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Zadey S. The global economic burden of youth self-harm: A systematic analysis of 204 countries and territories for 2019. HPHR. 2023;71. https://doi.org/10.54111/0001/SSS1
Globally, young people (<24 years of age) contribute to about a quarter of the total disease burden of self-harm. However, national strategic plans have been found to have no specific recommendations for managing children and young people suffering from suicidality or preventing youth self-harm. Limited policy attention and allocation of funds can be partially attributed to limited evidence on the economic burden of self-harm. Beyond ethical and health arguments, a high economic burden could persuade policy action. Hence, understanding the global economic burden of youth self-harm including that in low- and middle-income countries (LMICs) is crucial.
We analyzed the economic burden of self-harm among people up to 24 years of age for 204 countries and territories included in the Global Burden of Disease (GBD) study. We extracted self-harm DALYs in the <20, 20-24 age groups for both sexes for 2019 using the GBD Results tool.4 The mean estimates for the gross domestic product (GDP) per capita in 2020 purchasing power parity (PPP) adjusted dollars and projected population for 2019 were taken from GHDx. We used the value-of-life-year (VLY) or full-income approach for economic burden as outlined in ‘Global Health 2035’. Different World Bank regions are considered to have had different levels of impact of mortality reduction on full income in the past decades. We chose the region-based factors at a 3% discount rate. Economic burden or VLYs lost to youth self-harm were calculated as the product of DALYs, GDP per capita (in $ PPP (2020)), and the factor. Uncertainty was propagated for VLYs lost using the 95% uncertainty interval (UI) of DALYs.
The global economic burden of youth self-harm in 2019 was $251,779,943,868 (95% UI: 208,845,558,648 – 303,222,010,830). Of the 204 countries, India had the largest economic burden of youth self-harm of $71,098,857,448 (60,118,492,219 – 83,332,732,126) while Bermuda had the smallest burden of $1440346 (1,074,392 – 1,913,681). Among the World Bank Income Groups, the LMIC group had the largest economic burden followed by high-income, upper-middle-income, and low-income countries. Among WHO regions, Southeast Asia had the largest economic burden.
To our knowledge, these are the first such comprehensive estimates. Self-harm in youth massively burdens economies around the world. This necessitates urgent policy attention from the finance, youth empowerment, and family welfare ministries beyond health ministries for planning and implementing effective suicide prevention strategies.
Globally, young people (<24 years of age) contribute to about a quarter of the total burden of self-harm as measured by disability-adjusted life-years (DALYs). Attending to self-harm and suicide deaths among young people should be prioritized. Several adaptations are needed in clinical practice including increased focus on therapeutic alliance, use of interventions based on digital technology, establishment of care networks, and delivery of culturally sensitive care among others.1 However, these changes can be made possible only if self-harm in youth is gets the deserved policy attention and necessary financing. Previously, policy documents and national plans have been found to have no specific recommendations for managing children and young people suffering from suicidality or preventing youth self-harm.2
Among several other contributors, lack of policy focus can be due to the limited evidence on cost-effective interventions. However, another perspective towards to counter the inaction can be to look at the economic losses due to self-harm disease burden. Previously, it has been shown that the economic burden of preventable deaths due to self-harm was over $5 billion in 2014 for ten countries with the highest human development index (HDI).3 In addition to the ethical and health arguments, such high economic burden warranties policy action. However, these ten countries contribute to only a small fraction of the global youth self-harm DALYs. Hence, it is crucial to understand the global economic burden of youth self-harm including that in low- and middle-income countries.
We analyzed the economic burden of self-harm among people upto 24 years of age for 204 countries and territories included in the Global Burden of Disease (GBD) study. We extracted self-harm DALYs in the <20, 20-24 age groups for both sexes for 2019 using the GBD Results tool.4 To maintain source data homogeneity, the mean estimates for gross domestic product (GDP) per capita in 2020 purchasing power parity (PPP) adjusted dollars and projected population for 2019 were taken from the GHDx.5,6 For estimating the economic burden, we used the value-of-life-year (VLY) or full-income approach as outlined in the Global Health 2035 report.7 Going beyond the traditional human capital approach where an individual’s economic productivity if tied to healthy years of adult life, VLY assumes an intrinsic value to all lives.8 Hence, it is more suitable to understand the economic burden of health losses among the youth, who may not be actively or immediately contributing a country’s economy. Under full-income approach, different World Bank regions are considered to have different levels of impact of mortality reduction on full income in the past decades. We chose the region-based factors at 3% discount rate as presented in Table 1. Economic burden or VLYs lost to youth self-harm were calculated as the product of DALYs, GDP per capita (in $ PPP (2020)), and the factor. We also present the economic burden as percentage of country’s GDP. Uncertainty was propagated for VLYs lost and %GDP using the 95% uncertainty interval (UI) of the DALY estimates. Since this was a secondary analysis of publicly available data, no IRB review was considered necessary.
Table 1: Country-wise disease and economic burden of youth (up to 24 years of age) self-harm in 2019.
