Kassebaum Nicholas, Kyu Hmwe Hmwe, Zoeckler Leo, Olsen Helen Elizabeth, Thomas Katie, Pinho Christine, Bhutta Zulfiqar A, Dandona Lalit, Ferrari Alize, Ghiwot Tsegaye Tewelde, Hay Simon I, Kinfu Yohannes, Liang Xiaofeng, Lopez Alan, Malta Deborah Carvalho, Mokdad Ali H, Naghavi Mohsen, Patton George C, Salomon Joshua, Sartorius Benn, Topor-Madry Roman, Vollset Stein Emil, Werdecker Andrea, Whiteford Harvey A, Abate Kalkidan Hasen, Abbas Kaja, Damtew Solomon Abrha, Ahmed Muktar Beshir, Akseer Nadia, Al-Raddadi Rajaa, Alemayohu Mulubirhan Assefa, Altirkawi Khalid, Abajobir Amanuel Alemu, Amare Azmeraw T, Antonio Carl A T, Arnlov Johan, Artaman Al, Asayesh Hamid, Avokpaho Euripide Frinel G Arthur, Awasthi Ashish, Ayala Quintanilla Beatriz Paulina, Bacha Umar, Betsu Balem Demtsu, Barac Aleksandra, Bärnighausen Till Winfried, Baye Estifanos, Bedi Neeraj, Bensenor Isabela M, Berhane Adugnaw, Bernabe Eduardo, Bernal Oscar Alberto, Beyene Addisu Shunu, Biadgilign Sibhatu, Bikbov Boris, Boyce Cheryl Anne, Brazinova Alexandra, Hailu Gessessew Bugssa, Carter Austin, Castañeda-Orjuela Carlos A, Catalá-López Ferrán, Charlson Fiona J, Chitheer Abdulaal A, Choi Jee-Young Jasmine, Ciobanu Liliana G, Crump John, Dandona Rakhi, Dellavalle Robert P, Deribew Amare, deVeber Gabrielle, Dicker Daniel, Ding Eric L, Dubey Manisha, Endries Amanuel Yesuf, Erskine Holly E, Faraon Emerito Jose Aquino, Faro Andre, Farzadfar Farshad, Fernandes Joao C, Fijabi Daniel Obadare, Fitzmaurice Christina, Fleming Thomas D, Flor Luisa Sorio, Foreman Kyle J, Franklin Richard C, Fraser Maya S, Frostad Joseph J, Fullman Nancy, Gebregergs Gebremedhin Berhe, Gebru Alemseged Aregay, Geleijnse Johanna M, Gibney Katherine B, Gidey Yihdego Mahari, Ginawi Ibrahim Abdelmageem Mohamed, Gishu Melkamu Dedefo, Gizachew Tessema Assefa, Glaser Elizabeth, Gold Audra L, Goldberg Ellen, Gona Philimon, Goto Atsushi, Gugnani Harish Chander, Jiang Guohong, Gupta Rajeev, Tesfay Fisaha Haile, Hankey Graeme J, Havmoeller Rasmus, Hijar Martha, Horino Masako, Hosgood H Dean, Hu Guoqing, Jacobsen Kathryn H, Jakovljevic Mihajlo B, Jayaraman Sudha P, Jha Vivekanand, Jibat Tariku, Johnson Catherine O, Jonas Jost, Kasaeian Amir, Kawakami Norito, Keiyoro Peter N, Khalil Ibrahim, Khang Young-Ho, Khubchandani Jagdish, Ahmad Kiadaliri Aliasghar A, Kieling Christian, Kim Daniel, Kissoon Niranjan, Knibbs Luke D, Koyanagi Ai, Krohn Kristopher J, Kuate Defo Barthelemy, Kucuk Bicer Burcu, Kulikoff Rachel, Kumar G Anil, Lal Dharmesh Kumar, Lam Hilton Y, Larson Heidi J, Larsson Anders, Laryea Dennis Odai, Leung Janni, Lim Stephen S, Lo Loon-Tzian, Lo Warren D, Looker Katharine J, Lotufo Paulo A, Magdy Abd El Razek Hassan, Malekzadeh Reza, Markos Shifti Desalegn, Mazidi Mohsen, Meaney Peter A, Meles Kidanu Gebremariam, Memiah Peter, Mendoza Walter, Abera Mengistie Mubarek, Mengistu Gebremichael Welday, Mensah George A, Miller Ted R, Mock Charles, Mohammadi Alireza, Mohammed Shafiu, Monasta Lorenzo, Mueller Ulrich, Nagata