{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T08:11:39Z","timestamp":1772179899772,"version":"3.50.1"},"reference-count":42,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2020,1,8]],"date-time":"2020-01-08T00:00:00Z","timestamp":1578441600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000226","name":"Ontario Ministry of Health and Long-Term Care (MOHLTC).","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100000226","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000031","name":"Institute of Human Development, Child and Youth Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000031","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2019,12,15]]},"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Many youth deaths occur in the first year of life, from prematurity and anomalies. Detailing mortality after age 1\u2009year may differentially guide preventive strategies in children, adolescents and young adults.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A cohort study in Ontario, Canada comprised 3\u2009139\u2009698 children born from 1990 to 2016. Adjusted HR (aHR) for death between 1 and 24 years were generated, comparing demographic variables and parity.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>After a median of 13.7 years of follow-up, 6930 deaths occurred between ages 1 and 24 years (incidence rate 17.0 per 100\u2009000 person-years), peaking at age 23 years (43.7 per 100 000). The aHR for death was higher among males than females (1.44, 95%\u2009CI 1.37 to 1.51), rural versus urban areas (1.48, 95%\u2009CI 1.39 to 1.58), lowest versus highest income areas (1.39, 95%\u2009CI 1.29 to 1.51) and at parity 1 (1.16, 95%\u2009CI 1.10 to 1.23), parity 2 (1.34, 95%\u2009CI 1.23 to 1.45), parity 3+ (1.96, 95%\u2009CI 1.74 to 2.21), each relative to a child without an older sibling. Among males, the proportion of deaths due to injury jumped from 30% before age 15 years to 65% thereafter, and in females, from 28% to 51%. Intentional self-harm\/assault explained 11% of injury-related deaths among males before age 15 years, and 20% thereafter, with respective figures of 18% and 17% for females. Deaths outside of hospital increased with age, from 35% at age 1\u2009year, to 66% at age 22 years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>There is a heightened susceptibility of dying starting at age 15 years, especially among males, from injury, and arising outside of hospital.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2019-213365","type":"journal-article","created":{"date-parts":[[2020,1,8]],"date-time":"2020-01-08T17:16:17Z","timestamp":1578503777000},"page":"260-268","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Mortality in a cohort of 3.1 million children, adolescents and young adults"],"prefix":"10.1136","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1635-4658","authenticated-orcid":false,"given":"Joel G","family":"Ray","sequence":"first","affiliation":[{"name":"Medicine, and Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada"},{"name":"Psychiatry, University of Toronto, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Astrid","family":"Guttmann","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"},{"name":"Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Silveira","sequence":"additional","affiliation":[{"name":"Psychiatry, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alison L","family":"Park","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,1,8]]},"reference":[{"key":"2025100304222977000_74.3.260.1","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.chc.2018.05.010","article-title":"Bereavement After a Child\u2019s Death","volume":"27","author":"Jonas","year":"2018","journal-title":"Child Adolesc Psychiatr Clin N Am"},{"key":"2025100304222977000_74.3.260.2","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.jmhg.2006.04.002","article-title":"Patterns of mortality across 44 countries among men and women aged 15\u201344 years","volume":"3","author":"White","year":"2006","journal-title":"J Men's Health & Gender"},{"key":"2025100304222977000_74.3.260.3","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.110.085100"},{"key":"2025100304222977000_74.3.260.4","doi-asserted-by":"crossref","DOI":"10.1001\/jamapediatrics.2018.3317","article-title":"Infant and youth mortality trends by Race\/Ethnicity and cause of death in the United States","volume":"172","author":"Khan","year":"2018","journal-title":"JAMA Pediatr"},{"key":"2025100304222977000_74.3.260.5","doi-asserted-by":"crossref","first-page":"e97","DOI":"10.1016\/S2468-2667(18)30208-1","article-title":"Premature mortality from all causes and drug poisonings in the USA according to socioeconomic status and rurality: an analysis of death certificate data by County from 2000\u201315","volume":"4","author":"Shiels","year":"2019","journal-title":"Lancet Public Health"},{"key":"2025100304222977000_74.3.260.6","unstructured":"Special Advisory Committee on the Epidemic of Opioid Overdoses . 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