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The burden of disease in adolescents

Video discussing the burden of disease in adolescence and the top causes of morbidity.
DAVID ROSS: We’re now going to talk about the burden of disease in adolescents. This is a combination of mortality and morbidity. So for example, mortality contributes the years of life that you’ve lost if you die from a condition, and the disability in which, for example, if you were bedridden from an acute illness for one week and then you recover completely, you would have lost most of your healthy life for that one week. And the measure is the disability-adjusted life years lost. And this takes into account both life years, healthy life years lost within the age group and into the future.
One of the key things to note is that the burden of non-communicable health conditions has been increasing dramatically globally. And these are due to injuries, mental health disorders, cardiovascular disease, and diabetes, and obesity. Most of these either have their biggest effects during adolescence, such as injuries, or they present for the first time during adolescence, such as mental health disorders, or the behaviours and risk factors that start during adolescence lead to cardiovascular disease or diabetes and obesity in later life. If we look at the disability-adjusted life years by age and by sex, we can see here that the biggest burden of disease is in under fives.
And in fact, this is due to infants, where there’s a very high mortality rate and also disability rate. The burden of disease is minimal, at it’s lowest level in 10 to 14-year-olds. But already in 15 to 19-year-olds, it’s increased substantially, and it continues to go up in 20 to 24-year-olds. What’s causing this burden of disease in adolescents? And this graph shows what is going on, what the major causes are. I’d like to highlight two things in this graph. First of all, the real importance of neuropsychiatric conditions. These are also known as mental health problems, depression, for example. That’s the purple in this graph, and also the importance of injuries, especially in males. That’s in red in this graph.
When we look at the top five causes of burden of disease in adolescents, we can see the importance, especially in males, of road injuries, and then depression, HIV, interpersonal violence, and iron deficiency anaemia in males. In females, the number one is depression, followed by iron deficiency anaemia, HIV, anxiety disorders, and interestingly, diarrhoeal diseases, even in this age group of 10 to 19-year-olds. And you can see, if you look at the numbers on the right hand side of this graph, you can see the huge burden that comes from road injuries in males and from depression in females. When thinking about adolescent burden of disease, we must take a lifecycle or life course perspective.
And that’s illustrated in this diagram here, where things that happened to you even as a foetus in your mother’s womb have major impacts on you as an adolescent. Similarly, things that happen to you during childhood are very important for what’s going to happen to you in adolescence. Also, the issue of puberty and social role transitions that are happening, that we heard about in a previous step, is happening to you in adolescence, but that is affected dramatically by things that are happening outside you as an individual.
So the social determinants of health, such as the norms of the culture that you’re living in, the environment that you’re living in, the particular risk and protective factors such as whether you have parental care and concern. The health related behaviours and states such as smoking, alcohol consumption, drug use. All of these can lead to specific adolescent health outcomes but can also have important outcomes later into adulthood. And all of these factors are affected, both if you like, by the local environment but also the social, educational, and economic policies environment that you’re in and the particular health policies that you’re living within in the country that you’re living in. So what are the really important risk factors?
This is in 15 to 24-year-olds for the burden of disease. And here you can see in males, the really important factor is alcohol consumption. Just how much that’s contributing to the burden of disease. In females, the importance of unsafe sex, lack of contraception, and other conditions there that you can see in this graph. So from this, what are the major health priorities in adolescents. The number one, two, and three are injuries, mental health disorders, and sexual and reproductive health issues. And we’re going to be going into these in more detail in subsequent steps. Other really important priorities include nutrition and exercise, common endemic communicable diseases such as schistosomiasis, malaria, soil transmitted helminths such as hookworm.
Common infectious diseases remain an important problem in this age group. Diarrhoea and pneumonia being the most important. And also, alcohol consumption and other psychiatric drugs where cannabis is the major drug consumed in this age group, and tobacco.

The burden of disease is the impact of a health problem measured by mortality, morbidity and other indicators. What are the top causes of the burden of disease in adolescents?

In the video we see that the burden of non-communicable health conditions has been increasing dramatically in recent years, and many of these either have their biggest effects during adolescence or present for the first time at this stage of life. How are these health priorities being dealt with? What is being done?

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