TY - JOUR
T1 - The unfinished agenda of communicable diseases among children and adolescents before the COVID-19 pandemic, 1990-2019
T2 - a systematic analysis of the Global Burden of Disease Study 2019
AU - Azzopardi, Peter S.
AU - Kerr, Jessica A.
AU - Francis, Kate L.
AU - Sawyer, Susan M.
AU - Kennedy, Elissa Clare
AU - Steer, Andrew C.
AU - Graham, Stephen Michael
AU - Viner, Russell M.
AU - Ward, Joseph L.
AU - Hennegan, Julie
AU - Pham, Minh
AU - Habito, Christine Marie D.
AU - Kurji, Jaameeta
AU - Cini, Karly
AU - Beeson, James G.
AU - Brown, Alex
AU - Murray, Christopher J. L.
AU - Abbasi-Kangevari, Mohsen
AU - Abolhassani, Hassan
AU - Adekanmbi, Victor
AU - Agampodi, Suneth Buddhika
AU - Ahmed, Muktar Beshir
AU - Ajami, Marjan
AU - Akbarialiabad, Hossein
AU - Akbarzadeh-Khiavi, Mostafa
AU - AL-Ahdal, Tareq Mohammed Ali
AU - Ali, Musa Mohammed
AU - Samakkhah, Shohreh Alian
AU - Alimohamadi, Yousef
AU - Alipour, Vahid
AU - Al-Jumaily, Adel
AU - Amiri, Sohrab
AU - Amirzade-Iranaq, Mohammad Hosein
AU - Anoushiravani, Amir
AU - Anvari, Davood
AU - Arabloo, Jalal
AU - Arab-Zozani, Morteza
AU - Arkew, Mesay
AU - Armocida, Benedetta
AU - Asadi-Pooya, Ali A.
AU - Asemi, Zatollah
AU - Asgary, Saeed
AU - Athari, Seyyed Shamsadin
AU - Azami, Hiva
AU - Azangou-Khyavy, Mohammadreza
AU - Azizi, Hosein
AU - Bagheri, Nader
AU - Bagherieh, Sara
AU - Barone-Adesi, Francesco
AU - GBD 2019 Child & Adolescent
AU - Dianatinasab, Mostafa
PY - 2023/7/22
Y1 - 2023/7/22
N2 - Background Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. Methods In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. Findings In 2019, there were 3 & BULL;0 million deaths and 30 & BULL;0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288 & BULL;4 million DALYs from communicable diseases among children and adolescents globally (57 & BULL;3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4 & BULL;0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59 & BULL;8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. Interpretation Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world.Funding The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation. Copyright & COPY; 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
AB - Background Communicable disease control has long been a focus of global health policy. There have been substantial reductions in the burden and mortality of communicable diseases among children younger than 5 years, but we know less about this burden in older children and adolescents, and it is unclear whether current programmes and policies remain aligned with targets for intervention. This knowledge is especially important for policy and programmes in the context of the COVID-19 pandemic. We aimed to use the Global Burden of Disease (GBD) Study 2019 to systematically characterise the burden of communicable diseases across childhood and adolescence. Methods In this systematic analysis of the GBD study from 1990 to 2019, all communicable diseases and their manifestations as modelled within GBD 2019 were included, categorised as 16 subgroups of common diseases or presentations. Data were reported for absolute count, prevalence, and incidence across measures of cause-specific mortality (deaths and years of life lost), disability (years lived with disability [YLDs]), and disease burden (disability-adjusted life-years [DALYs]) for children and adolescents aged 0-24 years. Data were reported across the Socio-demographic Index (SDI) and across time (1990-2019), and for 204 countries and territories. For HIV, we reported the mortality-to-incidence ratio (MIR) as a measure of health system performance. Findings In 2019, there were 3 & BULL;0 million deaths and 30 & BULL;0 million years of healthy life lost to disability (as measured by YLDs), corresponding to 288 & BULL;4 million DALYs from communicable diseases among children and adolescents globally (57 & BULL;3% of total communicable disease burden across all ages). Over time, there has been a shift in communicable disease burden from young children to older children and adolescents (largely driven by the considerable reductions in children younger than 5 years and slower progress elsewhere), although children younger than 5 years still accounted for most of the communicable disease burden in 2019. Disease burden and mortality were predominantly in low-SDI settings, with high and high-middle SDI settings also having an appreciable burden of communicable disease morbidity (4 & BULL;0 million YLDs in 2019 alone). Three cause groups (enteric infections, lower-respiratory-tract infections, and malaria) accounted for 59 & BULL;8% of the global communicable disease burden in children and adolescents, with tuberculosis and HIV both emerging as important causes during adolescence. HIV was the only cause for which disease burden increased over time, particularly in children and adolescents older than 5 years, and especially in females. Excess MIRs for HIV were observed for males aged 15-19 years in low-SDI settings. Interpretation Our analysis supports continued policy focus on enteric infections and lower-respiratory-tract infections, with orientation to children younger than 5 years in settings of low socioeconomic development. However, efforts should also be targeted to other conditions, particularly HIV, given its increased burden in older children and adolescents. Older children and adolescents also experience a large burden of communicable disease, further highlighting the need for efforts to extend beyond the first 5 years of life. Our analysis also identified substantial morbidity caused by communicable diseases affecting child and adolescent health across the world.Funding The Australian National Health and Medical Research Council Centre for Research Excellence for Driving Investment in Global Adolescent Health and the Bill & Melinda Gates Foundation. Copyright & COPY; 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
KW - SUSTAINABLE DEVELOPMENT
KW - UNDER-5 MORTALITY
KW - MIDDLE-INCOME
KW - HEALTH
KW - DEATHS
KW - LIFE
U2 - 10.1016/S0140-6736(23)00860-7
DO - 10.1016/S0140-6736(23)00860-7
M3 - Article
SN - 0140-6736
VL - 402
SP - 313
EP - 335
JO - Lancet
JF - Lancet
IS - 10398
ER -