The Policy on Prevention and Control of Noncommunicable Diseases in Children, Adolescents, and Young Adults (DC60/7) (1), submitted to the 60th Directing Council of the Pan American Health Organization (PAHO), recognized the need to strengthen the availability of data and evidence on the health status of children, adolescents, and youth with regard to NCDs and their risk factors to inform decision making. It highlights this task should be approached with a health equity lens, focusing on absolute and relative measures of inequality and their impact on health-related behaviors and health outcomes among children, adolescents, and young adults.
In response, the PAHO's Department of Noncommunicable Diseases and Mental Health (NMH) is making available the most recent and comparable data on the burden of noncommunicable diseases (NCDs) and their risk factors in children, adolescents, and young adults in the Region of the Americas.
This visual summary presents the current situation and trends of NCDs and risk factors among children, adolescents, and young adults in the Region of the Americas.
THE BURDEN OF NONCOMMUNICABLE DISEASES IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS
Mortality
NCD deaths by broad cause and age
In 2019, total all-cause deaths for children, adolescents and young adults aged 0-24 years in the Region of the Americas was 390,251 deaths, for a mortality rate of 72 deaths per 100 000 population.
In 2019, total NCD deaths for children, adolescents and young adults aged 0-24 years in the Region of the Americas was 116,590 (95% UI 73,639–179,345) which equate to 31 (19-47) deaths per 100 000 population. NCDs accounted for 30% (27–32) of total deaths in this age group.
Distribution of deaths in children, adolescents, and young adults by broad group of causes and age
Note: The fluctuation observed are due to the mortality shock caused by the Haiti earthquake in 2010.
Hints on interactions with data: Use the selectors located at the top of the visualization to show data for a selected location, sex , and metric. Hover the chart for detailed information of data points.
Data source: WHO Global Health Estimates 2000-2019.
What is the regionwide time trend in mortality?
In the Region of the Americas, the absolute number of deaths from NCDs in people up to 24 years of age decreased by 23% from 150,478 (95% UI: 99,396 to 220, 957) deaths in 2000 to 116,590 (73,689 to 179,345) deaths in 2019. Similarly, the mortality rates declined by 23% from 40.0 (26.4 to 58.8) deaths per 100,000 population to 30.8 (19.5 to 47.4) deaths per 100,000 population.
This decline trend is offset by the modest decreasing trend in the age group 10-19 years and the upward trend in the age group 20-24 years.
Regionwide from 2000 to 2019, like most countries, mortality rates were consistently higher for boys than girls reaching 35.0 deaths per 100,000 population for boys and 26.4 deaths per 100,000 population for girls in 2019.
Noteworthy are the upward trends in NCD mortality among adolescent males aged 10 to 19 years and young males aged 20 to 24 years.
Learn about the mortality trends in specific subregion and/or country by selecting the location from the chart.
Trends in mortality rates from NCDs in children, adolescents, and young adults
Hints on interactions with data: Use the selectors located at the top of the visualization to show data for a selected location (region, subregion, or country), and age group. Hover over the chart to get detailed information on the data point. Data in parenthesis show the percentage change relative to year 2000.
Data source: WHO Global Health Estimates 2000-2019.
What are the levels of NCD mortality across countries?
Mortality rates from NCDs in people aged up to 24 years shows substantial disparities across countries.
In 2019 for both sexes combined, death rates from NCDs ranged from from 69.0 deaths per 100,000 population in Haiti to 15.4 deaths per 100,000 population in Canada.
The top 20% of countries with the highest mortality, fifth quintile marked in red color have mortality rates over 37.4 deaths per 100,000 population, more than two-fold higher than Canada, the country with the lowest risk of dying from NCDs.
For boys, mortality rates varied from 66.0 deaths per 100,000 population in Haiti to 18.4 deaths per 100,000 population in Canada.
For girls, mortality rates varied from 72.0 deaths per 100,000 population in Haiti to 12.2 deaths per 100,000 population in Canada.
Level of noncommunicable disease mortality in children, adolescents, and young adults by country, 2019
Notes: Data are classified by quintiles and countries are sort in descendent order by the level of mortality.
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Data source: WHO Global Health Estimates 2000-2019.
What are the leading causes of death from NCDs in children, adolescents and young adults?
