TY - JOUR
T1 - Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019
T2 - a comprehensive demographic analysis for the Global Burden of Disease Study 2019
AU - Wang, Haidong
AU - Abbas, Kaja M.
AU - Abbasifard, Mitra
AU - Abbasi-Kangevari, Mohsen
AU - Abbastabar, Hedayat
AU - Abd-Allah, Foad
AU - Abdelalim, Ahmed
AU - Abolhassani, Hassan
AU - Abreu, Lucas Guimarães
AU - Abrigo, Michael R.M.
AU - Abushouk, Abdelrahman I.
AU - Adabi, Maryam
AU - Adair, Tim
AU - Adebayo, Oladimeji M.
AU - Adedeji, Isaac Akinkunmi
AU - Adekanmbi, Victor
AU - Adeoye, Abiodun Moshood
AU - Adetokunboh, Olatunji O.
AU - Advani, Shailesh M.
AU - Afshin, Ashkan
AU - Aghaali, Mohammad
AU - Agrawal, Anurag
AU - Ahmadi, Keivan
AU - Ahmadieh, Hamid
AU - Ahmed, Muktar Beshir
AU - Al-Aly, Ziyad
AU - Alam, Khurshid
AU - Alam, Tahiya
AU - Alanezi, Fahad Mashhour
AU - Alanzi, Turki M.
AU - Alcalde-Rabanal, Jacqueline Elizabeth
AU - Ali, Muhammad
AU - Alicandro, Gianfranco
AU - Alijanzadeh, Mehran
AU - Alinia, Cyrus
AU - Alipour, Vahid
AU - Alizade, Hesam
AU - Aljunid, Syed Mohamed
AU - Allebeck, Peter
AU - Almadi, Majid Abdulrahman Hamad
AU - Almasi-Hashiani, Amir
AU - Al-Mekhlafi, Hesham M.
AU - Altirkawi, Khalid A.
AU - Alumran, Arwa Khalid
AU - Alvis-Guzman, Nelson
AU - Amini-Rarani, Mostafa
AU - Aminorroaya, Arya
AU - Amit, Arianna Maever L.
AU - Ancuceanu, Robert
AU - Andrei, Catalina Liliana
AU - Androudi, Sofia
AU - Angus, Colin
AU - Anjomshoa, Mina
AU - Ansari, Fereshteh
AU - Ansari, Iman
AU - Ansari-Moghaddam, Alireza
AU - Antonio, Carl Abelardo T.
AU - Antony, Catherine M.
AU - Anvari, Davood
AU - Appiah, Seth Christopher Yaw
AU - Arabloo, Jalal
AU - Arab-Zozani, Morteza
AU - Aravkin, Aleksandr Y.
AU - Aremu, Olatunde
AU - Ärnlöv, Johan
AU - Aryal, Krishna K.
AU - Asadi-Pooya, Ali A.
AU - Asgari, Samaneh
AU - Asghari Jafarabadi, Mohammad
AU - Atteraya, Madhu Sudhan
AU - Ausloos, Marcel
AU - Avila-Burgos, Leticia
AU - Avokpaho, Euripide Frinel Gbenato Arthur
AU - Ayala Quintanilla, Beatriz Paulina
AU - Ayano, Getinet
AU - Ayanore, Martin Amogre
AU - Azarian, Ghasem
AU - Babaee, Ebrahim
AU - Badiye, Ashish D.
AU - Bagli, Eleni
AU - Bahrami, Mohammad Amin
AU - Bakhtiari, Ahad
AU - Balassyano, Shelly
AU - Banach, Maciej
AU - Banik, Palash Chandra
AU - Barker-Collo, Suzanne Lyn
AU - Bärnighausen, Till Winfried
AU - Barzegar, Akbar
AU - Basu, Sanjay
AU - Baune, Bernhard T.
AU - Bayati, Mohsen
AU - Bazmandegan, Gholamreza
AU - Bedi, Neeraj
AU - Bell, Michellr L.
AU - Bennett, Derrick A.
AU - Bensenor, Isabela M.
AU - Berhe, Kidanemaryam
AU - Berman, Adam E.
AU - Bertolacci, Gregory J.
AU - Bhageerathy, Reshmi
AU - Bhala, Neeraj
AU - Bhattacharyya, Krittika
AU - Bhutta, Zulfiqar A.
AU - Bijani, Ali
AU - Biondi, Antonio
AU - Bisanzio, Donal
AU - Bisignano, Catherine
AU - Biswas, Raaj Kishore
AU - Bjørge, Tone
AU - Bohlouli, Somayeh
AU - Bohluli, Mehdi
AU - Bolla, Srinivasa Rao Rao
AU - Borzì, Antonio Maria
AU - Borzouei, Shiva
AU - Brady, Oliver J.
AU - Braithwaite, Dejana
AU - Brauer, Michael
AU - Briko, Andrey Nikolaevich
AU - Briko, Nikolay Ivanovich
AU - Bumgarner, Blair R.
AU - Burugina Nagaraja, Sharath
AU - Butt, Zahid A.
AU - Caetano dos Santos, Florentino Luciano
AU - Cai, Tianji
AU - Callender, Charlton SKH
AU - Cámera, Luis LA Alberto
AU - Campos-Nonato, Ismael R.
