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

Haidong Wang, Amanuel Alemu Abajobir, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M. Abbas, Foad Abd-Allah, Semaw Ferede Abera, Haftom Niguse Abraha, Laith J. Abu-Raddad, Niveen M.E. Abu-Rmeileh, Isaac Akinkunmi Adedeji, Rufus Adesoji Adedoyin, Ifedayo Morayo O. Adetifa, Olatunji Adetokunboh, Ashkan Afshin, Rakesh Aggarwal, Anurag Agrawal, Sutapa Agrawal, Aliasghar Ahmad Kiadaliri, Muktar Beshir AhmedAmani Nidhal Aichour, Ibthiel Aichour, Miloud Taki Eddine Aichour, Sneha Aiyar, Ali Shafqat Akanda, Tomi F. Akinyemiju, Nadia Akseer, Ayman Al-Eyadhy, Faris Hasan Al Lami, Samer Alabed, Fares Alahdab, Ziyad Al-Aly, Khurshid Alam, Noore Alam, Deena Alasfoor, Robert William Aldridge, Kefyalew Addis Alene, Samia Alhabib, Raghib Ali, Reza Alizadeh-Navaei, Syed M. Aljunid, Juma M. Alkaabi, Ala'a Alkerwi, François Alla, Shalini D. Allam, Peter Allebeck, Rajaa Al-Raddadi, Ubai Alsharif, Khalid A. Altirkawi, Elena Alvarez Martin, Nelson Alvis-Guzman, Azmeraw T. Amare, Emmanuel A. Ameh, Erfan Amini, Walid Ammar, Yaw Ampem Amoako, Nahla Anber, Catalina Liliana Andrei, Sofia Androudi, Hossein Ansari, Mustafa Geleto Ansha, Carl Abelardo T. Antonio, Palwasha Anwari, Johan Ärnlöv, Megha Arora, Al Artaman, Krishna Kumar Aryal, Hamid Asayesh, Solomon Weldegebreal Asgedom, Rana Jawad Asghar, Reza Assadi, Tesfay Mehari Atey, Sachin R. Atre, Leticia Avila-Burgos, Euripide Frinel G.Arthur Avokpaho, Ashish Awasthi, Beatriz Paulina Ayala Quintanilla, Tesleem Kayode Babalola, Umar Bacha, Alaa Badawi, Kalpana Balakrishnan, Shivanthi Balalla, Aleksandra Barac, Ryan M. Barber, Miguel A. Barboza, Suzanne L. Barker-Collo, Till Bärnighausen, Simon Barquera, Lars Barregard, Lope H. Barrero, Bernhard T. Baune, Shahrzad Bazargan-Hejazi, Neeraj Bedi, Ettore Beghi, Yannick Béjot, Bayu Begashaw Bekele, Michelle L. Bell, Aminu K. Bello, Derrick A. Bennett, James R. Bennett, Isabela M. Bensenor, Jennifer Benson, Adugnaw Berhane, Derbew Fikadu Berhe, Eduardo Bernabé, Mircea Beuran, Addisu Shunu Beyene, Neeraj Bhala, Anil Bhansali, Soumyadeep Bhaumik, Zulfiqar A. Bhutta, Boris Bikbov, Charles Birungi, Stan Biryukov, Donal Bisanzio, Habtamu Mellie Bizuayehu, Peter Bjerregaard, Christopher D. Blosser, Dube Jara Boneya, Soufiane Boufous, Rupert R.A. Bourne, Alexandra Brazinova, Nicholas J.K. Breitborde, Hermann Brenner, Traolach S. Brugha, Gene Bukhman, Lemma Negesa Bulto Bulto, Blair Randal Bumgarner, Michael Burch, Zahid A. Butt, Leah E. Cahill, Lucero Cahuana-Hurtado, Ismael Ricardo Campos-Nonato, Josip Car, Mate Car, Rosario Cárdenas, David O. Carpenter, Juan Jesus Carrero, Austin Carter, Carlos A. Castañeda-Orjuela, Jacqueline Castillo Rivas, Franz F. Castro, Ruben Estanislao Castro, Ferrán Catalá-López, Honglei Chen, Peggy Pei Chia Chiang, Mirriam Chibalabala, Vesper Hichilombwe Chisumpa, Abdulaal A. Chitheer, Jee Young Jasmine Choi, Hanne Christensen, Devasahayam Jesudas Christopher, Liliana G. Ciobanu, Massimo Cirillo, Aaron J. Cohen, Samantha M. Colquhoun, Josef Coresh, Michael H. Criqui, Elizabeth A. Cromwell, John A. Crump, Lalit