Regiowide in 2019, the top five causes of death from NCDs in people up to 24 years of age were: congenital anomalies, drug use disorders, Leukaemia, brain and nervous system cancer, and kidney disease.
Between 2000 and 2019, there were notable shifts in the leading causes of noncommunicable diseases (NCD) mortality among individuals aged up to 24 years. Specifically, five of the top 15 causes experienced notable upward movements in their rankings. The mortality rate attributed to drug use disorders saw a remarkable increase of 226%, propelling it from the 11th to the 2nd position in 2019. Additionally, brain and nervous system cancer advanced from the 8th to the 4th position, kidney diseases climbed from 7th to 5th place, ischemic heart disease ascended from 14th to 11th position, and diabetes (excluding chronic kidney disease due to diabetes) shifted from the 15th to the 12th position.
Top fifteen causes of death for NCDs in children, adolescents, and young adults up to 24 years of age, 2000 and 2019
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Data source: WHO Global Health Estimates 2000-2019.
YLD from NCDs by broad cause and age
In 2019, the all-cause YLD rate among children, adolescents and young adults aged 0-24 years in the Region of the Americas was 5,468 years per 100 000 population.
Regionwide in 2019, YLD rate fron NCDs for children, adolescents and young adults aged 0-24 years was 4,253 (95% UI 2,221–7,329) years per 100,000 population, representing 78% (76–79) of all-cause YLDs in this age group.
YLD from NCDs in individuals up to 24 years of age predominates in all age categories, except in infants under 1 year of age.
Distribution of YLDs in children, adolescents, and young adults by broad group of causes and age
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Data source: WHO Global Health Estimates 2000-2019.
What is the time trend in YLD rate in the region?
In the Region of the Americas, YLD rates from NCDs in people up to 24 years of age slightly increased by 6% from 4,006 (95% UI: 2,098 to 6,885) years per 100,000 population in 2000 to 4,253 (2,221 to 7,329) years per 100,000 population in 2019.
This increasing trend is observed in all age categories.
Regionwide from 2000 to 2019, YLD rates were consistently higher for girls than boys.
Learn about the trend in YLD from NCD in persons up to 24 years of age in specific subregion and/or country by selercting the location from the interactive visual.
Trends in YLD rates from NCDs in children, adolescents, and young adults
Hints on interactions with data: Use the selectors located at the top of the visualization to show data for a selected location (region, subregion, or country), and age group. Hover over the chart to get detailed information on the data point. Data in parenthesis show the percentage change relative to year 2000.
Data source: WHO Global Health Estimates 2000-2019.
What are the levels of YLD from NCD across countries?
YLD rates rates from NCDs in people aged up to 24 years varies across countries.
In 2019 for both sexes combined, YLD rates from NCDs ranged from from 5,303 years per 100,000 population in the United States of America to 3,360 years per 100,000 population in Venezuela.
The top 20% of countries with the highest YLD rates, fifth quintile marked in red color have YLD rates over 3,900 years per 100,000 population.
For boys, YLD rates varied from 4,862 years per 100,000 population in the united States of America to 3,019 years per 100,000 population in Mexico.
Meanwile, for girls, YLD rates varied from 5,765 years per 100,000 population in the united States of America to 3,710 years per 100,000 population in Venezuela.
Level of YLD rates from noncommunicable disease in children, adolescents, and young adults by country, 2019
Notes: Data are classified by quintiles and countries are sort in descendent order by the level of mortality.
Hints on interactions with data: Use the selectors located at the top of the visualization to show data for a selected age and sex. Hover the chart for detailed information of data points.
Data source: WHO Global Health Estimates 2000-2019.
What are the leading causes of YLD from NCDs in children, adolescents and young adults?
Regiowide in 2019, the top five causes of YLD from NCDs in people up to 24 years of age were: depressive disorders, anxiety disorders, asthma, drug use disorders, and migraine.
Between 2000 and 2019, there were notable shifts in the leading causes of YLD from NCD among individuals aged up to 24 years. Specifically, three of the top 15 causes experienced upward movements in their rankings. The YLD rate attributed to drug use disorders saw a remarkable increase of 60%, moving it up from the 9th to the 4nd position in 2019. Additionally, gynecoligical diseases, and bipolar disorders cancer advanced from the 12th to the 10th position and 14th to 12th pocition respectively.
