Estimates of global causes of death for children and adolescents aged 5-19 in 2000-24: secondary data analysis using bayesian multinomial logistic regression.
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OBJECTIVE: To estimate cause specific mortality among children and adolescents aged 5-19 years for 195 countries from 2000 to 2024. DESIGN: Secondary data analysis using a bayesian multinomial logistic regression model to estimate cause specific mortality fractions. DATA SOURCES: PubMed, Embase, Web of Science, Scopus, Cochrane Library, Global Index Medicus, Pan American Health Organization, Global Health Ovid, Africa-Wide Information, IndMed, WHO Mortality Database, Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Health and Demographic and Surveillance Systems. INCLUSION CRITERIA: Studies of the general population reporting cause specific mortality based on primary data for at least two causes in the age groups of interest, with a specified method for determining cause. For studies identifying causes of mortality with verbal autopsy, eligibility required between 15 and 5000 total deaths, with 25% or fewer of these deaths with unknown cause. For vital registration, country data points were limited to those with at least five years of data from 2010 or later with a minimum of 80% of total deaths assigned to a meaningful cause of death determined by international classification of diseases, ninth or 10th revision. RESULTS: Cause specific mortality fractions were calculated from vital registration data for 64 countries, disease surveillance points data for China, and modelled for the remainder. Of the 1.4 million global deaths among children and adolescents aged 5-19 years in 2024, the leading cause of death was road traffic injuries with 113 138 deaths (90% uncertainty interval 106 901 to 119 375), followed by malaria (99 219, 85 840 to 112 597) and neoplasms (87 827, 81 143 to 94 511). Deaths attributed to communicable, maternal, perinatal, and nutritional conditions comprised close to 50% of global deaths in 5-14 year olds, but less than 23% among those aged 15-19 years. In 15-19 year olds, self-harm was most prevalent in female adolescents (27 239 deaths, 24 537 to 29 941), while road traffic injuries caused the largest number of deaths in male adolescents (48 211, 44 607 to 51 816). Age and cause specific patterns varied considerably by region. In high mortality settings, the decline in most communicable, maternal, perinatal, and nutritional conditions has slowed since 2015 compared with the previous 15 years. CONCLUSION: The estimates presented here can help countries determine the most appropriate course of action to reduce child and adolescent mortality. As mortality rates from leading causes have declined over the years, maintaining the same pace of reduction becomes more challenging, making it necessary to focus on causes that have not previously been prioritised for children and adolescents, such as child cancer and other non-communicable diseases. Maternal mortality is another area of concern where progress has stalled since 2015 and more than 80% of countries risk missing the sustainable development goal target of less than 70 deaths per 100 000 live births by 2030.