The pressing need for better statistics on youth mortality
Authors: Andrea Werdecker, Ulrich Mueller
Journal: The Lancet Global Health (2021)

In their Article in The Lancet Global Health, Bruno Masquelier and colleagues1Masquelier B Hug L Sharrow D et al.Global, regional, and national mortality trends in youth aged 15–24 years between 1990 and 2019: a systematic analysis.Lancet Glob Health. 2021; (published online March 1.)https://doi.org/10.1016/S2214-109X(21)00023-1Summary Full Text Full Text PDF PubMed Scopus (3) Google Scholar show that over the past 30 years, we have been unable to substantially reduce mortality in youth aged 15–24 years. Even in peacetime, youth are disproportionately affected by deaths from violence, accidents, harmful lifestyle, and external causes, such as sexually transmitted diseases and other infectious diseases, compared with older age groups, especially in low-income countries. Young males are at a disproportionately high risk of fatal outcomes of interpersonal violence2UN Office on Drugs and CrimeGlobal study on homicide 2013. Trends, contexts, data. Vienna.https://www.unodc.org/documents/gsh/pdfs/2014_GLOBAL_HOMICIDE_BOOK_web.pdfDate: 2013Date accessed: January 30, 2021Google Scholar or traffic accidents.3US Department of TransportationFatality analysis reporting system.https://www-fars.nhtsa.dot.gov/Main/index.aspxDate: 2019Date accessed: January 30, 2021Google Scholar During wars and violent political conflicts, young males are also more at risk than females.4Murray CJ King G Lopez AD Tomijima N Krug EG Armed conflict as a public health problem.BMJ. 2002; 324: 346-349Crossref PubMed Scopus (226) Google Scholar A 2009 non-governmental organisation survey, funded by the Norwegian Ministry of Foreign Affairs, found a 1·3–10 times higher chance of death in males versus females in armed conflicts.5International Peace Research Institute, Oslo. Armed conflict deaths disaggregated by gender. A report for the Norwegian Ministry of Foreign Affairs. 2009.Google Scholar More investment in medical science and health-care facilities is only a partial remedy for this excess mortality of youth. Masquelier and colleagues' data reiterate that countries with prevalent armed conflict also have particularly high rates of youth deaths. Poverty and inadequate prospects (in terms of education, appropriate vocational training, and subsequent employment), accompanied by poor political freedom, are contributors to the higher violent and non-violent deaths among youths than adults in many low-income countries. Masquelier and colleagues' data show that mortality dynamics in high-income countries are not encouraging either. According to the WHO Health 2020 report for Europe,6WHOWHO Health 2020 report for Europe.https://www.euro.who.int/__data/assets/pdf_file/0009/215757/Health2020-Long-Ger.pdfDate accessed: January 30, 2021Google Scholar more than 300 young people die every day in the European region due to largely preventable causes. In Europe, nearly 10% of people aged 18 years have depression, the foremost risk factor for suicides. Injuries are the leading cause of death among adolescents and youth globally. Although better medical care, new treatment options, and rehabilitation services exist for adolescents today, and access to quality health-care services has improved, the gaps between the necessary and the available remain wide. Surveys and censuses do not typically stratify the number of deaths at each age across the group aged 15–59 years. Because most deaths in this wide age group occur in the upper half or even the upper third of this range, mortality in the group aged 15–24 years is often masked. As such, we suggest that it should be mandatory to split mortality data into 5-year intervals. Furthermore, deaths should be more consistently recorded by age and cause of death, for which proper and complete vital registration is necessary. Mortality registries with date and cause of death that are linked to longitudinal health microdata are necessary to establish accurate risks of death. The wide divergence between COVID-19 fatality numbers coming from different sources, even in high-income nations and especially in youths, has exposed these reporting deficiencies. If the risk of death was lowered in people aged 90 years, the relative number of deaths in the group aged 100 years and older would increase, but little could be done about these additional deaths. By contrast, if the relative numbers of deaths were reduced in the group aged 15–24 years, in which age group would prevented deaths occur? If they occurred in the next age group (ie, 25–34 years), little would be gained in terms of public health and social welfare. Rather, it would be desirable that these postponed deaths should occur many decades later, and by quite different causes of death. If, instead of dying from a violent cause at age 24 years, someone was to die at age 26 years, little is gained when compared with death at age 96 years from myocardial infarction while sleeping. Thus, when we study general and specific mortality among young people, and find even a small decline in relative numbers, we need a long-term perspective of what will happen in those lives saved. Because science cannot wait 70 years, comparative approaches and smart projections based on period rather than cohort data are needed. In older people, cause of death can be inferred from medical history, which is often unavailable in the young. In deaths among youths that are caused by external factors such as accidents, violence, suicide, or drug use—ie, a death not caused by disease—causes of death often cannot be inferred without autopsy. A striking example is the use of illicit drugs or synthetic opioids among adolescents in the USA and Europe. Behavioural and substance use disorders pose a high risk for premature death, because deaths from overdoses, particularly those from novel substances (so-called legal highs), often go unrecognised and are only possible to diagnose through forensic and toxicology data.7European Monitoring Centre for Drugs and Drug AddictionEuropean drug report. Trends and developments.https://www.emcdda.europa.eu/system/files/publications/13236/TDAT20001ENN_web.pdfDate accessed: February 1, 2021Google Scholar, 8Hess C Maas A Madea B Legal highs.Rechtsmedizin. 2014; 24: 291-305Crossref Scopus (6) Google Scholar Accordingly, the lack of internationally comparative studies outside the Global Burden of Disease context, especially its mortality capstone papers—with the exception of a study by Singh and colleagues9Singh G K Lokhande A Azuine R E Global inequalities in youth mortality, 2007–2012.J MCH AIDS. 2015; 3: 53-62PubMed Google Scholar—is notable. Action to provide more attention and support to this vulnerable population of youth is needed. It is the great merit of Masquelier and colleagues to have collected data from multiple sources to present the best available mortality estimation in global perspective and, by doing so, to have shown the inadequate reporting of these data. We declare no competing interests. Global, regional, and national mortality trends in youth aged 15–24 years between 1990 and 2019: a systematic analysisIt is urgent to accelerate progress in reducing youth mortality. Efforts are particularly needed in sub-Saharan Africa, where the burden of mortality is increasingly concentrated. In the future, a growing number of countries will see youth mortality exceeding under-5 mortality if current trends continue. Full-Text PDF Open Access