Global burden and trends of non-communicable diseases among children and adolescents from 1990 to 2021: an age-period-cohort and frontier analysis with projections to 2035.

BACKGROUND

Comprehensive analyses of non-communicable diseases (NCDs) in children and adolescents that disentangle age, period, and cohort effects, assess health system efficiency, and project future trends remain limited. This study aims to address these gaps using data from the Global Burden of Disease Study 2021.

METHODS

Utilizing data from GBD 2021, we analyzed age-standardized rates (ASRs) of prevalence, incidence, mortality, and disability-adjusted life years (DALYs) for NCDs. Analyses included joinpoint regression to assess trends, age-period-cohort (APC) modeling to distinguish age, period, and birth cohort effects, frontier analysis to evaluate health system efficiency relative to socio-demographic index (SDI), and Bayesian APC modeling to project future burden to 2035. Inequalities were measured using the Slope Index of Inequality and Concentration Index.

RESULTS

From 1990 to 2021, while global age-standardized mortality rate (ASMR) and DALY rate (ASDR) decreased substantially (AAPC:-2.20% and-1.30%, respectively), the age-standardized incidence rate (ASIR) increased (AAPC: +0.05%). The age-standardized prevalence rate (ASPR) remained largely stable (AAPC:-0.02%). Notably, the burden of mental disorders and diabetes and kidney diseases rose significantly. Adolescents (15-19 years) experienced increasing ASPR, contrasting with declines in younger children. Marked disparities were observed: lower SDI regions carried the highest burden, yet higher SDI regions showed rising ASIR. APC analysis confirmed strong age effects and modest cohort improvements. Frontier analysis identified significant efficiency gaps, even among high-SDI countries. Projections suggest a rising incidence in the 5-14 year age groups by 2035, alongside continued declines in mortality and DALYs.

CONCLUSION

The shifting NCD burden toward non-fatal morbidity, especially mental and metabolic conditions in adolescents, requires developmentally tailored interventions. Addressing health system inefficiencies and socioeconomic disparities is crucial to reduce the future NCD burden and achieve Sustainable Development Goals.