Background Changes in national wealth and income inequality are strong determinants for child and adolescent mortality in low and middle income countries (LMIC), but their influence may differ between young children and adolescents.
Methods Multilevel longitudinal models were used to describe associations between changes in income inequality (Gini coefficient) and national wealth (gross domestic product, GDP) and mortality among adolescents (15–19) compared with young children (1–4) in LMIC between 1990 and 2012. Mortality data were accessed from the Institute of Health Metrics and Evaluation (IHME) and causes were grouped by Global Burden Disease category, (communicable, non-communicable diseases (NCD), and injuries). Counterfactual models were used to describe mortality scenarios following significant changes in income inequality or national wealth.
Results Data were available for 109 countries. Gini was positively associated with increased all-cause, communicable, NCD and injury mortality in both age groups between 1990 and 2012. Relative improvements in all-cause mortality between 1990 and 2012 may have been up to 27% greater for 15–19 year olds and 10% greater for 1–4 year olds had all Gini coefficients decreased by the amount seen in the top 10% of countries. After adjusting for income level in 1990, higher GDP was associated with increased male all-cause mortality among 15–19 year olds and decreased male and female mortality among 1–4 year olds. Higher GDP was associated with increased injury mortality and decreased communicable mortality in both age groups.
Conclusion The impact of changes in national wealth on child and adolescent mortality in LMIC vary by age group and mortality cause, owing to changes in disease burden across age groups. Younger children benefit more from economic development than adolescents whose all-cause mortality actually increases as economies grow in low income settings. In contrast, increased income inequality was associated with worse outcomes in all age groups and mortality causes studied. Efforts to reduce income inequality may be particularly beneficial for adolescents in LMIC.
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