Elsevier

The Lancet

Volume 387, Issue 10036, 11–17 June 2016, Pages 2383-2401
The Lancet

Articles
Global burden of diseases, injuries, and risk factors for young people's health during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

https://doi.org/10.1016/S0140-6736(16)00648-6Get rights and content

Summary

Background

Young people's health has emerged as a neglected yet pressing issue in global development. Changing patterns of young people's health have the potential to undermine future population health as well as global economic development unless timely and effective strategies are put into place. We report the past, present, and anticipated burden of disease in young people aged 10–24 years from 1990 to 2013 using data on mortality, disability, injuries, and health risk factors.

Methods

The Global Burden of Disease Study 2013 (GBD 2013) includes annual assessments for 188 countries from 1990 to 2013, covering 306 diseases and injuries, 1233 sequelae, and 79 risk factors. We used the comparative risk assessment approach to assess how much of the burden of disease reported in a given year can be attributed to past exposure to a risk. We estimated attributable burden by comparing observed health outcomes with those that would have been observed if an alternative or counterfactual level of exposure had occurred in the past. We applied the same method to previous years to allow comparisons from 1990 to 2013. We cross-tabulated the quantiles of disability-adjusted life-years (DALYs) by quintiles of DALYs annual increase from 1990 to 2013 to show rates of DALYs increase by burden. We used the GBD 2013 hierarchy of causes that organises 306 diseases and injuries into four levels of classification. Level one distinguishes three broad categories: first, communicable, maternal, neonatal, and nutritional disorders; second, non-communicable diseases; and third, injuries. Level two has 21 mutually exclusive and collectively exhaustive categories, level three has 163 categories, and level four has 254 categories.

Findings

The leading causes of death in 2013 for young people aged 10–14 years were HIV/AIDS, road injuries, and drowning (25·2%), whereas transport injuries were the leading cause of death for ages 15–19 years (14·2%) and 20–24 years (15·6%). Maternal disorders were the highest cause of death for young women aged 20–24 years (17·1%) and the fourth highest for girls aged 15–19 years (11·5%) in 2013. Unsafe sex as a risk factor for DALYs increased from the 13th rank to the second for both sexes aged 15–19 years from 1990 to 2013. Alcohol misuse was the highest risk factor for DALYs (7·0% overall, 10·5% for males, and 2·7% for females) for young people aged 20–24 years, whereas drug use accounted for 2·7% (3·3% for males and 2·0% for females). The contribution of risk factors varied between and within countries. For example, for ages 20–24 years, drug use was highest in Qatar and accounted for 4·9% of DALYs, followed by 4·8% in the United Arab Emirates, whereas alcohol use was highest in Russia and accounted for 21·4%, followed by 21·0% in Belarus. Alcohol accounted for 9·0% (ranging from 4·2% in Hong Kong to 11·3% in Shandong) in China and 11·6% (ranging from 10·1% in Aguascalientes to 14·9% in Chihuahua) of DALYs in Mexico for young people aged 20–24 years. Alcohol and drug use in those aged 10–24 years had an annual rate of change of >1·0% from 1990 to 2013 and accounted for more than 3·1% of DALYs.

Interpretation

Our findings call for increased efforts to improve health and reduce the burden of disease and risks for diseases in later life in young people. Moreover, because of the large variations between countries in risks and burden, a global approach to improve health during this important period of life will fail unless the particularities of each country are taken into account. Finally, our results call for a strategy to overcome the financial and technical barriers to adequately capture young people's health risk factors and their determinants in health information systems.

Funding

Bill & Melinda Gates Foundation.

