title: Global burden of diseases, injuries, and risk factors for young people's health during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.
abstract: BACKGROUND
  Young people's health has emerged as a neglected yet pressing issue in global development. Changing patterns of young people's health have the potential to undermine future population health as well as global economic development unless timely and effective strategies are put into place. We report the past, present, and anticipated burden of disease in young people aged 10-24 years from 1990 to 2013 using data on mortality, disability, injuries, and health risk factors.
  
  
  METHODS
  The Global Burden of Disease Study 2013 (GBD 2013) includes annual assessments for 188 countries from 1990 to 2013, covering 306 diseases and injuries, 1233 sequelae, and 79 risk factors. We used the comparative risk assessment approach to assess how much of the burden of disease reported in a given year can be attributed to past exposure to a risk. We estimated attributable burden by comparing observed health outcomes with those that would have been observed if an alternative or counterfactual level of exposure had occurred in the past. We applied the same method to previous years to allow comparisons from 1990 to 2013. We cross-tabulated the quantiles of disability-adjusted life-years (DALYs) by quintiles of DALYs annual increase from 1990 to 2013 to show rates of DALYs increase by burden. We used the GBD 2013 hierarchy of causes that organises 306 diseases and injuries into four levels of classification. Level one distinguishes three broad categories: first, communicable, maternal, neonatal, and nutritional disorders; second, non-communicable diseases; and third, injuries. Level two has 21 mutually exclusive and collectively exhaustive categories, level three has 163 categories, and level four has 254 categories.
  
  
  RESULTS
  The leading causes of death in 2013 for young people aged 10-14 years were HIV/AIDS, road injuries, and drowning (25·2%), whereas transport injuries were the leading cause of death for ages 15-19 years (14·2%) and 20-24 years (15·6%). Maternal disorders were the highest cause of death for young women aged 20-24 years (17·1%) and the fourth highest for girls aged 15-19 years (11·5%) in 2013. Unsafe sex as a risk factor for DALYs increased from the 13th rank to the second for both sexes aged 15-19 years from 1990 to 2013. Alcohol misuse was the highest risk factor for DALYs (7·0% overall, 10·5% for males, and 2·7% for females) for young people aged 20-24 years, whereas drug use accounted for 2·7% (3·3% for males and 2·0% for females). The contribution of risk factors varied between and within countries. For example, for ages 20-24 years, drug use was highest in Qatar and accounted for 4·9% of DALYs, followed by 4·8% in the United Arab Emirates, whereas alcohol use was highest in Russia and accounted for 21·4%, followed by 21·0% in Belarus. Alcohol accounted for 9·0% (ranging from 4·2% in Hong Kong to 11·3% in Shandong) in China and 11·6% (ranging from 10·1% in Aguascalientes to 14·9% in Chihuahua) of DALYs in Mexico for young people aged 20-24 years. Alcohol and drug use in those aged 10-24 years had an annual rate of change of >1·0% from 1990 to 2013 and accounted for more than 3·1% of DALYs.
  
  
  CONCLUSIONS
  Our findings call for increased efforts to improve health and reduce the burden of disease and risks for diseases in later life in young people. Moreover, because of the large variations between countries in risks and burden, a global approach to improve health during this important period of life will fail unless the particularities of each country are taken into account. Finally, our results call for a strategy to overcome the financial and technical barriers to adequately capture young people's health risk factors and their determinants in health information systems.
  
