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Lancet Global Health


Background The global health community is devoting considerable attention to adolescents and young people, but risk of death in this population is poorly measured. We aimed to reconstruct global, regional, and national mortality trends for youths aged 15-24 years between 1990 and 2019. Methods In this systematic analysis, we used all publicly available data on mortality in the age group 15-24 years for 195 countries, as compiled by the UN Inter-agency Group for Child Mortality Estimation. We used nationally representative vital registration data, estimated the completeness of death registration, and extracted mortality rates from surveys with sibling histories, household deaths reported in censuses, and sample registration systems. We used a Bayesian B-spline bias-reduction model to generate trends in (10)q(15), the probability that an adolescent aged 15 years would die before reaching age 25 years. This model treats observations of the (10)q(15) probability as the product of the actual risk of death and an error multiplier that varies depending on the data source. The main outcome that we assessed was the levels of and trends in youth mortality and the global and regional mortality rates from 1990 to 2019. Findings Globally, the probability of an individual dying between age 15 years and 24 years was 11.2 deaths (90% uncertainty interval [UI] 10.7-12.5) per 1000 youths aged 15 in 2019, which is about 2.5 times less than infant mortality (28.2 deaths [27.2-30.0] by age 1 year per 1000 live births) but is higher than the risk of dying from age 1 to 5 (9.7 deaths [9.1-11.1] per 1000 children aged 1 year). The probability of dying between age 15 years and 24 years declined by 1.4% per year (90% UI 1.1-1.8) between 1990 and 2019, from 17.1 deaths (16.5-18.9) per 1000 in 1990; by contrast with this total decrease of 34% (27-41), under-5 mortality declined by 59% (56-61) in this period. The annual number of deaths declined from 1.7 million (90% UI 1.7-1.9) in 1990 to 1.4 million (1.3-1.5) in 2019. In sub-Saharan Africa, the number of deaths increased by 20.8% from 1990 to 2019. Although 18.3% of the population aged 15-24 years were living in sub-Saharan Africa in 2019, the region accounted for 37.9% (90% UI 34.8-41.9) of all worldwide deaths in youth. Interpretation It 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. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.









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UN Children's Fund; Bill & Melinda Gates FoundationBill & Melinda Gates FoundationCGIAR; United States Agency for International DevelopmentUnited States Agency for International Development (USAID)