Dandona, Rakhi Dandona, Paul I. Dargan, José Das Neves, Gail Davey, Dragos V. Davitoiu, Kairat Davletov, Barbora De Courten, Diego De Leo, Louisa Degenhardt, Selina Deiparine, Robert P. Dellavalle, Kebede Deribe, Amare Deribew, Don C. Des Jarlais, Subhojit Dey, Samath D. Dharmaratne, Mukesh K. Dherani, Cesar Diaz-Torné, Eric L. Ding, Priyanka Dixit, Shirin Djalalinia, Huyen Phuc Do, David Teye Doku, Christl Ann Donnelly, Kadine Priscila Bender Dos Santos, Dirk Douwes-Schultz, Tim R. Driscoll, Leilei Duan, Manisha Dubey, Bruce Bartholow Duncan, Laxmi Kant Dwivedi, Hedyeh Ebrahimi, Charbel El Bcheraoui, Christian Lycke Ellingsen, Ahmadali Enayati, Aman Yesuf Endries, Sergey Petrovich Ermakov, Setegn Eshetie, Babak Eshrati, Sharareh Eskandarieh, Alireza Esteghamati, Kara Estep, Fanuel Belayneh Bekele Fanuel, André Faro, Maryam S. Farvid, Farshad Farzadfar, Valery L. Feigin, Seyed Mohammad Fereshtehnejad, Jefferson G. Fernandes, João C. Fernandes, Tesfaye Regassa Feyissa, Irina Filip, Florian Fischer, Nataliya Foigt, Kyle J. Foreman, Tahvi Frank, Richard C. Franklin, Maya Fraser, Joseph Friedman, Joseph J. Frostad, Nancy Fullman, Thomas Fürst, Joao M. Furtado, Neal D. Futran, Emmanuela Gakidou, Ketevan Gambashidze, Amiran Gamkrelidze, Fortuné Gbètoho Gankpé, Alberto L. Garcia-Basteiro, Gebremedhin Berhe Gebregergs, Tsegaye Tewelde Gebrehiwot, Kahsu Gebrekirstos Gebrekidan, Mengistu Welday Gebremichael, Amha Admasie Gelaye, Johanna M. Geleijnse, Bikila Lencha Gemechu, Kasiye Shiferaw Gemechu, Ricard Genova-Maleras, Hailay Abrha Gesesew, Peter W. Gething, Katherine B. Gibney, Paramjit Singh Gill, Richard F. Gillum, Ababi Zergaw Giref, Bedilu Weji Girma, Giorgia Giussani, Shifalika Goenka, Beatriz Gomez, Philimon N. Gona, Sameer Vali Gopalani, Alessandra Carvalho Goulart, Nicholas Graetz, Harish Chander Gugnani, Prakash C. Gupta, Rahul Gupta, Rajeev Gupta, Tanush Gupta, Vipin Gupta, Juanita A. Haagsma, Nima Hafezi-Nejad, Hassan Haghparast Bidgoli, Alex Hakuzimana, Yara A. Halasa, Randah Ribhi Hamadeh, Mitiku Teshome Hambisa, Samer Hamidi, Mouhanad Hammami, Jamie Hancock, Alexis J. Handal, Graeme J. Hankey, Yuantao Hao, Hilda L. Harb, Habtamu Abera Hareri, Sivadasanpillai Harikrishnan, Josep Maria Haro, Mohammad Sadegh Hassanvand, Rasmus Havmoeller, Roderick J. Hay, Simon I. Hay, Fei He, Ileana Beatriz Heredia-Pi, Claudiu Herteliu, Esayas Haregot Hilawe, Hans W. Hoek, Nobuyuki Horita, H. Dean Hosgood, Sorin Hostiuc, Peter J. Hotez, Damian G. Hoy, Mohamed Hsairi, Aung Soe Htet, Guoqing Hu, Hsiang Huang, John J. Huang, Kim Moesgaard Iburg, Ehimario Uche Igumbor, Bogdan Vasile Ileanu, Manami Inoue, Asnake Ararsa Irenso, Caleb M.S. Irvine, Nazrul Islam, Kathryn H. Jacobsen, Thomas Jaenisch, Nader Jahanmehr, Mihajlo B. Jakovljevic, Mehdi Javanbakht, Achala Upendra Jayatilleke, Panniyammakal Jeemon, Paul N. Jensen, Vivekanand Jha, Ye Jin, Denny John, Oommen John, Sarah Charlotte Johnson, Jost B. Jonas, Mikk Jürisson, Zubair Kabir, Rajendra Kadel, Amaha Kahsay, Yogeshwar Kalkonde, Ritul Kamal, Haidong Kan, André Karch, Corine Kakizi Karema, Seyed M. Karimi, Ganesan