AU - Cárdenas, Rosario
AU - Carreras, Giulia
AU - Carrero, Juan J.
AU - Carvalho, Felix
AU - Castaldelli-Maia, Joao Mauricio
AU - Castelpietra, Giulio
AU - Castro, Franz
AU - Catalá-López, Ferrán
AU - Cederroth, Christopher R.
AU - Cerin, Ester
AU - Chattu, Vijay Kumar
AU - Chin, Ken Lee
AU - Chu, Dinh Toi
AU - Ciobanu, Liliana G.
AU - Cirillo, Massimo
AU - Comfort, Haley
AU - Costa, Vera Marisa
AU - Cowden, Richard G.
AU - Cromwell, Elizabeth A.
AU - Croneberger, Andrew J.
AU - Cunningham, Matthew
AU - Dahlawi, Saad M.A.
AU - Damiani, Giovanni
AU - D'Amico, Emanuele
AU - Dandona, Lalit
AU - Dandona, Rakhi
AU - Dargan, Paul I.
AU - Darwesh, Aso Mohammad
AU - Daryani, Ahmad
AU - Das Gupta, Rajat
AU - das Neves, José
AU - Davletov, Kairat
AU - De Leo, Diego
AU - Denova-Gutiérrez, Edgar
AU - Deribe, Kebede
AU - Dervenis, Nikolaos
AU - Desai, Rupak
AU - Dhungana, Govinda Prasad
AU - Dias da Silva, Diana
AU - Diaz, Daniel
AU - Dippenaar, Ilse N.
AU - Djalalinia, Shirin
AU - Do, Hoa Thi
AU - Dokova, Klara
AU - Doku, David Teye
AU - Dorostkar, Fariba
AU - Doshi, Chirag P.
AU - Doshmangir, Leila
AU - Doyle, Kerrie E.
AU - Dubljanin, Eleonora
AU - Duraes, Andre Rodrigues
AU - Edvardsson, David
AU - Effiong, Andem
AU - El Sayed, Iman
AU - El Tantawi, Maha
AU - Elbarazi, Iffat
AU - El-Jaafary, Shaimaa I.
AU - Emamian, Mohammad Hassan
AU - Eskandarieh, Sharareh
AU - Esmaeilzadeh, Firooz
AU - Estep, Kara
AU - Farahmand, Mohammad
AU - Faraj, Anwar
AU - Fareed, Mohammad
AU - Faridnia, Roghiyeh
AU - Faro, Andre
AU - Farzadfar, Farshad
AU - Fattahi, Nazir
AU - Fazaeli, Ali Akbar
AU - Fazlzadeh, Mehdi
AU - Feigin, Valery L.
AU - Fereshtehnejad, Seyed Mohammad
AU - Fernandes, Eduarda
AU - Ferreira, Manuela L.
AU - Filip, Irina
AU - Fischer, Florian
AU - Flohr, Carsten
AU - Foigt, Nataliya A.
AU - Folayan, Morenike Oluwatoyin
AU - Fomenkov, Artem Alekseevich
AU - Freitas, Marisa
AU - Fukumoto, Takeshi
AU - Fuller, John E.
AU - Furtado, João M.
AU - Gad, Mohamed M.
AU - Gakidou, Emmanuela
AU - Gallus, Silvano
AU - Gebrehiwot, Abiyu Mekonnen
AU - Gebremedhin, Ketema Bizuwork
AU - Gething, Peter W.
AU - Ghamari, Farhad
AU - Ghashghaee, Ahmad
AU - Gholamian, Asadollah
AU - Gilani, Syed Amir
AU - Gitimoghaddam, Mojgan
AU - Glushkova, Ekaterina Vladimirovna
AU - Gnedovskaya, Elena V.
AU - Gopalani, Sameer Vali
AU - Goulart, Alessandra C.
AU - Gugnani, Harish Chander
AU - Guo, Yuming
AU - Gupta, Rajeev
AU - Gupta, Subodh Sharan
AU - Haagsma, Juanita A.
AU - Haj-Mirzaian, Arvin
AU - Haj-Mirzaian, Arya
AU - Halvaei, Iman
AU - Hamadeh, Randah R.
AU - Hamagharib Abdullah, Kanaan
AU - Han, Chieh
AU - Handiso, Demelash Woldeyohannes
AU - Hankey, Graeme J.
AU - Haririan, Hamidreza
AU - Haro, Josep Maria
AU - Hasaballah, Ahmed I.
AU - Hassanipour, Soheil
AU - Hassankhani, Hadi
AU - Hay, Simon I.
AU - Heibati, Behzad
AU - Heidari-Soureshjani, Reza
AU - Li, Shanshan
AU - Thrift, Amanda G.
AU - Zaman, Sojib
AU - Lee, Shaun Wen Huey
AU - GBD 2019 Demographics Collaborators
PY - 2020/10/17
Y1 - 2020/10/17
N2 - Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation.
AB - Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. Funding: Bill & Melinda Gates Foundation.
UR - http://www.scopus.com/inward/record.url?scp=85092447915&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(20)30977-6
DO - 10.1016/S0140-6736(20)30977-6
M3 - Article
C2 - 33069325
AN - SCOPUS:85092447915
SN - 0140-6736
VL - 396
SP - 1160
EP - 1203
JO - The Lancet
JF - The Lancet
IS - 10258
ER -