Original article
Child and Adolescent Mortality Across Malaysia's Epidemiological Transition: A Systematic Analysis of Global Burden of Disease Data

https://doi.org/10.1016/j.jadohealth.2017.05.014Get rights and content

Abstract

Purpose

A rapid epidemiological transition in developing countries in Southeast Asia has been accompanied by major shifts in the health status of children and adolescents. In this article, mortality estimates in Malaysian children and adolescents from 1990 to 2013 are used to illustrate these changes.

Methods

All-cause and cause-specific mortality estimates were obtained from the 2013 Global Burden of Disease Study. Data were extracted from 1990 to 2013 for the developmental age range from 1 to 24 years, for both sexes. Trends in all-cause and cause-specific mortality for the major epidemiological causes were estimated.

Results

From 1990 to 2013, all-cause mortality decreased in all age groups. Reduction of all-cause mortality was greatest in 1- to 4-year-olds (2.4% per year reduction) and least in 20- to 24-year-olds (.9% per year reduction). Accordingly, in 2013, all-cause mortality was highest in 20- to 24-year-old males (129 per 100,000 per year). In 1990, the principal cause of death for 1- to 9-year boys and girls was vaccine preventable diseases. By 2013, neoplasms had become the major cause of death in 1–9 year olds of both sexes. The major cause of death in 10- to 24-year-old females was typhoid in 1990 and neoplasms in 2013, whereas the major cause of death in 10- to 24-year-old males remained road traffic injuries.

Conclusions

The reduction in mortality across the epidemiological transition in Malaysia has been much less pronounced for adolescents than younger children. The contribution of injuries and noncommunicable diseases to adolescent mortality suggests where public health strategies should focus.

Section snippets

Global Burden of Disease

GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. It covers 306 diseases and injuries, 1,233 sequelae, and 79 risk factors. Detailed descriptions of the methodology and approach of GBD 2013 have been published elsewhere [12], [13], [14], [15], [16], [17], [18]. Key methodological advances from GBD 2010 are the inclusion of new data through updated systematic reviews and through the contribution of unpublished data sources from many collaborators, together with

All-cause mortality

All-cause mortality was highest for 20- to 24-year-old young men across the study period (Figure 1). All-cause mortality for 20- to 24-year-old males was 166 per 100,000 per year in 1990 and 129 per 100,000 per year in 2013. In 1990, all-cause mortality for females and males aged 1–4, 5–9, 10–14, 15–19, and 20–24 years was 102, 39.5, 38.2, 87.5, and 116.3 per 100,000, respectively.

A trend of decreasing all-cause mortality was apparent for males and females across all age groups. By 2013, the

Discussion

This study reports a highly dynamic pattern of mortality in Malaysian children, adolescents, and young adults from 1 to 24 years. Within this age range, mortality rates substantially decreased for each age group from 1990 to 2013 but not to the same extent. We found that the steepest mortality decline was across the first decade of life, largely due to reduction in communicable diseases. The least reduction was in 20- to 24-year-old males, the age group with the highest mortality rate in 2013.

Acknowledgments

The authors are grateful to the Institute for Health Metrics and Evaluation for providing the data used in this paper.

References (40)

  • M.H. Forouzanfar et al.

    Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013

    Lancet

    (2015)
  • S.S. Lim et al.

    A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: A systematic analysis for the global burden of disease study 2010

    Lancet

    (2012)
  • G.C. Patton et al.

    Health of the world’s adolescents: A synthesis of internationally comparable data

    Lancet

    (2012)
  • E. Gakidou et al.

    Increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009: A systematic analysis

    Lancet

    (2010)
  • S. Ameratunga et al.

    Road-traffic injuries: Confronting disparities to address a global-health problem

    Lancet

    (2006)

  • Child Mortality

    (2015)

  • Malaysia: Achieving the Millennium development Goals: successes and challenges

    (2005)

  • Second Malaysian Burden of Disease and Injury Study

    (2012)
  • M.A. Bujang et al.

    Mortality rates by specific age group and gender in Malaysia: Trend of 16 years

    J Health Inform Dev Ctries

    (2012)

  • Statistics on causes of deaths

    (2015)

    • Cited by (14)

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    Conflicts of Interest: The authors have no conflicts of interest to disclose.

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