Country | World Bank Income Group | WHO Region | World Bank Region | Population (2019) | Value of a Life-Year (as % GDP per capita) | Youth Self-harm DALYs (95% UI) | Value of Life-Years lost to Youth Self-harm in $ PPP (2020) (95% UI) | Value of Life-Years lost to Youth Self-harm as % GDP |
China (CHN) | Upper-Middle Income Country | Western Pacific Region | East Asia and Pacific | 1422350422 | 2.2 | 505468 (424148, 608625) | 17392802302 (14594662506, 20942384091) | 0.08 (0.07, 0.09) |
Democratic People’s Republic of Korea (PRK) | Low Income Country | South-East Asian Region | East Asia and Pacific | 26232861 | 2.2 | 22854 (15344, 32897) | 91313580 (61306011, 131441658) | 0.19 (0.13, 0.28) |
Taiwan (Province of China) (TWN) | High Income Country | Western Pacific Region | East Asia and Pacific | 23620243 | 2.2 | 14341 (10722, 19006) | 1680971686 (1256836620, 2227777710) | 0.13 (0.1, 0.18) |
Cambodia (KHM) | Lower-Middle Income Country | Western Pacific Region | East Asia and Pacific | 16603118 | 2.2 | 11746 (7727, 16456) | 117732967 (77452461, 164944562) | 0.16 (0.1, 0.22) |
Indonesia (IDN) | Lower-Middle Income Country | South-East Asian Region | East Asia and Pacific | 259465835 | 2.2 | 114690 (86424, 148802) | 3121905489 (2352500712, 4050467512) | 0.1 (0.07, 0.13) |
Lao People’s Democratic Republic (LAO) | Lower-Middle Income Country | Western Pacific Region | East Asia and Pacific | 7158250 | 2.2 | 8764 (5527, 12543) | 164929009 (104016610, 236054049) | 0.27 (0.17, 0.39) |
Malaysia (MYS) | Upper-Middle Income Country | Western Pacific Region | East Asia and Pacific | 31301402 | 2.2 | 16787 (10386, 29570) | 1052159056 (650997554, 1853401240) | 0.12 (0.07, 0.21) |
Maldives (MDV) | Upper-Middle Income Country | South-East Asian Region | South Asia | 498414 | 2.8 | 165 (108, 241) | 11287092 (7356714, 16451004) | 0.09 (0.06, 0.14) |
Myanmar (MMR) | Lower-Middle Income Country | South-East Asian Region | East Asia and Pacific | 54676901 | 2.2 | 32780 (20564, 47945) | 401071012 (251612927, 586622241) | 0.13 (0.08, 0.19) |
Philippines (PHL) | Lower-Middle Income Country | Western Pacific Region | East Asia and Pacific | 112142764 | 2.2 | 78585 (55534, 97105) | 1613455212 (1140178307, 1993700496) | 0.15 (0.11, 0.19) |
Sri Lanka (LKA) | Lower-Middle Income Country | South-East Asian Region | South Asia | 21854452 | 2.8 | 50471 (36222, 68468) | 1998193698 (1434048397, 2710688019) | 0.65 (0.46, 0.88) |
Thailand (THA) | Upper-Middle Income Country | South-East Asian Region | East Asia and Pacific | 70111586 | 2.2 | 54897 (36360, 80270) | 2369608733 (1569458228, 3464867785) | 0.17 (0.11, 0.25) |
Timor-Leste (TLS) | Lower-Middle Income Country | South-East Asian Region | East Asia and Pacific | 1334823 | 2.2 | 1537 (837, 2229) | 11921704 (6491062, 17294604) | 0.25 (0.14, 0.37) |
Viet Nam (VNM) | Lower-Middle Income Country | Western Pacific Region | East Asia and Pacific | 96372928 | 2.2 | 68978 (46508, 97559) | 1385524142 (934175975, 1959607569) | 0.16 (0.11, 0.22) |
Fiji (FJI) | Upper-Middle Income Country | Western Pacific Region | East Asia and Pacific | 911248 | 2.2 | 1803 (1266, 2485) | 51344671 (36047907, 70735380) | 0.44 (0.31, 0.6) |
Kiribati (KIR) | Lower-Middle Income Country | Western Pacific Region | East Asia and Pacific | 118621 | 2.2 | 723 (499, 986) | 3645622 (2515917, 4973714) | 1.34 (0.93, 1.83) |
Marshall Islands (MHL) | Upper-Middle Income Country | Western Pacific Region | East Asia and Pacific | 56842 | 2.2 | 247 (163, 340) | 2249319 (1479665, 3096897) | 0.96 (0.63, 1.32) |
Micronesia (Federated States of) (FSM) | Lower-Middle Income Country | Western Pacific Region | East Asia and Pacific | 102116 | 2.2 | 545 (352, 749) | 4367567 (2826392, 6003068) | 1.17 (0.76, 1.61) |
Papua New Guinea (PNG) | Lower-Middle Income Country | Western Pacific Region | East Asia and Pacific | 9866614 | 2.2 | 5351 (3046, 12238) | 51067700 (29068944, 116791045) | 0.12 (0.07, 0.27) |
Samoa (WSM) | Lower-Middle Income Country | Western Pacific Region | East Asia and Pacific | 211354 | 2.2 | 642 (406, 907) | 9022263 (5707344, 12753660) | 0.67 (0.42, 0.94) |
Solomon Islands (SLB) | Lower-Middle Income Country | Western Pacific Region | East Asia and Pacific | 655632 | 2.2 | 3329 (1656, 4907) | 19917798 (9908611, 29356053) | 1.12 (0.56, 1.65) |
Tonga (TON) | Upper-Middle Income Country | Western Pacific Region | East Asia and Pacific | 102350 | 2.2 | 112 (76, 166) | 1600663 (1077596, 2374003) | 0.24 (0.16, 0.36) |
Vanuatu (VUT) | Lower-Middle Income Country | Western Pacific Region | East Asia and Pacific | 294550 | 2.2 | 1235 (771, 1725) | 8547546 (5333485, 11939999) | 0.92 (0.58, 1.29) |
Armenia (ARM) | Upper-Middle Income Country | European Region | Europe and Central Asia | 3019674 | 1.9 | 1464 (1127, 1889) | 39841712 (30670277, 51400203) | 0.09 (0.07, 0.12) |
Azerbaijan (AZE) | Upper-Middle Income Country | European Region | Europe and Central Asia | 10278674 | 1.9 | 4051 (2647, 5946) | 121130700 (79163128, 177792058) | 0.07 (0.05, 0.11) |
Georgia (GEO) | Upper-Middle Income Country | European Region | Europe and Central Asia | 3664752 | 1.9 | 1741 (1259, 2353) | 52732312 (38119316, 71266457) | 0.09 (0.07, 0.12) |
Kazakhstan (KAZ) | Upper-Middle Income Country | European Region | Europe and Central Asia | 18392068 | 1.9 | 38259 (31926, 46705) | 2014113393 (1680723671, 2458696757) | 0.4 (0.33, 0.48) |
Kyrgyzstan (KGZ) | Lower-Middle Income Country | European Region | Europe and Central Asia | 6535459 | 1.9 | 8301 (6853, 9993) | 94906050 (78356614, 114252222) | 0.24 (0.2, 0.29) |
Mongolia (MNG) | Lower-Middle Income Country | Western Pacific Region | East Asia and Pacific | 3387589 | 2.2 | 8052 (5150, 11060) | 236049469 (150971855, 324251211) | 0.52 (0.33, 0.72) |
