Global, regional, and national levels and trends in older child, adolescent, and youth (5-24 years) all cause mortality from 1990 to 2024: modelling study

AbstractObjectiveTo estimate all cause mortality among children, adolescents, and youths aged 5-24 years for 200 countries and areas from 1990 to 2024, to assess mortality levels and trends, and to identify which regions and countries require the greatest investment.DesignDatabase construction of empirical data on mortality, mortality estimation, and assessment of levels and trends.Data and methodsMortality databases were constructed from all available nationally representative data including vital registration data, sample vital registration data, household surveys, and population censuses to estimate mortality risk in the age groups in people aged 5 to 24 years.ResultsIn 2024, an estimated 2.1 million (90% uncertainty interval (UI) 2.1 million to 2.4 million) people aged 5-24 years died worldwide, representing 31% of all 7.0 million deaths under 25 years of age. This figure, an increase from 21% (3.3 million of 16.3 million) in 1990, reflects this age group’s increasing epidemiological importance as mortality in children under 5 years old declines faster. Globally, mortality risk was lowest at ages 10-14 years (2.7 (90% UI 2.5 to 3.3) deaths per 1000) and increased at ages 15-19 years (4.3 (4.1 to 4.6)) and 20-24 years (6.1 (5.7 to 7.7)). Male mortality was consistently higher than female mortality, with the male to female ratio increasing with age. Progress has been uneven: mortality fell by 64% for people aged 5-9 years from 1990 to 2024, compared with 33% for people aged 20-24 years, with slower declines in male mortality, particularly in older youth (26% reduction in male mortality v a 43% reduction in female mortality in people aged 20-24 years). Mortality declines have slowed since 2015, with increases in some low mortality regions, including North America, in people aged 10-24 years. In West and Central Africa, population growth outpaced mortality decline, increasing the absolute number of deaths. Deaths were increasingly concentrated in high mortality regions. Nearly half of deaths in 2024 occurred in just two regions: West and Central Africa, and Eastern and Southern Africa, which accounted for 23% (0.6 billion of 2.6 billion) of the global population of 5-24 year olds. This figure is an increase from 12% in 1990 (0.2 billion of 2.1 billion) and is projected to exceed 30% (0.9 billion of 2.6 billion) by 2050.ConclusionProgress in reducing mortality in people aged 5-24 years has been uneven and has slowed. Urgent, context specific investments—particularly in high mortality regions—are needed to reduce preventable deaths and strengthen mortality monitoring data systems.