Karthikeyan, Amir Kasaeian, Nigussie Assefa Kassaw, Nicholas J. Kassebaum, Anshul Kastor, Srinivasa Vittal Katikireddi, Anil Kaul, Norito Kawakami, Konstantin Kazanjan, Peter Njenga Keiyoro, Sefonias Getachew Kelbore, Andrew Haddon Kemp, Andre Pascal Kengne, Andre Keren, Maia Kereselidze, Chandrasekharan Nair Kesavachandran, Ezra Belay Ketema, Yousef Saleh Khader, Ibrahim A. Khalil, Ejaz Ahmad Khan, Gulfaraz Khan, Young Ho Khang, Sahil Khera, Abdullah Tawfih Abdullah Khoja, Mohammad Hossein Khosravi, Getiye Dejenu Kibret, Christian Kieling, Cho Il Kim, Daniel Kim, Pauline Kim, Sungroul Kim, Yun Jin Kim, Ruth W. Kimokoti, Yohannes Kinfu, Sami Kishawi, Katarzyna A. Kissimova-Skarbek, Niranjan Kissoon, Mika Kivimaki, Ann Kristin Knudsen, Yoshihiro Kokubo, Jacek A. Kopec, Soewarta Kosen, Parvaiz A. Koul, Ai Koyanagi, Michael Kravchenko, Kristopher J. Krohn, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Ernst J. Kuipers, Xie Rachel Kulikoff, Veena S. Kulkarni, G. Anil Kumar, Pushpendra Kumar, Fekede Asefa Kumsa, Michael Kutz, Carl Lachat, Abraham K. Lagat, Anton Carl Jonas Lager, Dharmesh Kumar Lal, Ratilal Lalloo, Nkurunziza Lambert, Qing Lan, Van C. Lansingh, Heidi J. Larson, Anders Larsson, Dennis Odai Laryea, Pablo M. Lavados, Avula Laxmaiah, Paul H. Lee, James Leigh, Janni Leung, Ricky Leung, Miriam Levi, Yongmei Li, Yu Liao, Misgan Legesse Liben, Stephen S. Lim, Shai Linn, Steven E. Lipshultz, Shiwei Liu, Rakesh Lodha, Giancarlo Logroscino, Scott A. Lorch, Stefan Lorkowski, Paulo A. Lotufo, Rafael Lozano, Raimundas Lunevicius, Ronan A. Lyons, Stefan Ma, Erlyn Rachelle King Macarayan, Isis Eloah Machado, Mark T. Mackay, Mohammed Magdy Abd El Razek, Carlos Magis-Rodriguez, Mahdi Mahdavi, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Rajesh Malhotra, Deborah Carvalho Malta, Lorenzo G. Mantovani, Tsegahun Manyazewal, Chabila C. Mapoma, Laurie B. Marczak, Guy B. Marks, Jose Martinez-Raga, Francisco Rogerlândio Martins-Melo, João Massano, Pallab K. Maulik, Bongani M. Mayosi, Mohsen Mazidi, Colm McAlinden, Stephen Theodore McGarvey, John J. McGrath, Martin McKee, Suresh Mehata, Man Mohan Mehndiratta, Kala M. Mehta, Toni Meier, Tefera Chane Mekonnen, Kidanu Gebremariam Meles, Peter Memiah, Ziad A. Memish, Walter Mendoza, Melkamu Merid Mengesha, Mubarek Abera Mengistie, Desalegn Tadese Mengistu, Geetha R. Menon, Bereket Gebremichael Menota, George A. Mensah, Atte Meretoja, Tuomo J. Meretoja, Haftay Berhane Mezgebe, Renata Micha, Joseph Mikesell, Ted R. Miller, Edward J. Mills, Shawn Minnig, Mojde Mirarefin, Erkin M. Mirrakhimov, Awoke Misganaw, Shiva Raj Mishra, Karzan Abdulmuhsin Mohammad, Alireza Mohammadi, Kedir Endris Mohammed, Shafiu Mohammed, Murali B.V. Mohan, Sanjay K. Mohanty, Ali H. Mokdad, Ashagre Molla Assaye, Sarah K. Mollenkopf, Mariam Molokhia, Lorenzo Monasta, Julio Cesar Montañez Hernandez, Marcella Montico, Meghan D. Mooney, Ami R. Moore, Maziar Moradi-Lakeh, Paula Moraga, Lidia Morawska, Ilais Moreno Velasquez, Rintaro Mori, Shane D. Morrison, Kalayu Birhane Mruts, Ulrich O. Mueller, Erin Mullany, Kate Muller, Gudlavalleti