Tajikistan (TJK) | Lower-Middle Income Country | European Region | Europe and Central Asia | 9492414 | 1.9 | 7152 (5236, 9751) | 51712972 (37860728, 70510211) | 0.14 (0.1, 0.2) |
Turkmenistan (TKM) | Upper-Middle Income Country | European Region | Europe and Central Asia | 5083080 | 1.9 | 7895 (5965, 10155) | 299821956 (226531652, 385645829) | 0.3 (0.22, 0.38) |
Uzbekistan (UZB) | Lower-Middle Income Country | European Region | Europe and Central Asia | 33677096 | 1.9 | 78241 (61849, 96430) | 1296137997 (1024588075, 1597453750) | 0.44 (0.35, 0.54) |
Albania (ALB) | Upper-Middle Income Country | European Region | Europe and Central Asia | 2720353 | 1.9 | 2100 (1298, 3045) | 57456303 (35516377, 83288786) | 0.15 (0.09, 0.21) |
Bosnia and Herzegovina (BIH) | Upper-Middle Income Country | European Region | Europe and Central Asia | 3299982 | 1.9 | 2259 (1548, 3107) | 64661572 (44288581, 88922198) | 0.13 (0.09, 0.18) |
Bulgaria (BGR) | Upper-Middle Income Country | European Region | Europe and Central Asia | 6934625 | 1.9 | 3516 (2610, 4612) | 165532276 (122875988, 217120321) | 0.1 (0.07, 0.13) |
Croatia (HRV) | High Income Country | European Region | Europe and Central Asia | 4247902 | 1.9 | 2491 (1878, 3238) | 143484629 (108201847, 186535212) | 0.11 (0.08, 0.14) |
Czechia (CZE) | High Income Country | European Region | Europe and Central Asia | 10643487 | 1.9 | 5758 (4498, 7216) | 473496509 (369942073, 593419172) | 0.1 (0.08, 0.13) |
Hungary (HUN) | High Income Country | European Region | Europe and Central Asia | 9674413 | 1.9 | 5004 (3901, 6282) | 321864529 (250942832, 404094622) | 0.1 (0.08, 0.12) |
North Macedonia (MKD) | Upper-Middle Income Country | European Region | Europe and Central Asia | 2152731 | 1.9 | 933 (660, 1271) | 31284560 (22112258, 42608622) | 0.08 (0.06, 0.11) |
Montenegro (MNE) | Upper-Middle Income Country | European Region | Europe and Central Asia | 620340 | 1.9 | 524 (382, 727) | 23573159 (17186234, 32692360) | 0.16 (0.12, 0.22) |
Poland (POL) | High Income Country | European Region | Europe and Central Asia | 38434445 | 1.9 | 33185 (27418, 40256) | 2206112701 (1822705573, 2676195008) | 0.16 (0.14, 0.2) |
Romania (ROU) | High Income Country | European Region | Europe and Central Asia | 19237066 | 1.9 | 9472 (7417, 11896) | 556034871 (435417099, 698337718) | 0.09 (0.07, 0.12) |
Serbia (SRB) | Upper-Middle Income Country | European Region | Europe and Central Asia | 8746785 | 1.9 | 3789 (2707, 5321) | 137313976 (98082007, 192802861) | 0.08 (0.06, 0.12) |
Slovakia (SVK) | High Income Country | European Region | Europe and Central Asia | 5437223 | 1.9 | 2902 (2048, 3944) | 185957197 (131196692, 252698846) | 0.1 (0.07, 0.14) |
Slovenia (SVN) | High Income Country | European Region | Europe and Central Asia | 2074271 | 1.9 | 1344 (1025, 1779) | 105071306 (80194326, 139134610) | 0.12 (0.09, 0.16) |
Belarus (BLR) | Upper-Middle Income Country | European Region | Europe and Central Asia | 9500785 | 1.9 | 8762 (6353, 12109) | 349045611 (253075893, 482417863) | 0.18 (0.13, 0.24) |
Estonia (EST) | High Income Country | European Region | Europe and Central Asia | 1312361 | 1.9 | 894 (656, 1191) | 64113056 (47049979, 85435942) | 0.13 (0.09, 0.17) |
Latvia (LVA) | High Income Country | European Region | Europe and Central Asia | 1915292 | 1.9 | 1349 (1003, 1777) | 82617941 (61447976, 108833589) | 0.13 (0.1, 0.18) |
Lithuania (LTU) | High Income Country | European Region | Europe and Central Asia | 2794223 | 1.9 | 3692 (2939, 4576) | 265337864 (211197644, 328828925) | 0.25 (0.2, 0.31) |
Republic of Moldova (MDA) | Upper-Middle Income Country | European Region | Europe and Central Asia | 3688191 | 1.9 | 2520 (1978, 3133) | 53298880 (41822771, 66257680) | 0.13 (0.1, 0.16) |
Russian Federation (RUS) | Upper-Middle Income Country | European Region | Europe and Central Asia | 146717427 | 1.9 | 214848 (182582, 258161) | 11702529309 (9945033231, 14061750912) | 0.28 (0.24, 0.33) |
Ukraine (UKR) | Lower-Middle Income Country | European Region | Europe and Central Asia | 44042431 | 1.9 | 89079 (69895, 110782) | 2340546452 (1836505351, 2910791138) | 0.38 (0.3, 0.48) |
Brunei Darussalam (BRN) | High Income Country | Western Pacific Region | East Asia and Pacific | 437119 | 2.2 | 206 (150, 274) | 26505665 (19295017, 35237823) | 0.1 (0.08, 0.14) |
Japan (JPN) | High Income Country | Western Pacific Region | East Asia and Pacific | 127788411 | 2.2 | 102099 (98822, 106145) | 9922619389 (9604109651, 10315856731) | 0.18 (0.17, 0.18) |
Republic of Korea (KOR) | High Income Country | Western Pacific Region | East Asia and Pacific | 53398252 | 2.2 | 44002 (31580, 51095) | 4375459167 (3140224980, 5080810356) | 0.18 (0.13, 0.21) |
Singapore (SGP) | High Income Country | Western Pacific Region | East Asia and Pacific | 5667451 | 2.2 | 2442 (2135, 2772) | 494828997 (432630965, 561567332) | 0.09 (0.08, 0.11) |
Australia (AUS) | High Income Country | Western Pacific Region | East Asia and Pacific | 24568113 | 2.2 | 26371 (23305, 29733) | 3191158004 (2820144482, 3598074493) | 0.24 (0.21, 0.27) |
New Zealand (NZL) | High Income Country | Western Pacific Region | East Asia and Pacific | 4495667 | 2.2 | 7014 (6305, 7844) | 696770549 (626384084, 779277613) | 0.34 (0.31, 0.38) |
Andorra (AND) | High Income Country | European Region | Europe and Central Asia | 83064 | 1.9 | 28 (19, 39) | 2021016 (1394397, 2853961) | 0.06 (0.04, 0.09) |
Austria (AUT) | High Income Country | European Region | Europe and Central Asia | 8916185 | 1.9 | 6470 (5609, 7442) | 746884590 (647496628, 859089503) | 0.14 (0.12, 0.16) |
Belgium (BEL) | High Income Country | European Region | Europe and Central Asia | 11419166 | 1.9 | 8898 (7690, 10135) | 928366372 (802378777, 1057480495) | 0.15 (0.13, 0.17) |
Cyprus (CYP) | High Income Country | European Region | Europe and Central Asia | 1313477 | 1.9 | 461 (305, 618) | 33023414 (21829620, 44267506) | 0.07 (0.04, 0.09) |
