Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017

a systematic analysis for the Global Burden of Disease Study 2017

Shanshan Li, GBD 2017 Mortality Collaborators

Research output: Contribution to journalArticleResearchpeer-review

70 Citations (Scopus)

Abstract

Background: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. Funding: Bill & Melinda Gates Foundation.

Original languageEnglish
Pages (from-to)1684-1735
Number of pages52
JournalThe Lancet
Volume392
Issue number10159
DOIs
Publication statusPublished - 10 Nov 2018

Cite this

@article{7527026aafa24f9a8ecb90fe4286b20d,
title = "Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017",
abstract = "Background: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 18·7{\%} (95{\%} uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8{\%} (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. Funding: Bill & Melinda Gates Foundation.",
author = "Daniel Dicker and Grant Nguyen and Degu Abate and Abate, {Kalkidan Hassen} and Abay, {Solomon M.} and Cristiana Abbafati and Nooshin Abbasi and Hedayat Abbastabar and Foad Abd-Allah and Jemal Abdela and Ahmed Abdelalim and Omar Abdel-Rahman and Alireza Abdi and Ibrahim Abdollahpour and Abdulkader, {Rizwan Suliankatchi} and Abdurahman, {Ahmed Abdulahi} and Abebe, {Haftom Temesgen} and Molla Abebe and Zegeye Abebe and Abebo, {Teshome Abuka} and Victor Aboyans and Abraha, {Haftom Niguse} and Abrham, {Aklilu Roba} and Abu-Raddad, {Laith Jamal} and Abu-Rmeileh, {Niveen ME} and Accrombessi, {Manfred Mario Kokou} and Pawan Acharya and Adebayo, {Oladimeji M.} and Adedeji, {Isaac Akinkunmi} and Adedoyin, {Rufus Adesoji} and Victor Adekanmbi and Adetokunboh, {Olatunji O.} and Adhena, {Beyene Meressa} and Adhikari, {Tara Ballav} and Adib, {Mina G.} and Adou, {Ars{\`e}ne Kouablan} and Adsuar, {Jose C.} and Mohsen Afarideh and Ashkan Afshin and Gina Agarwal and Rakesh Aggarwal and Aghayan, {Sargis Aghasi} and Sutapa Agrawal and Anurag Agrawal and Mehdi Ahmadi and Alireza Ahmadi and Hamid Ahmadieh and Ahmed, {Mohamed Lemine Cheikh brahim} and Sayem Ahmed and Ahmed, {Muktar Beshir} and Aichour, {Amani Nidhal} and Ibtihel Aichour and Aichour, {Miloud Taki Eddine} and Akanda, {Ali S.} and Akbari, {Mohammad Esmaeil} and Mohammed Akibu and Akinyemi, {Rufus Olusola} and Tomi Akinyemiju and Nadia Akseer and Fares Alahdab and Ziyad Al-Aly and Khurshid Alam and Animut Alebel and Aleman, {Alicia V.} and Alene, {Kefyalew Addis} and Ayman Al-Eyadhy and Raghib Ali and Mehran Alijanzadeh and Reza Alizadeh-Navaei and Aljunid, {Syed Mohamed} and Ala'a Alkerwi and Fran{\cc}ois Alla and Peter Allebeck and Allen, {Christine A.} and Jordi Alonso and Al-Raddadi, {Rajaa M.} and Ubai Alsharif and Khalid Altirkawi and Nelson Alvis-Guzman and Amare, {Azmeraw T.} and Erfan Amini and Walid Ammar and Amoako, {Yaw Ampem} and Anber, {Nahla Hamed} and Andrei, {Catalina Liliana} and Sofia Androudi and Animut, {Megbaru Debalkie} and Mina Anjomshoa and Anlay, {Degefaye Zelalem} and Hossein Ansari and Ansariadi Ansariadi and Ansha, {Mustafa Geleto} and Antonio, {Carl Abelardo T.} and Appiah, {Seth Christopher Yaw} and Olatunde Aremu and Areri, {Habtamu Abera} and Johan {\"A}rnl{\"o}v and Megha Arora and Al Artaman and Aryal, {Krishna K.} and Mohsen Asadi-Lari and Hamid Asayesh and Asfaw, {Ephrem Tsegay} and Asgedom, {Solomon Weldegebreal} and Reza Assadi and Zerihun Ataro and Atey, {Tesfay Mehari Mehari} and Athari, {Seyyed Shamsadin} and Suleman Atique and Atre, {Sachin R.