Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013: Findings From the Global Burden of Disease 2013 Study
Open accessAbstract
IMPORTANCE: The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce. OBJECTIVE: To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study. EVIDENCE REVIEW: Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14,244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35,620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates. FINDINGS: Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905.059 deaths; 95% UI, 810,304-998,125), diarrheal diseases among older children (38,325 deaths; 95% UI, 30,365-47,678), and road injuries among adolescents (115,186 deaths; 95% UI, 105,185-124,870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world's deaths from neonatal encephalopathy. Half of the world's diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia. CONCLUSIONS AND RELEVANCE: Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed.
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- Authors
- Global Burden of Disease Pediatrics Collaboration, Kyu, H. H., Pinho, C., Wagner, J. A., Brown, J. C., Bertozzi-Villa, A., Charlson, F. J., Coffeng, L. E., Dandona, L., Erskine, H. E., Ferrari, A. J., Fitzmaurice, C., Fleming, T. D., Forouzanfar, M. H., Graetz, N., Guinovart, C., Haagsma, J., Higashi, H., Kassebaum, N. J., Larson, H. J., Lim, S. S., Mokdad, A. H., Moradi-Lakeh, M., Odell, S. V., Roth, G. A., Serina, P. T., Stanaway, J. D., Misganaw, A., Whiteford, H. A., Wolock, T. M., Wulf Hanson, S., Abd-Allah, F., Abera, S. F., Abu-Raddad, L. J., AlBuhairan, F. S., Amare, A. T., Antonio, C. A. T., Artaman, A., Barker-Collo, S. L., Barrero, L. H., Benjet, C., Bensenor, I. M., Bhutta, Z. A., Bikbov, B., Brazinova, A., Campos-Nonato, I., Castañeda-Orjuela, C. A., Catalá-López, F., Chowdhury, R., Cooper, C., Crump, J. A., Dandona, R., Degenhardt, L., Dellavalle, R. P., Dharmaratne, S. D., Faraon, E. J. A., Feigin, V. L., Fürst, T., Geleijnse, J. M., Gessner, B. D., Gibney, K. B., Goto, A., Gunnell, D., Hankey, G. J., Hay, R. J., Hornberger, J. C., Hosgood, H. D., Hu, G., Jacobsen, K. H., Jayaraman, S. P., Jeemon, P., Jonas, J. B., Karch, A., Kim, D., Kim, S., Kokubo, Y., Kuate Defo, B., Kucuk Bicer, B., Kumar, G. A., Larsson, A., Leasher, J. L., Leung, R., Li, Y., Lipshultz, S. E., Lopez, A. D., Lotufo, P. A., Lunevicius, R., Lyons, R. A., Majdan, M., Malekzadeh, R., Mashal, T., Mason-Jones, A. J., Melaku, Y. A., Memish, Z. A., Mendoza, W., Miller, T. R., Mock, C. N., Murray, J., Nolte, S., Oh, I.-H., Olusanya, B. O., Ortblad, K. F., Park, E.-K., Paternina Caicedo, A. J., Patten, S. B., Patton, G. C., Pereira, D. M., Perico, N., Piel, F. B., Polinder, S., Popova, S., Pourmalek, F., Quistberg, D. A., Remuzzi, G., Rodriguez, A., Rojas-Rueda, D., Rothenbacher, D., Rothstein, D. H., Sanabria, J., Santos, I. S., Schwebel, D. C., Sepanlou, S. G., Shaheen, A., Shiri, R., Shiue, I., Skirbekk, V., Sliwa, K., Sreeramareddy, C. T., Stein, D. J., Steiner, T. J., Stovner, L. J., Sykes, B. L., Tabb, K. M., Terkawi, A. S., Thomson, A. J., Thorne-Lyman, A. L., Towbin, J. A., Ukwaja, K. N., Vasankari, T., Venketasubramanian, N., Vlassov, V. V., Vollset, S. E., Weiderpass, E., Weintraub, R. G., Werdecker, A., Wilkinson, J. D., Woldeyohannes, S. M., Wolfe, C. D. A., Yano, Y., Yip, P., Yonemoto, N., Yoon, S.-J., Younis, M. Z., Yu, C., El Sayed Zaki, M., Naghavi, M., Murray, C. J. L., & Vos, T.