Denmark (DNK) | High Income Country | European Region | Europe and Central Asia | 5802733 | 1.9 | 2301 (1887, 2761) | 266218841 (218358071, 319363375) | 0.08 (0.06, 0.09) |
Finland (FIN) | High Income Country | European Region | Europe and Central Asia | 5534095 | 1.9 | 5646 (4887, 6405) | 548126717 (474443469, 621784669) | 0.19 (0.17, 0.22) |
France (FRA) | High Income Country | European Region | Europe and Central Asia | 66204315 | 1.9 | 37223 (31218, 44061) | 3513301143 (2946562093, 4158789643) | 0.11 (0.09, 0.13) |
Germany (DEU) | High Income Country | European Region | Europe and Central Asia | 84914056 | 1.9 | 46129 (39821, 53095) | 5139813715 (4437003470, 5916082182) | 0.1 (0.09, 0.12) |
Greece (GRC) | High Income Country | European Region | Europe and Central Asia | 10337172 | 1.9 | 1964 (1544, 2479) | 118424768 (93094793, 149514616) | 0.04 (0.03, 0.05) |
Iceland (ISL) | High Income Country | European Region | Europe and Central Asia | 344876 | 1.9 | 207 (167, 249) | 23322716 (18890798, 28152658) | 0.11 (0.09, 0.14) |
Ireland (IRL) | High Income Country | European Region | Europe and Central Asia | 4910357 | 1.9 | 4091 (3474, 4782) | 729009212 (619097788, 852248892) | 0.16 (0.13, 0.19) |
Israel (ISR) | High Income Country | European Region | Middle East and North Africa | 9309583 | 1.4 | 4533 (3734, 5400) | 279717169 (230439743, 333241286) | 0.07 (0.06, 0.08) |
Italy (ITA) | High Income Country | European Region | Europe and Central Asia | 60313170 | 1.9 | 15030 (13968, 16184) | 1310941971 (1218387010, 1411591573) | 0.05 (0.04, 0.05) |
Luxembourg (LUX) | High Income Country | European Region | Europe and Central Asia | 618550 | 1.9 | 335 (265, 417) | 70550031 (55728613, 87721011) | 0.1 (0.08, 0.13) |
Malta (MLT) | High Income Country | European Region | Middle East and North Africa | 439221 | 1.4 | 130 (102, 165) | 8564879 (6681676, 10868439) | 0.04 (0.03, 0.05) |
Netherlands (NLD) | High Income Country | European Region | Europe and Central Asia | 17156788 | 1.9 | 8859 (7747, 10157) | 1014601032 (887224358, 1163210009) | 0.1 (0.09, 0.11) |
Norway (NOR) | High Income Country | European Region | Europe and Central Asia | 5348847 | 1.9 | 4420 (4085, 4744) | 593645498 (548762608, 637225126) | 0.16 (0.15, 0.17) |
Portugal (PRT) | High Income Country | European Region | Europe and Central Asia | 10651263 | 1.9 | 3443 (2801, 4276) | 234431973 (190698040, 291191737) | 0.06 (0.05, 0.08) |
Spain (ESP) | High Income Country | European Region | Europe and Central Asia | 46021218 | 1.9 | 11907 (9976, 14229) | 986786358 (826752733, 1179270364) | 0.05 (0.04, 0.06) |
Sweden (SWE) | High Income Country | European Region | Europe and Central Asia | 10222546 | 1.9 | 7712 (6877, 8566) | 821587692 (732658147, 912574988) | 0.14 (0.13, 0.16) |
Switzerland (CHE) | High Income Country | European Region | Europe and Central Asia | 8775204 | 1.9 | 5130 (4470, 5882) | 732713581 (638438745, 840150910) | 0.11 (0.1, 0.13) |
United Kingdom (GBR) | High Income Country | European Region | Europe and Central Asia | 67220447 | 1.9 | 34336 (32817, 36265) | 3226305774 (3083562975, 3407533018) | 0.1 (0.09, 0.1) |
Argentina (ARG) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 45115284 | 1.4 | 84496 (71233, 99844) | 2742789833 (2312266442, 3240982781) | 0.26 (0.22, 0.31) |
Chile (CHL) | High Income Country | Region of the Americas | Latin America and the Caribbean | 18198359 | 1.4 | 21283 (18018, 24893) | 772734919 (654203989, 903801599) | 0.16 (0.14, 0.19) |
Uruguay (URY) | High Income Country | Region of the Americas | Latin America and the Caribbean | 3436137 | 1.4 | 6068 (5055, 7193) | 191926559 (159901231, 227526792) | 0.25 (0.21, 0.29) |
Canada (CAN) | High Income Country | Region of the Americas | North America | 36519840 | 1.4 | 38187 (32932, 43595) | 2805284199 (2419243578, 3202548916) | 0.15 (0.13, 0.17) |
United States of America (USA) | High Income Country | Region of the Americas | North America | 327978730 | 1.4 | 381773 (362676, 400715) | 35583465309 (33803546397, 37348967272) | 0.16 (0.15, 0.17) |
Antigua and Barbuda (ATG) | High Income Country | Region of the Americas | Latin America and the Caribbean | 88489 | 1.4 | 26 (18, 37) | 816043 (558227, 1144735) | 0.04 (0.03, 0.06) |
Bahamas (BHS) | High Income Country | Region of the Americas | Latin America and the Caribbean | 376940 | 1.4 | 102 (73, 140) | 5509084 (3941873, 7567583) | 0.04 (0.03, 0.05) |
Barbados (BRB) | High Income Country | Region of the Americas | Latin America and the Caribbean | 297771 | 1.4 | 81 (58, 110) | 1678188 (1205805, 2278909) | 0.04 (0.03, 0.05) |
Belize (BLZ) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 410094 | 1.4 | 347 (263, 455) | 3666305 (2783095, 4802867) | 0.12 (0.09, 0.16) |
Cuba (CUB) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 11358510 | 1.4 | 5788 (4377, 7487) | 80662111 (60998569, 104341353) | 0.07 (0.05, 0.09) |
Dominica (DMA) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 68681 | 1.4 | 33 (21, 48) | 584863 (382003, 854980) | 0.07 (0.04, 0.1) |
Dominican Republic (DOM) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 10881855 | 1.4 | 7291 (4586, 10846) | 198351383 (124778902, 295093153) | 0.09 (0.06, 0.14) |
Grenada (GRD) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 103215 | 1.4 | 42 (31, 56) | 1082980 (800869, 1425795) | 0.06 (0.04, 0.08) |
Guyana (GUY) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 770705 | 1.4 | 3305 (2334, 4491) | 67473884 (47650994, 91684468) | 0.6 (0.42, 0.82) |
Haiti (HTI) | Lower-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 12402099 | 1.4 | 16629 (10432, 24796) | 51364162 (32223411, 76591406) | 0.19 (0.12, 0.28) |
Jamaica (JAM) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 2810754 | 1.4 | 849 (610, 1165) | 12078586 (8668349, 16560900) | 0.04 (0.03, 0.06) |
