Globally, 2 in 5 adolescent deaths are due to injuries and violence, and death rates much lower in high-income countries

The first study to look at global death rates for young people aged 10—24 years has shown that the vast majority of deaths in this age group (97%) occur in low- and middle-income countries. Furthermore, the current focus on maternal mortality, HIV/AIDS and other infectious disease such as tuberculosis in this age group, while important, is an insufficient response since two in five deaths worldwide in this age group are due to injuries and violence. These and many other conclusions are reported in an Article in this week's edition of The Lancet—written by Professor George Patton, Centre for Adolescent Health and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia, and Dr Russell Viner, UCL Institute of Child Health, University College London, UK, Krishna Bose, Department of Child and Adolescent Health and Development, WHO, Switzerland, and colleagues.

The authors used data from the 2004 Global Burden of Disease study, and used mortality estimates developed for the 2006 World Health Report. Patterns of mortality were investigated by WHO region, income status, and cause in age groups from early adolescence (10—14 years), through late adolescence (15—19 years) to young adulthood (20—24 years). High-income countries represented one category, while the low- and middle-income countries were grouped by WHO region (Africa, Americas. Eastern Mediterranean, European, Southeast Asia, Western Pacific). Causes of death were categorised as group 1 (comprising group 1A maternal deaths and group 1B communicable diseases including nutritional conditions); group II—non-communicable disease, and group III—injury including traffic accidents, fires, drowning, self-inflicted injury, and violence and war.

The researchers found that 2.6 million deaths occurred in young people aged 10—24 years in 2004 (from a worldwide population of 1.8 billion people in that age group). Of those, 2.56 million (97%) were in low- and middle-income countries. Nearly two thirds (1.67 million) were in sub-Saharan Africa and Southeast Asia, despite these regions containing 42% of 10—24 year olds; high-income countries* had only 3% of the deaths, despite having 11% of the population in this age range. Death rates were higher in young adulthood than young adolescence, but reasons varied by region and sex. Globally, death rates more than doubled from age 10—14 years (95 deaths per 100,000 population) to 20—24 years (224 deaths). Maternal conditions (which comprised several individual categories) were a leading cause of female deaths at 15%. HIV/AIDS and tuberculosis contributed to 11% of deaths. Traffic accidents were the largest cause of deaths for both sexes combined (10%) and accounted for 14% of male and 5% of female deaths. Other prominent causes included violence (12% of male deaths) and suicide (6% of all deaths). There were many other interesting findings relating to all regions and age-groups, which are summarised in a key findings document which accompanies this press release.

The authors say: "Mortality rates in low-income and middle-incomes countries were almost four-fold higher than were those in high-income countries, a difference that was particularly pronounced for young women."

They add that in some regions, including Africa and southeast Asia, group I causes of death rise in adolescence and young adulthood and thus are of major importance. Present global health policies for the prevention and management of HIV and other infectious diseases, and provision of access to information and services for sexual and reproductive health, will probably have major beneficial effects. But they conclude: "However, even in these regions, tuberculosis and lower respiratory tract infections cause more youth deaths than does HIV/AIDS, but have not yet attracted a similar response in policy. Importantly, group I causes of death were not prominent in most low-income and-middle-income countries. In the western Pacific and eastern Europe, although overall death rates were increased, patterns of death resembled those reported in high-income regions, suggesting a need for very different strategies."

In an accompanying Comment, Dr Robert W Blum, Department of Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA, says: "Although adolescence is often referred to as the healthiest stage of life, [this report] makes clear that young people are at substantial risk for mortality."

He concludes: "In view of our present understanding of juvenile mortality, at least 75% of all deaths in the second decade of life are preventable through implementation of established prevention and intervention strategies. We know that access to contraceptives and family planning services reduces mistimed and unplanned pregnancies. We know that safe abortion reduces maternal mortality, and education and empowerment of women improve health outcomes in many dimensions and create options for young women. We know that several road safety and driving policies reduce vehicular related mortality. We know enough about effective interventions to base our services and programmes on what has been empirically shown to work—not what we think should work. And we know that reduction of risk alone is insufficient; we need to build the protective factors that buffer young people from adversity. The challenges are great but so too are the opportunities."

