US 1 of 8 nations where child & adolescent health improved but maternal mortality worsened

April 29, 2019

SEATTLE - The United States is one of only eight countries in the world where decreases in child and adolescent mortality over a 27-year period haven't also been matched by reductions in maternal mortality, according to a new scientific study.

This divergent trend also was found in American Samoa, Canada, Greece, Guam, Jamaica, St. Vincent and the Grenadines, and Zimbabwe. Of these countries, the United States had the largest increase in maternal mortality rate at 67.5%.

"Our findings are particularly alarming because the health of children is very closely linked to that of their mothers," said Dr. Nicholas Kassebaum, a senior author on the study and adjunct associate professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine. "This paradox warrants closer investigation in the United States to determine how we can prioritize health improvements for mothers alongside those for children and adolescents."

Kassebaum emphasized the study also identifies uneven progress in child and adolescent health over the 27-year study period, with inequity increasing between countries with the highest and lowest Socio-demographic Index (SDI) scores. SDI, a measure of development, takes into account per capita income, adult education, and total fertility rate for women under 25 years old.

For example, findings show the gap between the best and worst performers has widened. Low-SDI and low-middle-SDI countries experienced 82.2% of all child and adolescent deaths, up from 70.9% in 1990.

Published today in the international medical journal JAMA Pediatrics, the study covers 1990 to 2017 and 195 countries and territories. A part of the Global Burden of Disease (GBD) study, this new analysis is a comprehensive effort to quantify child and adolescent health internationally. Findings are presented for the collective age group of birth to 19 years, but also separately for neonates, infants, children, and adolescents. Study authors defined neonates as those younger than 28 days, infants as those younger than 1 year, children as those younger than 10 years, and adolescents as those aged 10 to 19 years.

Researchers found children today are more likely than ever to reach their 20th birthdays as a result of substantial mortality reductions. Child and adolescent deaths were halved between 1990 and 2017, falling from 13.8 million to 6.6 million. These dramatic gains were largely due to global declines in deaths from diarrhea, lower respiratory infections, and other common infectious diseases, especially among children aged 1-4 years, who saw the most rapid reduction in mortality.

Despite this considerable progress, lower respiratory infections, diarrhea, and acute malnutrition remained among the top killers of children and adolescents globally in 2017. Furthermore, HIV/AIDS remains an imminent threat to the health and well-being of older children and adolescents in many countries in sub-Saharan Africa, including South Africa, Zimbabwe, Lesotho, Swaziland, Botswana, and Zambia.

With reductions in mortality from communicable diseases, many middle- and high-income countries have experienced increased health loss from non-communicable diseases (NCDs) such as congenital birth defects, mental and behavioral disorders, and asthma. Injuries also continue to be a major cause of early mortality and long-term disability among older children and adolescents in all countries.

"An emerging threat is the large and growing burden of mental health and substance use disorders among older children and adolescents globally," said Dr. Bobby Reiner, lead author on the study and assistant professor at IHME. "As more children survive infancy, already overburdened health systems will need to adapt to the challenge of addressing non-communicable diseases among older children and adolescents."

Reiner also noted that few countries showed any evidence of health improvements among adolescents over the 27-year period beyond what was expected with general gains in societal development.

Additional findings include:The study is entitled "Diseases, Injuries, and Risk Factors in Child and Adolescent Health, 1990 to 2017."


Under 20 years

  1. India: 1,299,265 deaths
  2. Nigeria: 866,170
  3. Pakistan: 421,784
  4. Democratic Republic of the Congo: 286,991
  5. China: 243,609
  6. Ethiopia: 232,389
  7. Indonesia: 147,791
  8. Bangladesh: 143,528
  9. Tanzania: 138,382
  10. Mali: 113,600


Under 20 years

  1. India: 3,399,581 deaths
  2. China: 1,629,696
  3. Nigeria: 877,069
  4. Bangladesh: 654,730
  5. Pakistan: 601,805
  6. Ethiopia: 471,391
  7. Indonesia: 470,377
  8. Democratic Republic of the Congo: 299,385
  9. Brazil: 267,476
  10. Tanzania: 188,343


Under 20 years - largest decrease

  1. Serbia: -86.9% (4,839 to 636 deaths)
  2. Armenia: -86.6% (3,836 to 514)
  3. Estonia: -86.5% (611 to 82)
  4. China: -85.0% (1,629,696 to 243,609)
  5. Maldives: -84.8% (488 to 74)
  6. Latvia: -84.5% (1,066 to 165)
  7. Albania: -84.0% (4,070 to 651)
  8. Portugal: -83.5% (3,013 to 499)
  9. South Korea: -82.7% (14,748 to 2,545)
  10. Romania: -82.3% (13,607 to 2,411)