Saint Lucia (LCA) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 174626 | 1.4 | 91 (66, 124) | 1923274 (1391910, 2629099) | 0.07 (0.05, 0.1) |
Saint Vincent and the Grenadines (VCT) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 113144 | 1.4 | 55 (41, 73) | 991520 (729526, 1319768) | 0.07 (0.05, 0.09) |
Suriname (SUR) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 575888 | 1.4 | 1443 (1080, 1882) | 35198940 (26361095, 45907070) | 0.35 (0.26, 0.46) |
Trinidad and Tobago (TTO) | High Income Country | Region of the Americas | Latin America and the Caribbean | 1387457 | 1.4 | 1462 (1019, 2049) | 64562387 (45016577, 90506543) | 0.15 (0.1, 0.21) |
Bolivia (Plurinational State of) (BOL) | Lower-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 12011750 | 1.4 | 13244 (8478, 19125) | 166816433 (106784060, 240889857) | 0.15 (0.1, 0.22) |
Ecuador (ECU) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 17588392 | 1.4 | 40788 (26028, 54381) | 693043883 (442247298, 924007864) | 0.32 (0.21, 0.43) |
Peru (PER) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 33995397 | 1.4 | 17520 (11597, 25458) | 333657762 (220845988, 484820832) | 0.07 (0.05, 0.1) |
Colombia (COL) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 47776679 | 1.4 | 52039 (37061, 70928) | 1139751120 (811702495, 1553462086) | 0.15 (0.11, 0.21) |
Costa Rica (CRI) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 4716744 | 1.4 | 5135 (3742, 6769) | 148484219 (108211362, 195736395) | 0.15 (0.11, 0.2) |
El Salvador (SLV) | Lower-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 6256143 | 1.4 | 9393 (6180, 13346) | 126616597 (83305296, 179901584) | 0.21 (0.14, 0.3) |
Guatemala (GTM) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 17776490 | 1.4 | 23953 (17470, 31694) | 295362397 (215414326, 390813527) | 0.19 (0.14, 0.25) |
Honduras (HND) | Lower-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 9814396 | 1.4 | 3100 (1569, 6082) | 27298081 (13821045, 53563254) | 0.04 (0.02, 0.09) |
Mexico (MEX) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 124940175 | 1.4 | 147938 (126638, 171822) | 4282423082 (3665837483, 4973794138) | 0.17 (0.14, 0.19) |
Nicaragua (NIC) | Lower-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 6510365 | 1.4 | 9230 (6489, 12656) | 74637371 (52473049, 102338397) | 0.2 (0.14, 0.27) |
Panama (PAN) | High Income Country | Region of the Americas | Latin America and the Caribbean | 4160457 | 1.4 | 3265 (2286, 4500) | 153857244 (107710576, 212052177) | 0.11 (0.08, 0.15) |
Venezuela (Bolivarian Republic of) (VEN) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 28068986 | 1.4 | 36375 (25142, 50435) | 340780788 (235545069, 472493763) | 0.18 (0.13, 0.25) |
Brazil (BRA) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 216664814 | 1.4 | 150539 (138184, 166479) | 3257289504 (2989959471, 3602187616) | 0.1 (0.09, 0.11) |
Paraguay (PRY) | Upper-Middle Income Country | Region of the Americas | Latin America and the Caribbean | 6930455 | 1.4 | 9662 (5994, 13495) | 154761271 (96005978, 216165942) | 0.2 (0.12, 0.27) |
Algeria (DZA) | Lower-Middle Income Country | African Region | Middle East and North Africa | 41847290 | 1.4 | 22829 (15096, 34170) | 369877147 (244586300, 553619395) | 0.08 (0.05, 0.11) |
Bahrain (BHR) | High Income Country | Eastern Mediterranean Region | Middle East and North Africa | 1442691 | 1.4 | 616 (439, 839) | 38128716 (27158058, 51877693) | 0.06 (0.04, 0.08) |
Egypt (EGY) | Lower-Middle Income Country | Eastern Mediterranean Region | Middle East and North Africa | 99069551 | 1.4 | 44603 (26376, 72041) | 765219438 (452500239, 1235940450) | 0.06 (0.04, 0.1) |
Iran (Islamic Republic of) (IRN) | Lower-Middle Income Country | Eastern Mediterranean Region | Middle East and North Africa | 84297882 | 1.4 | 60470 (48354, 69384) | 1070982226 (856389330, 1228847146) | 0.1 (0.08, 0.12) |
Iraq (IRQ) | Upper-Middle Income Country | Eastern Mediterranean Region | Middle East and North Africa | 42119490 | 1.4 | 33799 (21889, 50591) | 534019568 (345843409, 799314746) | 0.11 (0.07, 0.17) |
Jordan (JOR) | Upper-Middle Income Country | Eastern Mediterranean Region | Middle East and North Africa | 11636717 | 1.4 | 3581 (2602, 5018) | 58535034 (42526902, 82018978) | 0.04 (0.03, 0.06) |
Kuwait (KWT) | High Income Country | Eastern Mediterranean Region | Middle East and North Africa | 4426561 | 1.4 | 1093 (789, 1472) | 70537498 (50901421, 94988531) | 0.03 (0.02, 0.05) |
Lebanon (LBN) | Lower-Middle Income Country | Eastern Mediterranean Region | Middle East and North Africa | 5177069 | 1.4 | 2455 (1456, 3881) | 56635782 (33594930, 89538729) | 0.07 (0.04, 0.1) |
Libya (LBY) | Upper-Middle Income Country | Eastern Mediterranean Region | Middle East and North Africa | 6735543 | 1.4 | 4352 (2882, 6342) | 121922471 (80745945, 177645935) | 0.09 (0.06, 0.13) |
Morocco (MAR) | Lower-Middle Income Country | Eastern Mediterranean Region | Middle East and North Africa | 35952186 | 1.4 | 29911 (18923, 46416) | 354345647 (224173894, 549867531) | 0.12 (0.07, 0.18) |
Palestine (PSE) | Lower-Middle Income Country | European Region | Middle East and North Africa | 4956597 | 1.4 | 2319 (1318, 3214) | 22194362 (12608752, 30751280) | 0.07 (0.04, 0.09) |
Oman (OMN) | High Income Country | Eastern Mediterranean Region | Middle East and North Africa | 4583999 | 1.4 | 1820 (1211, 2762) | 72365155 (48156665, 109844591) | 0.06 (0.04, 0.08) |
Qatar (QAT) | High Income Country | Eastern Mediterranean Region | Middle East and North Africa | 2864548 | 1.4 | 1334 (843, 2051) | 176061814 (111222649, 270726130) | 0.07 (0.04, 0.1) |
Saudi Arabia (SAU) | High Income Country | Eastern Mediterranean Region | Middle East and North Africa | 35731972 | 1.4 | 13958 (9051, 20915) | 875649879 (567782616, 1312052508) | 0.05 (0.04, 0.08) |