Chie, Naheed Aliya, Nguyen Grant, Nguyen Quyen Le, Nsoesie Elaine, Oh In-Hwan, Okoro Anselm, Olusanya Jacob Olusegun, Olusanya Bolajoko O, Ortiz Alberto, Paudel Deepak, Pereira David M, Perico Norberto, Petzold Max, Phillips Michael Robert, Polanczyk Guilherme V, Pourmalek Farshad, Qorbani Mostafa, Rafay Anwar, Rahimi-Movaghar Vafa, Rahman Mahfuzar, Rai Rajesh Kumar, Ram Usha, Rankin Zane, Remuzzi Giuseppe, Renzaho Andre M N, Roba Hirbo Shore, Rojas-Rueda David, Ronfani Luca, Sagar Rajesh, Sanabria Juan Ramon, Kedir Mohammed Muktar Sano, Santos Itamar S, Satpathy Maheswar, Sawhney Monika, Schöttker Ben, Schwebel David C, Scott James G, Sepanlou Sadaf G, Shaheen Amira, Shaikh Masood Ali, She June, Shiri Rahman, Shiue Ivy, Sigfusdottir Inga Dora, Singh Jasvinder, Silpakit Naris, Smith Alison, Sreeramareddy Chandrashekhar, Stanaway Jeffrey D, Stein Dan J, Steiner Caitlyn, Sufiyan Muawiyyah Babale, Swaminathan Soumya, Tabarés-Seisdedos Rafael, Tabb Karen M, Tadese Fentaw, Tavakkoli Mohammad, Taye Bineyam, Teeple Stephanie, Tegegne Teketo Kassaw, Temam Shifa Girma, Terkawi Abdullah Sulieman, Thomas Bernadette, Thomson Alan J, Tobe-Gai Ruoyan, Tonelli Marcello, Tran Bach Xuan, Troeger Christopher, Ukwaja Kingsley N, Uthman Olalekan, Vasankari Tommi, Venketasubramanian Narayanaswamy, Vlassov Vasiliy Victorovich, Weiderpass Elisabete, Weintraub Robert, Gebrehiwot Solomon Weldemariam, Westerman Ronny, Williams Hywel C, Wolfe Charles D A, Woodbrook Rachel, Yano Yuichiro, Yonemoto Naohiro, Yoon Seok-Jun, Younis Mustafa Z, Yu Chuanhua, Zaki Maysaa El Sayed, Zegeye Elias Asfaw, Zuhlke Liesl Joanna, Murray Christopher J L, Vos Theo
Institute for Health Metrics and Evaluation, University of Washington, Seattle.
Centre of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan.
JAMA Pediatr. 2017 Jun 1;171(6):573-592. doi: 10.1001/jamapediatrics.2017.0250.
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.
全面且及时地监测包括儿童和青少年在内的所有年龄组的疾病负担，对于改善人群健康至关重要。
量化并描述1990年至2015年期间儿童和青少年的死亡率及非致命性健康结局的水平和趋势，以为政策讨论提供一个框架。
采用标准化的数据处理和统计建模方法，对195个国家和地区1990年至2015年按年龄组、性别和年份划分的特定病因死亡率及非致命性健康结局进行了分析，随后对研究结果进行分析，以描述19岁及以下儿童和青少年在不同地理区域和时间的水平和趋势。为每个地理区域和年份制定了一个收入、教育和生育率的综合指标（社会人口指数[SDI]），该指标评估了SDI与健康损失之间的历史关联。
全球儿童和青少年死亡率从1990年的1418万（95%不确定区间[UI]，1409万至1428万）例死亡降至2015年的726万（95% UI，714万至739万）例死亡，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，大多数死亡发生在南亚和撒哈拉以南非洲。全球趋势是由传染病、营养性疾病和新生儿疾病导致的死亡率下降所驱动的，总体而言，这导致了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。1990年至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%），这一增加主要归因于人口增长以及儿童和青少年存活至更高年龄。除了传染病外，许多主要的残疾原因与出生时存在的疾病的长期后遗症（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缺乏的并发症有关。贫血、发育性智力残疾、听力损失、癫痫和视力损失是儿童残疾的重要促成因素，可能由多种原因引起。孕产妇和生殖健康仍然是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较低的国家，死亡率是儿童和青少年健康损失的主要驱动因素，而在SDI较高的地区，残疾则占主导地位；不同疾病和伤害的流行病学转变具体模式各不相同。
持续的国际关注和投资已使许多国家儿童和青少年健康损失的病因得到持续改善，尽管进展并不均衡。一些国家传染病的持续存在，再加上向伤害和非传染性疾病的持续流行病学转变，要求所有国家仔细评估并实施适当战略，以最大限度地提高其儿童和青少年的健康水平，同时要求国际社会仔细考虑应监测儿童和青少年健康的哪些方面。
