American Kids' Health Has Been Declining, Study Finds

 

• Child health in the U.S. has been declining in multiple domains in recent years.
• From 2007 to 2022, infants were 1.78 times more likely to die in the U.S. than in other high-income countries, and 1- to 19-year-olds were 1.80 times more likely to die.
• From 2011 to 2023, the prevalence of 3- to 17-year-olds in the U.S. with a chronic condition rose from 39.9% to 45.7%, according to electronic health records from 10 pediatric health systems.

Child health in the U.S. has been declining in multiple domains in recent years, researchers found.

From 2007 to 2022, infants were 1.78 (95% CI 1.78-1.79) times more likely to die in the U.S. than in other high-income countries, and 1- to 19-year-olds were 1.80 (95% CI 1.80-1.80) times more likely to die, reported Christopher Forrest, MD, PhD, of Children's Hospital of Philadelphia, and colleagues.

The two causes of death with the largest net difference between the U.S. and peer nations were prematurity (rate ratio [RR] 2.22, 95% CI 2.20-2.24) and sudden unexpected death (RR 2.39, 95% CI 2.35-2.43) for infants, and firearm-related incidents (RR 15.34, 95% CI 14.89-15.80) and motor vehicle crashes (RR 2.45, 95% CI 2.42-2.48) for 1- to 19-year-olds, they noted in JAMAopens in a new tab or window.

From 2011 to 2023, the prevalence of 3- to 17-year-olds in the U.S. with a chronic condition rose from 39.9% to 45.7% (RR 1.15, 95% CI 1.14-1.15), according to electronic health records from 10 U.S. health systems, and from 25.8% to 31% (RR 1.20, 95% CI 1.20-1.20), according to parent-reported data for the general population.

Rates of obesity, early onset of menstruation, trouble sleeping, limitations in activity, physical symptoms, depressive symptoms, and loneliness increased in U.S. youth as well.

"Research that addresses health domains (e.g., emotional health) one by one rather than all together leaves a gap in knowledge," Forrest and colleagues wrote.

"Focusing on one domain at a time may result in policy responses in which single programs target single outcomes," they continued. "However, if children's health is declining across multiple health indicators as derived from diverse data sources, a more effective response may be to address underlying systemic factors that are influencing the health of children more broadly, i.e., improving the developmental ecosystems where children live and grow."

In an accompanying editorialopens in a new tab or window, Elizabeth Wolf, MD, MPH, of Virginia Commonwealth University (VCU) and Children's Hospital of Richmond at VCU, and colleagues wrote, "Evidence is mounting that the U.S. health disadvantage, a phenomenon that had been restricted to adults, has now spread to the pediatric population."

"Without decisive action to change the trajectory, the U.S. health disadvantage is likely to worsen," they added. "Policymakers who are invested in enhancing children's health must intervene. They could increase social media protections, invest in anti-poverty measures such as child tax credits and income transfers, broaden health insurance coverage, invest in primary care, and pass firearm safety laws."

MedPage Today previously reportedopens in a new tab or window that from 1999 to 2019, among kids 19 and under, the U.S. had 413,948 more deaths than expected based on the average among 16 comparable nations, according to to Steven Woolf, MD, MPH, and Derek Chapman, PhD, both of VCU (Woolf co-authored the editorial accompanying the current study).

Forrest and colleagues conducted repeated, cross-sectional analyses using mortality statistics from the U.S. and 18 comparator high-income countries from the Organisation for Economic Co-operation and Development, five nationally representative surveys, and the PEDSnet electronic health records database from 10 pediatric health systems.

Within PEDSnet data, from 2010 to 2023, conditions with the largest increases were major depression (RR 3.30), sleep apnea (RR 3.22), eating disorder (RR 3.20), anxiety (RR 3.06), autism spectrum disorder (RR 2.62), obesity (RR 2.37), disorders of lipid metabolism (RR 2.06), and developmental disorder (RR 2.05).

From 2007-2008 to 2021-2023, childhood obesity rates for 2- to 19-year-olds increased significantly from 17% to 20.9% (RR 1.23), and early onset of menstruation (before age 12) rose from 9.1% to 14.8% (RR 1.63).

Trouble sleeping for 16- to 17-year-olds rose from 7% in 2007-2008 to 12.6% in 2017-2020 (RR 1.80), and limitations in activity due to a chronic disease rose from 7.7% in 2008-2009 to 9.1% in 2018 (RR 1.21).

In 9th to 12th graders, depressive symptoms significantly increased from 26.1% in 2009 to 39.7% in 2023 (RR 1.51), and feelings of loneliness significantly increased from 20.2% in 2007 to 30.8% in 2021 (RR 1.52) among 12- to 18-year-olds.

Study limitations included that a stratified analysis by socioeconomic status or other social characteristics was not conducted, Forrest and colleagues noted. Also, mortality and survey data were nationally representative while PEDSnet included electronic health record data from 10 health systems in 10 U.S. states. Findings of PEDSnet data may have been due to changes in practice patterns, increases in diagnostic coding, or healthcare seeking.

Finally, the study "did not investigate the underlying causes for these extensive and consistent declines across multiple dimensions of children's health," Forrest and colleagues added, "leaving these explanations an open area for future inquiry."

Disclosures

The study was supported by institutional funds managed by the Applied Clinical Research Center at the Children's Hospital of Philadelphia.

Forrest reported being a co-developer of the Johns Hopkins Adjusted Clinical Groups System, which was used in the study. The copyright for this software is owned by the Johns Hopkins University, and Forrest receives royalties in accordance with the university's technology transfer policy.

The authors of the accompanying editorial did not report any relevant conflicts of interest.

Primary Source

JAMA

Source Reference: opens in a new tab or windowForrest CB, et al "Trends in US children's mortality, chronic conditions, obesity, functional status, and symptoms" JAMA 2025; DOI: 10.1001/jama.2025.9855.

Secondary Source

JAMA

Source Reference: opens in a new tab or windowWolf ER, et al "How we are failing US children" JAMA 2025; DOI: 10.1001/jama.2025.10639.

https://www.medpagetoday.com/pediatrics/generalpediatrics/116402