} and Atteraya, {Madhu Sudhan} and Attia, {Engi F.} and Marcel Ausloos and Leticia Avila-Burgos and Avokpaho, {Euripide F.G.A.} and Ashish Awasthi and Baffour Awuah and {Ayala Quintanilla}, {Beatriz Paulina} and Ayele, {Henok Tadesse} and Yohanes Ayele and Rakesh Ayer and Ayuk, {Tambe B.} and Azzopardi, {Peter S.} and Natasha Azzopardi-Muscat and Hamid Badali and Alaa Badawi and Kalpana Balakrishnan and Bali, {Ayele Geleto} and Maciej Banach and Amrit Banstola and Aleksandra Barac and Barboza, {Miguel A.} and Simon Barquera and Barrero, {Lope H.} and Huda Basaleem and Quique Bassat and Arindam Basu and Sanjay Basu and Baune, {Bernhard T.} and Shahrzad Bazargan-Hejazi and Neeraj Bedi and Ettore Beghi and Masoud Behzadifar and Meysam Behzadifar and Yannick B{\'e}jot and Bekele, {Bayu Begashaw} and Belachew, {Abate Bekele} and Belay, {Aregawi Gebreyesus} and Ezra Belay and Belay, {Saba Abraham} and Belay, {Yihalem Abebe} and Bell, {Michelle L.} and Bello, {Aminu K.} and Bennett, {Derrick A.} and Bensenor, {Isabela M.} and Adugnaw Berhane and Berman, {Adam E.} and Eduardo Bernabe and Bernstein, {Robert S.} and Bertolacci, {Gregory J.} and Mircea Beuran and Tina Beyranvand and Neeraj Bhala and Eesh Bhatia and Samir Bhatt and Suraj Bhattarai and Soumyadeeep Bhaumik and Bhutta, {Zulfiqar A.} and Belete Biadgo and Ali Bijani and Boris Bikbov and Nigus Bililign and {Bin Sayeed}, {Muhammad Shahdaat} and Birlik, {Sait Mentes} and Charles Birungi and Donal Bisanzio and Tuhin Biswas and Tone Bj{\o}rge and Archie Bleyer and Basara, {Berrak Bora} and Dipan Bose and Cristina Bosetti and Soufiane Boufous and Rupert Bourne and Brady, {Oliver J.} and Bragazzi, {Nicola Luigi} and Brant, {Luisa C.} and Alexandra Brazinova and Breitborde, {Nicholas J.K.} and Hermann Brenner and Gabrielle Britton and Traolach Brugha and Burke, {Kristin E.} and Reinhard Busse and Butt, {Zahid A.} and Lucero Cahuana-Hurtado and Callender, {Charlton S.K.H.} and Campos-Nonato, {Ismael R.} and {Campuzano Rincon}, {Julio Cesar} and Jorge Cano and Mate Car and Rosario C{\'a}rdenas and Giulia Carreras and Carrero, {Juan J.} and Austin Carter and F{\'e}lix Carvalho and Casta{\~n}eda-Orjuela, {Carlos A.} and {Castillo Rivas}, Jacqueline and Franz Castro and Ferr{\'a}n Catal{\'a}-L{\'o}pez and Alanur {\cC}avlin and Ester Cerin and Yazan Chaiah and Champs, {Ana Paula} and Chang, {Hsing Yi} and Chang, {Jung Chen} and Aparajita Chattopadhyay and Pankaj Chaturvedi and Wanqing Chen and Chiang, {Peggy Pei Chia} and Odgerel Chimed-Ochir and Chin, {Ken Lee} and Chisumpa, {Vesper Hichilombwe} and Abdulaal Chitheer and Choi, {Jee Young J.} and Hanne Christensen and Christopher, {Devasahayam J.} and Chung, {Sheng Chia} and Cicuttini, {Flavia M.} and Ciobanu, {Liliana G.} and Massimo Cirillo and Claro, {Rafael M.} and Cohen, {Aaron J.} and Daniel Collado-Mateo and Constantin, {Maria Magdalena} and Sara Conti and Cyrus Cooper and Cooper, {Leslie Trumbull} and Cortesi, {Paolo Angelo} and Monica Cortinovis and Ewerton Cousin and Criqui, {Michael H.} and Cromwell, {Elizabeth A.} and Crowe, {Christopher Stephen} and Crump, {John A.} and Alexandra Cucu and Driscoll, {Tim Robert} and Richard Ofori-Asenso and Renzaho, {Andre M.N.} and Thrift, {Amanda G.} and Shanshan Li and {GBD 2017 Mortality Collaborators}",
year = "2018",
month = "11",
day = "10",
doi = "10.1016/S0140-6736(18)31891-9",
language = "English",
volume = "392",
pages = "1684--1735",
journal = "The Lancet",
issn = "0140-6736",
publisher = "Elsevier",
number = "10159",

