Abstract
Methods We estimated age-sex-specifi c all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specifi c causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions.
Findings Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute diff erences between countries decreased but relative diff erences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative diff erences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions.
Interpretation For most countries, the general pattern of reductions in age-sex specifi c mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade
Original language | English |
---|---|
Pages (from-to) | 117-171 |
Number of pages | 55 |
Journal | Lancet |
Volume | 385 |
Issue number | 9963 |
DOIs | |
Publication status | Published - 2015 |
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Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. / Murray, Christopher; wang, Haidong; Lozano, Rafael; Davis, Adrian; Liang, Xiaofeng; Zhou, Maigeng; Vollset, Stein; Ozgoren, Ayse Abbasoglu; Abdalla, Safa; Abd-Allah, Foad; Aziz, Muna; Abera, Semaw Ferede; Aboyans, Victor; Abraham, Biju; Abuabara, Katrina; Abubakar, Ibrahim; Abu-Raddad, Laith; Abu-Rmeileh, Niveen; Achoki, Tom; Adelekan, Ademola; Ademi, Zanfina; Adofo, Koranteng; Adou, Arsene; Adsuar, Jose; Arnlov, Johan; Al Khabouri, Mazin; Alasfoor, Deena; Albittar, Mohammed; Alegretti, Miguel; Aleman, Alicia; Alemu, Zewdie Aderaw; Alfonso-Cristancho, Rafael; Alhabib, Samia; Ali, Mohammed; Ali, Raghib; Alla, Francois; Al Lami, Faris; Allebeck, Peter; AlMazroa, Mohammad; Al-Shahi Salman, Rustam; Alsharif, Ubai; Alvarez, Elena; Alviz-Guzman, Nelson; Amankwaa, Adansi; Badawi, Alaa; Bahit, Maria; Bakfalouni, Talal; Balakrishnan, Kalpana; Balalla, Shivanthi; Banerjee, Amitava; Barber, Ryan; Barker-Collo, Suzanne; Barquera, Simon; Barregard, Lars; Barrero, Lope; Barrientos-Gutierrez, Tonatiuh; Basu, Arindam; Basulaiman, Mohammed; Beardsley, Justin; Charlson, Fiona; Che, Xuan; Chen, Honglei; Chen, Yingyao; Chen, Jian Sheng; Chen, Zhengming; Chiang, Peggy; Chimed-Ochir, Odgerel; Chowdhury, Rajiv; Christensen, Hanne; Christophi, Costas; Deribe, Kebede; Jarlais, Don; Dessalegn, Muluken; DeVeber, Gabrielle; Dharmaratne, Samath; Diaz-Ortega, Jose-Luis; Diaz-Torne, Cesar; Dicker, Daniel; Ding, Eric; Dokova, Klara; Dorsey, E; Driscoll, Tim; Duan, Leilei; Edmond, Karen; Ellenbogen, Richard; Elshrek, Yousef; Furst, Thomas; Fahimi, Saman; Fahrion, Anna; Faraon, Emerito; Fay, Derek; Feigl, Andrea; Feigin, Valery; Ginawi, Ibrahim; Giroud, Maurice; Glaser, Elizabeth; Goenka, Shifalika; Dantes, Hector; Gona, Philimon; Gonzalez-Medina, Diego; Guinovart, Caterina; Gupta, Rahul; Gosselin, Richard; Gotay, Carolyn; Goto, Atsushi; Haagsma, Juanita; Hafezi-Nejad, Nima; Hagan, Holly; Hagstromer, Maria; Halasa, Yara; Hamadeh, Randah; Hamavid, Hannah; Hammami, Mouhanad; Hancock, Jamie