Sharp increases in deaths, chronic conditions, and emotional symptoms among U.S. children and adolescents signal a broad decline in pediatric health over the last 17 years, according to a new analysis of national surveys, electronic health records, and global mortality data.
The study found that from 2007 to 2023, children in the United States experienced worsening trends across mortality, chronic physical and mental conditions, functional status, and physical and emotional symptoms. The findings were consistent across multiple independent datasets, including U.S. federal surveys, pediatric electronic health records, and mortality data from 18 peer high-income countries.
Children in the U.S. were significantly more likely to die than peers in 18 other high-income countries. Infants younger than 1 year had a 78% higher death rate (rate ratio [RR], 1.78; 95% confidence interval [CI] = 1.78-1.79), and individuals aged 1 to 19 years had an 80% higher rate (RR = 1.80; 95% CI = 1.80-1.80). These disparities widened from 2020 to 2022. Over the full period, the US recorded an estimated 315,795 excess child deaths compared with Organisation for Economic Co-operation and Development (OECD18) countries.
Among infants, leading causes of excess mortality included prematurity (RR = 2.22; 95% CI = 2.20-2.24), sudden unexpected infant death (RR = 2.39; 95% CI = 2.35-2.43), congenital anomalies, and respiratory infections. In the 1- to 19-year-old group, firearm-related deaths (RR, 15.34; 95% CI, 14.89-15.80), motor vehicle crashes (RR = 2.45; 95% CI = 2.42-2.48), substance use, and homicide were primary contributors.
Chronic health conditions among children aged 3 to 17 years increased across both electronic health record (EHR) data and national survey responses. In PEDSnet clinical records, prevalence rose from 39.9% in 2011 to 45.7% in 2023 (RR = 1.15; 95% CI = 1.14-1.15). Survey data showed an increase from 25.8% to 31.0% (RR = 1.20; 95% CI = 1.20-1.20). Anxiety, autism, depression, and developmental delays were among the conditions with the largest increases. Major depression rose more than threefold (RR = 3.30; 95% CI = 3.16-3.44).
Obesity in children aged 2 to 19 years rose from 17.0% in 2007–2008 to 20.9% in 2021–2023 (RR = 1.23; 95% CI = 1.23-1.23). Early onset of menstruation among girls aged 8 to 11 years increased from 9.1% to 14.8% (RR, 1.63; 95% CI, 1.63-1.64). Trouble sleeping among 16- to 17-year-olds also increased (RR = 1.80; 95% CI = 1.80-1.81).
The proportion of children aged 5 to 17 years with at least one diagnosed physical symptom increased from 31.2% to 41.2% (RR, 1.39; 95% CI = 1.39-1.40). Commonly reported symptoms included dermatologic complaints, pain, and menstrual issues. Reports of emotional symptoms, including depressive feelings and loneliness, also increased during the study period.
These trends were consistent across multiple sources, including national mortality databases, five federal health surveys, and EHRs from 10 pediatric hospital systems. The analysis did not stratify findings by race, socioeconomic status, or geography but observed consistent deterioration across the overall pediatric population.
Source: JAMA