}

Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017 : a systematic analysis for the Global Burden of Disease Study 2017. / Li, Shanshan; GBD 2017 Mortality Collaborators.

In: The Lancet, Vol. 392, No. 10159, 10.11.2018, p. 1684-1735.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017

T2 - a systematic analysis for the Global Burden of Disease Study 2017

AU - Dicker, Daniel

AU - Nguyen, Grant

AU - Abate, Degu

AU - Abate, Kalkidan Hassen

AU - Abay, Solomon M.

AU - Abbafati, Cristiana

AU - Abbasi, Nooshin

AU - Abbastabar, Hedayat

AU - Abd-Allah, Foad

AU - Abdela, Jemal

AU - Abdelalim, Ahmed

AU - Abdel-Rahman, Omar

AU - Abdi, Alireza

AU - Abdollahpour, Ibrahim

AU - Abdulkader, Rizwan Suliankatchi

AU - Abdurahman, Ahmed Abdulahi

AU - Abebe, Haftom Temesgen

AU - Abebe, Molla

AU - Abebe, Zegeye

AU - Abebo, Teshome Abuka

AU - Aboyans, Victor

AU - Abraha, Haftom Niguse

AU - Abrham, Aklilu Roba

AU - Abu-Raddad, Laith Jamal

AU - Abu-Rmeileh, Niveen ME

AU - Accrombessi, Manfred Mario Kokou

AU - Acharya, Pawan

AU - Adebayo, Oladimeji M.

AU - Adedeji, Isaac Akinkunmi

AU - Adedoyin, Rufus Adesoji

AU - Adekanmbi, Victor

AU - Adetokunboh, Olatunji O.

AU - Adhena, Beyene Meressa

AU - Adhikari, Tara Ballav

AU - Adib, Mina G.

AU - Adou, Arsène Kouablan

AU - Adsuar, Jose C.

AU - Afarideh, Mohsen

AU - Afshin, Ashkan

AU - Agarwal, Gina

AU - Aggarwal, Rakesh

AU - Aghayan, Sargis Aghasi

AU - Agrawal, Sutapa

AU - Agrawal, Anurag

AU - Ahmadi, Mehdi

AU - Ahmadi, Alireza

AU - Ahmadieh, Hamid

AU - Ahmed, Mohamed Lemine Cheikh brahim

AU - Ahmed, Sayem

AU - Ahmed, Muktar Beshir

AU - Aichour, Amani Nidhal

AU - Aichour, Ibtihel

AU - Aichour, Miloud Taki Eddine

AU - Akanda, Ali S.