Venkata Satyanarayana Murthy, Srinivas Murthy, Kamarul Imran Musa, Jean B. Nachega, Chie Nagata, Gabriele Nagel, Mohsen Naghavi, Kovin S. Naidoo, Lipika Nanda, Vinay Nangia, Bruno Ramos Nascimento, Gopalakrishnan Natarajan, Ionut Negoi, Cuong Tat Nguyen, Grant Nguyen, Quyen Le Nguyen, Trang Huyen Nguyen, Dina Nur Anggraini Ningrum, Muhammad Imran Nisar, Marika Nomura, Vuong Minh Nong, Ole F. Norheim, Bo Norrving, Jean Jacques N. Noubiap, Luke Nyakarahuka, Carla Makhlouf Obermeyer, Martin J. O'Donnell, Felix Akpojene Ogbo, In Hwan Oh, Anselm Okoro, Olanrewaju Oladimeji, Andrew Toyin Olagunju, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Eyal Oren, Alberto Ortiz, Aaron Osgood-Zimmerman, Erika Ota, Mayowa O. Owolabi, Abayomi Samuel Oyekale, P. A. Mahesh, Rosana E. Pacella, Smita Pakhale, Adrian Pana, Basant Kumar Panda, Songhomitra Panda-Jonas, Eun Kee Park, Mahboubeh Parsaeian, Tejas Patel, Scott B. Patten, George C. Patton, Deepak Paudel, David M. Pereira, Rogelio Perez-Padilla, Fernando Perez-Ruiz, Norberto Perico, Aslam Pervaiz, Konrad Pesudovs, Carrie Beth Peterson, William Arthur Petri, Max Petzold, Michael Robert Phillips, Frédéric B. Piel, David M. Pigott, Farhad Pishgar, Dietrich Plass, Suzanne Polinder, Svetlana Popova, Maarten J. Postma, Richie G. Poulton, Farshad Pourmalek, Narayan Prasad, Manorama Purwar, Mostafa Qorbani, Rynaz H.S. Rabiee, Amir Radfar, Anwar Rafay, Afarin Rahimi-Movaghar, Vafa Rahimi-Movaghar, Mahfuzar Rahman, Mohammad Hifz Ur Rahman, Sajjad Ur Rahman, Rajesh Kumar Rai, Sasa Rajsic, Usha Ram, Saleem M. Rana, Chhabi Lal Ranabhat, Paturi Vishnupriya Rao, Salman Rawaf, Sarah E. Ray, Maria Albertina Santiago Rego, Jürgen Rehm, Robert C. Reiner, Giuseppe Remuzzi, Andre M.N.N. Renzaho, Serge Resnikoff, Satar Rezaei, Mohammad Sadegh Rezai, Antonio L. Ribeiro, Mohammad Bagher Rokni, Luca Ronfani, Gholamreza Roshandel, Gregory A. Roth, Dietrich Rothenbacher, Ambuj Roy, Enrico Rubagotti, George Mugambage Ruhago, Soheil Saadat, Yogesh Damodar Sabde, Perminder S. Sachdev, Nafis Sadat, Mahdi Safdarian, Sare Safi, Saeid Safiri, Rajesh Sagar, Ramesh Sahathevan, Amirhossein Sahebkar, Mohammad Ali Sahraian, Joseph Salama, Payman Salamati, Joshua A. Salomon, Sundeep Santosh Salvi, Abdallah M. Samy, Juan Ramon Sanabria, Maria Dolores Sanchez-Niño, Itamar S. Santos, Milena M. Santric Milicevic, Rodrigo Sarmiento-Suarez, Benn Sartorius, Maheswar Satpathy, Monika Sawhney, Sonia Saxena, Mete I. Saylan, Maria Inês Schmidt, Ione J.C. Schneider, Aletta E. Schutte, David C. Schwebel, Falk Schwendicke, Soraya Seedat, Abdulbasit Musa Seid, Sadaf G. Sepanlou, Edson E. 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    Research output: Contribution to journalArticlepeer-review

    339 Scopus citations

    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.
    Original languageEnglish (US)
    Pages (from-to)1084-1150
    Number of pages67
    JournalThe Lancet
    Volume390
    Issue number10100
    DOIs
    StatePublished - Sep 16 2017

    ASJC Scopus subject areas

    • Medicine(all)

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