  
  BACKGROUND
  Bill & Melinda Gates Foundation.
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA. Electronic address: mokdaa@uw.edu.
authors.forename: Ali H
authors.initials: AH
authors.lastname: Mokdad
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Mohammad Hossein
authors.initials: MH
authors.lastname: Forouzanfar
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Farah
authors.initials: F
authors.lastname: Daoud
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Arwa A
authors.initials: AA
authors.lastname: Mokdad
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Charbel
authors.initials: C
authors.lastname: El Bcheraoui
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Department of Community Medicine, Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Maziar
authors.initials: M
authors.lastname: Moradi-Lakeh
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Hmwe Hmwe
authors.initials: HH
authors.lastname: Kyu
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Barber
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Wagner
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Kelly
authors.initials: K
authors.lastname: Cercy
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Hannah
authors.initials: H
authors.lastname: Kravitz
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Coggeshall
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Adrienne
authors.initials: A
authors.lastname: Chew
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Kevin F
authors.initials: KF
authors.lastname: O'Rourke
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Caitlyn
authors.initials: C
authors.lastname: Steiner
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Marwa
authors.initials: M
authors.lastname: Tuffaha
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Raghid
authors.initials: R
authors.lastname: Charara
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Essam Abdullah
authors.initials: EA
authors.lastname: Al-Ghamdi
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Yaser
authors.initials: Y
authors.lastname: Adi
authors.affiliation: Department of Health Promotion and Community Health, American University of Beirut, Beirut, Lebanon.
authors.forename: Rima A
authors.initials: RA
authors.lastname: Afifi
authors.affiliation: Institute of Public Administration, Riyadh, Saudi Arabia.
authors.forename: Hanan
authors.initials: H
authors.lastname: Alahmadi
authors.affiliation: King Abdullah Specialized Children's Hospital, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
authors.forename: Fadia
authors.initials: F
authors.lastname: AlBuhairan
authors.affiliation: Department of Psychology, University of Oregon, Eugene, OR, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Allen
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: AlMazroa
authors.affiliation: Ministry of Health, Sana'a, Yemen.
authors.forename: Abdulwahab A
authors.initials: AA
authors.lastname: Al-Nehmi
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Zulfa
authors.initials: Z
authors.lastname: AlRayess
authors.affiliation: Public Health Foundation of India, Delhi, India.
authors.forename: Monika
authors.initials: M
authors.lastname: Arora
authors.affiliation: Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Azzopardi
authors.affiliation: International Planned Parenthood Federation, New York, NY, USA.
authors.forename: Carmen
authors.initials: C
authors.lastname: Barroso
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Basulaiman
authors.affiliation: Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan; Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada.
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
authors.affiliation: Department of Social Science, UCL Institute of Education, University College London, London, UK.
authors.forename: Chris
authors.initials: C
authors.lastname: Bonell
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Breinbauer
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA, USA.
authors.forename: Donna
authors.initials: D
authors.lastname: Denno
authors.affiliation: Institute for Health Sciences, Kunming Medical University, Kunming City, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Fang
authors.affiliation: Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile Ife, Nigeria.
authors.forename: Adesegun
authors.initials: A
authors.lastname: Fatusi
authors.affiliation: Department of Global Health and Population, TH Chan School of Public Health, Harvard University, Boston, MA, USA.
authors.forename: Andrea B
authors.initials: AB
authors.lastname: Feigl
authors.affiliation: Global and Cultural Mental Health Unit, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Ritsuko
authors.initials: R
authors.lastname: Kakuma
authors.affiliation: University of Balamand, Beirut, Lebanon.
authors.forename: Nadim
authors.initials: N
authors.lastname: Karam
authors.affiliation: Centre for International Health, Burnet Institute and School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: Elissa
authors.initials: E
authors.lastname: Kennedy
authors.affiliation: Executive Board, Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia.
authors.forename: Tawfik A M
authors.initials: TA
authors.lastname: Khoja
authors.affiliation: Faculty of Health Sciences, Department of Psychiatry; Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon.
authors.forename: Fadi
authors.initials: F
authors.lastname: Maalouf
authors.affiliation: Center for Research on Population and Health; Faculty of Medicine and Medical Center, American University of Beirut, Beirut, Lebanon.
authors.forename: Carla Makhlouf
authors.initials: CM
authors.lastname: Obermeyer
authors.affiliation: Melbourne School of Government, University of Melbourne, Melbourne, VIC, Australia; Australia India Institute, Carlton, VIC, Australia; School of International Studies, Jawaharlal Nehru University, New Delhi, Delhi, India.
authors.forename: Amitabh
authors.initials: A
authors.lastname: Mattoo
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: Terry
authors.initials: T
authors.lastname: McGovern
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia; College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
authors.affiliation: Center for Translation Research and Implementation Science, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Mensah
authors.affiliation: Public Health Foundation of India, Delhi, India; Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.affiliation: International Center for Research on Women, Washington, DC, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Petroni
authors.affiliation: Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Nicola
authors.initials: N
authors.lastname: Reavley
authors.affiliation: Salud Mesoamérica 2015 Initiative, Panama City, Panama.
authors.forename: Diego Rios
authors.initials: DR
authors.lastname: Zertuche
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Saeedi
authors.affiliation: Mailman School of Public Health, Columbia University, New York, NY, USA.
authors.forename: John
authors.initials: J
authors.lastname: Santelli
authors.affiliation: Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sawyer
authors.affiliation: International Center for Child Health and Asset Development, Columbia University, New York, NY, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Ssewamala
authors.affiliation: The Lancet Youth, Lancet Commission on Adolescent Health and Wellbeing, London, UK.
authors.forename: Kikelomo
authors.initials: K
authors.lastname: Taiwo
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Tantawy
authors.affiliation: Institute of Child Health, University College London, London, UK.
authors.forename: Russell M
authors.initials: RM
authors.lastname: Viner
authors.affiliation: School of Social Work, Columbia University, New York, NY, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Waldfogel
authors.affiliation: Salud Mesoamérica 2015 Initiative, Panama City, Panama.
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Zuñiga
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naghavi
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Haidong
authors.initials: H
authors.lastname: Wang
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Theo
authors.initials: T
authors.lastname: Vos
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: Alan D
authors.initials: AD
authors.lastname: Lopez
authors.affiliation: Saudi Ministry of Health, Riyadh, Saudi Arabia.
authors.forename: Abdullah A
authors.initials: AA
authors.lastname: Al Rabeeah
authors.affiliation: Centre for Adolescent Health, Royal Children's Hospital, Parkville, VIC, Australia; Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.
authors.forename: George C
authors.initials: GC
authors.lastname: Patton
authors.affiliation: Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Murray
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D000293:Adolescent; D017677:Age Distribution; D000367:Age Factors; D000437:Alcoholism / Q000401:mortality; D002423:Cause of Death; D002648:Child; D017281:Cost of Illness; D006233:Persons with Disabilities; D004332:Drowning / Q000401:mortality*; D005260:Female; D015658:HIV Infections / Q000401:mortality; D006801:Humans; D007239:Infections / Q000401:mortality*; D008297:Male; D019057:Quality-Adjusted Life Years; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000401:mortality*; D055815:Young Adult