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BMJ 2011; 342 doi: (Published 06 April 2011) Cite this as: BMJ 2011;342:d2120

Older boys and young men gain least from 50 years of falling death rates

Worldwide, adolescents and young adults now have higher death rates than preschool children, reversing the traditional pattern of the past 50 years, say researchers. It is time to shift our focus to include older children, particularly young men, who are now dying at two to three times the rate of boys under five in many regions.

A close look at mortality data from 50 countries collated by the World Health Organization since 1955 identifies the sharp decline in deaths among all age groups, but particularly in preschool children, who have benefited most from global attention to infectious diseases. Boys and young men between 10 and 24 years have gained substantially less. By the 1970s injuries were dominating the picture in this group. By the turn of the 20th century, violence and suicide accounted for between a quarter and a third of all deaths among boys and men aged 10-24 across all countries studied, including high income countries in the Organisation for Economic Co-operation and Development (OECD). Transport injuries accounted for a substantial proportion of the rest.

Young women between 15 and 24 years have also seen slower declines in mortality than girls aged 1-10. Their mortality rates converged between 2000 and 2004.

This study identifies a serious problem, says a linked comment (doi:10.1016/S0140-6736(11)60412-1). Older children have lost out, partly because of political neglect. Deaths from violence, suicide, and transport injuries have their roots in deprivation, poverty of opportunity, and other destructive social problems. Protecting young people will require “political change of real substance.”

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