Syrian Arab Republic (SYR) | Low Income Country | Eastern Mediterranean Region | Middle East and North Africa | 14491247 | 1.4 | 5281 (3494, 7725) | 158584259 (104928437, 231990288) | 0.05 (0.03, 0.07) |
Tunisia (TUN) | Lower-Middle Income Country | Eastern Mediterranean Region | Middle East and North Africa | 11571604 | 1.4 | 4326 (2647, 6672) | 69539274 (42538518, 107244604) | 0.05 (0.03, 0.08) |
Turkey (TUR) | Upper-Middle Income Country | European Region | Europe and Central Asia | 81359693 | 1.9 | 33658 (24594, 45402) | 1841228492 (1345384134, 2483696368) | 0.08 (0.06, 0.11) |
United Arab Emirates (ARE) | High Income Country | Eastern Mediterranean Region | Middle East and North Africa | 9241704 | 1.4 | 1801 (1139, 2797) | 164022252 (103700569, 254659101) | 0.03 (0.02, 0.04) |
Yemen (YEM) | Low Income Country | Eastern Mediterranean Region | Middle East and North Africa | 31502896 | 1.4 | 25882 (12498, 41730) | 80246201 (38747954, 129383175) | 0.12 (0.06, 0.19) |
Afghanistan (AFG) | Low Income Country | Eastern Mediterranean Region | South Asia | 38277536 | 2.8 | 28846 (18341, 44475) | 183061007 (116395064, 282249129) | 0.21 (0.13, 0.33) |
Bangladesh (BGD) | Lower-Middle Income Country | South-East Asian Region | South Asia | 159259850 | 2.8 | 140583 (98853, 197071) | 1978914137 (1391503714, 2774080615) | 0.25 (0.17, 0.35) |
Bhutan (BTN) | Lower-Middle Income Country | South-East Asian Region | South Asia | 754250 | 2.8 | 470 (266, 917) | 15808310 (8946424, 30809118) | 0.17 (0.1, 0.34) |
India (IND) | Lower-Middle Income Country | South-East Asian Region | South Asia | 1390706968 | 2.8 | 3562912 (3012663, 4175977) | 71098857448 (60118492219, 83332732126) | 0.72 (0.61, 0.84) |
Nepal (NPL) | Lower-Middle Income Country | South-East Asian Region | South Asia | 30416382 | 2.8 | 67291 (44787, 92936) | 679899510 (452520136, 939015132) | 0.62 (0.41, 0.86) |
Pakistan (PAK) | Lower-Middle Income Country | South-East Asian Region | South Asia | 224062847 | 2.8 | 446253 (261540, 699272) | 6883086031 (4034033371, 10785689978) | 0.56 (0.33, 0.87) |
Angola (AGO) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 30138521 | 4.2 | 23761 (14412, 35751) | 731787879 (443873486, 1101060924) | 0.33 (0.2, 0.5) |
Central African Republic (CAF) | Low Income Country | African Region | Sub-Saharan Africa | 5299863 | 4.2 | 7476 (4565, 12089) | 29891166 (18251672, 48335281) | 0.59 (0.36, 0.96) |
Congo (COG) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 5265846 | 4.2 | 3497 (2163, 5600) | 67071691 (41488934, 107401310) | 0.28 (0.17, 0.45) |
Democratic Republic of the Congo (COD) | Low Income Country | African Region | Sub-Saharan Africa | 87670444 | 4.2 | 69905 (44768, 108618) | 338597522 (216840982, 526111932) | 0.33 (0.21, 0.52) |
Equatorial Guinea (GNQ) | Upper-Middle Income Country | African Region | Sub-Saharan Africa | 1419839 | 4.2 | 1130 (580, 1989) | 98926521 (50762103, 174130481) | 0.33 (0.17, 0.59) |
Gabon (GAB) | Upper-Middle Income Country | African Region | Sub-Saharan Africa | 1750038 | 4.2 | 1447 (812, 2366) | 95059824 (53319254, 155451673) | 0.35 (0.19, 0.57) |
Burundi (BDI) | Low Income Country | African Region | Sub-Saharan Africa | 11934361 | 4.2 | 11654 (7730, 16765) | 43453920 (28821713, 62512596) | 0.41 (0.27, 0.59) |
Comoros (COM) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 714351 | 4.2 | 387 (166, 654) | 5055669 (2172381, 8542757) | 0.23 (0.1, 0.38) |
Djibouti (DJI) | Lower-Middle Income Country | Eastern Mediterranean Region | Middle East and North Africa | 1202797 | 1.4 | 731 (359, 1238) | 4411569 (2164977, 7467939) | 0.09 (0.04, 0.14) |
Eritrea (ERI) | Low Income Country | African Region | Sub-Saharan Africa | 6711213 | 4.2 | 7297 (3982, 12078) | 57066045 (31143164, 94451979) | 0.46 (0.25, 0.76) |
Ethiopia (ETH) | Low Income Country | African Region | Sub-Saharan Africa | 107591164 | 4.2 | 77563 (56636, 102167) | 795191006 (580641522, 1047437944) | 0.3 (0.22, 0.4) |
Kenya (KEN) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 50227709 | 4.2 | 34721 (26061, 48024) | 715823103 (537286739, 990065676) | 0.29 (0.22, 0.4) |
Madagascar (MDG) | Low Income Country | African Region | Sub-Saharan Africa | 26690344 | 4.2 | 20999 (14143, 30723) | 149229569 (100504601, 218335895) | 0.33 (0.22, 0.48) |
Malawi (MWI) | Low Income Country | African Region | Sub-Saharan Africa | 18442238 | 4.2 | 18089 (11161, 27258) | 80583379 (49719802, 121425927) | 0.41 (0.25, 0.62) |
Mauritius (MUS) | Upper-Middle Income Country | African Region | Sub-Saharan Africa | 1276663 | 4.2 | 1610 (1246, 2034) | 166359212 (128678781, 210115752) | 0.53 (0.41, 0.67) |
Mozambique (MOZ) | Low Income Country | African Region | Sub-Saharan Africa | 29528037 | 4.2 | 31796 (19484, 47177) | 176690900 (108271129, 262161971) | 0.45 (0.28, 0.67) |
Rwanda (RWA) | Low Income Country | African Region | Sub-Saharan Africa | 12688117 | 4.2 | 9943 (6102, 15036) | 98743798 (60593814, 149318995) | 0.33 (0.2, 0.5) |
Seychelles (SYC) | High Income Country | African Region | Sub-Saharan Africa | 102145 | 4.2 | 71 (49, 102) | 9923668 (6871028, 14293233) | 0.29 (0.2, 0.42) |
Somalia (SOM) | Low Income Country | Eastern Mediterranean Region | Sub-Saharan Africa | 20343112 | 4.2 | 21706 (11789, 36237) | 14660241 (7962350, 24474119) | 0.45 (0.24, 0.75) |
United Republic of Tanzania (TZA) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 56736116 | 4.2 | 40981 (26659, 61917) | 483292944 (314395427, 730192957) | 0.3 (0.2, 0.46) |
Uganda (UGA) | Low Income Country | African Region | Sub-Saharan Africa | 41117856 | 4.2 | 32979 (19386, 50736) | 296612500 (174355414, 456319975) | 0.34 (0.2, 0.52) |
Zambia (ZMB) | Low Income Country | African Region | Sub-Saharan Africa | 18237683 | 4.2 | 19019 (12516, 27735) | 297381156 (195707330, 433669383) | 0.44 (0.29, 0.64) |
Botswana (BWA) | Upper-Middle Income Country | African Region | Sub-Saharan Africa | 2338721 | 4.2 | 4260 (2475, 6639) | 327326149 (190198648, 510148474) | 0.77 (0.44, 1.19) |
