Knowledge Brief Health, Nutrition and Population Global Practice YOUNG PEOPLE: AdAd GLOBAL AND REGIONAL BURDEN OF DISEASE Amparo Gordillo-Tobar, Nashira Calvo, and Meaghen Quinlan-Davidson November 2019 KEY MESSAGES: • Adolescence is a critical period to define the trajectory of an individual’s life and its potential contribution to society and the economy. Current global and regional estimates of the burden of disease (BoD) for the 10 to 24 age group show that adolescent health is a neglected dimension of public health and a strong case for prompt investments to minimize ill health at later ages. • The BoD is higher among young males than among young females. South Asia and Sub-Saharan Africa are the regions with the highest burdens of communicable diseases (CDs), noncommunicable diseases (NCDs), and injuries in the 10 to 24 age group. The main CDs affecting young people worldwide are diarrhea, lower respiratory diseases, and nutritional deficiencies as well as HIV/AIDS mostly in Sub-Saharan Africa. Cardiovascular diseases and mental illness are the most prevalent NCDs among adolescents, while most injuries among this age group are transport-related injuries. North America has the highest burden of drug use disorders, while Latin America and the Caribbean has the highest burden of self-harm and interpersonal violence. Introduction health systems should be taking to curb behavior related to health risks, for example, eating patterns, physical activity Adolescence and youth are periods of opportunities but and weight, sexual behavior, the use of psychoactive also of increasing vulnerability defined by social and substances, and transport-related injuries. political factors. Early marriages and risky behaviors are strongly associated with inequalities of income, education, Methods gender, and ethnicity, all of which can increase young people's susceptibility to poor health and well-being The burden of disease is measured in disability- throughout their lifecycle. Adolescent health is more adjusted life years (DALYs) calculated as a combination important than ever, given that the world contains the of years of life lost (YLL) because of premature death and largest cohort in history of young people aged between 10 years lived with disability (YLD). and 24 years old. In 2017, the Institute of Health Metrics and Evaluation The challenges affecting the livelihood of young people are (IHME) compiled the Global Burden of Disease (GBD) reflected in their burden of disease (BoD). A better database based on the BoD Report published by the World understanding of the BoD for this generation of Health Organization (WHO) in 1994. The database adolescents and youths can help to reveal what measures contains information on 291 cause and diseases, 20 age Page 1 HNPGP Knowledge Brief • groups, and 187 countries, and aggregates these data into Globally, noncommunicable diseases (NCDs) have the regional and global burdens of disease for six different highest BoDs, followed by communicable diseases (CDs) points in time (1990, 1995, 2000, 2005, 2010, and 2015). and injuries, although this varies by age group. The causes of death and illness in the IHME report are classified into three broad groups: communicable Among those aged 10 to 14 years old, NCDs have the diseases, noncommunicable diseases, and injuries. highest BoD with 5,540 DALYs per 100,000 population in that age group, followed by CDs (4,427 DALYs per The GBD data serve as a basis to analyze the main causes 100,000) and injuries (1,595 DALYs per 100,000). The of diseases among young people between 1990 and 2015. proportion changes among 20 to 24-year-olds, where The estimates are presented for three age subgroups (10 injuries represent 4,449 DALYs per 100,000, which is to 14, 15 to 19, and 20 to 24 years) and reflect changes in higher than CDs with 4,018 DALYs per 100,000. DALYs and diseases over time by gender and region. The Figure 2: Global Prevalence of Noncommunicable regions are classified according to the World Bank’s Diseases, 10–24 Age Group, 2015 definitions as East Asia and Pacific, Europe and Central Asia, Latin America and the Caribbean, the Middle East Mental and substance use disorders 2,857 and North Africa, North America, South Asia, and Sub- Musculoskeletal disorders 1,968 Saharan Africa. Cardiovascular diseases 1,846 Global Analysis Other non-communicable diseases 1,524 Neoplasms 1,348 According to the World Population Prospects (United Diabetes, urogenital, blood, and endocrine diseases 1,260 Nations 2015), as of 2015, there were more than 