Top fifteen causes of YLD from NCDs in children, adolescents, and young adults up to 24 years of age, 2000 and 2019
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Data source: WHO Global Health Estimates 2000-2019.
DALYs from NCDs by broad cause and age
In 2019, all-cause DALYs account for 42 million years of healthy life lost among children, adolescents and young adults aged 0-24 years in the Region of the Americas, equivalent to 13,866 years per 100 000 population.
Regionwide in 2019, DALY rate fron NCDs for children, adolescents and young adults aged 0-24 years was 6,751 (95% UI 2,930–10,571) years per 100,000 population, representing 49% of all-cause DALYs in this age group.
DALYs from NCDs predominates in all age categories except under-one years.
Distribution of DALYs in children, adolescents, and young adults by broad causes and age
Note: The fluctuation observed are due to the mortality shock caused by the Haiti earthquake in 2010.
Hints on interactions with data: Use the selectors located at the top of the visualization to show data for a selected location, sex , and metric. Hover the chart for detailed information of data points.
Data source: WHO Global Health Estimates 2000-2019.
What is the time trend in DALY rate in the region?
In the Region of the Americas, DALY rates from NCDs in people up to 24 years of age slightly decreased by 8% from 7,345 (95% UI: 3,466-11,8224) years per 100,000 population in 2000 to 6,751 (2,930-10,3571) years per 100,000 population in 2019.
This downward trend was driven by the trend in age categories under-1 years, and 1-9 years old. Notably, DALY rates is increasing by 4.5% in the age group 20-24 years.
Regionwide from 2000 to 2019, DALY rates were consistently higher for boys than girls aged up to 24 years, it was higher in girls tha boys aged 1-9 years.
Learn about the trend in YLD from NCD in persons up to 24 years of age in specific subregion and/or country by selercting the location from the interactive visual.
Trends in DALY rates from NCDs in children, adolescents, and young adults
Hints on interactions with data: Use the selectors located at the top of the visualization to show data for a selected location (region, subregion, or country), and age group. Hover over the chart to get detailed information on the data point. Data in parenthesis show the percentage change relative to year 2000.
Data source: WHO Global Health Estimates 2000-2019.
What are the levels of DALYs from NCD across countries?
In 2019 for both sexes combined, DALY rates from NCDs ranged from from 9,521 years per 100,000 population in Haiti to 5,308 years per 100,000 population in Cuba. Two-fold higher in Haiti compared to Cuba, the country with the lowest rate.
The top 20% of countries with the highest DALY rates (Haiti, Saint Vincent and the Grenadines, Guyana, Paraguay, Brazil, Guatemala, and the United States of America), fifth quintile marked in red color had DALY rates over 7,000 years per 100,000 population.
For boys, DALY rates varied from the highest 8,915 years per 100,000 population in Haiti to the lowest 5,056 years per 100,000 population in Cuba.
For girls, DALY rates ranged from the highest 10,141 years per 100,000 population in Haiti to the lowest 5,576 years per 100,000 population in Cuba.
Level of DALY rates from noncommunicable disease in children, adolescents, and young adults by country, 2019
Notes: Data are classified by quintiles and countries are sort in descendent order by the level of mortality.
Hints on interactions with data: Use the selectors located at the top of the visualization to show data for a selected age and sex. Hover the chart for detailed information of data points.
Data source: WHO Global Health Estimates 2000-2019.
What are the leading causes of DALYs from NCDs in children, adolescents and young adults?
Regiowide in 2019, the top five causes of DALYs from NCDs in people up to 24 years of age were: congenital anomalies, drug use disorders, depressive disorders, anxiety disorders, and asthma.
Between 2000 and 2019, there were some shifts in the leading causes of DALYs from NCD among individuals aged up to 24 years.
Specifically, four of the top 15 causes experienced upward movements in their rankings. The DALY rate attributed to drug use disorders saw a remarkable increase of 89%, moving it up from the 7th to 2nd position in 2019. Additionally, back and neck pain moved up from 9th to 8th position, gynecological diseases rose from 14th to 12th position, and bipolar disorders advanced from 15th to 13th position.
Top fifteen causes of DALYs from NCDs in children, adolescents, and young adults up to 24 years of age, 2000 and 2019
Hints on interactions with data: Use the selectors at the top of the visualization to show data for a selected location, age group, and sex. Hover over the chart for detailed information on data points.
Data source: WHO Global Health Estimates 2000-2019.