AU - Akbari, Mohammad Esmaeil

AU - Akibu, Mohammed

AU - Akinyemi, Rufus Olusola

AU - Akinyemiju, Tomi

AU - Akseer, Nadia

AU - Alahdab, Fares

AU - Al-Aly, Ziyad

AU - Alam, Khurshid

AU - Alebel, Animut

AU - Aleman, Alicia V.

AU - Alene, Kefyalew Addis

AU - Al-Eyadhy, Ayman

AU - Ali, Raghib

AU - Alijanzadeh, Mehran

AU - Alizadeh-Navaei, Reza

AU - Aljunid, Syed Mohamed

AU - Alkerwi, Ala'a

AU - Alla, François

AU - Allebeck, Peter

AU - Allen, Christine A.

AU - Alonso, Jordi

AU - Al-Raddadi, Rajaa M.

AU - Alsharif, Ubai

AU - Altirkawi, Khalid

AU - Alvis-Guzman, Nelson

AU - Amare, Azmeraw T.

AU - Amini, Erfan

AU - Ammar, Walid

AU - Amoako, Yaw Ampem

AU - Anber, Nahla Hamed

AU - Andrei, Catalina Liliana

AU - Androudi, Sofia

AU - Animut, Megbaru Debalkie

AU - Anjomshoa, Mina

AU - Anlay, Degefaye Zelalem

AU - Ansari, Hossein

AU - Ansariadi, Ansariadi

AU - Ansha, Mustafa Geleto

AU - Antonio, Carl Abelardo T.

AU - Appiah, Seth Christopher Yaw

AU - Aremu, Olatunde

AU - Areri, Habtamu Abera

AU - Ärnlöv, Johan

AU - Arora, Megha

AU - Artaman, Al

AU - Aryal, Krishna K.

AU - Asadi-Lari, Mohsen

AU - Asayesh, Hamid

AU - Asfaw, Ephrem Tsegay

AU - Asgedom, Solomon Weldegebreal

AU - Assadi, Reza

AU - Ataro, Zerihun

AU - Atey, Tesfay Mehari Mehari

AU - Athari, Seyyed Shamsadin

AU - Atique, Suleman

AU - Atre, Sachin R.

AU - Atteraya, Madhu Sudhan

AU - Attia, Engi F.

AU - Ausloos, Marcel

AU - Avila-Burgos, Leticia

AU - Avokpaho, Euripide F.G.A.

AU - Awasthi, Ashish

AU - Awuah, Baffour

AU - Ayala Quintanilla, Beatriz Paulina

AU - Ayele, Henok Tadesse

AU - Ayele, Yohanes

AU - Ayer, Rakesh

AU - Ayuk, Tambe B.

AU - Azzopardi, Peter S.

AU - Azzopardi-Muscat, Natasha

AU - Badali, Hamid

AU - Badawi, Alaa

AU - Balakrishnan, Kalpana

AU - Bali, Ayele Geleto

AU - Banach, Maciej

AU - Banstola, Amrit

AU - Barac, Aleksandra

AU - Barboza, Miguel A.

AU - Barquera, Simon

AU - Barrero, Lope H.

AU - Basaleem, Huda

AU - Bassat, Quique

AU - Basu, Arindam

AU - Basu, Sanjay

AU - Baune, Bernhard T.

AU - Bazargan-Hejazi, Shahrzad

AU - Bedi, Neeraj

AU - Beghi, Ettore

AU - Behzadifar, Masoud

AU - Behzadifar, Meysam

AU - Béjot, Yannick

AU - Bekele, Bayu Begashaw

AU - Belachew, Abate Bekele

AU - Belay, Aregawi Gebreyesus

AU - Belay, Ezra

AU - Belay, Saba Abraham

AU - Belay, Yihalem Abebe

AU - Bell, Michelle L.

AU - Bello, Aminu K.

AU - Bennett, Derrick A.

AU - Bensenor, Isabela M.

AU - Berhane, Adugnaw

AU - Berman, Adam E.

AU - Bernabe, Eduardo

AU - Bernstein, Robert S.

AU - Bertolacci, Gregory J.

