The association between disability and mortality among children and adolescents: A systematic review and meta-analysis
- 1Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
- 2Department of Population Health, International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
- 3Missing Billion Initiative, Seattle, Washington, United States of America
Abstract
Background: Mortality is a fundamental marker of population health and equity. Despite major global declines in mortality over recent decades, disparities in survival persist across childhood and adolescence, particularly by disability status. We aimed to synthesise current evidence on all-cause mortality among children and adolescents with disabilities compared to their non-disabled peers through a systematic review and meta-analysis. Methods and findings: This review was prospectively registered with PROSPERO (CRD420251072039). We searched Embase, Global Health, MEDLINE, PubMed and PsycInfo to identify relevant studies published from January 1, 2000 to August 20, 2026. We included cohort studies that compared all-cause mortality rates for children and adolescents with and without disabilities (aged 0–19 years). We excluded studies without a clear definition of disability, disaggregated mortality data, or a control group. Two authors independently screened studies, with data extraction by one and verification by a second. We assessed risk of bias using a Joanna Briggs Institute critical appraisal tool. We conducted meta-analyses in RevMan for studies reporting age-sex-adjusted or multivariable-adjusted mortality ratios and R software to assess for publication bias. We reported heterogeneity using the I2 and τ2 statistics. We identified 12,664 records of which 29 studies met the inclusion criteria, representing over 35 million children/adolescents. Sixteen studies were eligible to be included in the meta-analysis. Overall, children with disabilities had a 5.31-fold (95% confidence interval (CI) [3.63,7.77]; p < 0.001; τ2 = 0.88; I2 = 98%) higher all-cause mortality than their peers. The association between disability and mortality was higher in both younger children 0–5 years (Hazard ratio (HR)=7.51: 95%CI [4.70,12.00]; p < 0.001; τ2 = 0.44; I2 = 91%) and children 6–19 years (HR = 4.68: 95%CI [2.26,9.69]; p < 0.001; τ2 = 0.93; I2 = 96%). The association varied by disability type and was most stark for children with neurological disabilities (HR = 11.71: 95%CI [7.90,17.35]; p < 0.001; τ2 = 0.19; I2 = 76%). Interpretation is limited by substantial between-study heterogeneity, differences in methods used to ascertain disability ascertainment and in the effect measures used, and the small number of studies from low-income and middle-income countries. Conclusions: Children with disabilities experience substantially higher mortality than their peers without disabilities. There is an urgent need for evidence on what works to close the mortality gap. Why was this study done?: What did researchers do and find?: What do these findings mean?: In this systematic review and meta-analysis, Maureen Moyo-Chilufya and colleagues synthesize evidence from more than 35 million children and adolescents to examine differences in all-cause mortality by disability status. The study finds that children and adolescents with disabilities experienced higher mortality rates than their non-disabled peers, with variations across age groups and disability types, while highlighting important evidence gaps, particularly in low- and middle-income countries.
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BibTeX
@article{moyochilufya2026association,
title = {{The association between disability and mortality among children and adolescents: A systematic review and meta-analysis}},
author = {Maureen Moyo-Chilufya and Arthemon Nguweneza and Sara Rotenberg and Hannah Kuper and Tracey Smythe},
journal = {PLOS Medicine},
year = {2026},
month = sep,
doi = {10.1371/journal.pmed.1004947},
url = {https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004947},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - The association between disability and mortality among children and adolescents: A systematic review and meta-analysis
AU - Maureen Moyo-Chilufya
AU - Arthemon Nguweneza
AU - Sara Rotenberg
AU - Hannah Kuper
AU - Tracey Smythe
PY - 2026
DA - 2026/09/30
JO - PLOS Medicine
DO - 10.1371/journal.pmed.1004947
UR - https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004947
AB - Background: Mortality is a fundamental marker of population health and equity. Despite major global declines in mortality over recent decades, disparities in survival persist across childhood and adolescence, particularly by disability status. We aimed to synthesise current evidence on all-cause mortality among children and adolescents with disabilities compared to their non-disabled peers through a systematic review and meta-analysis. Methods and findings: This review was prospectively registered with PROSPERO (CRD420251072039). We searched Embase, Global Health, MEDLINE, PubMed and PsycInfo to identify relevant studies published from January 1, 2000 to August 20, 2026. We included cohort studies that compared all-cause mortality rates for children and adolescents with and without disabilities (aged 0–19 years). We excluded studies without a clear definition of disability, disaggregated mortality data, or a control group. Two authors independently screened studies, with data extraction by one and verification by a second. We assessed risk of bias using a Joanna Briggs Institute critical appraisal tool. We conducted meta-analyses in RevMan for studies reporting age-sex-adjusted or multivariable-adjusted mortality ratios and R software to assess for publication bias. We reported heterogeneity using the I2 and τ2 statistics. We identified 12,664 records of which 29 studies met the inclusion criteria, representing over 35 million children/adolescents. Sixteen studies were eligible to be included in the meta-analysis. Overall, children with disabilities had a 5.31-fold (95% confidence interval (CI) [3.63,7.77]; p < 0.001; τ2 = 0.88; I2 = 98%) higher all-cause mortality than their peers. The association between disability and mortality was higher in both younger children 0–5 years (Hazard ratio (HR)=7.51: 95%CI [4.70,12.00]; p < 0.001; τ2 = 0.44; I2 = 91%) and children 6–19 years (HR = 4.68: 95%CI [2.26,9.69]; p < 0.001; τ2 = 0.93; I2 = 96%). The association varied by disability type and was most stark for children with neurological disabilities (HR = 11.71: 95%CI [7.90,17.35]; p < 0.001; τ2 = 0.19; I2 = 76%). Interpretation is limited by substantial between-study heterogeneity, differences in methods used to ascertain disability ascertainment and in the effect measures used, and the small number of studies from low-income and middle-income countries. Conclusions: Children with disabilities experience substantially higher mortality than their peers without disabilities. There is an urgent need for evidence on what works to close the mortality gap. Why was this study done?: What did researchers do and find?: What do these findings mean?: In this systematic review and meta-analysis, Maureen Moyo-Chilufya and colleagues synthesize evidence from more than 35 million children and adolescents to examine differences in all-cause mortality by disability status. The study finds that children and adolescents with disabilities experienced higher mortality rates than their non-disabled peers, with variations across age groups and disability types, while highlighting important evidence gaps, particularly in low- and middle-income countries.
SN - 1549-1676
ER -