Adolescent & Young Adult (AYA) Health, including Cancer

Young Adult Mortality

This section provides recent analyses that are not available elsewhere.  Please acknowledge this source when citing information below

Adolescent and young adult (AYA) Americans have unique health challenges, including suicide, firearm access, substance access and abuse, and opioid and other drug overdose. Cancer in AYAs has also not had the attention, research, and progress that younger and older persons have had.

Impact of HIV/AIDS Epidemic on Cancer in AYAs

The impact of the HIV/AIDS epidemic on cancer incidence and survival in adolescent and young adults (AYAs, age 15-39) in the U.S. is obvious in the San Franciso/Oakland SMSA of the SEER 9 Registries.  The solid curves indicate all invasive cancer. The dotted curves eliminate Kaposi sarcoma and non-Burkitt non-Hodgkin lymphoma in males that were markedly increased during the HIV/AID epidemic) and thyroid cancer in both females and males (to eliminate the overdiagnosis effect on both incidence and survival), the HIV/AIDS effect can be minimized and a more indicative trend of progress demonstrated.

Ten publications in the peer-reviewed medical literature since 2006 that adjust the incidence and survival rates for the HIV/AIDS-related cancer are available by clicking here or the title.

Mortality Rates of Common Causes of Deaths in AYAs

These data are being submitted for publication; contact Archie Bleyer at if you would like more information
Death rates in American AYAs were declining, both in rates and number (lower panel) until 2013 when they have reversed course and have been increasing.  In 2015 more AYAs died in the U.S. than any prior year.  Why?
Since 2011, more AYAs in the U.S. have died of firearms than any other cause.  Since 2014,  rate of firearm deaths has accelerated and appears to be increasing more rapidly than any other cause with the exception of unintentional overdoses.

In the U.S., AYAs, cancer has declined from the #2 cause of death in 1969 to #4 in 2014, tied with homicides. After firearm deaths, accidents still kill far more AYAs than any other cause, and since 1992 has not improved.  Suicide in AYAs has increased from the 5th most common cause to the 2nd, and is the only common cause that has increased since 2000. HIV deaths, which reach epidemic levels in 1994, was the 2nd most common cause from 1992 to 1996.  Homicides in males also peaked during the HIV epidemic, during which it was the 2nd most common cause of death in AYA males. Heart disease, which was the 2nd most common cause of death due to disease for a few years, has been the 5th or 6th most common cause of death in AYAs since 1975.

In U.S. AYA females, cancer has been the #2 cause of death ever since 1969 to #4 in 2014, and is exceeded only by accidents. Accidents still kill twice as many AYA females as cancer and has been increasing as a cause of death since 1992.  Suicide in AYA females has increased from the 4th most common cause to the 2nd, and has been steadily increasing since 2000. Heart disease and homicides have become the 3rd and 4th most common causes of death.
In U.S. AYA males, cancer has been the 4th of 5th most common cause of death since 1969. Accidents still kill far fewer AYA males they used to but are still by far the most leading cause and have not significantly declined since 1996. Suicide in AYA males has increased from the 5th most common cause to the 2nd, and has been increasing since 2000. Homicide has decreased from the 2nd most common to the 3rd, but still results in twice as many deaths in AYA males as cancer. Heart disease has been the 4th most common cause of death in AYA males for most of the last 45 years.  HIV deaths, which reach epidemic levels in 1994, was the 2nd most common cause from 1991 to 1996.

Source: Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database, released December, 2016. Data are from the Multiple Cause of Death Files, 1999-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at on Jun 25, 2017 10:36:28 AM

The Prominence and Acceleration of Gun Deaths among AYA Americans

These data are being submitted for publication; contact Archie Bleyer at if you would like more information
•  Since 2007, bullets have killed more American AYAs 15 to 39 years of age than any other cause (Fig. 1).
•  The firearm death rate in AYAs has accelerated with statistically significant increases since early 2014 (Table 1, Figs. 2 & 3).
•  Firearm deaths have replaced motor vehicle accidents as the #1 cause of deaths in AYAs (Table 1, Figs. 1-3).
•  As of 2015, there were 56%-91% more firearm deaths than each of the next four most common causes of death in AYAs (Fig. 1).
•  The increase in firearm deaths is due to increases in both firearm-mediated suicides and homicides (Table 1, Figs. 2 & 3).
•  The increase in firearm deaths has been occurring in both males and females (Table 1, Figs. 2 & 3).
•  Since 2005-2007, the proportion of all deaths in AYAs due to firearm-mediated suicide has increased in both males and females (Fig. 4, A),
•  Since 2005-2007, proportionately more firearms have been used for suicide, especially in females (Fig. 4, B).
•  As of 2014-2015, the rate of firearm deaths was increasing at the same rate as opioid overdose deaths (Fig. 1), the latter receiving far more national attention.
•  The U.S. is undergoing more of an increase in gun deaths in AYAs relative to other causes of death in AYAs than any other high-income country.
•  The U.S. has 91% of the world’s children and adolescents who die from guns in high-income countries.2
•  Guns are the 3rd leading cause of death for all children between ages 1 and 17. 2

Why has the number of gun deaths accelerated in the U.S.?
•  It’s not the population increase for which the AYA population has increased only 12% since 19993 while the gun sales have increased >200% (Fig. 6).
•  In part, it’s the availability and access to guns (Figs. 7 & 8).
•  The U.S. has more guns per capita in citizen hands than any other country.
•  In 2015 the average monthly purchase in the U.S. was 2.2 million guns, more than 3x the average of 700,000 per month in 2007 (Fig. 5).

Adenocarcinoma of GI Tract in AYAs

The sites within the longitudinal axis of the GI tract from the esophagus to the anus that are least likely to develop adenocarcinoma in AYAs are the small intestine and the anus/anorectum/anal canal. Approximately 50 cases of each gastric adenocarcinoma and 10 of anal adenocarcinoma occur in AYAs on an average annual basis in the U.S..

To access the chart and related information, click the title of this section (above)