Online First in The Lancet, highlight the lack of interventions and resources
directed to tackling the contemporary health problems faced by young people.
The authors hope their findings will promote a new
global focus on the health and causes of death in adolescents and young adults.
“Mortality
in young adults aged 10–24 years has proved less responsive to the
epidemiological transition [of the past 50 years], and to alliances and
interventions, than has early childhood mortality (1–4 years). These trends are
likely to continue because mortality in children younger than 5 years is
expected to decline further, and injury-related mortality is expected to
increase in the next 25 years with the continuation of the epidemiological
transition in developing countries”, explain Russell Viner from the UCL
Institute of Child Health, London, UK and colleagues.
A
strong international focus on reducing mortality in children under 5 years has
not been matched by a similar response in older groups, even though more than
two-fifths of the world’s population is in the 5–24 year age group.
In
this study, the authors used the WHO mortality database, to analyse mortality
data for 50 countries with a range of incomes between 1955 and 2004. Patterns
of mortality were investigated by cause of death (communicable and
non-communicable diseases and injury), age group, and sex. To analyse changes
in morality, they calculated death rates averaged over three 5-year periods
(1995–59, 1978–82, and 2000–04).
Findings
showed that in the 1950s, mortality in the 1–4 year age-group greatly exceeded
that of all other age-groups in all regions studied. But in the 50 years up to
2004, death rates in children aged 1–9 declined by 80–93% mostly due to
reductions in deaths from infectious disease.
In
contrast, reductions in mortality in young people aged 15–24 years were only
about half that in children, largely because of increases in injury-related
deaths, particularly in young men. Indeed, by the start of the 21st
century, injuries were responsible for 70–75% of all deaths in young men aged
10–24 years in all regions studied.
The
research also showed that violence and suicide have become key causes of death
in young people, responsible for a quarter to a third of deaths in young men
aged 10-24 years in all regions studied by 2004.
The
authors point out: “The high injury burden in young people means that they are
particularly affected by the persistent low global investment in
non-communicable diseases and injury relative to global disease burden.”
They
conclude: “Future global health targets should include the causes of death in people
aged 10–24 years, and should extend beyond HIV infection and maternal mortality
to include injury and mental health.”
In a Comment,
Michael Resnick from the University of
Minnesota, Minneapolis, says: “The profound health and
social changes that have accompanied economic development and urbanisation are
particularly toxic for young people in both high-income and low-income
settings.”
He
adds: “Breakthroughs in medical discovery and service delivery are incomplete
responses to the health threats faced by young people, in view of the profound
role of socioeconomic conditions, access to education, and opportunity as
determinants of life trajectory…Adolescence represents the second crucial
window for prevention and health promotion. Effectively addressing the social
determinants of health in the second decade of life can interrupt the processes
by which disadvantage becomes adverse destiny, including premature mortality.”
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