; Hankey, Graeme; Hansen, Gillian; Ohkubo, Takayoshi; Iannarone, Marissa; Iburg, Kim; Idrisov, Bulat; Ikeda, Nayu; Innos, Kaire; Inoue, Manami; Islami, Farhad; Jacobsen, Kathryn; Jassal, Simerjot; Jayaraman, Sudha; Jensen, Paul; Jha, Vivekanand; Jiang, Guohong; Jiang, Ying; Jonas, Jost; Joseph, Jonathan; Juel, Knud; Kabagambe, Edmond; Kan, Haidong; Karch, Andre; Karimkhani, Chante; Karthikeyan, Ganesan; Kassebaum, Nicholas; Kaul, Anil; kawakami, Norito; Kazanjan, Konstantin; Kazi, Dhruv; Kemp, Andrew; Kengne, Andre; Keren, Andre; Kereselidze, Maia; Khader, Yousef; Kinfu, Yohannes; Lalloo, Ratilal; Lallukka, Tea; Lam, Hilton; Lan, Qing; Lansingh, Van; Larson, Heidi; Larsson, Anders; Lavados, Pablo; Lawrynowicz, Alicia; Leasher, Janet; Lee, Jong-Tae; Leigh, James; Leinsalu, Mall; Leung, Ricky; Levitz, Carly; Mahdi, Abbas; Majdan, Marek; Malekzadeh, Reza; Mangalam, Srikanth; Mapoma, Christopher; Marape, Marape; MArcenes, wagner; Margono, Christopher; Marks, Guy; Marzan, Melvin; Masci, Joseph; Mashal, Mohammad; Nangia, Vinay; Narayan, K; Nash, Denis; Nejjari, Chakib; Nasher, Jamal; Nelson, Robert; Neuhouser, Marian; Neupane, Sudan; Newcomb, Polly; Newton, Charles; Ng, Marie; Ngalesoni, Frida; Nguyen, Grant; Nguyen, Nhung; Nisar, Muhammad; Odell, Shaun; O'Donnell, Martin; Ohno, Summer; Olusanya, Bolajoko; Omer, Saad; Opio, John; Orisakwe, Orish; Ortblad, Katrina; Ortiz, Alberto; Otayza, Maria; Pavlin, Boris; Pearce, Niel; Pellegrini, Carlos; Pereira, David; Peresson, Sophie; Perez-Padilla, Rogelio; Perez-Ruiz, Fernando; Perico, Norberto; Pervaiz, Aslam; Pesudovs, Konrad; Peterson, Carrie; Petzold, Max; Phillips, Bryan; Qato, Dima; Quezada, Amado; Quistberg, D; Raju, Murugesan; Rakovac, Ivo; Rana, Saleem; Refaat, Amany; Remuzzi, Giuseppe; Ribeiro, Antonio; Ricci, Stefano; Riccio, Patricia; Richardson, Lee; Richardus, Jan; Roberts, Bayard; Saha, Sukanta; Sahathevan, Ramesh; Sahraian, Mohammad; Sahle, Berhe; Salomon, Joshua; Salvo, Deborah; Samonte, Genesis; Sampson, Uchechukwu; Sanabria, Juan; Sandar, Logan; Santos, Itamar; Tenkorang, Eric; Terkawi, Abdullah; Thomas, Bernadette; Thorne-Lyman, Andrew; Thrift, Amanda; Thurston, GEorge; Tillmann, Taavi; Tirschwell, David; Tleyjeh, Imad; Tonelli, Marcello; Topouzis, Fotis; Towbin, Jeffrey; Ubeda, Clotilde; Uchendu, Uche; Undurraga, Eduardo; Vallely, Andrew; Van De Vijver, Steven; Van Gool, Coen; Varakin, Yuri; Vasankari, Tommi; Vasconcelos, Ana; Wagner, Gregory; Waller, Stephen; Wang, Jianli; Wang, Linhong; Wang, XiaoRong; Warouw, Tati; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert; Wenzhi, Wang; Xu, Gelin; Yang, Rebecca; Yano, Yuichiro; Yatsuya, Hiroshi; Yip, Paul; Yonemoto, Naohiro; Yoon, Seok-Jun; Younis, Mustafa; Yu, Chuanhua; Zhu, Jun; Zhu, Shankuan; Zonies, Davies; Zou, Xiao; Zunt, Joseph; Vos, Theo; lopez, Alan; Gosslin, R; Karam, Nadim; Sabin, Nsanzimana; Temesgen, A.
