The Lancet ( IF 168.9 ) Pub Date : 2021-10-28 , DOI: 10.1016/s0140-6736(21)01546-4 Joseph L Ward , Peter S Azzopardi , Kate Louise Francis , John S Santelli , Vegard Skirbekk , Susan M Sawyer , Nicholas J Kassebaum , Ali H Mokdad , Simon I Hay , Foad Abd-Allah , Amir Abdoli , Mohammad Abdollahi , Aidin Abedi , Hassan Abolhassani , Lucas Guimarães Abreu , Michael R M Abrigo , Eman Abu-Gharbieh , Abdelrahman I Abushouk , Oladimeji M Adebayo , Victor Adekanmbi , Davoud Adham , Shailesh M Advani , Khashayar Afshari , Anurag Agrawal , Tauseef Ahmad , Keivan Ahmadi , Anwar E Ahmed , Budi Aji , Blessing Akombi-Inyang , Fares Alahdab , Ziyad Al-Aly , Khurshid Alam , Fahad Mashhour Alanezi , Turki M Alanzi , Jacqueline Elizabeth Alcalde-Rabanal , Biresaw Wassihun Alemu , Samar Al-Hajj , Robert Kaba Alhassan , Saqib Ali , Gianfranco Alicandro , Mehran Alijanzadeh , Syed Mohamed Aljunid , Amir Almasi-Hashiani , Nihad A Almasri , Hesham M Al-Mekhlafi , Jordi Alonso , Rajaa M Al-Raddadi , Khalid A Altirkawi , Nelson Alvis-Guzman , Azmeraw T Amare , Saeed Amini , Arya Aminorroaya , Arianna Maever L Amit , Dickson A Amugsi , Robert Ancuceanu , Deanna Anderlini , Catalina Liliana Andrei , Sofia Androudi , Fereshteh Ansari , Iman Ansari , Carl Abelardo T Antonio , Davood Anvari , Razique Anwer , Seth Christopher Yaw Appiah , Jalal Arabloo , Morteza Arab-Zozani , Johan Ärnlöv , Malke Asaad , Mehran Asadi-Aliabadi , Ali A Asadi-Pooya , Maha Moh'd Wahbi Atout , Marcel Ausloos , Elvis Korku Avenyo , Leticia Avila-Burgos , Beatriz Paulina Ayala Quintanilla , Getinet Ayano , Yared Asmare Aynalem , Samad Azari , Zelalem Nigussie Azene , Mohammad Hossein Bakhshaei , Shankar M Bakkannavar , Maciej Banach , Palash Chandra Banik , Miguel A Barboza , Suzanne Lyn Barker-Collo , Till Winfried Bärnighausen , Sanjay Basu , Bernhard T Baune , Mohsen Bayati , Neeraj Bedi , Ettore Beghi , Tariku Tesfaye Bekuma , Arielle Wilder Bell , Michelle L Bell , Corina Benjet , Isabela M Bensenor , Abadi Kidanemariam Berhe , Kidanemaryam Berhe , Adam E Berman , Akshaya Srikanth Bhagavathula , Nikha Bhardwaj , Pankaj Bhardwaj , Krittika Bhattacharyya , Suraj Bhattarai , Zulfiqar A Bhutta , Ali Bijani , Boris Bikbov , Antonio Biondi , Tesega Tesega Mengistu Birhanu , Raaj Kishore Biswas , Somayeh Bohlouli , Srinivasa Rao Bolla , Archith Boloor , Rohan Borschmann , Soufiane Boufous , Nicola Luigi Bragazzi , Dejana Braithwaite , Nicholas J K Breitborde , Hermann Brenner , Gabrielle B Britton , Richard A Burns , Sharath Burugina Nagaraja , Zahid A Butt , Florentino Luciano Caetano dos Santos , Luis Alberto Cámera , Ismael R Campos-Nonato , Julio Cesar Campuzano Rincon , Rosario Cárdenas , Giulia Carreras , Juan J Carrero , Felix Carvalho , Joao Mauricio Castaldelli-Maia , Carlos A Castañeda-Orjuela , Giulio Castelpietra , Ferrán Catalá-López , Ester Cerin , Joht Singh Chandan , Hsing-Yi Chang , Jung-Chen Chang , Jaykaran Charan , Vijay Kumar Chattu , Sarika Chaturvedi , Jee-Young Jasmine Choi , Mohiuddin Ahsanul Kabir Chowdhury , Devasahayam J Christopher , Dinh-Toi Chu , Michael T Chung , Sheng-Chia