HEALTH FOR THE WORLD'S ADOLESCENTS

What we can learn from mortality data?

Despite the rates being relatively low, there is still significant mortality during the adolescent years. In 2012 an estimated 1.3 million adolescents died, down from 1.5 million in 2000. The mortality rate decreased from 126 to 111 per 100,000 between 2000 and 2012. This modest decline of about 12% continues the trend of the past 50 years₃. Mortality rates dropped in all regions and for all age groups except 15–19 year old males in the Eastern Mediterranean and the Americas regions. Mortality continued to be highest in the African Region, increasing from 34% to 43% of global mortality in 10-19 year olds between 2000 and 2012

Common priorities

What is perhaps most surprising about the mortality data is the similarities rather than the differences across regions and between different age groups and sexes.

Unintentional injuries, particularly road injuries, are the leading cause of adolescent death globally. Road injuries are among the top five causes of death in all regions, all age groups and all sexes, except among adolescent females in the African Region (although, with a mortality rate of 11 per 100,000 population, the rate of death from road injuries among adolescent females in the African Region is higher than the rates of death from this cause in any other region). Drowning is also a major cause of mortality. It is among the top five causes in all regions except the African Region, although, again, the actual mortality rates from drowning in the African Region are higher than in all other regions.

Maternal causes rank number two among causes of mortality in 15–19 year old females globally, with little change in the ranking since 2000. They are the leading cause of death in this age group in the Eastern Mediterranean Region and among the top four causes in the African Region, the South-East Asia Region and the Americas Region. The mortality rates from maternal causes in the African Region are more than three times higher than the rates in the Eastern Mediterranean Region (34 and 10 per 100,000 respectively).

Suicide is estimated to be a major cause of mortality during adolescence for males and females, particularly at ages 15–19. It is the leading cause of death for 15-19 year old males and females in the South-East Asia Region, the rates being slightly higher for females than males (28 and 21 per 100,000 population respectively), and among the top five causes of mortality for both sexes and in all regions, apart from the African Region and boys in the Eastern Mediterranean Region. Again, it is interesting to note that, although suicide is not in the top five causes of mortality in the African Region, the mortality rate from suicide in this region (9 per 100,000 population) is higher than in any other region except the South East Asia Region, where the rate is 25 per 100,000.

Infectious diseases remained among the leading causes of adolescent mortality in 2012, despite the epidemiological transition taking place globally. Lower respiratory infections rank among the top five causes of adolescent deaths in all regions except for high income countries and the Western Pacific Region, with more deaths occurring among younger adolescents. Diarrhoeal diseases are also an important cause of mortality, particularly in 10-14 year olds. In this age group, diarrhoeal diseases, lower respiratory infections and meningitis together account for 21%, 18% and 16% of all deaths in the African, South-East Asia and Eastern Mediterranean regions, respectively. One infectious disease success story is mortality from measles: In 10-14 year olds the rate decreased from 4 to 1 per 100,000 population between 2000 and 2012.

HIV and interpersonal violence are the two top-five causes of mortality that do show important differences between regions.

Differences and variations in mortality

Regional differences

Of every 100 adolescent deaths globally in 2012, 70 occurred in just two regions—43 in the Africa Region and 27 in the South-East Asia Region, with overall mortality rates in 10-19 year olds of 282 and 102 per 100,000 respectively. The lowest rates are in high income countries: 31 per 100,000.

Between 2000 and 2012 adolescent all-cause mortality rates dropped by about one-third in the high income countries, the European Region and the Western Pacific Region. Mortality rates were stagnant for 15-19 year old males in the Region of the Americas and rose slightly in this age group in the Eastern Mediterranean Region, where the increase in war-related deaths more than cancelled out reductions in other deaths. War-related deaths in 15-19 year old males increased from 8 to 39 per 100,000 in the Eastern Mediterranean Region, while in the African Region they dropped from 26 to 1 per 100,000.

HIV: The African Region has by far the highest adolescent mortality rates. HIV accounts for 16% of this, and 90% of the world’s HIV-related deaths in adolescents occur in this region. Since 2000 the estimated numbers and rates of death related to HIV among African adolescents have increased more in males than females.

Regional highlights:

• 1 of every 3 deaths among adolescent males the Americas Region is due to interpersonal violence.
• 1 of every 5 deaths among adolescents in high income countries is due to road traffic injuries.
• 1 of every 5 deaths among adolescent males the Eastern Mediterranean Region is due to war and conflicts.
• 1 of every 6 deaths among adolescent females in the South-East Asia Region is due to suicide.
• 1 of every 6 deaths among adolescents in the African Region is due to HIV.

Variations by age and sex

Mortality rates are slightly higher at ages 15–19 years than at 10–14 years (127 and 94 per 100,000 respectively), a trend that has been noted in past analyses of mortality and that continues into the 20–24 year age group.₄

Mortality rates are consistently higher for adolescent males than for females, often substantially higher, except among 10–14 year olds in the African Region. Males’ higher mortality rates often reflect more deaths from road injuries and interpersonal violence.

Interpersonal violence is the leading cause of mortality in the Americas Region and ranks among the top five causes of death for older adolescent males in every region, including high income countries.

As already noted, for 15–19 year old adolescent females, maternal causes of death ranked consistently high in both 2000 and 2012. However, this ranking hides the significant drops in the number of deaths from maternal causes in all regions over this period, most notably in the South-East Asia Region, where mortality rates from maternal causes fell from 21 per 100,000 population to 9 per 100,000, but also in the African Region (54 to 34 per 100,000) and the Eastern Mediterranean Region (20 to 10 per 100,000). These decreases are in line with declines in overall maternal mortality.₅

Finally, there are a number of causes of death that predominantly affect a small number of regions, or specific age groups. For example, protein-energy malnutrition is ranked 5 in the Eastern Mediterranean region among 10-14 year girls (3 per 100,000). Although not in the top 5 causes, rates for protein-energy malnutrition in 10-14 year old girls and boys are estimated to be even higher in the African Region, at 12 and 10 per 100,000 respectively. In this age group congenital anomalies are also seen among the top 5 causes in high income countries and the Western Pacific Region, and among girls in the Americas and European regions.

In 15-19 year olds, non-communicable diseases become increasingly important, for example, leukaemia, which is ranked 4 in the Western Pacific Region, and stroke, ranked 3 in the European region. Drug use disorders are ranked 5 for both males and females in high income countries, the rates being higher among males.