Professor George Patton, Centre for Adolescent Health and Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia E) george.patton@mcri.edu.au (currently in London for launch-please e-mail Prof Patton and he will respond via Blackberry re interview requests)

Alternative contact for Professor Patton: Eszter Vasenszky, Media Office, Murdoch Children's Research Institute, Melbourne, Australia (currently in Melbourne T) +61 3 8341 6433/+61 415 319 421 E) eszter.vasenszky@mcri.edu.au

For Dr Russell Viner, UCL Institute of Child Health, University College London, UK please contact Institute of Child Health press office. Stephen Cox T) +44 (0) 20 7239 3119 E) coxs@gosh.nhs.uk / Jo Barber T) +44 (0) 20 7239 3125 E) barbej@gosh.nhs.uk

For Krishna Bose, Department of Child and Adolescent Health and Development, WHO, Switzerland, please contact Olivia Lawe-Davies, Communications Officer, T) +41 794 755 545 E) lawedavieso@who.int / bosek@who.int

Dr Robert W Blum, Department of Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA T) +1 410 218 6770 E) rblum@jhsph.edu

For full Article and Comment, see: http://press.thelancet.com/gpamfinal.pdf
For key findings document, see: http://press.thelancet.com/amkf.doc
For slide presentation from the Press Conference, see: http://press.thelancet.com/AMS.ppt
For audio from the press conference (see speakers listed below), see: http://press.thelancet.com/adolescents.mp3

*Death rate for 10—24 year olds in High-Income Countries overall 45 per 100,000; for UK 35 per 100,000; for Australia 41 per 100,000; for USA 60 per 100,000. For other countries, please contact your country's own department of health/statistics.

The speakers at the press conference, plus the topics they covered:
Dr Sabine Kleinert (Senior Executive Editor, The Lancet, introduction)
Professor George Patton (credit as above) (lead author—paper overview and Australia),
Dr Sally-Ann Ohene WHO Ghana Office (Africa/Ghana);
Dr Russell Viner, UCL Institute of Child Health, University College London (UK)
Dr Krishna Bose, Department of Child and Adolescent Health and Development, WHO (General comments from WHO perspective)
Dr Dominique Behague, London School of Hygiene and Tropical Medicine (LSHTM) (Brazil)
Dr John S. Santelli, Columbia University, New York (USA)

Some contact details for some other high-income and low- and middle-income countries are below.

Ghana/Africa: Sally-Ann Ohene E) salohene@yahoo.com
Brazil: Dominique Behague, LSHTM. E) Dominique.Behague@lshtm.ac.uk
China: Professor Ersheng Gao, Director, WHO Collaborating Centre for Research in Human Production and Shanghai Institute of Planned Parenthood Research. T) +86-21-1370191 6427 / +86-21-64-54083371 E) ersheng_gao@yahoo.com.cn
USA: John S. Santelli, Columbia University, New York. E) js2637@columbia.edu
Spain: Carme Borrell +34 93.238.4545 ext 771 / +34 93.202.7771, head of Health Information Systems at the Agency of Public Health of Barcelona (cborrell@aspb.cat); also Enrique Regidor, Ministry of Health. T) enriqueregidor@hotmail.com
Nigeria: Dr. Adesegun Ola, Fatusi Obafemi Awolowo University, Ile-Ife. T) +234 703-181-9773 E) adesegunfatusi@yahoo.co.uk
Vietnam: Le Cu Linh, Hanoi School of Public Health. T) +84 4 6266 2335 E) lcl@hsph.edu.vn / leculinh@gmail.com
India: Vikram Patel, LSHTM T) +44-7910230037 /+91-9822132038 E) vikram.patel@lshtm.ac.uk
Lebanon: Dr Rima Afifi, American University of Beruit. T) +961-1-374374 extn. 4660 / +961-3-355975E) ra15@aub.edu.lb
Occupied Palestinian territory: Rita Giacaman, Birzeit University. RITA@birzeit.edu

For any other individual country, reporters need to contact their own country's department of health for mortality data and comment.