Under 20 years - largest increase

  1. Papua New Guinea: 40.5% (12,624 to 17,736)
  2. Vanuatu: 36.1% (238 to 324)
  3. Chad: 31.0% (67,124 to 87,908)
  4. Central African Republic: 24.3% (21,360 to 26,545)
  5. Zimbabwe: 12.5% (28,549 to 32,117)
  6. Iraq: 10.8% (40,510 to 44,894)
  7. South Sudan: 9.2% (48,460 to 52,897)
  8. Qatar: 4.9% (287 to 301)
  9. Afghanistan: 4.2% (96,809 to 100,823)
  10. United Arab Emirates: 2.8% (1,431 to 1,471)
Media contacts:

IHME: Kelly Bienhoff, +1-206-897-2884 (office); +1-913-302-3817 (mobile);

IHME: Dean Owen, +1-206-897-2858 (office); +1-206-434-5630 (mobile);

JAMA: Jim Michalski, +1-312-464-5786 (office);

Available for comment:

Dr. Nicholas Kassebaum, Adjunct Associate Professor of Health Metrics Sciences, IHME;

Dr. Bobby Reiner, Assistant Professor of Health Metrics Sciences, IHME,

About the Institute for Health Metrics and Evaluation

The Institute for Health Metrics and Evaluation (IHME) is an independent global health research organization at the University of Washington that provides rigorous and comparable measurement of the world's most important health problems and evaluates the strategies used to address them. IHME is committed to transparency and makes this information widely available so that policymakers have the evidence they need to make informed decisions on allocating resources to improve population health.

About the Global Burden of Disease study

The Global Burden of Disease (GBD) study is the largest and most comprehensive effort to quantify health loss across places and over time. It draws on the work of more than 3,600 collaborators from 146 countries and territories. The Institute for Health Metrics and Evaluation coordinates the study. The GBD 2017 study was published in November 2018 and includes more than 38 billion estimates of 359 diseases and injuries and 84 risk factors in 195 countries and territories.

Institute for Health Metrics and Evaluation

Related Mortality Articles from Brightsurf:

Being in treatment with statins reduces COVID-19 mortality by 22% to 25%
A research by the Universitat Rovira i Virgili (URV) and Pere Virgili Institut (IISPV) led by LluĂ­s Masana has found that people who are being treated with statins have a 22% to 25% lower risk of dying from COVID-19.

Mortality rate higher for US rural residents
A recent study by Syracuse University sociology professor Shannon Monnat shows that mortality rates are higher for U.S. working-age residents who live in rural areas instead of metro areas, and the gap is getting wider.

COVID-19, excess all-cause mortality in US, 18 comparison countries
COVID-19 deaths and excess all-cause mortality in the U.S. are compared with 18 countries with diverse COVID-19 responses in this study.

New analysis shows hydroxychloroquine does not lower mortality in COVID-19 patients, and is associated with increased mortality when combined with the antibiotic azithromycin
A new meta-analysis of published studies into the drug hydroxychloroquine shows that it does not lower mortality in COVID-19 patients, and using it combined with the antibiotic azithromycin is associated with a 27% increased mortality.

Hydroxychloroquine reduces in-hospital COVID-19 mortality
An Italian observational study contributes to the ongoing debate regarding the use of hydroxychloroquine in the current pandemic.

What's the best way to estimate and track COVID-19 mortality?
When used correctly, the symptomatic case fatality ratio (sCFR) and the infection fatality ratio (IFR) are better measures by which to monitor COVID-19 epidemics than the commonly reported case fatality ratio (CFR), according to a new study published this week in PLOS Medicine by Anthony Hauser of the University of Bern, Switzerland, and colleagues.

COVID-19: Bacteriophage could decrease mortality
Bacteriophage can reduce bacterial growth in the lungs, limiting fluid build-up.

COPD and smoking associated with higher COVID-19 mortality
Current smokers and people with chronic obstructive pulmonary disease (COPD) have an increased risk of severe complications and higher mortality with COVID-19 infection, according to a new study published May 11, 2020 in the open-access journal PLOS ONE by Jaber Alqahtani of University College London, UK, and colleagues.

Highest mortality risks for poor and unemployed
Large dataset shows that income, work status and education have a clear influence on mortality in Germany.

Addressing causes of mortality in Zambia
Despite the fact that people in sub-Saharan Africa are now living longer than they did two decades ago, their average life expectancy remains below that of the rest of the world population.

Read More: Mortality News and Mortality Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to