Introduction

The health of young people (defined here as those aged between 10 and 24 years)1 has emerged as a neglected yet pressing issue in global development.2, 3 Young people's health has the potential to affect future population health as well as global economic development unless timely and effective strategies are put into place.4, 5, 6, 7 Rapid declines in fertility, increasing survival through infancy and childhood, and greater longevity in many parts of the world have led to this generation of young people in developing countries being the largest in human history.8 In low-income countries, this cohort will decrease the dependency ratio and bring the prospect of a demographic dividend and economic prosperity. By contrast, many high-income countries that have already undergone a demographic transition now have a youth deficit that poses a threat to economic development.9, 10, 11 In both contexts, the health and wellbeing of this generation of young people, as well as that of the generation they parent, will be an important determinant of the economic future of nations.

Maximisation of health at all stages of life has been framed as the overarching health objective for the Sustainable Development Goals (SDGs),12 and youth activists (younger than 30 years) have been involved in the process of developing these goals during the past few years.13 Despite commitments to all age groups in the SDGs, young people have traditionally been neglected in global health and health measurement. The decrease in mortality in young people was much lower than that of young children aged younger than 5 years over a recent 50-year period.14 Greater emphasis is needed on the potential contribution that investments in youth health can provide in terms of health benefits and economic gains across generations.15, 16 Moreover, the Global Burden of Disease 2010 study17, 18, 19, 20, 21 showed the significant burden of disease due to mental disorders, injuries, sexually transmitted diseases, and non-communicable disease (NCD) risks that arise during youth, but which increase their effect on health later in life. For example, the rates of sexually transmitted infections (STIs) are highest in people younger than 25 years. To address these health issues in young people will not only have benefits across the lifespan of the young people affected, but also the health and wellbeing of the next generation, given that many of these young people are about to enter into parenthood.

Our knowledge of many risk factors is lacking in this age group, especially for those associated with mental health. The major health and nutrition surveys have generally started from the age of 15 years (eg, household surveys) or in some instances, 25 years, with few data for the 10–14-year-old age group. The emphasis in many household surveys, such as the Demographic and Health Surveys (DHS), has been on married women, with unmarried girls and boys poorly represented. Many concerns about privacy in doing these surveys have been raised, which has reduced the extent to which sensitive information is collected from younger age groups. More recent school-based surveys, such as the ongoing Centers for Disease Control and Prevention's Global School-based Student Survey (GSHS), have given coverage to lower ages of young people attending school (ie, ages 10–17 years), but many young people who are out of school are still not included. This shortage of coverage is especially true in low-income and middle-income countries where retention rates, even for early secondary school, remain low. This is especially problematic because young people from poor backgrounds face higher health risks, such as early pregnancies and poor outcomes from pregnancies.22, 23

In this Article, we report the burden of diseases, injuries, and risk factors for individuals aged 10–24 years from 1990 to 2013 in 188 countries. This age range covers the groups defined by the United Nations Department of Economic and Social Affairs (UNDESA) as adolescents (ages 10–19 years), youths (ages 15–24 years), and young people (ages 10–24 years).21

Section snippets

Overview

The Global Burden of Disease Study 2013 (GBD 2013) includes annual assessments for 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Detailed descriptions of the methods and approach of GBD 2013 have been reported previously.17, 18, 19, 20, 21, 24, 25, 26, 27 Key methodological changes from the Global Burden of Disease Study 2010 (GBD 2010) are the inclusion of new data from updated systematic reviews and from the contribution of

Results

The leading causes of death for ages 10–14 years, 15–19 years, and 20–24 years by sex and total (ages 10–24 years) for the years 1990, 2005, and 2013 are presented in table 1 and the appendix p 1). The leading cause of death in 2013 for males aged 10–24 years was road injuries (18·3% [95% UI 16·6–19·7]) followed by self-harm (7·8% [5·9–9·3]), whereas HIV/AIDS was the leading cause for females (7·5% [6·7–8·5]) followed by self-harm (7·4% [5·8–9·4]). Causes of death in young people varied by age

Discussion

Young people face challenges that affect their health now and in the future, as well as that of future generations. These data show a clear need for renewed efforts to improve health and reduce the burden of disease in young people. Investment in successful programmes, policies, and interventions targeted at young people is key to improve health and maximise future population health and global economic development. This study can play a key part in raising awareness of the health issues faced

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