Death Among Children And Adolescents
Alternative names:
childhood and adolescent causes of death
Information:
Health is dependent upon many factors. Often just knowing what factors contribute to states of non-health or, as in this article, death may be a step toward avoiding situations with potential for a bad or fatal outcome.
First of all, what kills young people. With the exception of children under one year of age the number one killer of children, adolescents and young adults is ACCIDENTS. This sad statistic holds for all ages up to 44 years. This is a statistic that can be reduced only by continued attention to safety-conscious behavior, continued improvement in industrial, recreational, and transportational equipment and environments, and education of the individual concerning his or her specific areas of risk.
A good example of specific area of risk is the automobile. Most states allow adolescents to obtain a beginners license at age 15 years and a drivers license at 16. Adolescents have the ability to be among the best of drivers. They have quick reflexes, excellent vision and hearing (both peak during adolescence) and are capable of rapid information processing. What they don't have is learned automatic responses to common situations, experience, and judgment learned from years of driving. In addition, adolescent boys often display certain traits which are conducive to increased risk such as aggressive driving, reckless driving and a need to prove themselves. Because of these traits, boys are primarily responsible for the increased rate of deaths/100,000 in their age group while teenage girls are killed at a rate only minutely above the national average for all ages (see below). The end result of this is that young people (young males especially) die in cars at a rate far above the general public. Here are the figures for car related deaths from the United States Government Centers for Disease Control for 1989-1991.
For all ages together there are 18.1 deaths/100,000 population from car accidents.- 1-14 years 6.1 deaths/100,000
- 15-24 years 33.6 deaths/100,000 (boys 48.2/100,000 girls 18.4/1000,000)
- 25-44 years 19.8 deaths/100,000
- 45-64 years 15.3 deaths/100,000
- over 65 years 23.0 deaths/100,000
No other age group comes close to the high automobile accident mortality rate than that of young inexperienced drivers. The slightly increased rate among drivers over 65 years of age represents a decrease in physical abilities such as hearing, vision and reflex speed and an increased susceptibility to death from less serious accidents.
Knowing the peak time of car fatal car accidents, the ages involved and other factors have allowed insurance companies to make recommendations which should reduce the likelihood of teenage driving fatalities. See Automobile Safety and the Teenage Driver.
Going from the specific to the general, here is a listing of the top 3 causes of death for the various age groups. Those areas which can be improved upon will be discussed following the statistics. The figures below the causes represent the total number of deaths (in the United States) resulting from that cause for the year 1991
0-1 YEAR:- 1. congenital anomalies (7,685)
- 2. SIDS (5,349)
- 3. Pre & LBW* (,139)
1-4 YEARS:- 1. accidents (2,665)
- 2. congenital anomalies (871)
- 3. cancer (526)
5-14 YEARS:- 1. accidents (3,660)
- 2. cancer (1,106)
- 3. homicide (519)
15-24 YEARS:- 1. accidents (15,278)
- 2. homicide (8,159)
- 3. suicide (4,751)
(*all conditions associated with prematurity and low birth weight)
As can be seen from the above information the first year of life (especially the newborn period) is a dangerous time. There are almost twice as many deaths in the first year of life than there are in the next 13 years total. The death rate rises rapidly following puberty as can be seen by the large number of fatal accidents, homicides and suicides in the 15-24 year age group. These three causes of death, accidents, homicide, and suicide should all be preventable . The fact that suicide and homicide rank in the top 3 causes of deaths among teens is a sad social commentary.
What is preventable?
Congenital anomalies: Congenital anomalies which show no genetic or hereditary component , are not drug, toxin or nutrient related, are not radiation related, and show no evidence of being caused by outside influences are not yet preventable. However, the number of congenital anomalies which have a recognized cause, or a genetic basis and can be diagnosed within the first two months of pregnancy has grown enormously. These conditions, when recognized, may be preventable, treatable in the intrauterine environment, treated immediately upon birth, or if the abnormality is so severe that it is evident that life will not be possible, may be considered for termination of pregnancy.
Predictive evaluation may include genetic screening of the parents, parental medical histories and childbearing history, chorionic villus sampling, amniocentesis, and fetal ultrasound.
SIDS (sudden infant death syndrome): SIDS is probably a group of different conditions whose end result appears similar. Studies done in Europe have demonstrated that putting infants on their back to sleep markedly reduces the incidence of SIDS. The American Academy of Pediatrics and the Centers for Disease Control have now recommended that infants be placed on their back for sleeping. In several years statistics should be available which will demonstrate the efficacy of this simple procedure.