RISK FACTORS FOR NONCOMMUNICABLE DISEASES IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS
The risk of developing NCDs, including asthma, cardiovascular disease, diabetes, and cancer, begins during the prenatal period and increases throughout the life course, from infancy through late adulthood (2). It is during adolescence—a time for exploration and independence-seeking behaviors—that many NCD risks become more evident. Smoking, harmful use of alcohol, unhealthy diet, and physical inactivity, among other risky behaviors, typically start during the early teenage years (3). Indeed, the social determinants that contribute to these behaviors, and the biological changes that predispose to disease, start much earlier, during the preconception period or even in previous generations.
This section presents information on the level and trends of NCD risk factors for infants, children, adolescents, and young adults in the Region of the Americas.
Exclusive breastfeeding in infants under six months of age
Breastfeeding is one of the most effective ways to ensure infant health and survival. It also plays a key role in health during childhood. However, nearly two out of three infants are not exclusively breastfed in the first six months of life as recommended—a rate that has not improved in two decades.
In the Region of the Americas, the prevalence of exclusive breastfeeding in infants under six months of age was 32%, nearly two out of three infants are not exclusively breastfed in the first six months of life as recommended.
According to the latest available data, the prevalence of exclusive breastfeeding in infants under six months of age varies across countries of the Americas from the lowest of 3.5% in Saint Lucia in 2012 to the highest of 65.3% (62.1-68.4) in Peru in 2019.
Prevalence of breastfeeding in infants under six months of age in countries of the Americas.
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Data source: WHO Global Health Observatory.
Several forms of malnutrition in infants and children under-five years of age
Malnutrition refers to deficiencies or excesses in nutrient intake, imbalance of essential nutrients, or impaired nutrient utilization. The double burden of malnutrition consists of both undernutrition and overweight and obesity, as well as diet-related noncommunicable diseases. Undernutrition manifests in four broad forms: wasting, stunting, underweight, and micronutrient deficiencies.
Wasting: The median prevalence of wasted children under 5 years of age in the Americas was 2% (interquartile range [IQR]: 1.4-3.7). The prevalence of wasting varied from 0.1% in the United States of America to 6.8% in Barbados. Four countries (Venezuela, Suriname, Guyana, and Barbados) had a rate of wasting over 4%.
Stunting: The median prevalence of stunted children under 5 years of age in the Region was 8.9% (IQR: 6.6-12.9).
Underweight: The median prevalence of underweight in children under 5 years of age in the Region was 3.6% (IQR: 2.4-4.9). This rate varied from 0.5% in the United States of the Americas to 12.4% in Guatemala. The countries with the highest rates (over 6.5%) were Honduras, Suriname, Guyana, and Guatemala.
Prevalence of several forms of malnutrition in infants, and children under five years old across countries of the Americas.
Notes: Vertical black line represents the median, and the gray band represents the lower and upper quartile or interquartile range of the distribution of the data.
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Data source: WHO Global Health Observatory.
Overweight and obesity in children and adolescents
Overweight and obesity during childhood and adolescence is an important NCD risk. It is linked to ill health and premature mortality from cardiovascular disease, diabetes, asthma, and certain types of cancer later in life.
In the Region of the Americas, the prevalence of overweight, and obesity among children and adolescents aged 5−19 years increased by 102% from 18.6% in 1990 to 37.6% in 2022, and by 204% from 5.6% in 1990 to 16.9% in 2022 (the latest year of available regional data), respectively.
From 1990 to 2022, both, the prevalence of overweight, and obesity remarkably increased in all age categories.
There is a notable shift in the prevalence of overweight across sexes, where it is higher for males than females since 2003. Meanwhile, the prevalence of obesity is consistently higher for boys than girls during the full period.
Trends in the prevalence of overweight and obesity in children and adolescents by sex and age categories, 1990-2022
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Data source: WHO Global Health Observatory.
Tobacco use in adolescents
Tobacco use is a major risk factor for cardiovascular and respiratory diseases, over 20 different types or subtypes of cancer, and many other debilitating health conditions. Tobacco use is started and established primarily during adolescence, with a striking impact on health during adulthood.
In 2020, the prevalence of tobacco use among adolescents aged 13 to 15 years in the Region of the Americas was 11.3% (11.9% among males and 10.7% among females). There are an estimated 5.2 million tobacco users in this age group in the Region.
