Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017

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Abstract

BACKGROUND: Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017. METHODS: The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised. FINDINGS: At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5-74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9-19·6), and injuries 8·0% (7·7-8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5-23·9), representing an additional 7·61 million (7·20-8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0-8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0-24·0) and the death rate by 31·8% (30·1-33·3). Total deaths from injuries increased by 2·3% (0·5-4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2-15·1) to 57·9 deaths (55·9-59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8-148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2-40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2-36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990-neonatal disorders, lower respiratory infections, and diarrhoeal diseases-were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases. INTERPRETATION: Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade. FUNDING: Bill & Melinda Gates Foundation.

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The record

Venue

The Lancet

Topic

Global Maternal and Child Health

Field

Medicine

Canadian institutions

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Funders

Institute of Infection and ImmunityFogarty International CenterNational Institute of Mental HealthUniversiti Brunei DarussalamFaculty of Medicine and Health, University of SydneyWageningen University and ResearchNewcastle UniversitySydney Medical SchoolSveučilište u ZagrebuUniversität BaselUniversity of California, IrvineSchool of Medicine, Duke UniversityPublic Health EnglandCochrane South AfricaUniwersytet OpolskiDipartimento di Medicina e Chirurgia, Università degli Studi di Milano-BicoccaUniversidad de Ciencias Aplicadas y AmbientalesDamietta UniversityUniversitair Ziekenhuis AntwerpenUniversitas Muhammadiyah SurakartaMinistry of Health of the Russian FederationHáskólinn í ReykjavíkMenzies Health Institute QueenslandStudent Research Committee, Tabriz University of Medical SciencesFrankfurt University of Applied SciencesKurdistan University Of Medical SciencesUniversity of the PunjabUniversidade Federal de Santa CatarinaHormozgan University of Medical SciencesSavitribai Phule Pune UniversityMedizinische Universität GrazUniversidade Federal do Rio Grande do SulUniversity of ColomboHawassa UniversityUniversity of PeradeniyaUniversitetet i BergenDuke Global Health Institute, Duke UniversityUniversità degli Studi di MilanoUniversity of OtagoPomorski Uniwersytet Medyczny W SzczecinieGolestan University of Medical SciencesCollege of Engineering, Michigan State UniversityTartu ÜlikoolSree Chitra Tirunal Institute for Medical Sciences and TechnologyMadras Diabetes Research FoundationGonabad University of Medical SciencesChungnam National University HospitalSchool of Public Health and Family Medicine, University of Cape TownBall State UniversityUniversità degli Studi di SalernoCentro de Investigación Biomédica en Red de Salud MentalUniversity of TsukubaSouthern University of Science and TechnologyInternational Medical UniversityIslamic Azad UniversityAristotle University of ThessalonikiBaqiyatallah University of Medical SciencesUniversitat de BarcelonaPolitechnika CzestochowskaDirectorate for Biological SciencesGöteborgs UniversitetFlinders UniversityUniversität BielefeldNational and Kapodistrian University of AthensBirjand University of Medical SciencesGuilan University of Medical SciencesUniversitair Medisch Centrum GroningenUmeå UniversitetBanaras Hindu UniversityNational University of SingaporeNational Institutes of HealthNational Institute on AgingChinese University of Hong KongMashhad University of Medical SciencesUniversity of California, San DiegoHamadan University of Medical SciencesInyuvesi Yakwazulu-NataliBritish Heart FoundationErasmus Universitair Medisch Centrum RotterdamTampereen YliopistoTabriz University of Medical SciencesKarl-Franzens-Universität GrazUniversitat de ValènciaHebrew University of JerusalemCase Western Reserve UniversityFudan UniversityUniversity of CanberraLunds UniversitetUniversität UlmWorld Health OrganizationUrmia UniversityUniversity of EmbuUniwersytet Jagielloński Collegium MedicumChalmers Tekniska HögskolaArabian Gulf UniversityQatar UniversitySeattle Children's Research InstituteCentral South UniversityKyung Hee UniversityHacettepe ÜniversitesiKosin UniversityShiraz University of Medical SciencesAin Shams UniversityNational Drug and Alcohol Research CentreFriedrich-Schiller-Universität JenaQueensland University of TechnologyTulane UniversityGriffith UniversityOklahoma State UniversityMonash UniversityRijksuniversiteit GroningenShanghai Jiao Tong UniversityTaipei Medical UniversityUniversity College CorkRMIT UniversityHelsingin YliopistoDelhi Technological UniversityIndian Council of Medical ResearchUniversity College LondonUniversity of WarwickNational Institute for Health and Care ResearchUniversity of NamibiaMaragheh University of Medical SciencesShiraz UniversityCentral University of Tamil NaduUniversity of ChichesterUniversitas Negeri SemarangUniversity of TabrizAhmadu Bello UniversityAksum UniversityChest Research FoundationJordan University of Science and TechnologyDartmouth CollegeNational Cerebral and Cardiovascular CenterUniversity of West FloridaGeorg-August-Universität GöttingenSeoul National UniversityUniversity of Massachusetts BostonMinistry of Health and Medical EducationKaiser PermanenteUniversitetet i OsloWest Virginia UniversityUniversity of RochesterAuckland University of Technology, New ZealandBiomedical Research CouncilNorth-West UniversitySimmons CollegeAarhus UniversitetWellcome TrustKorea UniversitySaint Paul's Hospital Millennium Medical CollegeUniversity of Social Welfare and Rehabilitation SciencesFundação Oswaldo CruzDrexel UniversityYork UniversityUniversity of Technology SydneyMedical Research CouncilDurban University of TechnologyUniversity of Cape TownUniversity of OttawaBirzeit UniversityYonsei UniversityUniversity of OklahomaBournemouth UniversityUniversity of New South WalesUniversidad de ChileUniversity of PittsburghCurtin University of TechnologyKing Khalid UniversityUniversiti MalayaIsfahan University of Medical SciencesInstituto de Salud Carlos IIISan Diego State UniversityXiamen UniversityUniversity of PennsylvaniaUniversity of HaifaUniversidade Federal de SergipeChungnam National UniversityHamad Medical CorporationI.M. Sechenov First Moscow State Medical UniversityMedical University - VarnaSchool of Medicine, Boston UniversityDeakin UniversityNorwegian Institute of Public HealthUnited Nations Population FundBrien Holden Vision InstituteMoscow Institute of Physics and TechnologyUniversitetet i TromsøUniversiti Sains MalaysiaBill and Melinda Gates FoundationKarabük ÜniversitesiNational Center for Global Health and MedicineUniversity of GlasgowGeorge Mason UniversityDebre Tabor UniversityAn-Najah National UniversityAlborz University of Medical SciencesNorthwestern UniversityLomonosov Moscow State UniversityMichigan State UniversitySanjay Gandhi Postgraduate Institute of Medical SciencesTrường Đại học Duy Tân

Keywords

Verbal autopsyCause of deathDemographyEstimationPopulationMortality rateLife expectancyMedicineBurden of diseaseGeographyDiseaseEnvironmental health

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yes

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