- Affiliations
- Intermountain Healthcare (US)
- University of Washington (US)
- The University of Queensland (AU)
- Seattle Children's Hospital (US)
- Institute for Health Metrics and Evaluation, University of Washington, Seattle10Department of Community Medicine, Iran University of Medical Sciences, Tehran, Iran
- Institute for Health Metrics and Evaluation, University of Washington, Seattle
- Cairo University (EG)
- Mekelle University (ET)
- Weill Cornell Medical College in Qatar (QA)
- King Saud bin Abdulaziz University for Health Sciences (SA)
- University of Groningen (NL)
- University of the Philippines Manila (PH)
- Consultant, Windsor, Ontario, Canada
- University of Auckland (NZ)
- Pontificia Universidad Javeriana (CO)
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz (MX)
- University of São Paulo, São Paulo, Brazil
- Aga Khan University (PK)
- Russian University of Medicine (RU)
- International Neurotrama Research Organization, Vienna, Austria34Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
- National Institute of Public Health, Cuernavaca, Mexico36School of Public Health, Harvard University, Boston, Massachusetts
- Universidad Nacional de Colombia (CO)
- Universitat de València (ES)
- University of Cambridge (GB)
- University Hospital Southampton NHS Foundation Trust (GB)
- University of Otago (NZ)
- UNSW Sydney (AU)
- Colorado School of Public Health (US)
- University of Peradeniya (LK)
- Department of Health (PH)
- Auckland University of Technology (NZ)
- Imperial College London (GB)
- Wageningen University & Research (NL)
- Agence de Médecine Préventive (FR)
- Monash University (AU)
- Tokyo Women's Medical University (JP)
- University of Bristol (GB)
- The University of Western Australia (AU)
- King's College London (GB)
- Stanford University (US)
- Albert Einstein College of Medicine (US)
- George Mason University (US)
- Virginia Commonwealth University (US)
- Centre for Chronic Disease Control (IN)
- Heidelberg University (DE)
- German Center for Infection Research (DE)
- Northeastern University (US)
- Soonchunhyang University (KR)
- National Cerebral and Cardiovascular Center (JP)
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Québec, Canada78Department of Demography, University of Montreal, Montreal, Québec, Canada79Public Health Research Institute, University of Montreal,
- Institute of Public Health, Hacettepe University, Ankara, Turkey
- Public Health Foundation of India (IN)
- Uppsala University (SE)
- Nova Southeastern University (US)
- State University of New York (US)
- Wayne State University (US)
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Universidade de São Paulo (BR)
- Aintree University Hospital National Health Service Foundation Trust, Liverpool, England89School of Medicine, University of Liverpool, Liverpool, England
- Swansea University (GB)
- Faculty of Health Sciences and Social Work, Trnava University, Trnava, Slovakia
- Digestive Disease Research Institute (IR)
- Ministry of Public Health (AF)
- Department of Health Sciences, University of York, York, England
- The University of Adelaide (AU)
- Alfaisal University (SA)
- United Nations Population Fund (US)
- Curtin University (AU)
- Deakin University (AU)
- Kyung Hee University (KR)
- Centre for Healthy Start Initiative (NG)
- Harvard University (US)
- Kosin University (KR)
- Universidad de Cartagena, Cartagena, Colombia
- University of Calgary (CA)
- The University of Melbourne (AU)
- Universidade do Porto (PT)
- Mario Negri Institute for Pharmacological Research (IT)
- University of Oxford (GB)
- Erasmus MC (NL)
- Centre for Addiction and Mental Health (CA)
- University of British Columbia (CA)
- Centre for Research in Environmental Epidemiology, Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
- Universität Ulm (DE)
- Women & Children's Hospital of Buffalo (US)
- Rosalind Franklin University of Medicine and Science (US)
- University of Alabama at Birmingham (US)
- An-Najah National University (PS)
- Finnish Institute of Occupational Health (FI)
- Northumbria University (GB)
- Columbia University (US)
- University of Cape Town (ZA)
- IMU University (MY)
- South African Medical Research Council (ZA)
- Norwegian University of Science and Technology (NO)
- University of California, Irvine (US)
- University of Illinois Urbana-Champaign (US)
- Cleveland Clinic (US)
- Adaptive Knowledge Management, Victoria, British Columbia, Canada
- Department of Nutrition, Harvard T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts152WorldFish, Penang, Malaysia
- St. Jude Children's Research Hospital (US)
- Federal Teaching Hospital Abakaliki (NG)
- Urho Kaleva Kekkonen Institute (FI)
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore
- National Research University Higher School of Economics, Moscow, Russia
- Norwegian Institute of Public Health (NO)
- Karolinska Institutet (SE)
- Royal Children's Hospital (AU)
- Federal Institute for Population Research (DE)
- University of Gondar (ET)
- National Health Service (GB)
- Northwestern University (US)
- Hong Kong Jockey Club (HK)
- National Center of Neurology and Psychiatry (JP)
- Korea University (KR)
- Jackson State University (US)
- Mansoura Faculty of Medicine, Mansoura, Egypt
- Corresponding author
- Vos, Theo
- ORCID
- Kyu, Hmwe H.
