Kyu Hmwe H, Stein Claudia E, Boschi Pinto Cynthia, Rakovac Ivo, Weber Martin W, Dannemann Purnat Tina, Amuah Joseph E, Glenn Scott D, Cercy Kelly, Biryukov Stan, Gold Audra L, Chew Adrienne, Mooney Meghan D, O'Rourke Kevin F, Sligar Amber, Murray Christopher J L, Mokdad Ali H, Naghavi Mohsen
Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
World Health Organization, Division of Information, Evidence, Research and Innovation, Copenhagen, Denmark.
Lancet Child Adolesc Health. 2018 May;2(5):321-337. doi: 10.1016/S2352-4642(18)30095-6.
The mortality burden in children aged 5-14 years in the WHO European Region has not been comprehensively studied. We assessed the distribution and trends of the main causes of death among children aged 5-9 years and 10-14 years from 1990 to 2016, for 51 countries in the WHO European Region.
We used data from vital registration systems, cancer registries, and police records from 1980 to 2016 to estimate cause-specific mortality using the Cause of Death Ensemble model.
For children aged 5-9 years, all-cause mortality rates (per 100 000 population) were estimated to be 46·3 (95% uncertainty interval [UI] 45·1-47·5) in 1990 and 19·5 (18·1-20·9) in 2016, reflecting a 58·0% (54·7-61·1) decline. For children aged 10-14 years, all-cause mortality rates (per 100 000 population) were 37·9 (37·3-38·6) in 1990 and 20·1 (18·8-21·3) in 2016, reflecting a 47·1% (43·8-50·4) decline. In 2016, we estimated 10 740 deaths (95% UI 9970-11 542) in children aged 5-9 years and 10 279 deaths (9652-10 897) in those aged 10-14 years in the WHO European Region. Injuries (road injuries, drowning, and other injuries) caused 4163 deaths (3820-4540; 38·7% of total deaths) in children aged 5-9 years and 4468 deaths (4162-4812; 43·5% of total) in those aged 10-14 years in 2016. Neoplasms caused 2161 deaths (1872-2406; 20·1% of total deaths) in children aged 5-9 years and 1943 deaths (1749-2101; 18·9% of total deaths) in those aged 10-14 years in 2016. Notable differences existed in cause-specific mortality rates between the European subregions, from a two-times difference for leukaemia to a 20-times difference for lower respiratory infections between the Commonwealth of Independent States (CIS) and EU15 (the 15 member states that had joined the European Union before May, 2004).
Marked progress has been made in reducing the mortality burden in children aged 5-14 years over the past 26 years in the WHO European Region. More deaths could be prevented, especially in CIS countries, through intervention and prevention efforts focusing on the leading causes of death, which are road injuries, drowning, and lower respiratory infections. The findings of our study could be used as a baseline to assess the effect of implementation of programmes and policies on child mortality burden.
WHO and Bill & Melinda Gates Foundation.
世界卫生组织欧洲区域5至14岁儿童的死亡负担尚未得到全面研究。我们评估了1990年至2016年期间世界卫生组织欧洲区域51个国家中5至9岁和10至14岁儿童主要死因的分布及趋势。
我们使用了1980年至2016年生命登记系统、癌症登记处和警方记录的数据，通过死因综合模型估计特定原因死亡率。
对于5至9岁儿童，1990年全死因死亡率（每10万人）估计为46.3（95%不确定区间[UI]45.1 - 47.5），2016年为19.5（18.1 - 20.9），下降了58.0%（54.7 - 61.1）。对于10至14岁儿童，1990年全死因死亡率（每10万人）为37.9（37.3 - 38.6），2016年为20.1（18.8 - 21.3），下降了47.1%（43.8 - 50.4）。2016年，我们估计世界卫生组织欧洲区域5至9岁儿童死亡10740例（95%UI 9970 - 11542），10至14岁儿童死亡10279例（9652 - 10897）。2016年，伤害（道路伤害、溺水和其他伤害）导致5至9岁儿童死亡4163例（3820 - 4540；占总死亡人数的38.7%），10至14岁儿童死亡4468例（4162 - 4812；占总死亡人数的43.5%）。肿瘤导致2016年5至9岁儿童死亡2161例（1872 - 2406；占总死亡人数的20.1%），10至14岁儿童死亡1943例（1749 - 2101；占总死亡人数的18.9%）。欧洲各次区域之间特定原因死亡率存在显著差异，从独立国家联合体（CIS）和欧盟15国（2004年5月前加入欧盟的15个成员国）之间白血病死亡率相差两倍到下呼吸道感染死亡率相差20倍不等。
在过去26年里，世界卫生组织欧洲区域在减轻5至14岁儿童死亡负担方面取得了显著进展。通过针对主要死因（道路伤害、溺水和下呼吸道感染）的干预和预防措施，可以预防更多死亡，特别是在独联体国家。我们的研究结果可作为评估方案和政策实施对儿童死亡负担影响的基线。
世界卫生组织和比尔及梅琳达·盖茨基金会。
