JAMA子刊揭示:威胁儿童、青少年生命的罪魁祸首!
2016/01/29
1月25日,JAMA儿科(JAMA Pediatrics)期刊发表一篇以儿童和青少年为主体的全球疾病负担(GBD)的文章,依据2013年全球GBD数据重新审视全球188个国家儿童和青少年致命和非致命疾病、伤害造成的死亡率,评估主要死亡原因以及预防措施的重要性。


1月25日,JAMA儿科(JAMA Pediatrics)期刊发表一篇以儿童和青少年为主体的全球疾病负担(GBD)的文章,依据2013年全球GBD数据重新审视全球188个国家儿童和青少年致命和非致命疾病、伤害造成的死亡率,评估主要死亡原因以及预防措施的重要性。

2013年,全球总计770万儿童和青少年死亡。其中,5岁以下的儿童死亡人数高达630万,5-9岁儿童的死亡数量约50万,10到19岁青少年的死亡数量约为100万。

死亡原因分析:呼吸道感染、腹泻疾病、交通意外属于高危原因

对5岁以下儿童死亡原因分析发现,呼吸道感染、早产并发症、新生儿出生创伤和窒息引发的脑部疾病、疟疾和腹泻作为5大主要原因严重威胁着幼儿的生命。数据显示,这五个原因在2013年造成全球340万5岁以下儿童死亡,占总死亡人数的54%。

对于5-9岁儿童而言:致死最高发疾病是腹泻疾病,其次是呼吸道感染、交通意外、肠道传染病(主要由伤寒引发)和疟疾。2013年,这五种疾病或者伤害造成18.1万儿童死亡,占总死亡人数的39%。

对于青少年(10-19岁)死亡原因分析显示,2013年造成死亡的主要原因是交通意外,其次是艾滋病、自杀、疟疾和肠道传染病。这5大原因导致的死亡比例占该年龄段总死亡人口的34%。

其中,因腹泻疾病导致死亡的儿童和青少年有一半来自于以下5个国家:印度、刚果共和国、巴基斯坦、尼日利亚和埃塞俄比亚。

2013年,缺铁性贫血影响着6.19亿残疾儿童和青少年的健康。与2013年之前的死亡率比较发现,发展中国家儿童和青少年全因死亡率在1990年到2013年间明显降低。

研究人员强调,上述调查数据因不同国家地区儿童和青少年死因调查差异、医疗水平不一致等因素存在一定偏差。

他们表示,这些死亡数量的背后意味着医疗干预措施还未得到充分应用。因为腹泻疾病、呼吸道感染、新生儿疾病、交通意外、缺铁性贫血等主要原因都可以提前预防、避免造成死亡。虽然总体死亡率正处于下降趋势,但是专家分析这种趋势原本可以更快。

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Global, national burden of diseases, injuries among children and adolescents

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  • Global and National Burden of Diseases and Injuries Among Children and Adolescents Between 1990 and 2013

    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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  • The Grand Divergence in Global Child Health Confronting Data Requirements in Areas of Conflict and Chronic Political Instability

    There is something deeply troubling about a death that goes unnoticed. Beyond the humane impulse to provide solace through collective acknowledgment and community support lies the recognition that an unnoticed death implies an unnoticed life. There can be no doubt that the accurate counting and causal attribution of morbidity and mortality provide technical information that is essential for public health planning, evaluation, and improvement in program performance. However, there is also a justice imperative inherent in counting and attribution—an imperative that transcends the practical and touches on the moral basis of global health and its commitment to the rights and societal claims of those whose health and well-being have for too long gone unnoticed.

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