Mortality

Elizabeth M. Ozer

Mortality rates for adolescents have decreased over the past 3 decades, yet the trends remain troubling. The mortality rate is 18.0 per 100,000 population for early adolescents (10–14 years) and 65.1 per 100,000 population for late adolescents (15–19 years). The more than 300% increase in mortality from early to late adolescence reflects the violent etiology of most deaths with increased access to motor vehicles and firearms combined with use of substances. The trend worsens in young adulthood: Young adults have 5 times the mortality rate of younger adolescents, with 97.5 deaths per 100,000 population (20–24 years). The majority of adolescent and young adult deaths are due to preventable causes, with unintentional injury (mostly due to motor vehicle accidents), homicide, and suicide accounting for 75% of all deaths. Adolescent males are more likely than females to die from each leading cause of death, and this gap increases with age. The most striking difference between males and females is in homicide rates: Older adolescent and young adult males are about 6 times as likely as females to die from homicide. Although homicide rates have decreased significantly since peak levels in the early 1990s, black, non-Hispanic male adolescents still have the highest rates of mortality, primarily due to homicide.^1,2

Unintentional injuries account for the greatest number of adolescent deaths (about 45%); the majority of these unintentional deaths involve motor vehicle accidents. Among young people ages 10 to 24 in 2005, 17,443 died from unintentional injuries. Mortality rates from unintentional injuries increased from 7.2 per 100,000 population among early adolescents to 40.5 among young adults. Male adolescents and young adults have a higher unintentional injury mortality rate than females, and this disparity increases with age.^1,3 Seven in 10 unintentional injury deaths involve motor vehicle accidents, making motor vehicle crashes the leading cause of mortality among adolescents, accounting for about a third of all deaths among adolescents and young adults. Among 15 to 24 year olds, the mortality rate is 25.8 per 100,000 population. Non-Hispanic American Indian/Alaska Native youth have the highest motor vehicle accident mortality rate, followed by white, non-Hispanic youth.^1-4 The peak time for vehicular accidents among 15 to 19 year olds occurs on weekends between 11 pm and 5 am. Factors such as inexperience leading to judgment errors, poor decision making and low control, fatigue, failure to use seatbelts, alcohol use, high speed, and recklessness all contribute to motor vehicle accident mortality.^1,3 Three in 10 fatal vehicle crashes involve alcohol. Due to these factors, the implementation of graduated driver licensing (GDL) has become widely accepted in the United States over the past decade. Research has demonstrated that GDL reduces teenage driver crashes and fatalities. The GDL components of extended learner’s permit holding periods, nighttime restrictions, and passenger restrictions—have been found to be particularly effective in reducing accidents.⁵ While mortality rates for motor vehicle accidents among male adolescents have decreased significantly in the past decade, female high school students are still more likely than same-age males to wear seatbelts, and male students are more likely than their female peers to drink and drive.

Other unintentional injuries include poisoning, drowning, fires/burns, and falls. Alcohol and other substances are also cofactors in injuries associated with bicycles, skateboards, boating, and swimming.^1,3

Homicide is the second leading cause of death, accounting for 14.2% of all deaths among adolescents and young adults in 2004. The homicide rate is 1.0 per 100,000 population for early adolescents, 9.3 for older adolescents, and 14.8 for young adults. Homicide is the leading cause of death for adolescent and young adult black males, accounting for 44.5% of all deaths among black, non-Hispanic males.^1-3

Suicide is the third leading cause of death, accounting for 12.3% of adolescent and young adult deaths. In 2003, the rate of suicide was 7 times greater in late adolescence (7.3 per 100,000) than in early adolescence (1.2 per 100,000), and increased 10-fold between early adolescence and young adulthood (12.1 per 100,000 population). Adolescent and young adult males have a consistently higher suicide rate than their female peers, averaging more than 5 times the rate of same-age females; and American Indian/Alaskan Native, non-Hispanics have the highest suicide rate.^1-3

The most frequent nonviolent causes of mortality among adolescents and young adults ages 10 to 24 are malignant neoplasms (5.9%) and heart disease (3.2%).^1-8

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