Chung , Flavia M Cicuttini , Traian Vasile Constantin , Vera Marisa Costa , Saad M A Dahlawi , Haijiang Dai , Xiaochen Dai , Giovanni Damiani , Lalit Dandona , Rakhi Dandona , Parnaz Daneshpajouhnejad , Aso Mohammad Darwesh , Claudio Alberto Dávila-Cervantes , Kairat Davletov , Fernando Pio De la Hoz , Diego De Leo , Nikolaos Dervenis , Rupak Desai , Assefa Desalew , Keshab Deuba , Samath Dhamminda Dharmaratne , Govinda Prasad Dhungana , Mostafa Dianatinasab , Diana Dias da Silva , Daniel Diaz , Alireza Didarloo , Shirin Djalalinia , Fariba Dorostkar , Chirag P Doshi , Leila Doshmangir , Kerrie E Doyle , Andre Rodrigues Duraes , Mohammad Ebrahimi Kalan , Sanam Ebtehaj , David Edvardsson , Maha El Tantawi , Islam Y Elgendy , Shaimaa I El-Jaafary , Aisha Elsharkawy , Babak Eshrati , Sharareh Eskandarieh , Saman Esmaeilnejad , Firooz Esmaeilzadeh , Sadaf Esteghamati , Andre Faro , Farshad Farzadfar , Nazir Fattahi , Valery L Feigin , Tomas Y Ferede , Seyed-Mohammad Fereshtehnejad , Eduarda Fernandes , Pietro Ferrara , Irina Filip , Florian Fischer , James L Fisher , Nataliya A Foigt , Morenike Oluwatoyin Folayan , Artem Alekseevich Fomenkov , Masoud Foroutan , Takeshi Fukumoto , Mohamed M Gad , Abhay Motiramji Gaidhane , Silvano Gallus , Teshome Gebre , Ketema Bizuwork Gebremedhin , Gebreamlak Gebremedhn Gebremeskel , Leake Gebremeskel , Assefa Ayalew Gebreslassie , Hailay Abrha Gesesew , Keyghobad Ghadiri , Mansour Ghafourifard , Farhad Ghamari , Ahmad Ghashghaee , Syed Amir Gilani , Elena V Gnedovskaya , Myron Anthony Godinho , Mahaveer Golechha , Srinivas Goli , Philimon N Gona , Sameer Vali Gopalani , Giuseppe Gorini , Michal Grivna , Mohammed Ibrahim Mohialdeen Gubari , Harish Chander Gugnani , Rafael Alves Guimarães , Yuming Guo , Rajeev Gupta , Juanita A Haagsma , Nima Hafezi-Nejad , Teklehaimanot Gereziher Haile , Arvin Haj-Mirzaian , Arya Haj-Mirzaian , Brian J Hall , Randah R Hamadeh , Kanaan Hamagharib Abdullah , Samer Hamidi , Demelash Woldeyohannes Handiso , Asif Hanif , Graeme J Hankey , Hamidreza Haririan , Josep Maria Haro , Ahmed I Hasaballah , Abdiwahab Hashi , Amr Hassan , Soheil Hassanipour , Hadi Hassankhani , Khezar Hayat , Reza Heidari-Soureshjani , Claudiu Herteliu , Fatemeh Heydarpour , Hung Chak Ho , Michael K Hole , Ramesh Holla , Praveen Hoogar , Mostafa Hosseini , Mehdi Hosseinzadeh , Mihaela Hostiuc , Sorin Hostiuc , Mowafa Househ , Mohamed Hsairi , Tanvir M Huda , Ayesha Humayun , Rabia Hussain , Bing-Fang Hwang , Ivo Iavicoli , Segun Emmanuel Ibitoye , Olayinka Stephen Ilesanmi , Irena M Ilic , Milena D Ilic , Leeberk Raja Inbaraj , Nirun Intarut , Usman Iqbal , Seyed Sina Naghibi Irvani , M Mofizul Islam , Sheikh Mohammed Shariful Islam , Hiroyasu Iso , Rebecca Q Ivers , Mohammad Ali Jahani , Mihajlo Jakovljevic , Amir Jalali , Manthan Dilipkumar Janodia , Tahereh Javaheri , Panniyammakal Jeemon , Ensiyeh Jenabi , Ravi Prakash Jha , Vivekanand Jha , John S Ji , Jost B Jonas , Kelly M Jones , Farahnaz Joukar , Jacek Jerzy Jozwiak , Petur B Juliusson , Mikk Jürisson , Ali Kabir , Zubair Kabir , Leila R Kalankesh , Rohollah Kalhor , Naser Kamyari , Tanuj Kanchan , André Karch , Salah Eddin Karimi , Supreet Kaur , Gbenga A Kayode , Peter Njenga Keiyoro , Nauman Khalid , Mohammad Khammarnia , Maseer Khan , Md Nuruzzaman Khan , Khaled Khatab , Mona M Khater , Mahalaqua Nazli Khatib , Maryam Khayamzadeh , Habibolah Khazaie , Abdullah T Khoja , Christian Kieling , Young-Eun Kim , Yun Jin Kim , Ruth W Kimokoti , Adnan Kisa , Sezer Kisa , Mika Kivimäki , Ali Koolivand , Soewarta Kosen , Ai Koyanagi , Kewal Krishan , Nuworza Kugbey , G Anil Kumar , Manasi Kumar , Nithin Kumar , Om P Kurmi , Dian Kusuma , Carlo La Vecchia , Ben Lacey , Dharmesh Kumar Lal , Ratilal Lalloo , Qing Lan , Iván Landires , Van Charles Lansingh , Anders O Larsson , Savita Lasrado , Zohra S Lassi , Paolo Lauriola , Paul H Lee , Shaun Wen Huey Lee , James Leigh , Matilde Leonardi , Janni Leung , Miriam Levi , Sonia Lewycka , Bingyu Li , Ming-Chieh Li , Shanshan Li , Lee-Ling Lim , Stephen S Lim , Xuefeng Liu , Stefan Lorkowski , Paulo A Lotufo , Raimundas Lunevicius , Ralph Maddison , Phetole Walter Mahasha , Mokhtar Mahdavi Mahdavi , Morteza Mahmoudi , Azeem Majeed , Afshin Maleki , Reza Malekzadeh , Deborah Carvalho Malta , Abdullah A Mamun , Borhan Mansouri , Mohammad Ali Mansournia , Gabriel Martinez , Jose Martinez-Raga , Francisco Rogerlândio Martins-Melo , Amanda J Mason-Jones , Seyedeh Zahra Masoumi , Manu Raj Mathur , Pallab K Maulik , John J McGrath , Man Mohan Mehndiratta , Fereshteh Mehri , Peter T N Memiah , Walter Mendoza , Ritesh G Menezes , Endalkachew Worku Mengesha , Atte Meretoja , Tuomo J Meretoja , Tomislav Mestrovic , Bartosz Miazgowski , Tomasz Miazgowski , Irmina Maria Michalek , Ted R Miller , GK Mini , Andreea Mirica , Erkin M Mirrakhimov , Hamed Mirzaei , Maryam Mirzaei , Babak Moazen , Dara K Mohammad , Shadieh Mohammadi , Abdollah Mohammadian-Hafshejani , Noushin Mohammadifard , Reza Mohammadpourhodki , Shafiu Mohammed , Lorenzo Monasta , Ghobad Moradi , Maziar Moradi-Lakeh , Rahmatollah Moradzadeh , Paula Moraga , Shane Douglas Morrison , Abbas Mosapour , Amin Mousavi Khaneghah , Ulrich Otto Mueller , Moses K Muriithi , Christopher J L Murray , Saravanan Muthupandian , Mehdi Naderi , Ahamarshan Jayaraman Nagarajan , Mohsen Naghavi , Mukhammad David Naimzada , Vinay Nangia , Vinod C Nayak , Javad Nazari , Rawlance Ndejjo , Ionut Negoi , Ruxandra Irina Negoi , Henok Biresaw Netsere , Georges Nguefack-Tsague , Diep Ngoc Nguyen , Huong Lan Thi Nguyen , Jing Nie , Dina Nur Anggraini Ningrum , Chukwudi A Nnaji , Shuhei Nomura , Jean Jacques Noubiap , Christoph Nowak , Virginia Nuñez-Samudio , Felix Akpojene Ogbo , Onome Bright Oghenetega , In-Hwan Oh , Morteza Oladnabi , Andrew T Olagunju , Bolajoko Olubukunola Olusanya , Jacob Olusegun Olusanya , Ahmed Omar Bali , Muktar Omer Omer , Obinna E Onwujekwe , Alberto Ortiz , Adrian Otoiu , Nikita Otstavnov , Stanislav S Otstavnov , Simon Øverland , Mayowa O Owolabi , Mahesh P A , Jagadish Rao Padubidri , Keyvan Pakshir , Raffaele Palladino , Adrian Pana , Songhomitra Panda-Jonas , Anamika Pandey , Carlo Irwin Able Panelo , Eun-Kee Park , Scott B Patten , Amy E Peden , Veincent Christian Filipino Pepito , Emmanuel K Peprah , Jeevan Pereira , Konrad Pesudovs , Hai Quang Pham , Michael R Phillips , Michael A Piradov , Meghdad Pirsaheb , Maarten J Postma , Faheem Hyder Pottoo , Hadi Pourjafar , Akram Pourshams , Sergio I Prada , Elisabetta Pupillo , Zahiruddin Quazi Syed , Mohammad Hasan Rabiee , Navid Rabiee , Amir Radfar , Ata Rafiee , Alberto Raggi , Fakher Rahim , Vafa Rahimi-Movaghar , Mohammad Hifz Ur Rahman , Muhammad Aziz Rahman , Kiana Ramezanzadeh , Chhabi Lal Ranabhat , Sowmya J Rao , Vahid Rashedi , Prateek Rastogi , Priya Rathi , David Laith Rawaf , Salman Rawaf , Lal 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Kumar Shetty , Peilin Shi , Mika Shigematsu , Jae Il Shin , Rahman Shiri , Kerem Shuval , Soraya Siabani , Inga Dora Sigfusdottir , Rannveig Sigurvinsdottir , Diego Augusto Santos Silva , João Pedro Silva , Biagio Simonetti , Jasvinder A Singh , Virendra Singh , Abiy H Sinke , Valentin Yurievich Skryabin , Helen Slater , Emma U R Smith , Mohammad Reza Sobhiyeh , Eugene Sobngwi , Amin Soheili , Oluwaseyi Dolapo Somefun , Muluken Bekele Sorrie , Ireneous N Soyiri , Chandrashekhar T Sreeramareddy , Dan J Stein , Mark A Stokes , Agus Sudaryanto , Iyad Sultan , Rafael Tabarés-Seisdedos , Takahiro Tabuchi , Santosh Kumar Tadakamadla , Amir Taherkhani , Animut Tagele Tamiru , Md Ismail Tareque , Kavumpurathu Raman Thankappan , Rekha Thapar , Nihal Thomas , Mariya Vladimirovna Titova , Marcello Tonelli , Marcos Roberto Tovani-Palone , Bach Xuan Tran , Ravensara S Travillian , Alexander C Tsai , Aristidis Tsatsakis , Lorainne Tudor Car , Riaz Uddin , Brigid Unim , Bhaskaran Unnikrishnan , Era Upadhyay , Marco Vacante , Sahel Valadan Tahbaz , Pascual R Valdez , Santosh Varughese , Tommi Juhani Vasankari , Narayanaswamy Venketasubramanian , Paul J Villeneuve , Francesco S Violante , Vasily Vlassov , Theo Vos , Giang Thu Vu , Yasir Waheed , Richard G Wamai , Yafeng Wang , Yanzhong Wang , Yuan-Pang Wang , Ronny Westerman , Nuwan Darshana Wickramasinghe , Ai-Min Wu , Chenkai Wu , Seyed Hossein Yahyazadeh Jabbari , Kazumasa Yamagishi , Yuichiro Yano , Sanni Yaya , Vahid Yazdi-Feyzabadi , Yordanos Gizachew Yeshitila , Paul Yip , Naohiro Yonemoto , Seok-Jun Yoon , Mustafa Z Younis , Taraneh Yousefinezhadi , Chuanhua Yu , Yong Yu , Deniz Yuce , Syed Saoud Zaidi , Sojib Bin Zaman , Mohammad Zamani , Maryam Zamanian , Hadi Zarafshan , Ahmad Zarei , Mikhail Sergeevich Zastrozhin , Yunquan Zhang , Zhi-Jiang Zhang , Xiu-Ju George Zhao , Cong Zhu , George C Patton , Russell M Viner
Background
Documentation of patterns and long-term trends in mortality in young people, which reflect huge changes in demographic and social determinants of adolescent health, enables identification of global investment priorities for this age group. We aimed to analyse data on the number of deaths, years of life lost, and mortality rates by sex and age group in people aged 10–24 years in 204 countries and territories from 1950 to 2019 by use of estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019.
