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Mortality Risk of Youth With Neurodevelopmental Conditions: An Aotearoa New Zealand Nationwide Birth Cohort Study
Nicholas Bowden1,2,3, Philip J Schluter3,4, Umi Asaka5
1Department of Paediatrics and Child Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
Insights
Youth with neurodevelopmental conditions (NDCs) face significantly higher mortality risks, particularly females. Targeted interventions and systemic changes are crucial to address health inequities and improve care for this population.
Area of Science:
- Public Health
- Epidemiology
- Pediatrics
Background:
- Neurodevelopmental conditions (NDCs) affect approximately 15% of children globally and are associated with increased mortality.
- Existing research on NDC mortality risk primarily focuses on adults or specific conditions, leaving a gap in understanding youth mortality.
- Lifelong NDCs manifest in childhood, necessitating a focus on mortality risks during this developmental period.
Purpose of the Study:
- To assess all-cause and cause-specific mortality risks for youth aged 0 to 24 years.
- To compare mortality risks between youth with and without NDCs.
- To examine mortality risks within specific NDC groups and by sex.
Main Methods:
- A national 15-year birth cohort study in Aotearoa New Zealand (1995-2009) included 888,975 youth.
- Cox proportional hazard models were used to compare mortality risks, adjusting for sociodemographic factors.
- Statistical analysis was performed between August 17, 2024, and August 27, 2025.
Main Results:
- Youth with NDCs (4.5% of the cohort) had a significantly higher overall mortality risk (aHR, 4.67).
- Mortality risk was substantially higher for females with NDCs (aHR, 9.69) compared to females without NDCs.
- Increased mortality risk was observed across all specific NDCs, with notable risks for intellectual disability and specific learning/motor disorders. Medical-related deaths showed the highest cause-specific risk (aHR, 12.13).
Conclusions:
- Youth with NDCs experience significantly elevated mortality risks, with a pronounced disparity observed in females.
- Specific NDCs are associated with varying degrees of increased mortality, highlighting the need for tailored approaches.
- Findings emphasize the critical need for enhanced healthcare interventions, improved access to services, and systemic changes to mitigate health inequities for youth with NDCs.
Importance:
Neurodevelopmental conditions (NDCs) are common, lifelong conditions that typically manifest during childhood. Cumulatively, approximately 15% of children globally have an NDC. NDCs have been associated with increased mortality risk, although extant literature pertains mostly to adults or to specific NDCs.
Objective:
To assess the mortality risk for youth aged 0 to 24 years with and without NDCs, for specific NDC groups, and by sex.
Design, Setting, And Participants:
A national 15-year birth cohort study of 888 975 youth from 1995 to 2009 in Aotearoa New Zealand. Cox proportional hazard models compared mortality risk after adjusting for sociodemographic characteristics. Statistical analysis was conducted from August 17, 2024, to August 27, 2025.
Exposures:
Youth with NDCs.
Main Outcomes:
All-cause mortality was the primary outcome, with medical, injury, and suicide cause-specific mortality as secondary outcomes.
Results:
Of the 888 975 youths in the birth cohort, NDCs were identified in 40 071 (4.5%) (mean [SD] age at NDC diagnosis of 8.5 [4.6] years; 10 605 [26.5%] were female). Mortality risk was significantly higher for youth with NDCs compared with those without NDCs (adjusted hazard ratio [aHR], 4.67 [95% CI, 4.13-5.28]) and higher for female individuals with NDCs compared with female individuals without NDCs (aHR, 9.69 [95% CI, 7.93-11.84]). Mortality risk was higher for all specific NDCs, including specific learning and motor disorders (aHR, 8.50 [95% CI, 7.11-10.16]), intellectual disability (aHR, 8.27 [95% CI, 6.92-9.89]), communication and language disorders (aHR, 6.06 [95% CI, 4.14-8.86]), autism (aHR, 2.58 [95% CI, 1.94-3.42]), and attention-deficit/hyperactivity disorder (aHR, 2.06 [95% CI, 1.67-2.54]) compared with those without these respective conditions. Cause-specific mortality risk for those with any NDC was notably higher for medical-related deaths (aHR, 12.13 [95% CI, 10.31-14.28]) but also significantly higher for injury (aHR, 1.88 [95% CI, 1.42-2.48]) and suicide (aHR, 1.69 [95% CI, 1.21-2.37]) compared with those without NDCs.
Conclusions And Relevance:
This population-level birth cohort study revealed a significantly higher mortality risk among youth with NDCs, especially female individuals, and marked variation in mortality risk by NDC diagnosis. These findings underscore the urgent need for targeted health care interventions, improved access to medical and mental health services, and systemic changes to address the social and structural barriers that contribute to health inequities.
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