Prematurity and low birth weight: Much of the morbidity and mortality from this condition results from absent or inadequate prenatal care. Non-availability of medical care, ignorance of the importance of prenatal care, and fear and embarrassment may all lead to a pregnant individual's first medical visit occurring only at the time of delivery. Programs such as Baby Your Baby and Women, Infants and Children (WIC) are government and state sponsored programs that are intended to help with that problem. National medical insurance will also make prenatal care available to more people. Education about the importance of prenatal care should be available to sexually active adolescents who face a high risk of pregnancy. Populations at risk include:- pregnant teenagers (especially those less than 16 years of age)
- socioeconomically disadvantaged individuals
- inner city populations
- those individuals with less than a high school education
- the medically uninsured middle class
Studies have demonstrated that timely and adequate prenatal care reduces the risk to the developing child. Marked improvement is attainable in this area.
Cancer: Cancer has not lent itself well to prevention. Genetic markers have been discovered for malignant diseases such as retinoblastoma and certain types of colon cancer. Increased familial incidence has been demonstrated in other types of malignancy such as breast cancer, ovarian cancer, osteosarcoma and malignant melanoma. These discoveries have made it possible to follow at-risk populations but have not yet reduced fatalities from cancer. Continuing discovery and mapping of genes related to colon cancer, melanoma, breast cancer and other genetically influenced disease are rapidly improving the prospects of either preventive measures or cures in the relatively near future.
Suicide: Overall suicide rates have remained level over the last 10 years. In all age groups suicides by women have decreased or remained level. In the last ten years increases are evident in the following age and race groups.- 15-24 years (white males)
+- from 19.9 to 21 (deaths /100,000 population)- 15-24 years (black males)
+- from 11.6 to 16.1- 15-24 years (Asian or Pacific Islander)
+- from 10.5 to 12.6- 15-24 years (American Indian)
+- from 41.2 to 43.6
Suicide rates for ages 25-64 (all races) have decreased or remained constant but the overall decrease is balanced by the increase in adolescent suicide. Overall teenage suicide rates in the 90's are higher than those in the 80's for all races.
Prevention of suicide requires increased recognition of pending psychological stresses, depression and suicidal ideation in the adolescent. (see Suicidal Behavior in the disease section of HouseCall) Environmental stresses and changing social structure in the United States have led to increased stress, expectation and failure on the part of the adolescent. These societal changes have occurred gradually and can only be reversed gradually. Until these changes occur only increased recognition of pending problems and maintenance of two way avenues of communication between the troubled adolescent and parents or person of trust will impact the increasing rate of adolescent suicide.
Homicide: This is one of the most disturbing causes of death among children and adolescents. It is a killer that should be completely preventable an yet is increasing dramatically among the young to the point that it has increased the overall homicide rate in the US. It is disconcerting to realize that between 1980 and 1991 homicides decreased in all age groups from age 24 up (Asian males age 25-44 remained constant) yet in the 15-24 category almost all races experienced an increase in homicide. For the years 1980 (listed first) and 1991 (listed second) the statistics are as follows:
- 15-24 years, male (all races)
+- 22.9 (in 1980) up to 32.3 (in 1991) /100,000 population- 15-24 years, male (white)
+- from 14.3 up to 14.9- 15-25 years, male (black)
+- from 78.7 up to 137.1- 15-25 years, male (Asian)
+- from 9.5 up to 14.3- 15-24 years, male (Am. Indian)
+- from 31.6 down to 27.5- 15-24 years, male (Hispanic)
+- from N.A. to 50.6
Among females, all races, homicide was down with the exception of one group:
- 15-24 years, female (black)
+- 16.9 up to 19.3 deaths /100,000 population
These figures are self explanatory. Young males in the 15-24 year age group are being murdered with increasing frequency. Sociologist feel that the increase of gangs, teenage homicide, teenage suicide, teenage pregnancy, school drop-out and other problems are a reflection of the rapidly changing social climate, disintegration of the family structure, depersonalization of the individual and increasing class stratification. It is a complex issue which does not have a simple answer but it is obvious that while the adult population is moving away from violent death, youth is not. Prevention will require understanding of the root cause and a willingness on the part of the public to change those causes.
Accidents: Accidents are, by far, the leading cause of death among children and adolescents. The automobile accounts for the largest number of these accidental deaths. Other sources include drowning, fire, falls and poisoning. Safety has been an ongoing concern of the federal government (OSHA, EPA, FDA, CDC); local government (building codes, state health departments, fire departments, Dept. of Safety Regulation, and school safety programs for children; private industry; and increased parental attention to safety in the home. Despite good programs accidental deaths continue to be the leading cause of death in this age group. No amount of safety education or regulation will entirely eliminate accidental death but every bit helps.
Special attention must be paid to the automobile. In the 15-24 year age range car accidents account for one third off all the deaths in that group each year. This is a cause of death that can be corrected.
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The information provided herein should not be used for diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Copyright 2000 adam.com, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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