- Brown, Jonathan C.
- Bertozzi-Villa, Amelia
- Charlson, Fiona J.
- Coffeng, Luc Edgar
- Dandona, Lalit
- Erskine, Holly E.
- Ferrari, Alize J.
- Fitzmaurice, Christina
- Forouzanfar, Mohammad H.
- Graetz, Nicholas
- Guinovart, Caterina
- Haagsma, Juanita
- Higashi, Hideki
- Kassebaum, Nicholas J.
- Larson, Heidi J.
- Lim, Stephen S.
- Mokdad, Ali H.
- Roth, Gregory A.
- Serina, Peter T.
- Stanaway, Jeffrey D.
- Misganaw, Awoke
- Whiteford, Harvey A.
- Wolock, Timothy M.
- Abd-Allah, Foad
- Abera, Semaw Ferede
- Abu-Raddad, Laith J.
- AlBuhairan, Fadia S.
- Amare, Azmeraw T.
- Antonio, Carl Abelardo T.
- Barker-Collo, Suzanne L.
- Barrero, Lope H.
- Benjet, Corina
- Bhutta, Zulfiqar A.
- Bikbov, Boris
- Castañeda-Orjuela, Carlos A.
- Catalá-López, Ferrán
- Chowdhury, Rajiv
- Cooper, Cyrus
- Crump, John A.
- Dandona, Rakhi
- Degenhardt, Louisa
- Dharmaratne, Samath D.
- Faraon, Emerito Jose A.
- Feigin, Valery L.
- Fürst, Thomas
- Geleijnse, Johanna M.
- Gessner, Bradford D.
- Gibney, Katherine B.
- Goto, Atsushi
- Gunnell, David
- Hankey, Graeme J.
- Hay, Roderick J.
- Hornberger, John C.
- Hu, Guoqing
- Jacobsen, Kathryn H.
- Jayaraman, Sudha P.
- Jeemon, Panniyammakal
- Jonas, Jost B.
- Karch, André
- Kim, Daniel
- Kim, Sungroul
- Kokubo, Yoshihiro
- Kumar, G. Anil
- Larsson, Anders
- Leasher, Janet L.
- Leung, Ricky
- Li, Yongmei
- Lipshultz, Steven E.
- Lotufo, Paulo A.
- Lyons, Ronan A.
- Malekzadeh, Reza
- Melaku, Yohannes Adama
- Memish, Ziad A.
- Miller, Ted R.
- Mock, Charles N.
- Murray, Joseph
- Nolte, Sandra
- Oh, In-Hwan
- Olusanya, Bolajoko Olubukunola
- Ortblad, Katrina F.
- Park, Eun-Kee
- Patten, Scott B.
- Patton, George C.
- Pereira, David M.
- Perico, Norberto
- Piel, Frédéric B.
- Polinder, Suzanne
- Popova, Svetlana
- Pourmalek, Farshad
- Quistberg, D. Alex
- Remuzzi, Giuseppe
- Rodriguez, Alina
- Rothenbacher, Dietrich
- Rothstein, David H.
- Sanabria, Juan
- Santos, Itamar S.
- Schwebel, David C.
- Sepanlou, Sadaf G.
- Shaheen, Amira
- Shiri, Rahman
- Shiue, Ivy
- Skirbekk, Vegard
- Sliwa, Karen
- Sreeramareddy, Chandrashekhar T.
- Stein, Dan J.
- Steiner, Timothy J.
- Stovner, Lars Jacob
- Sykes, Bryan L.
- Tabb, Karen M.
- Terkawi, Abdullah Sulieman
- Ukwaja, Kingsley Nnanna
- Vasankari, Tommi
- Venketasubramanian, Narayanaswamy
- Weiderpass, Elisabete
- Werdecker, Andrea
- Wilkinson, James D.
- Woldeyohannes, Solomon Meseret
- Wolfe, Charles D. A.
- Yano, Yuichiro
- Yip, Paul
- Yonemoto, Naohiro
- Yoon, Seok-Jun
- Younis, Mustafa Z.
- Yu, Chuanhua
- Naghavi, Mohsen
- Murray, Christopher J. L.