Lesotho (LSO) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 2091588 | 4.2 | 7900 (4339, 12143) | 100612949 (55260523, 154655606) | 1.59 (0.87, 2.44) |
Namibia (NAM) | Upper-Middle Income Country | African Region | Sub-Saharan Africa | 2403124 | 4.2 | 3412 (1954, 5440) | 152357926 (87253273, 242928557) | 0.6 (0.34, 0.95) |
South Africa (ZAF) | Upper-Middle Income Country | African Region | Sub-Saharan Africa | 55588425 | 4.2 | 68438 (51473, 87062) | 3812829364 (2867663792, 4850434450) | 0.52 (0.39, 0.66) |
Eswatini (SWZ) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 1142109 | 4.2 | 3217 (1906, 4981) | 117057569 (69346287, 181238570) | 1.18 (0.7, 1.83) |
Zimbabwe (ZWE) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 15010852 | 4.2 | 33169 (20204, 50032) | 356468756 (217129222, 537689390) | 0.93 (0.57, 1.4) |
Benin (BEN) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 12665751 | 4.2 | 9569 (5590, 15289) | 122694917 (71672032, 196032636) | 0.32 (0.19, 0.51) |
Burkina Faso (BFA) | Low Income Country | African Region | Sub-Saharan Africa | 22691773 | 4.2 | 18098 (10157, 28637) | 164906681 (92548910, 260930831) | 0.33 (0.19, 0.53) |
Cameroon (CMR) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 29101868 | 4.2 | 26932 (15550, 41672) | 428902117 (247628823, 663636189) | 0.39 (0.22, 0.6) |
Cabo Verde (CPV) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 563563 | 4.2 | 552 (360, 810) | 18200222 (11863422, 26736635) | 0.41 (0.27, 0.6) |
Chad (TCD) | Low Income Country | African Region | Sub-Saharan Africa | 16398860 | 4.2 | 14359 (8601, 21812) | 101839056 (61001824, 154703780) | 0.37 (0.22, 0.56) |
CÔøΩÔøΩte d’Ivoire (CIV) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 26171532 | 4.2 | 21587 (12239, 34516) | 408594043 (231646640, 653310494) | 0.35 (0.2, 0.55) |
Gambia (GMB) | Low Income Country | African Region | Sub-Saharan Africa | 2245866 | 4.2 | 1637 (903, 2615) | 15765363 (8694962, 25185637) | 0.31 (0.17, 0.49) |
Ghana (GHA) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 31536232 | 4.2 | 22058 (13136, 33894) | 457533180 (272479527, 703043181) | 0.29 (0.17, 0.45) |
Guinea (GIN) | Low Income Country | African Region | Sub-Saharan Africa | 12643149 | 4.2 | 10767 (6507, 16582) | 111753744 (67542063, 172105692) | 0.36 (0.22, 0.55) |
Guinea-Bissau (GNB) | Low Income Country | African Region | Sub-Saharan Africa | 1901191 | 4.2 | 2046 (1264, 3115) | 20391996 (12592291, 31045592) | 0.45 (0.28, 0.69) |
Liberia (LBR) | Low Income Country | African Region | Sub-Saharan Africa | 4789907 | 4.2 | 3194 (1912, 4769) | 18157941 (10871914, 27114065) | 0.28 (0.17, 0.42) |
Mali (MLI) | Low Income Country | African Region | Sub-Saharan Africa | 21917467 | 4.2 | 14069 (7908, 22439) | 149724451 (84154805, 238796935) | 0.27 (0.15, 0.43) |
Mauritania (MRT) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 4014273 | 4.2 | 1648 (871, 2927) | 33075353 (17485362, 58736157) | 0.17 (0.09, 0.31) |
Niger (NER) | Low Income Country | African Region | Sub-Saharan Africa | 23295353 | 4.2 | 14931 (8402, 24188) | 71226169 (40079361, 115380576) | 0.27 (0.15, 0.44) |
Nigeria (NGA) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 214823786 | 4.2 | 89666 (58082, 136770) | 2012228858 (1303432395, 3069308914) | 0.18 (0.11, 0.27) |
Sao Tome and Principe (STP) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 205385 | 4.2 | 65 (36, 99) | 1152881 (643326, 1751400) | 0.13 (0.07, 0.2) |
Senegal (SEN) | Lower-Middle Income Country | African Region | Sub-Saharan Africa | 15134067 | 4.2 | 12453 (7357, 19177) | 178125208 (105237855, 274303184) | 0.35 (0.2, 0.53) |
Sierra Leone (SLE) | Low Income Country | African Region | Sub-Saharan Africa | 8284755 | 4.2 | 6378 (3692, 10089) | 51915854 (30050988, 82118304) | 0.32 (0.19, 0.51) |
Togo (TGO) | Low Income Country | African Region | Sub-Saharan Africa | 7921527 | 4.2 | 6326 (3811, 9558) | 45355200 (27324807, 68527143) | 0.34 (0.2, 0.51) |
American Samoa (ASM) | Upper-Middle Income Country | Western Pacific Region | East Asia and Pacific | 55505 | 2.2 | 95 (65, 135) | 2462689 (1688954, 3517205) | 0.38 (0.26, 0.54) |
Bermuda (BMU) | High Income Country | Region of the Americas | North America | 64030 | 1.4 | 12 (9, 15) | 1440346 (1074392, 1913681) | 0.03 (0.02, 0.03) |
Cook Islands (COK) | High Income Country | Western Pacific Region | East Asia and Pacific | 17987 | 2.2 | 30 (21, 43) | 1923330 (1321382, 2734527) | 0.37 (0.25, 0.53) |
Greenland (GRL) | High Income Country | European Region | Europe and Central Asia | 56188 | 1.9 | 323 (251, 409) | 66326749 (51565333, 84174739) | 1.09 (0.85, 1.38) |
Guam (GUM) | High Income Country | Western Pacific Region | East Asia and Pacific | 170628 | 2.2 | 594 (458, 734) | 48642266 (37568543, 60154533) | 0.77 (0.59, 0.95) |
Monaco (MCO) | High Income Country | European Region | Europe and Central Asia | 37572 | 1.9 | 20 (14, 28) | 6296243 (4449011, 8883685) | 0.1 (0.07, 0.14) |
Nauru (NRU) | High Income Country | Western Pacific Region | East Asia and Pacific | 10551 | 2.2 | 53 (32, 76) | 1284130 (786755, 1861053) | 1.1 (0.67, 1.59) |
Niue (NIU) | High Income Country | Western Pacific Region | East Asia and Pacific | 1672 | 2.2 | 4 (2, 6) | 100714 (65668, 149763) | 0.49 (0.32, 0.73) |
Northern Mariana Island (MNP) | High Income Country | Western Pacific Region | East Asia and Pacific | 42494 | 2.2 | 128 (95, 167) | 6651363 (4919528, 8690874) | 0.66 (0.49, 0.87) |
Palau (PLW) | Upper-Middle Income Country | Western Pacific Region | East Asia and Pacific | 18007 | 2.2 | 32 (22, 45) | 1219531 (827440, 1722096) | 0.39 (0.26, 0.55) |
Puerto Rico (PRI) | High Income Country | Region of the Americas | Latin America and the Caribbean | 3521431 | 1.4 | 1274 (881, 1756) | 67908231 (46923685, 93569239) | 0.05 (0.04, 0.07) |
