Catholic University of Louvain, Louvain-la-Neuve, Belgium.
Division of Data, Analytics, Planning and Monitoring, UNICEF, New York, NY, USA.
Lancet Glob Health. 2021 Apr;9(4):e409-e417. doi: 10.1016/S2214-109X(21)00023-1. Epub 2021 Mar 1.
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.
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 q, the probability that an adolescent aged 15 years would die before reaching age 25 years. This model treats observations of the q 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.
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.
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.
UN Children's Fund, Bill & Melinda Gates Foundation, United States Agency for International Development.
全球卫生界正在高度关注青少年和年轻人，但该人群的死亡风险却未得到充分评估。本研究旨在重建 1990 年至 2019 年期间，15-24 岁青少年的全球、区域和国家死亡率趋势。
在这项系统分析中，我们使用了联合国儿童死亡率估算机构间小组汇编的，来自 195 个国家的年龄在 15-24 岁之间的所有公开可用的死亡率数据。我们使用了具有代表性的国家生命登记数据，评估了死亡登记的完整性，并从具有同胞史的调查、人口普查中报告的家庭死亡以及抽样登记系统中提取死亡率数据。我们使用贝叶斯 B-样条偏差减少模型来生成 q 趋势，即 15 岁青少年在 25 岁之前死亡的概率。该模型将 q 概率的观察值视为实际死亡风险与因数据源而异的误差乘数的乘积。我们评估的主要结果是 1990 年至 2019 年期间的青年死亡率水平和趋势，以及全球和区域死亡率。
全球范围内，2019 年，15 岁青少年每 1000 人中有 11.2 人（90%置信区间 [90%UI] 10.7-12.5）死于 15-24 岁之间，这大约是婴儿死亡率（每 1000 例活产中有 28.2 人[27.2-30.0]在 1 岁时死亡）的 2.5 倍，但高于 1 岁至 5 岁期间的死亡风险（每 1000 名 1 岁儿童中有 9.7 人[9.1-11.1]死亡）。1990 年至 2019 年间，15-24 岁青少年的死亡概率每年下降 1.4%（90%UI 1.1-1.8），从 1990 年的每 1000 人中有 17.1 人（16.5-18.9）死亡；相比之下，在这一时期，总降幅为 34%（27-41），5 岁以下儿童死亡率下降了 59%（56-61）。1990 年，全球每年死亡人数为 170 万人（90%UI 1.7-1.9），到 2019 年降至 140 万人（1.3-1.5）。在撒哈拉以南非洲，1990 年至 2019 年期间，死亡人数增加了 20.8%。尽管 2019 年，15-24 岁的青少年中有 18.3%生活在撒哈拉以南非洲，但该地区占全球青年死亡人数的 37.9%（90%UI 34.8-41.9）。
迫切需要加快降低青年死亡率的步伐。在死亡率负担日益集中的撒哈拉以南非洲地区，尤其需要做出努力。如果目前的趋势继续下去，未来将有越来越多的国家的青年死亡率超过 5 岁以下儿童死亡率。
联合国儿童基金会、比尔及梅琳达·盖茨基金会、美国国际开发署。
