# Global and Chinese growth failure disease burden analysis and projections for adolescents and children, 1990–2021

## TL;DR

This study analyzed the global and Chinese burden of growth failure in children and adolescents from 1990 to 2021, showing significant declines but persistent disparities in low-income regions.

## Contribution

The study provides a detailed analysis of growth failure trends and disparities in China and globally, emphasizing the need for targeted interventions in low-SDI regions.

## Key findings

- Global growth failure burden declined significantly from 1990 to 2021, with China showing even greater reductions.
- Children under 5 and males were disproportionately affected, with low-SDI regions bearing over 60% of the global burden.
- Despite progress, growth failure remains a critical public health issue in low-SDI regions like Western Sub-Saharan Africa and South Asia.

## Abstract

This study aimed to comprehensively analyze the global and Chinese burden of growth failure (GF) in children and adolescents from 1990 to 2021, focusing on mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs). The study also explored disparities across gender, age, socio-demographic index (SDI) regions, and geographic locations to inform targeted interventions.

A retrospective analysis was conducted using data from the Global Burden of Disease (GBD) 2021 database. Trends in deaths, DALYs, YLDs, YLLs, and their age-standardized rates (ASRs) were evaluated. Decomposition, health inequality, and prediction analyses were performed to assess contributing factors and future trends.

Children and adolescents aged 0–19 years, with emphasis on those under 5 years, were included in the analysis.

From 1990 to 2021, global deaths, DALYs, YLDs, and YLLs for GF declined by 78.17, 77.86, 49.71, and 78.20%, respectively. China exhibited even more pronounced declines (98.16, 98.15, 97.10, and 98.15%). The burden was concentrated in children under 5, with males disproportionately affected. Low-SDI regions, particularly Western Sub-Saharan Africa and South Asia, accounted for over 60% of the global burden, with ASRs up to 1,000 times higher than in high-SDI regions.

Despite substantial progress, GF remains a critical public health challenge, with pronounced disparities persisting in low-SDI regions. Urgently needed are targeted interventions—particularly for children under 5 in these settings—to address the inequitable burden. These conclusions should be interpreted in light of key limitations: the analysis relies on modeled GBD 2021 estimates that may be biased due to data sparsity and cause-redistribution assumptions in low-SDI contexts; furthermore, incidence/prevalence and intervention coverage were not assessed.