In: Lancet, Vol. 385, No. 9963, 2015, p. 117-171.Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013
AU - Murray, Christopher
AU - wang, Haidong
AU - Lozano, Rafael
AU - Davis, Adrian
AU - Liang, Xiaofeng
AU - Zhou, Maigeng
AU - Vollset, Stein
AU - Ozgoren, Ayse Abbasoglu
AU - Abdalla, Safa
AU - Abd-Allah, Foad
AU - Aziz, Muna
AU - Abera, Semaw Ferede
AU - Aboyans, Victor
AU - Abraham, Biju
AU - Abuabara, Katrina
AU - Abubakar, Ibrahim
AU - Abu-Raddad, Laith
AU - Abu-Rmeileh, Niveen
AU - Achoki, Tom
AU - Adelekan, Ademola
AU - Ademi, Zanfina
AU - Adofo, Koranteng
AU - Adou, Arsene
AU - Adsuar, Jose
AU - Arnlov, Johan
AU - Al Khabouri, Mazin
AU - Alasfoor, Deena
AU - Albittar, Mohammed
AU - Alegretti, Miguel
AU - Aleman, Alicia
AU - Alemu, Zewdie Aderaw
AU - Alfonso-Cristancho, Rafael
AU - Alhabib, Samia
AU - Ali, Mohammed
AU - Ali, Raghib
AU - Alla, Francois
AU - Al Lami, Faris
AU - Allebeck, Peter
AU - AlMazroa, Mohammad
AU - Al-Shahi Salman, Rustam
AU - Alsharif, Ubai
AU - Alvarez, Elena
AU - Alviz-Guzman, Nelson
AU - Amankwaa, Adansi
AU - Badawi, Alaa
AU - Bahit, Maria
AU - Bakfalouni, Talal
AU - Balakrishnan, Kalpana
AU - Balalla, Shivanthi
AU - Banerjee, Amitava
AU - Barber, Ryan
AU - Barker-Collo, Suzanne
AU - Barquera, Simon
AU - Barregard, Lars
AU - Barrero, Lope
AU - Barrientos-Gutierrez, Tonatiuh
AU - Basu, Arindam
AU - Basulaiman, Mohammed
AU - Beardsley, Justin
AU - Charlson, Fiona
AU - Che, Xuan
AU - Chen, Honglei
AU - Chen, Yingyao
AU - Chen, Jian Sheng
AU - Chen, Zhengming
AU - Chiang, Peggy
AU - Chimed-Ochir, Odgerel
AU - Chowdhury, Rajiv
AU - Christensen, Hanne
AU - Christophi, Costas
AU - Deribe, Kebede
AU - Jarlais, Don
AU - Dessalegn, Muluken
AU - DeVeber, Gabrielle
AU - Dharmaratne, Samath
AU - Diaz-Ortega, Jose-Luis
AU - Diaz-Torne, Cesar
AU - Dicker, Daniel
AU - Ding, Eric
AU - Dokova, Klara
AU - Dorsey, E
AU - Driscoll, Tim
AU - Duan, Leilei
AU - Edmond, Karen
AU - Ellenbogen, Richard
AU - Elshrek, Yousef
AU - Furst, Thomas
AU - Fahimi, Saman
AU - Fahrion, Anna
AU - Faraon, Emerito
AU - Fay, Derek
AU - Feigl, Andrea
AU - Feigin, Valery
AU - Ginawi, Ibrahim
AU - Giroud, Maurice
AU - Glaser, Elizabeth
AU - Goenka, Shifalika
AU - Dantes, Hector
AU - Gona, Philimon
AU - Gonzalez-Medina, Diego
AU - Guinovart, Caterina
AU - Gupta, Rahul
AU - Gosselin, Richard
AU - Gotay, Carolyn
AU - Goto, Atsushi
AU - Haagsma, Juanita
AU - Hafezi-Nejad, Nima
AU - Hagan, Holly
AU - Hagstromer, Maria
AU - Halasa, Yara
AU - Hamadeh, Randah
AU - Hamavid, Hannah
AU - Hammami, Mouhanad
AU - Hancock, Jamie
AU - Hankey, Graeme
AU - Hansen, Gillian
AU - Ohkubo, Takayoshi
AU - Iannarone, Marissa
AU - Iburg, Kim
AU - Idrisov, Bulat
AU - Ikeda, Nayu
AU - Innos, Kaire
AU - Inoue, Manami
AU - Islami, Farhad
AU - Jacobsen, Kathryn
