Adolescent mortality

There is a high risk of death among adolescence, with accidents and suicide being two of the highest causes of death for young people aged between 10 and 19.

Background

  • Adolescence (10-19 years of age) is the life stage with the second highest risk of death among children and young people – second only to infancy.
  • The UK has not matched the recent reductions in adolescent mortality seen in comparable wealthy countries, largely due to higher rates of death from non-communicable diseases.1

Key findings

  • There were approximately 1,330 death registrations for young people aged 10 to 19 years across the UK in 2018: 1,141 in England and Wales,2 48 in Northern Ireland3 and 141 in Scotland.4 The majority of these deaths are among 15 to 19 year olds.
  • The risk of dying for young men is notably higher than for young women.
  • There has been an increase in mortality among adolescents in the UK since 2014, from 17.5 to 18.0 per 100,000 young people aged 10-19 years.2,3,4
  • In 2018, the most common causes of death in England and Wales in this age group were accidental injury, cancer and intentional self-harm (including suicide), followed by neurological, cardiovascular and respiratory disorders.2
  • Among the older 15-19 year age group, deaths from assaults account for 3.0% of all deaths (25 out of 831 deaths in England and Wales).2

Adolescent mortality rate calculated using the number of adolescent deaths (10-19 years) divided by ONS population estimates for that age group and year, multiplied by 100,000.5

Fluctuations within mortality data from Northern Ireland and Scotland should be read with caution, due to small numbers of registered deaths.

What does good look like?

Focus on environmental and social factors to reduce inequalities. Social inequalities are associated with nearly all the leading causes of deaths in young people aged 15 to 19 years, especially injuries. Injury deaths in young people are linked with environmental factors relating to poor housing and infrastructure that are more often found in deprived neighbourhoods, as well as broader determinants of poor health such as parental mental health, employment, education, relationship status and income.6

Better healthcare services, to provide appropriate access to mental health support for young people. Poor adolescent mental health underlies many causes of death in adolescence, most obviously suicide, but also for many injuries and other conditions including substance use.2 Alongside improving access to appropriate Child and Adolescent Mental Health Services (CAMHS), efforts should be made to improve mental health among young people by strengthening the knowledge, skills and capacity of all professionals who work with young people (eg school staff or youth workers) to support their mental wellbeing.

Better care for children with long term health conditions. Long term conditions are common: 23.0% of young people in England report that they live with a long-term condition or disability; and 30.0% of these report that their condition or disability affected their school attendance and/or participation.7 The UK mortality rate among young people aged 10-19 due to long term conditions such as asthma and diabetes compares unfavourably to similar wealthy countries.8 This may be due to socioeconomic and population differences, or healthcare amenable factors (such as fragmentation of services, support for families and recognition and response to acute illness.9,10 Improvement in care for children and young people with long term conditions should be driven by robust national outcome data collection, to inform quality improvement efforts.

Policy recommendations

  • UK Government should resource Local Authorities to provide safer environments for children and young people to walk, play and travel. Local Authorities should commit to:
    • Expansion of 20mph zones within built up / urban areas;
    • Greater number of cycle lanes;
    • Greater number of pedestrian zones;
    • Monitoring and measurement of their population’s exposure to air pollution, particularly in urban areas and near schools.
  • NHS England should implement the Long Term Plan commitment to create 0-25 year services in England by 2028, to ensure delivery of seamless services for children with long term physical and mental health conditions.
  • Scottish Government should fulfil their 2018 commitment for Healthcare Improvement Scotland and the Care Inspectorate to develop a National Hub for Reviewing and Learning from the Deaths of Children and Young People with full implementation in 2020. The National Hub should ensure the death of every child up to the age of 26 is reviewed. It should produce a core data set, which allows for systematic collection, analysis and interpretation of all infant, child and young person deaths to improve local learning and national policy making and allow meaningful international comparison.
  • Local Authorities should provide safer environments for children and young people to walk, play and travel. They should commit to:
    • Expansion of 20mph zones within built up / urban areas;
    • Greater number of cycle lanes;
    • Greater number of pedestrian zones;
    • Monitoring and measurement of their population’s exposure to air pollution, particularly in urban areas and near schools.
  • We welcome Welsh Government’s commitments within ‘Healthy Weight, Healthy Wales’ to expand 20mph zones and increase the number of pedestrian and cycle routes, which will provide safer environments for children and young people to walk, play and travel. Welsh Government should implement these changes within the first two-year phase, as outlined in the delivery plan.
  • We welcome the Active Travel Act (Wales), but in order for the Act to be successful in increasing the number of school pupils walking or cycling to school, Welsh Government should meet the recommendations outlined by the Economy, Infrastructure and Skills Committee 2018 report on the Act.
  • The Department of Infrastructure should continue to provide safer environments for children and young people to walk, play and travel. Including:
    • Expansion of 20mph zones within built up / urban areas;
    • Implementation of the ‘Bicycle Strategy for Northern Ireland’;
    • Creation of more pedestrian zones and implementation of ‘Exercise – Explore – Enjoy: A strategic plan for greenways’;
    • Monitor and measure of the population’s exposure to air pollution, particularly in urban areas and near schools.

What can health professionals do about this?

  • Participate in data collection. Professionals and services should participate actively in the audits which review the care of young people with long term conditions (eg Epilepsy12, National Paediatric Diabetes Audit), and use the findings to understand what is being done well and how services could be improved.
  • Make every contact count. Young people may see an encounter with a trusted health professional as an opportunity to discuss issues beyond their immediate, physical complaint. Professionals should actively explore other issues the young person (or their family) may be struggling with. These could be physical, mental, or relate to their social and family circumstances.

Contributing authors

  • Dr Ronny Cheung, RCPCH State of Child Health Clinical Lead
  • Rachael McKeown, RCPCH State of Child Health Project Manager
  • Dr Rakhee Shah, RCPCH State of Child Health Clinical Advisor

Royal College of Paediatrics and Child Health (2020) State of Child Health. London: RCPCH. [Available at: stateofchildhealth.rcpch.ac.uk]

References

(1)

Shah, R. et al. 2019. International comparisons of health and wellbeing in adolescence and early adulthood. Nuffield Trust in association with the Association for Young People’s Health.

(3)

Northern Ireland Statistics and Research Agency. Registrar General Annual Report 2018, Deaths. November 2018.

(4)

National Records of Scotland. 2019. Vital Events Reference Tables.

(6)

Roberts, J., Bell, R. 2015. Social inequalities in the leading causes of early death: a life course approach. UCL Institute of Health Equity.

(7)

Health Behaviour in School-Aged Children England. 2020. Health Behaviour in School-aged Children (HBSC): World Health Organization Collaborative Cross National Study. Hertfordshire: University of Hertfordshire.

(8)

Viner, R.M. et al. 2014. Deaths in young people aged 0-24 years in the UK compared with the EU15+ countries, 1970-2008: Analysis of the WHO mortality database. Lancet.

(9)

Sidebotham, P. et al. .2015. Deaths in children with epilepsies: a UK-wide study. Seizure.

(10)

Royal College of Physicians. 2014. Why asthma still kills: The National Review of Asthma Deaths (NRAD). London: Royal College of Physicians.