By Lisa Rapaport

(Reuters Health) – Children today are more likely to survive to early adulthood than they were in years past, but progress has been concentrated in higher-income countries and a growing number of kids worldwide are living with disabling health problems, a new study suggests.

Researchers examined data collected from 195 countries and territories between 1990 and 2017, during which time the annual number of fatalities among youth under age 20 fell 52 percent, from about 13.8 million to just 6.6 million. The decline was driven primarily by a decrease in deaths from infectious diseases.

“While the global health community should celebrate these successes, continued monitoring is crucial to sustain progresses of the past 27 years,” said lead study author Dr. Robert Reiner Jr. of the School of Medicine at the University of Washington in Seattle.

“Moreover, considerable effort is needed to reduce inequality in burden between high and low income countries,” Reiner said by email. “Areas with the highest risk for disease and death have improved slower than average over this period, and given the population growth rates in these countries, already overburdened health systems will need increased support to avoid increases in unnecessary and preventable childhood and adolescent death.”

By the end of the study, 82 percent of childhood and adolescent deaths worldwide were concentrated in low- and middle-income countries, up from 71 percent in 1990.

Globally, reductions in mortality rates were most rapid in children between the ages of one and four, driven by declines in deaths from diarrhea, lower respiratory infection and other common infectious diseases.

The largest absolute declines in childhood mortality were seen in western, eastern, and sub-Saharan Africa, researchers report in JAMA Pediatrics.

The fastest rates of decline, however, were concentrated in east Asia, Andean Latin America, and south Asia.

Improvements were largely associated with gains in development assistance for health care, which lead to improved access to vaccinations, early childhood nutrition, sanitation, clean water, and targeted interventions for HIV/AIDS and malaria.

But while deaths became less common during the study period, the burden of childhood disability got worse.

Researchers analyzed the impact of health on children’s lives using a measure known as disability-adjusted life years (DALY), which reflects the gap between children’s current health status and an ideal situation where kids are all free of disease and disability. During the study, aggregate childhood disability increased 4.7 percent to a total of 145 million years lived with disability.

One limitation of the study is that there is a time delay in reporting health information in many countries, researchers note. Another drawback is that data deficiencies from conflict zones like Syria, Iraq, Yemen, South Sudan and Afghanistan and from certain subpopulations like migrants and refugees may limit the precision of some estimates of mortality and disability.

The reason deaths are still concentrated in low-income nations is that issues remain with combating infectious diseases, malaria, and malnutrition and providing vaccinations, sanitation, and clean water, said Evan Peet, an economist at RAND in Pittsburgh, Pennsylvania.

“This is inherently an issue of income and resources,” Peet, who wasn’t involved in the study, said by email.

Peet noted that along with infectious diseases, “there is still much work and investment to be done with non-communicable diseases,” Peet added. “Non-communicable diseases limit the capabilities of the individual and cause severe burdens to health and social support systems.”

Still, he said, “The best news is that children and adolescents throughout the world are more likely to become adults than ever before.”

SOURCE: http://bit.ly/2vr1Tfl JAMA Pediatrics, online April 29, 2019.