AU - Jassal, Simerjot
AU - Jayaraman, Sudha
AU - Jensen, Paul
AU - Jha, Vivekanand
AU - Jiang, Guohong
AU - Jiang, Ying
AU - Jonas, Jost
AU - Joseph, Jonathan
AU - Juel, Knud
AU - Kabagambe, Edmond
AU - Kan, Haidong
AU - Karch, Andre
AU - Karimkhani, Chante
AU - Karthikeyan, Ganesan
AU - Kassebaum, Nicholas
AU - Kaul, Anil
AU - kawakami, Norito
AU - Kazanjan, Konstantin
AU - Kazi, Dhruv
AU - Kemp, Andrew
AU - Kengne, Andre
AU - Keren, Andre
AU - Kereselidze, Maia
AU - Khader, Yousef
AU - Kinfu, Yohannes
AU - Lalloo, Ratilal
AU - Lallukka, Tea
AU - Lam, Hilton
AU - Lan, Qing
AU - Lansingh, Van
AU - Larson, Heidi
AU - Larsson, Anders
AU - Lavados, Pablo
AU - Lawrynowicz, Alicia
AU - Leasher, Janet
AU - Lee, Jong-Tae
AU - Leigh, James
AU - Leinsalu, Mall
AU - Leung, Ricky
AU - Levitz, Carly
AU - Mahdi, Abbas
AU - Majdan, Marek
AU - Malekzadeh, Reza
AU - Mangalam, Srikanth
AU - Mapoma, Christopher
AU - Marape, Marape
AU - MArcenes, wagner
AU - Margono, Christopher
AU - Marks, Guy
AU - Marzan, Melvin
AU - Masci, Joseph
AU - Mashal, Mohammad
AU - Nangia, Vinay
AU - Narayan, K
AU - Nash, Denis
AU - Nejjari, Chakib
AU - Nasher, Jamal
AU - Nelson, Robert
AU - Neuhouser, Marian
AU - Neupane, Sudan
AU - Newcomb, Polly
AU - Newton, Charles
AU - Ng, Marie
AU - Ngalesoni, Frida
AU - Nguyen, Grant
AU - Nguyen, Nhung
AU - Nisar, Muhammad
AU - Odell, Shaun
AU - O'Donnell, Martin
AU - Ohno, Summer
AU - Olusanya, Bolajoko
AU - Omer, Saad
AU - Opio, John
AU - Orisakwe, Orish
AU - Ortblad, Katrina
AU - Ortiz, Alberto
AU - Otayza, Maria
AU - Pavlin, Boris
AU - Pearce, Niel
AU - Pellegrini, Carlos
AU - Pereira, David
AU - Peresson, Sophie
AU - Perez-Padilla, Rogelio
AU - Perez-Ruiz, Fernando
AU - Perico, Norberto
AU - Pervaiz, Aslam
AU - Pesudovs, Konrad
AU - Peterson, Carrie
AU - Petzold, Max
AU - Phillips, Bryan
AU - Qato, Dima
AU - Quezada, Amado
AU - Quistberg, D
AU - Raju, Murugesan
AU - Rakovac, Ivo
AU - Rana, Saleem
AU - Refaat, Amany
AU - Remuzzi, Giuseppe
AU - Ribeiro, Antonio
AU - Ricci, Stefano
AU - Riccio, Patricia
AU - Richardson, Lee
AU - Richardus, Jan
AU - Roberts, Bayard
AU - Saha, Sukanta
AU - Sahathevan, Ramesh
AU - Sahraian, Mohammad
AU - Sahle, Berhe
AU - Salomon, Joshua
AU - Salvo, Deborah
AU - Samonte, Genesis
AU - Sampson, Uchechukwu
AU - Sanabria, Juan
AU - Sandar, Logan
AU - Santos, Itamar
AU - Tenkorang, Eric
AU - Terkawi, Abdullah
AU - Thomas, Bernadette
AU - Thorne-Lyman, Andrew
AU - Thrift, Amanda
AU - Thurston, GEorge
AU - Tillmann, Taavi
AU - Tirschwell, David
AU - Tleyjeh, Imad
AU - Tonelli, Marcello
AU - Topouzis, Fotis
AU - Towbin, Jeffrey
AU - Ubeda, Clotilde
AU - Uchendu, Uche
AU - Undurraga, Eduardo
AU - Vallely, Andrew
AU - Van De Vijver, Steven
AU - Van Gool, Coen
AU - Varakin, Yuri
AU - Vasankari, Tommi