Across countries, this prevalence ranged from a high of 25.3% in Dominica to a low of 6.9% in Brazil. In most countries, the prevalence of tobacco use was higher in men than women, except in Argentina, Uruguay, and Brazil.
Alcohol consumption in adolescents
In the Region of the Americas, it is estimated that one in every three adolescents aged 15-19 years were current alcohol drinkers in 2016. These estimates varied from 60% in the United States of America to 17% in Guatemala. These rates were higher for boys than for girls in every country.
The regional prevalence of heavy episodic drinking among adolescents 15−19 years of age was 18.5% in 2016 (latest year of available data), with rates across countries ranging from 28.0% in the United States of America to 6.7% in Guatemala. Rates of heavy episodic drinking were higher for boys than for girls in every country in the Region.
The prevalence of heavy episodic drinking (drinkers only) among adolescents 15−19 years of age shows a more concerning magnitude. It varied from 60% in Trinidad and Tobago to 40% in Guatemala. Indeed, levels are substantially higher for boys (two-fold higher) compared to girls.
Prevalence and patterns of alcohol consumption in adolescents aged 15-19 years by sex in countries of the Americas, 2016.
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Data source: WHO Global Health Observatory, Global Information System for Alcohol and Health.
Physical inactivity in children and adolescents
In the Region of the Americas, the prevalence of insufficient physical activity among adolescents aged 11-17 years was 80.7% in 2016 (latest available data), a figure that has remained constant since 2000.
Across countries of the Americas in 2016, this prevalence varied from 88.8% in Venezuela to 72.1% in the United States of America, being consistently higher for girls than boys.
Prevalence of insufficient physical activity in adolescents aged 11-17 years in countries of the Americas.
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Data source: WHO Global Health Observatory.
The prevention of NCDs requires multisectoral public policies that address the social determinants of health, promote environmental changes favorable to health, and strive for policy coherence across governmental sectors. Strong connectedness and modeling of healthy behaviors among family and peers represent significant protective factors for child and adolescent health behaviors. Age-appropriate messaging and counseling strategies can help address specific NCD risk factors in the youth population. Nutrition is a critical area, given the importance of maternal nutritional status during the prenatal period and of child feeding during the first 1,000 days of life. Interventions should include the promotion of exclusive breastfeeding/chestfeeding in the first six months, followed by optimal nutrition in infancy, childhood, and adolescence. Promotion of healthy school environments can foster healthy lifestyle habits, including adequate nutrition and physical activity.
Equally critical are efforts to increase access to health care and to strengthen the integration of NCD prevention and treatment for children into health programming. For example, human papillomavirus (HPV) vaccination is a key intervention in adolescent girls to prevent cervical cancer, a very common yet highly preventable type of cancer among women in Latin America and the Caribbean. Children, adolescents, and young adults who suffer from NCDs require access to quality diagnosis, treatment, follow-up, rehabilitation, and palliative care, based on their situation and needs.
The first two decades of life are when the individual’s capabilities are undergoing rapid development, and this is therefore the time when the greatest efforts should be made to shape lifelong health, learning, and social relations. Furthermore, children, adolescents, and young adults can become drivers of change in their families, communities, and society at large. However, meaningful participation of youth in policy formulation and accountability remains a challenge for the Region.
References
- Pan American Health Organization. Policy on Prevention and Control of Noncommunicable Diseases in Children, Adolescents, and Young Adults [Document CD60/7]. 60th PAHO Directing Council, 74th Session of the Regional Committee of WHO for the Americas; 26-29 September 2023. Washington DC: PAHO; 2023. Available from: https://www.paho.org/en/documents/cd607-policy-prevention-and-control-n…
- Patton GC, Sawyer SM, Santelli JS, Ross DA, Afifi R, Allen NB, et al. Our future: a Lancet commission on adolescent health and wellbeing. Lancet. 2016;387(10036):2423–2478. Available from: https://doi.org/10.1016/S0140-6736(16)00579-1.
- Hughes K, Bellis MA, Hardcastle KA, Sethi D, Butchart A, Mikton C, Jones L, Dunne MP. The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis. Lancet Public Health. 2017;2(8):e356–e366. Available from: https://www.thelancet.com/pdfs/journals/lanpub/PIIS2468-2667(17)30118-4….
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