AU - Beuran, Mircea

AU - Beyranvand, Tina

AU - Bhala, Neeraj

AU - Bhatia, Eesh

AU - Bhatt, Samir

AU - Bhattarai, Suraj

AU - Bhaumik, Soumyadeeep

AU - Bhutta, Zulfiqar A.

AU - Biadgo, Belete

AU - Bijani, Ali

AU - Bikbov, Boris

AU - Bililign, Nigus

AU - Bin Sayeed, Muhammad Shahdaat

AU - Birlik, Sait Mentes

AU - Birungi, Charles

AU - Bisanzio, Donal

AU - Biswas, Tuhin

AU - Bjørge, Tone

AU - Bleyer, Archie

AU - Basara, Berrak Bora

AU - Bose, Dipan

AU - Bosetti, Cristina

AU - Boufous, Soufiane

AU - Bourne, Rupert

AU - Brady, Oliver J.

AU - Bragazzi, Nicola Luigi

AU - Brant, Luisa C.

AU - Brazinova, Alexandra

AU - Breitborde, Nicholas J.K.

AU - Brenner, Hermann

AU - Britton, Gabrielle

AU - Brugha, Traolach

AU - Burke, Kristin E.

AU - Busse, Reinhard

AU - Butt, Zahid A.

AU - Cahuana-Hurtado, Lucero

AU - Callender, Charlton S.K.H.

AU - Campos-Nonato, Ismael R.

AU - Campuzano Rincon, Julio Cesar

AU - Cano, Jorge

AU - Car, Mate

AU - Cárdenas, Rosario

AU - Carreras, Giulia

AU - Carrero, Juan J.

AU - Carter, Austin

AU - Carvalho, Félix

AU - Castañeda-Orjuela, Carlos A.

AU - Castillo Rivas, Jacqueline

AU - Castro, Franz

AU - Catalá-López, Ferrán

AU - Çavlin, Alanur

AU - Cerin, Ester

AU - Chaiah, Yazan

AU - Champs, Ana Paula

AU - Chang, Hsing Yi

AU - Chang, Jung Chen

AU - Chattopadhyay, Aparajita

AU - Chaturvedi, Pankaj

AU - Chen, Wanqing

AU - Chiang, Peggy Pei Chia

AU - Chimed-Ochir, Odgerel

AU - Chin, Ken Lee

AU - Chisumpa, Vesper Hichilombwe

AU - Chitheer, Abdulaal

AU - Choi, Jee Young J.

AU - Christensen, Hanne

AU - Christopher, Devasahayam J.

AU - Chung, Sheng Chia

AU - Cicuttini, Flavia M.

AU - Ciobanu, Liliana G.

AU - Cirillo, Massimo

AU - Claro, Rafael M.

AU - Cohen, Aaron J.

AU - Collado-Mateo, Daniel

AU - Constantin, Maria Magdalena

AU - Conti, Sara

AU - Cooper, Cyrus

AU - Cooper, Leslie Trumbull

AU - Cortesi, Paolo Angelo

AU - Cortinovis, Monica

AU - Cousin, Ewerton

AU - Criqui, Michael H.

AU - Cromwell, Elizabeth A.

AU - Crowe, Christopher Stephen

AU - Crump, John A.

AU - Cucu, Alexandra

AU - Driscoll, Tim Robert

AU - Ofori-Asenso, Richard

AU - Renzaho, Andre M.N.

AU - Thrift, Amanda G.

AU - Li, Shanshan

AU - GBD 2017 Mortality Collaborators

PY - 2018/11/10

Y1 - 2018/11/10

N2 - Background: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. Funding: Bill & Melinda Gates Foundation.

AB - Background: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. Funding: Bill & Melinda Gates Foundation.

UR - http://www.scopus.com/inward/record.url?scp=85056148226&partnerID=8YFLogxK

U2 - 10.1016/S0140-6736(18)31891-9

DO - 10.1016/S0140-6736(18)31891-9

M3 - Article

VL - 392

SP - 1684

EP - 1735

JO - The Lancet

JF - The Lancet

SN - 0140-6736

IS - 10159

ER -