Global and Chinese Growth Failure Disease Burden Analysis and Projections for Adolescents and Children, 1990–2021

Zhifei WuDongkai QiuHaiyan WangJiajing Zheng^*

• Beilun District People's Hospital of Ningbo, Ningbo, China

Objective: 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. Design: 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. Participants: Children and adolescents aged 0–19 years, with emphasis on those under 5 years, were included in the analysis. Results: 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. Conclusions: 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.