The association between disability and mortality among children and adolescents: A systematic review and meta-analysis
Maureen Moyo-Chilufya, Arthemon Nguweneza, Sara Rotenberg, Hannah Kuper, Tracey SmytheBackground
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 I 2 and τ 2 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; τ 2 = 0.88; I 2 = 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; τ 2 = 0.44; I 2 = 91%) and children 6–19 years (HR = 4.68: 95%CI [2.26,9.69]; p < 0.001; τ 2 = 0.93; I 2 = 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; τ 2 = 0.19; I 2 = 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.