1,193.6 Neurological disorders 1,036 million in the 10 to 24 age group with this number projected Chronic respiratory diseases 551 to grow to 1,286.3 million by 2030. Cirrhosis and other chronic liver diseases 427 The GBD data indicate that this age group account for 24 Digestive diseases 423 percent of the world’s population, with males experiencing - 500 1,000 1,500 2,000 2,500 3,000 the highest BoD. For specific age subgroups, the estimates According to the GBD data, the BoD in most regions has of DALYs per 100,000 population were 10,902 DALYs for declined over time with the highest decrease rates reported females and 12,179 DALYs for males in the 10 to 14 age in South Asia and Sub-Saharan Africa (42 and 44 percent, group; 13,586 DALYs for females and 15,198 DALYs for respectively) followed by the Middle East and North Africa males in the 15 to 19 age group; and 15,972 DALYs for (37 percent), East Asia and Pacific (29 percent), Latin females and 19,274 DALYs for males in the 20 to 24 age America and the Caribbean (25 percent), Europe and group. Central Asia (12 percent), and North America (7 percent). According to the 2015 data, even though Sub-Saharan Figure 1: Global Prevalence of Specific Communicable Africa and South Asia have had the largest decreases in Diseases, 10–24 Age Group, 2015 the BoD with 54,450 DALYs per 100,000 and 38,580 HIV/AIDS and tuberculosis 1,774 DALYs per 100,000, respectively, these two regions still Diarrhea, lower respiratory, and other 1,010 have the highest BoDs in the world. common infectious diseases Nutritional deficiencies 580 Figure 3: Global Prevalence of Injuries, 10–24 Age Group, Neglected tropical diseases and malaria 499 2015 Maternal disorders 423 Unintentional injuries 1,240 Neonatal disorders 149 Other communicable, maternal, neonatal, Transport injuries 1,226 and nutritional diseases 134 Self-harm and interpersonal violence 1,122 - 500 1,000 1,500 2,000 Forces of nature, war, and legal intervention 229 - 200 400 600 800 1,0001,2001,400 Page 2 HNPGP Knowledge Brief Regional Analysis Table 1: Summary of the Burden of Diseases by Region Europe Middle East Latin & East & North South Sub-Saharan Asia & America & Central North America Asia Africa Pacific Caribbean (%) Asia Africa (%) (%) (%) (%) (%) (%) Communicable diseases 17.4 11.2 13.4 12.1 8.5 33.7 51.2 Of which, maternal disorders 1.44 0.36 1.50 1.59 0.57 5.29 6.64 Noncommunicable diseases 61.6 67.4 57.2 55.3 70.6 47.4 37.9 Injuries 21.6 21.6 30.0 33.4 21.1 21.7 14.7 Communicable Diseases While the BoD for cardiovascular disease is higher among Among CDs, HIV/AIDS, diarrhea, and nutritional the elderly than among young people, the prevalence deficiencies are the most prevalent worldwide in the 10 to within the 10 to 24 age group is a predictor of the future 24 age group. The most common disease is HIV/AIDS with 1,774 DALYs per 100,000 population. health of the adult population. Drug abuse disorders are most common among younger age groups, with most Sub-Saharan Africa and South Asia are the regions with individuals starting this behavior at around 15 years of age the highest BoD for CDs among young adults aged 20 to and reaching a peak between 25 to 29 years old. 24 years old. For both regions, diarrhea, lower respiratory and infectious diseases, nutritional deficiencies, and The data for NCDs are very similar among regions, with the maternal disorders are the main drivers of the BoD among highest BoD being concentrated among 20 to 24-year-age 10 to 24-year-olds, and maternal disorders are over five group, followed by 15 to 19-year-olds, and finally the 10 to times more prevalent. In all other regions, adolescents 14 age group. North America (70.6 percent) and South aged 10 to 14 years old had the highest burden. Asia (47.4 percent) are the regions with the highest reported prevalence of NCDs worldwide. In Sub-Saharan Africa, CDs are over 30 to 40 percent more common than in any other region, with HIV/AIDS In North America and South Asia, mental health and being a continuous public health concern. In 2015, the substance abuse disorders are among the main NCDs for highest burden of HIV/AIDS fell on those between 25 to 59 those between 10 and 24 years of age. North America is years old, but those in the 10 to 14 and 20 to 24 age groups the region with the highest burden of drug abuse with 515 are also at risk because of low levels of education and the (for the 15 to 19 age group) and 1,390 (for the 20 to 24 age limited availability of prevention activities. group) DALYs per 100,000. Noncommunicable