Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016
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Abstract
BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. INTERPRETATION: Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. FUNDING: Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.
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The record
- Venue
- The Lancet
- Topic
- Global Maternal and Child Health
- Field
- Medicine
- Canadian institutions
- —
- Funders
- Institute of GeneticsDavid Geffen School of Medicine, University of California, Los AngelesEunice Kennedy Shriver National Institute of Child Health and Human DevelopmentNational Institute of Allergy and Infectious DiseasesNational Cancer InstituteNational Human Genome Research InstituteNational Institute of Mental HealthNational Institute on AgingInstitute of Genetics and Developmental Biology, Chinese Academy of SciencesQueensland Brain InstituteNational Health and Medical Research CouncilEconomic and Social Research CouncilUppsala UniversitetDepartment of Global Health and Population, Harvard T.H. Chan School of Public HealthRussian Academy of SciencesJohns Hopkins Bloomberg School of Public HealthGraduate School of Public Health, University of PittsburghNational University of SingaporeWollega UniversityNational Institutes of HealthUniversity of Health and Allied SciencesAswan UniversityArak University of Medical SciencesRede de Química e TecnologiaBrown UniversityWestern Sydney UniversityWageningen University and ResearchSamara UniversityArkansas State UniversityH. Lundbeck A/SAlborz University of Medical SciencesUniversidade Federal do Rio Grande do SulChildren's Hospital of MichiganUniversity of ThessalyUniversidade Federal de SergipeEthiopian Public Health AssociationChristian Medical College, VelloreUniversity Hospitals Bristol NHS Foundation TrustPontificia Universidad JaverianaThe Wellcome Trust DBT India AllianceHorizon PharmaceuticalsUniversität UlmUniversity of PeradeniyaUniversidade de São PauloUniversidade do Estado de Santa CatarinaUniversità degli Studi di SalernoAddis Ababa UniversityAlfaisal UniversityUnited Arab Emirates UniversityUniversity of GondarUniversity of the PhilippinesMedical Research CouncilSri Ramachandra UniversityUniversity of Massachusetts BostonFundação Instituto de Pesquisas EconômicasAlzheimer's AssociationUniversidade Federal de Minas GeraisUniversity of DelhiUnited States Agency for International DevelopmentBaqiyatallah University of Medical SciencesFlinders UniversityUniversität BielefeldKermanshah University of Medical SciencesFoundation for Education and European CultureUniversitetet i OsloAstellas PharmaEuropean Regional Development FundKarolinska InstitutetRegione ToscanaMassachusetts General HospitalMashhad University of Medical SciencesShanghai Jiao Tong UniversityTaipei Medical UniversityInyuvesi Yakwazulu-NataliUniversity College LondonKorea Health Industry Development InstituteUniversiti Kebangsaan MalaysiaHawassa UniversityKuwait UniversityApplied Molecular Biosciences UnitMuhimbili University of Health and Allied SciencesStockholms Läns LandstingSeoul National University HospitalTampereen YliopistoHospital de Clínicas de Porto AlegreGeneralitat ValencianaGöteborgs UniversitetEusko JaurlaritzaDepartment for International DevelopmentKyung Hee UniversityYonsei UniversitySoonchunhyang UniversityChinese Academy of SciencesQueensland University of TechnologyUniversidad de Costa RicaCoordenação de Aperfeiçoamento de Pessoal de Nível SuperiorErasmus Universiteit RotterdamFriedrich-Schiller-Universität JenaSahlgrenska AkademinUniversiteit GentJames Cook UniversityGriffith UniversityLaboratório Associado para a Química VerdeOklahoma State UniversityMonash UniversityDanmarks GrundforskningsfondUniversität HeidelbergEuropean CommissionUniversity of North Carolina at Chapel HillPublic Health AgencyDepartment of Biotechnology, Ministry of Science and Technology, IndiaSwansea UniversityNorwegian Institute of Public HealthUnited Nations Population FundInternational Society of NephrologyUniversity of GlasgowSchool of Medicine, Wayne State UniversityUniversity of OxfordIndian Council of Medical ResearchUniwersytet Jagielloński Collegium MedicumKing's College LondonImperial College LondonGolestan University of Medical SciencesAmerican University of BeirutNational Research FoundationNational Institute for Health and Care ResearchUniversitetet i BergenSimmons CollegePublic Health WalesJordan University of Science and TechnologyGE FoundationChest Research FoundationUniversity of CanberraTata Institute of Social SciencesUniversität BaselMaragheh University of Medical SciencesUniversidade do PortoAustralian GovernmentHacettepe ÜniversitesiKosin UniversityWarwick Medical SchoolUniversity of Cape TownUniversity of OttawaPublic Health Agency of CanadaMadda Walabu UniversityIstituto di Ricerche Farmacologiche Mario Negri - IRCCSUmweltbundesamtUniversitas Negeri SemarangIran University of Medical SciencesAmgenTrường Đại học Duy TânUniversity of WarwickJohns Hopkins UniversityWellcome TrustNational Cerebral and Cardiovascular CenterUniversity of California, San DiegoConselho Nacional de Desenvolvimento Científico e TecnológicoUniversity of West FloridaUniversity of PittsburghNational University of IrelandRensselaer Polytechnic InstituteHelsingin YliopistoOttawa Hospital Research InstituteAin Shams UniversityKletjian FoundationNational Institute for Social Care and Health ResearchSeattle Children's Research InstituteAhmadu Bello UniversityWayne State UniversityMansoura UniversityNational Heart, Lung, and Blood InstituteAstraZenecaTehran University of Medical Sciences and Health ServicesMount Sinai Health SystemCollege of Medicine, Seoul National UniversityAuckland University of Technology, New ZealandUniversità degli Studi di MilanoUniversity of OtagoCurtin University of TechnologyJapan Agency for Medical Research and DevelopmentSeoul National UniversityUniversity of California, San FranciscoUniversity of Central FloridaNational Institute on Minority Health and Health DisparitiesSchool of Medicine, Shanghai Jiao Tong UniversityPlan Nacional sobre DrogasUniversity of North TexasBrandeis UniversityUniversity of GalwayInstituto de Salud Carlos IIIBill and Melinda Gates FoundationAteneo de Manila UniversityHögskolan DalarnaAalborg UniversitetUniversity of WashingtonEmory UniversityBahir Dar UniversityFogarty International CenterNational Center for Child Health and DevelopmentSouth African Medical Research CouncilEngineering and Physical Sciences Research CouncilChildren's Hospital of PhiladelphiaXiamen UniversityUniversity of PennsylvaniaZahedan University of Medical SciencesHarvard UniversityUniversity of HaifaUniversité de LorraineCase Western Reserve UniversityBritish Heart FoundationMazandaran University of Medical SciencesMinistry of Health and Medical EducationKaiser PermanenteLa Trobe UniversityCancer Research UK
- Keywords
- Life expectancyDemographyBurden of diseaseMedicineDiseaseGerontologyMortality rateEnvironmental healthPopulationInternal medicine
- Has abstract in OpenAlex
- yes