- Vos, Theo
- Venue
- JAMA Pediatrics
- Publisher
- American Medical Association (AMA)
- Published
- 2016-03-01
- Volume
- 170
- Issue
- 3
- Pages
- 267
- ISSN
- 1072-4710 (ISSN-L)
- 2168-6203
- PMC
- PMC5076765
- OpenAlex
- W2258831804
- Semantic Scholar
- 8d2b3b28c99d2b3265b24b9a903c3e33dfebdde0
- Cited by
- 618
- References
- 27
- Citations by year
- 2026: 22 · 2025: 29 · 2024: 52 · 2023: 53 · 2022: 61 · 2021: 83 · 2020: 81 · 2019: 60 · 2018: 74 · 2017: 63 · 2016: 38
- FWCI
- 91.15
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Archives of Pediatrics and Adolescent Medicine (publishedVersion)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion)
- Lincoln Repository (University of Lincoln) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Socio-Environmental Systems Modeling (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- HZI (Helmholtz Centre for Infection Research) (submittedVersion, cc-by-nc-sa)
- NSUWorks (Nova Southeastern University) (submittedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- Own your potential (DEAKIN) (submittedVersion)
- eSpace (Curtin University) (submittedVersion)
- Figshare (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Minerva Access (University of Melbourne) (submittedVersion)
- Northumbria Research Link (Northumbria University) (submittedVersion)
- Hacettepe University Institutional Repository (hacettepe.edu.tr) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion)
- Explore Bristol Research (submittedVersion, other-oa)
- Bristol Research (University of Bristol) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Funders
- Pacific Institute for Research and Evaluation
- George Mason University
- United Nations Population Fund
- Wayne State University
- Rensselaer Polytechnic Institute
- Harvard University
- School of Medicine, Wayne State University
- University of Washington
- Case Western Reserve University
- Auckland University of Technology, New Zealand
- University of Otago
- Virginia Commonwealth University
- Nova Southeastern University
- Wellcome Trust (089963/Z/09/Z, 089963)
- University Hospital Southampton NHS Foundation Trust
- Rosalind Franklin University of Medicine and Science
- NIHR Biomedical Research Centre, Royal Marsden NHS Foundation Trust/Institute of Cancer Research
- Istituto di Ricerche Farmacologiche Mario Negri - IRCCS
- National Cerebral and Cardiovascular Center
- National Institute for Health and Care Research (NF-SI-0512-10165, NF-SI-0510-10060, RP-PG-0407-10184, NF-SI-0508-10082, NF-SI-0513-10085, NF-SI-0512-10068)
- British Heart Foundation (RG/08/014/24067)
- University of Southampton
- Imperial College London
- King's College London
- University of Oxford
- University of Bristol
- Swansea University
- Public Health Foundation of India
- Universität Heidelberg
- University of New South Wales
- Deakin University
- Monash University
- Curtin University of Technology
- Kosin University
- Soonchunhyang University
- Kyung Hee University
- Central South University
- University of Toronto
- Tehran University of Medical Sciences and Health Services
- Mittuniversitetet
- Hacettepe Üniversitesi
- Universidade de São Paulo
- Universidade do Porto
- Uppsala Universitet
- University of Peradeniya
- Universität Ulm
- Mekelle University
- Tokyo Women's Medical University
- Rede de Química e Tecnologia
- Laboratório Associado para a Química Verde
- Alfaisal University
- Children's Hospital of Michigan
- Genentech
- University at Buffalo
- Medical Research Council (MR/L003120/1, MR/K006525/1, MC_UU_12011/1, MC_PC_13043)
- Economic and Social Research Council (ES/L007444/1)
- Wageningen University and Research
- National Drug and Alcohol Research Centre
- School of Public Health, Imperial College London
- National Heart, Lung, and Blood Institute (T32HL007093)
- University of Colorado School of Medicine, Anschutz Medical Campus
- Colorado School of Public Health
- Topics
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
- Keywords
- child mortality, adolescent mortality, disease burden, injuries, lower respiratory tract infection, diarrheal disease, road traffic injuries, iron deficiency anemia, HIV/AIDS, measles, hepatitis B, prevalence trends, global health disparities, verbal autopsy, cause-specific mortality, disability-adjusted life years, years of life lost
- MeSH terms
- Child Health, Adolescent Health, Adolescent, Bayes Theorem, Child, Child, Preschool, Developing Countries, Female, Humans, Male, Global Health, Wounds and Injuries, Prevalence, Cost of Illness, Developed Countries, Quality-Adjusted Life Years, Child Mortality, Public Health Surveillance
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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