Diseases The Middle East and North Africa has the highest burden of cardiovascular disease among the 10 to 19 age group, The main NCDs experienced by the 10 to 24 age group including 475 DALYs per 100,000 for the 10 to 14 age worldwide are mental health and substance abuse group and 838 DALYs per 100,000 for the 15 to 19 age disorders (2,857 DALYs per 100,000), musculoskeletal group. For the 20 to 24 age group, South Asia reports the disorders (1,968 DALYs per 100,000), and cardiovascular highest burden of cardiovascular disease with 1,140 disease (1,846 DALYs per 100,000). DALYs per 100,000 population Page 3 HNPGP Knowledge Brief • Latin America and the Caribbean, East Asia and Latin America and the Caribbean, compared to other Pacific, and Sub-Saharan Africa have the highest regions, has the highest BoD for self-harm and burdens for neoplasms for the 10 to 14 age group with 427, interpersonal violence with 391 (10 to 14 age group), 2,412 447, and 386 DALYs per 100,000 respectively. The 15 to (15 to 19 age group), and 3,557 (20 to 24 age group) 19 age group in Latin America and the Caribbean, East DALYs per 100,000. Asia and Pacific, the Middle East and North Africa, and Sub-Saharan Africa have roughly the same burden of In North America, the burden of disease for the 10 to 14 neoplasms disease. For the 20 to 24 age group, Sub- age group is a combination of transport-related injuries and Saharan Africa is the leader for BoD in neoplasms with 618 self-harm. For the 20 to 24 age group, the leading cause of DALYs per 100,000. injury is self-harm and interpersonal violence. Injuries Next Steps Injuries are categorized as unintentional, transport-related, The burden of disease reflects the economic development, and self-harm and interpersonal violence with 1,240, 1,226, political stability, security conditions, and peaceful and 1,122 DALYs per 100,000, respectively worldwide. environments of countries and regions. The estimates The prevalence of injuries ranges from 15 to 33 percent show that in many countries, diseases and violence are among the regions. hampering the essential period of adolescence for thousands of individuals. They also reflect the dearth of The BoD related to injuries is similar in all the regions, with frameworks aimed at protecting the health of adolescents the highest BoD being concentrated in the 20 to 24 age or at mitigating their enormous exposure to manipulative group, followed by the 15 to 19 age group. Transport- advertising. It is clearly a time for action, where related injuries have almost the same rate in all regions and governments and international organizations focus more are most common in the 20 to 24 age group. The burden attention on initiatives to protect this important set of the of disease for self-harm and interpersonal violence is population. highest in the 20 and 24 age group. References South Asia and the Middle East and North Africa are the regions with the highest burden of injuries worldwide. − IHME (2017). The Global Burden of Disease Study. Institute of Health Metrics and Evaluation, Seattle, WA. In South Asia, the main injuries are transport-related and Retrieved from http://www.healthdata.org/. those due to unintentional, self-harm, and interpersonal violence, with unintentional injuries being the highest − Christopher J.L. Murray and Alan D. Lopez (1994). The among the 10 to 24 age group. Gobal Burden of Disease. World Health Organization, World Bank, and and Harvard School of Public Health. In the Middle East and North Africa, unintentional injuries (1996). are the highest among the 10 to 14-year-old age group, and transport-related injuries are the highest among the 15 to − United Nations (2015). World Population Prospects: 24-year-old population. The BoD for transport-related The 2015 Revision. injuries is the highest in the 20 to 24 age group (1,733 DALYs per 100,000 inhabitants) in this region, followed by Latin America and the Caribbean and East Asia. This HNP Knowledge Note highlights the key findings from the document titled Global and Regional Burden of Disease Among People Aged 10 to 24 Years Old prepared by the author. The Health, Nutrition and Population Knowledge Briefs of the World Bank are a quick reference on the essentials of specific HNP-related topics summarizing new findings and information. These may highlight an issue and key interventions proven to be effective in improving health, or disseminate new findings and lessons learned from the regions. For more information on this topic, go to: www.worldbank.org/health. Page 4