Journal article
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
The Lancet (British edition), Vol.390(10100), pp.1084-1150
09/16/2017
DOI: 10.1016/S0140-6736(17)31833-0
PMCID: PMC5666151
PMID: 29032994
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 Sociodemographic 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. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
Details
- Title: Subtitle
- 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
- Creators
- Haidong Wang - Seattle UniversityAmanuel Alemu Abajobir - Seattle UniversityKalkidan Hassen Abate - Seattle UniversityCristiana Abbafati - Seattle UniversityKaja M. Abbas - Seattle UniversityFoad Abd-Allah - Seattle UniversitySemaw Ferede Abera - Seattle UniversityHaftom Niguse Abraha - Seattle UniversityLaith J. Abu-Raddad - Seattle UniversityNiveen M. E. Abu-Rmeileh - Seattle UniversityIsaac Akinkunmi Adedeji - Seattle UniversityRufus Adesoji Adedoyin - Seattle UniversityIfedayo Morayo O. Adetifa - London Sch Hyg & Trop Med, London, EnglandOlatunji Adetokunboh - Seattle UniversityAshkan Afshin - Seattle UniversityRakesh Aggarwal - Seattle UniversityAnurag Agrawal - Seattle UniversitySutapa Agrawal - Seattle UniversityAliasghar Ahmad Kiadaliri - Lund UniversityMuktar Beshir Ahmed - Seattle UniversityAmani Nidhal Aichour - Seattle UniversityIbthiel Aichour - Seattle UniversityMiloud Taki Eddine Aichour - Seattle UniversitySneha Aiyar - Seattle UniversityShafqat Akanda - Univ Rhode Isl, Kingston, RI 02881 USATomi F. Akinyemiju - Seattle UniversityNadia Akseer - Seattle UniversityAyman Al-Eyadhy - Seattle UniversityFaris Hasan Al Lami - Baghdad Coll Med, Baghdad, IraqSamer Alabed - Seattle UniversityFares Alahdab - Seattle UniversityZiyad Al-Aly - Seattle UniversityKhurshid Alam - Seattle UniversityNoore Alam - Seattle UniversityDeena Alasfoor - Seattle UniversityRobert William Aldridge - Seattle UniversityKefyalew Addis Alene - Seattle UniversitySamia Alhabib - Seattle UniversityRaghib Ali - Seattle UniversityReza Alizadeh-Navaei - Seattle UniversitySyed M. Aljunid - Seattle UniversityJuma M. Alkaabi - Seattle UniversityAla'a Alkerwi - LIH, Strassen, LuxembourgFrancois Alla - Seattle UniversityShalini D. Allam - Seattle UniversityPeter Allebeck - Seattle UniversityRajaa Al-Raddadi - Seattle UniversityUbai Alsharif - Seattle UniversityKhalid A. Altirkawi - Seattle UniversityElena Alvarez Martin - Seattle UniversityNelson Alvis-Guzman - Seattle UniversityAzmeraw T. Amare - Seattle UniversityEmmanuel A. Ameh - Seattle UniversityErfan Amini - Seattle UniversityWalid Ammar - Seattle UniversityYaw Ampem Amoako - Seattle UniversityNahla Anber - Seattle UniversityCatalina Liliana Andrei - Seattle UniversitySofia Androudi - Seattle UniversityHossein Ansari - Seattle UniversityMustafa Geleto Ansha - Seattle UniversityCarl Abelardo T. Antonio - Seattle UniversityPalwasha Anwari - Seattle UniversityJohan Arnlov - Seattle UniversityMegha Arora - Seattle UniversityAl Artaman - Seattle UniversityKrishna Kumar Aryal - Seattle UniversityHamid Asayesh - Seattle UniversitySolomon Weldegebreal Asgedom - Seattle UniversityRana Jawad Asghar - Seattle UniversityReza Assadi - Seattle UniversityTesfay Mehari Atey - Seattle UniversitySachin R. Atre - Seattle UniversityLeticia Avila-Burgos - Seattle UniversityEuripide Frinel G. Arthur Avokpaho - IRCB, Cotonou, BeninAshish Awasthi - Seattle UniversityBeatriz Paulina Ayala Quintanilla - Seattle UniversityTesleem Kayode Babalola - Seattle UniversityUmar Bacha - Seattle UniversityAlaa Badawi - Seattle UniversityKalpana Balakrishnan - Seattle UniversityShivanthi Balalla - Seattle UniversityAleksandra Barac - Seattle UniversityRyan M. Barber - Seattle UniversityMiguel A. Barboza - Seattle UniversitySuzanne L. Barker-Collo - Seattle UniversityTill Barnighausen - Seattle UniversitySimon Barquera - Seattle UniversityLars Barregard - Seattle UniversityLope H. Barrero - Seattle UniversityBernhard T. Baune - Seattle UniversityShahrzad Bazargan-Hejazi - Seattle UniversityNeeraj Bedi - Seattle UniversityEttore Beghi - Seattle UniversityYannick Bejot - Seattle UniversityBayu Begashaw Bekele - Seattle UniversityMichelle L. Bell - Seattle UniversityAminu K. Bello - Seattle UniversityDerrick A. Bennett - Seattle UniversityJames R. Bennett - Seattle UniversityGBD 2016 Mortality CollaboratorsDavid C Schwebel (Contributor) - Research Administration
- Resource Type
- Journal article
- Publication Details
- The Lancet (British edition), Vol.390(10100), pp.1084-1150
- DOI
- 10.1016/S0140-6736(17)31833-0
- PMID
- 29032994
- PMCID
- PMC5666151
- NLM abbreviation
- Lancet
- ISSN
- 0140-6736
- eISSN
- 1474-547X
- Publisher
- Elsevier
- Number of pages
- 67
- Grant note
- MR/K013351/1; MC_UU_12017/13; MC_UU_12017/15 / MRC; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) Bill AMP; Melinda Gates Foundation; CGIAR MR/K010174/1B; MC_UU_12017/15; MR/K013351/1; MC_UU_12017/13; MC_PC_13043 / Medical Research Council; UK Research & Innovation (UKRI); Medical Research Council UK (MRC) National Institute on Aging; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute on Aging (NIA) CL-2015-18-011; CDF-2011-04-048; ACF-2014-04-008 / National Institute for Health Research; National Institutes of Health Research (NIHR) National Institute of Mental Health of the National Institutes of Health; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Mental Health (NIMH) SPHSU13; SPHSU15; SCAF/15/02 / Chief Scientist Office; Chief Scientist Office - Scotland
- Language
- English
- Date published
- 09/16/2017
- Academic Unit
- Research Administration
- Record Identifier
- 9984949178602771
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