Methods
We report trends in estimated total numbers of deaths and mortality rate per 100 000 population in young people aged 10–24 years by age group (10–14 years, 15–19 years, and 20–24 years) and sex in 204 countries and territories between 1950 and 2019 for all causes, and between 1980 and 2019 by cause of death. We analyse variation in outcomes by region, age group, and sex, and compare annual rate of change in mortality in young people aged 10–24 years with that in children aged 0–9 years from 1990 to 2019. We then analyse the association between mortality in people aged 10–24 years and socioeconomic development using the GBD Socio-demographic Index (SDI), a composite measure based on average national educational attainment in people older than 15 years, total fertility rate in people younger than 25 years, and income per capita. We assess the association between SDI and all-cause mortality in 2019, and analyse the ratio of observed to expected mortality by SDI using the most recent available data release (2017).
Findings
In 2019 there were 1·49 million deaths (95% uncertainty interval 1·39–1·59) worldwide in people aged 10–24 years, of which 61% occurred in males. 32·7% of all adolescent deaths were due to transport injuries, unintentional injuries, or interpersonal violence and conflict; 32·1% were due to communicable, nutritional, or maternal causes; 27·0% were due to non-communicable diseases; and 8·2% were due to self-harm. Since 1950, deaths in this age group decreased by 30·0% in females and 15·3% in males, and sex-based differences in mortality rate have widened in most regions of the world. Geographical variation has also increased, particularly in people aged 10–14 years. Since 1980, communicable and maternal causes of death have decreased sharply as a proportion of total deaths in most GBD super-regions, but remain some of the most common causes in sub-Saharan Africa and south Asia, where more than half of all adolescent deaths occur. Annual percentage decrease in all-cause mortality rate since 1990 in adolescents aged 15–19 years was 1·3% in males and 1·6% in females, almost half that of males aged 1–4 years (2·4%), and around a third less than in females aged 1–4 years (2·5%). The proportion of global deaths in people aged 0–24 years that occurred in people aged 10–24 years more than doubled between 1950 and 2019, from 9·5% to 21·6%.
Interpretation
Variation in adolescent mortality between countries and by sex is widening, driven by poor progress in reducing deaths in males and older adolescents. Improving global adolescent mortality will require action to address the specific vulnerabilities of this age group, which are being overlooked. Furthermore, indirect effects of the COVID-19 pandemic are likely to jeopardise efforts to improve health outcomes including mortality in young people aged 10–24 years. There is an urgent need to respond to the changing global burden of adolescent mortality, address inequities where they occur, and improve the availability and quality of primary mortality data in this age group.