Saint Kitts and Nevis (KNA) | High Income Country | Region of the Americas | Latin America and the Caribbean | 59508 | 1.4 | 15 (11, 21) | 592036 (409909, 824830) | 0.04 (0.02, 0.05) |
San Marino (SMR) | High Income Country | European Region | Europe and Central Asia | 33100 | 1.9 | 20 (12, 30) | 2363289 (1494788, 3636808) | 0.11 (0.07, 0.17) |
Tokelau (TKL) | High Income Country | Western Pacific Region | East Asia and Pacific | 1411 | 2.2 | 2 (2, 4) | 89218 (55924, 133541) | 0.38 (0.24, 0.58) |
Tuvalu (TUV) | Upper-Middle Income Country | Western Pacific Region | East Asia and Pacific | 11798 | 2.2 | 38 (24, 55) | 374814 (242113, 551313) | 0.7 (0.45, 1.03) |
United States Virgin Islands (VIR) | High Income Country | Region of the Americas | Latin America and the Caribbean | 103985 | 1.4 | 28 (17, 43) | 1530684 (947169, 2365938) | 0.04 (0.02, 0.06) |
South Sudan (SSD) | Low Income Country | African Region | Sub-Saharan Africa | 9282963 | 4.2 | 5636 (3359, 9398) | 20703760 (12341451, 34523883) | 0.25 (0.15, 0.43) |
Sudan (SDN) | Low Income Country | Eastern Mediterranean Region | Sub-Saharan Africa | 40808425 | 4.2 | 44320 (25293, 69442) | 823260978 (469835229, 1289923574) | 0.46 (0.26, 0.71) |
Footnotes: Values rounded to nearest whole number. UI = Uncertainty Interval
The global economic burden of youth self-harm in 2019 was $251,779,943,868 (95% UI: 208845558648 – 303,222,010,830). Figure 1 depicts economic burden of youth self-harm across countries. Of the 204 countries, India had the largest economic burden of youth self-harm of $71,098,857,448 (60,118,492,219 – 83,332,732,126). The values of economic burden relative to country GDP ranged from 1.5% in Lesotho to 0.03% in Bermuda. Among the World Bank Income Groups, lower-middle income countries had the largest economic burden followed by high-income, upper-middle income, and low-income countries. Among World Health Organization (WHO) regions, South-east Asia had the largest economic burden. Table 2 summarizes disease and economic burdens by WHO regions, World Bank regions, and World Bank Income Groups.
Figure 1: Economic burden of self-harm in people up to 24 years of age as assessed by value-of-life-years (VLYs).
Values are expressed in $ PPP (2020). The color ranges represent quantile breaks. Economic burden = DALY * GDP per capita * factor (defined for World Bank Region)
Table 2: Disease and economic burden of youth (up to 24 years of age) self-harm for different regions and groups.
Group | Youth Self-harm DALYs (95% UI) | Value of Life-Years lost to Youth Self-harm in $ PPP (2020) (95% UI) |
Global | ||
| 8455104 (6683109, 10636334) | 251779943868 (208845558648, 303222010830) |
World Bank Income Groups | ||
High Income Country | 947258 (846728, 1054881) | 87312434035 (78380509739, 96730251188) |
Low Income Country | 553049 (343746, 836089) | 4486307443 (2811229565, 6719976261) |
Lower-Middle Income Country | 5339114 (4189973, 6734085) | 102984835533 (81589821815, 128695049647) |
Upper-Middle Income Country | 1615683 (1302662, 2011279) | 56996366858 (46063997529, 71076733735) |
WHO Regions | ||
African Region | 839523 (539804, 1247642) | 14405518329 (9584430081, 20799342312) |
Eastern Mediterranean Region | 330888 (210373, 492027) | 5692189008 (3727269156, 8330054898) |
European Region | 787114 (649311, 955079) | 46566497393 (39246194762, 55474532718) |
Region of the Americas | 1092861 (932700, 1279003) | 53888395577 (48905871496, 59367437110) |
South-East Asian Region | 4494902 (3613966, 5547026) | 88661866745 (71688269916, 108840159792) |
Western Pacific Region | 909816 (736955, 1115558) | 42565476817 (35693523236, 50410484001) |
World Bank Regions | ||
East Asia and Pacific | 1136573 (896484, 1427702) | 48561297335 (39934892177, 58661177802) |
Europe and Central Asia | 780132 (644158, 946300) | 46256020981 (38996464590, 55099671712) |
Latin America and the Caribbean | 672889 (537083, 834678) | 15498205724 (12682007129, 18814007241) |
Middle East and North Africa | 265828 (175200, 384822) | 5351560340 (3627392984, 7661888476) |
North America | 419972 (395617, 444326) | 38390189853 (36223864368, 40553429869) |
South Asia | 4296991 (3472779, 5279357) | 82849107234 (67563296040, 100871715120) |
Sub-Saharan Africa | 882719 (561790, 1319151) | 14873562400 (9817641360, 21560120610) |
Footnotes: UI = Uncertainty Interval.
To our knowledge, these are the first such comprehensive estimates. Self-harm in youth massively burdens the economies around the world. This necessitates urgent policy attention from the finance, youth empowerment, human resource development, and family welfare ministries beyond health ministries. Multi-sectoral collaboration is essential for planning and implementing effective suicide prevention strategies.9 Policy changes and better financing lie at the foundation of real action to ensure no youth self-harm in the future.
I would like to thank Dr. Divya Shrinivas for help with data assimilation.
I represent the Association for Socially Applicable Research (ASAR) on the drafting committee of the Maharashtra State Mental Health Policy.
Siddhesh Zadey is a health systems, surgical care, and mental health researcher. He is a co-founding director of the non-profit think-and-do tank – Association for Socially Applicable Research (ASAR) based in India. He is also affiliated with Duke University where he leads the work on alcohol use behavioral phenotyping. He is a part of the Mental Health Innovation Network, Global Mental Health Action Network, and currently serves on the Drafting Committee for the State Mental Health Policy of Maharashtra, India. He completed his training from the Indian Institute of Science Education and Research (IISER) Pune and Duke Global Health Institute (US).
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