Adolescent and young adult mortality in Bangladesh: findings from household surveys.

BACKGROUND

In 2021, over 1.5 million adolescents (aged 10-19 years) and young adults (aged 20-24 years) died globally, approximately 4500 deaths daily. However, research on causes and factors influencing deaths among adolescents and young adults in Bangladesh is limited. We aimed to address this gap by identifying the leading causes of mortality and the factors affecting adolescent and young adult deaths.

METHODS

We conducted two cross-sectional, population-based surveys in urban Dhaka (December 2022) and rural Sitakunda (May 2023), covering 53 680 households and 250 249 individuals, with 72 530 aged 10-24 years. Between 2018-22, 163 deaths in this age group were recorded. We conducted verbal autopsies using the World Health Organization tool and assigned causes of death using the InSilicoVA algorithm. With descriptive statistics, we reported cause-specific mortality and utilised Cox proportional hazards models to estimate associations with background characteristics.

RESULTS

Road traffic accidents were the primary cause of death, accounting for 10% (n = 17) among adolescents and 10% (n = 16) among young adults, followed by respiratory diseases (14% in adolescents and 3% in young adults). Older adolescents (adjusted hazard ratio (AHR) = 2.0; 95% confidence interval (CI) = 1.4-3.0) and young adults (AHR = 1.6; 95% CI = 1.1-1.4) had a higher risk of death compared to early adolescents. Individuals with high wealth status had a lower risk of death (AHR = 0.5; 95% CI = 0.3-0.8) compared to those with low wealth status. Adolescents and young adults with no education had a higher likelihood of dying compared to those with education (AHR = 5.6; 95% CI = 3.7-8.2).

CONCLUSIONS

To prevent untimely mortality among adolescents and young adults, efforts should prioritise leading causes such as road traffic accidents and respiratory diseases, and address vulnerabilities among rural residents, the uneducated, and those with low socioeconomic status. We recommend strengthening existing health programs for adolescents and young adults to reduce preventable deaths.