Funding
Bill & Melinda Gates Foundation.
中文翻译：
1950-2019 年 10-24 岁年轻人的全球、区域和国家死亡率：2019 年全球疾病负担研究的系统分析
背景
年轻人死亡率的模式和长期趋势的记录反映了青少年健康的人口和社会决定因素的巨大变化，有助于确定该年龄组的全球投资重点。我们的目的是通过使用全球疾病负担的估计值，分析 1950 年至 2019 年 204 个国家和地区 10-24 岁人群中按性别和年龄组划分的死亡人数、寿命损失年数和死亡率数据。 、伤害和风险因素研究 (GBD) 2019。
方法
我们报告了 204 个国家和地区按年龄组（10-14 岁、15-19 岁和 20-24 岁）和性别分列的 10-24 岁年轻人的估计死亡总数和每 10 万人口死亡率的趋势，以及1950 年至 2019 年所有原因的领土，以及 1980 年至 2019 年死亡原因的领土。我们按地区、年龄组和性别分析了结果的差异，并比较了 1990 年至 2019 年 10-24 岁年轻人和 0-9 岁儿童死亡率的年变化率。然后我们分析了两者之间的关联使用 GBD 社会人口指数 (SDI) 计算 10-24 岁人群的死亡率和社会经济发展，该指数是基于 15 岁以上人群的国民平均受教育程度、25 岁以下人群的总生育率和收入的综合衡量指标人均。
发现
2019 年，全球 10-24 岁人群中有 1·49 万人死亡（95% 不确定区间为 1·39–1·59），其中 61% 发生在男性。32·7% 的青少年死亡是由于交通伤害、意外伤害或人际暴力和冲突造成的；32·1% 是由于传染、营养或孕产原因；27·0% 为非传染性疾病；8·2% 是由于自残。自 1950 年以来，该年龄组的女性死亡率下降了 30·0%，男性下降了 15·3%，并且在世界大部分地区，基于性别的死亡率差异已经扩大。地域差异也有所增加，尤其是在 10-14 岁的人群中。自 1980 年以来，在大多数 GBD 超区域，传染性和孕产妇死亡占总死亡人数的比例急剧下降，但仍然是撒哈拉以南非洲和南亚的一些最常见原因，超过一半的青少年死亡发生在这些地区。自 1990 年以来，15-19 岁青少年的全因死亡率每年下降百分比为男性 1·3%，女性为 1·6%，几乎是 1-4 岁男性 (2·4%) 的一半，比 1-4 岁女性 (2·5%) 少三分之一左右。1950 年至 2019 年间，全球 0-24 岁人群死亡人数占 10-24 岁人群死亡人数的比例增加了一倍多，从 9·5% 增加到 21·6%。比 1-4 岁女性 (2·5%) 少三分之一左右。1950 年至 2019 年间，全球 0-24 岁人群死亡人数占 10-24 岁人群死亡人数的比例增加了一倍多，从 9·5% 增加到 21·6%。比 1-4 岁女性 (2·5%) 少三分之一左右。1950 年至 2019 年间，全球 0-24 岁人群死亡人数占 10-24 岁人群死亡人数的比例增加了一倍多，从 9·5% 增加到 21·6%。
解释
由于在减少男性和年龄较大的青少年死亡率方面进展缓慢，各国和不同性别的青少年死亡率差异正在扩大。降低全球青少年死亡率将需要采取行动解决这个年龄组的具体脆弱性，这些脆弱性正在被忽视。此外，COVID-19 大流行的间接影响可能会危及改善 10-24 岁年轻人健康结果（包括死亡率）的努力。迫切需要应对不断变化的全球青少年死亡率负担，解决不公平现象，并提高该年龄组主要死亡率数据的可用性和质量。
资金
比尔和梅琳达·盖茨基金会。
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