AU - Vasconcelos, Ana
AU - Wagner, Gregory
AU - Waller, Stephen
AU - Wang, Jianli
AU - Wang, Linhong
AU - Wang, XiaoRong
AU - Warouw, Tati
AU - Weichenthal, Scott
AU - Weiderpass, Elisabete
AU - Weintraub, Robert
AU - Wenzhi, Wang
AU - Xu, Gelin
AU - Yang, Rebecca
AU - Yano, Yuichiro
AU - Yatsuya, Hiroshi
AU - Yip, Paul
AU - Yonemoto, Naohiro
AU - Yoon, Seok-Jun
AU - Younis, Mustafa
AU - Yu, Chuanhua
AU - Zhu, Jun
AU - Zhu, Shankuan
AU - Zonies, Davies
AU - Zou, Xiao
AU - Zunt, Joseph
AU - Vos, Theo
AU - lopez, Alan
AU - Gosslin, R
AU - Karam, Nadim
AU - Sabin, Nsanzimana
AU - Temesgen, A
PY - 2015
Y1 - 2015
N2 - Background Up-to-date evidence on levels and trends for age-sex-specifi c all-cause and cause-specifi c mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specifi c all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specifi c causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute diff erences between countries decreased but relative diff erences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative diff erences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specifi c mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade
AB - Background Up-to-date evidence on levels and trends for age-sex-specifi c all-cause and cause-specifi c mortality is essential for the formation of global, regional, and national health policies. In the Global Burden of Disease Study 2013 (GBD 2013) we estimated yearly deaths for 188 countries between 1990, and 2013. We used the results to assess whether there is epidemiological convergence across countries. Methods We estimated age-sex-specifi c all-cause mortality using the GBD 2010 methods with some refinements to improve accuracy applied to an updated database of vital registration, survey, and census data. We generally estimated cause of death as in the GBD 2010. Key improvements included the addition of more recent vital registration data for 72 countries, an updated verbal autopsy literature review, two new and detailed data systems for China, and more detail for Mexico, UK, Turkey, and Russia. We improved statistical models for garbage code redistribution. We used six different modelling strategies across the 240 causes; cause of death ensemble modelling (CODEm) was the dominant strategy for causes with sufficient information. Trends for Alzheimer's disease and other dementias were informed by meta-regression of prevalence studies. For pathogen-specifi c causes of diarrhoea and lower respiratory infections we used a counterfactual approach. We computed two measures of convergence (inequality) across countries: the average relative difference across all pairs of countries (Gini coefficient) and the average absolute difference across countries. To summarise broad findings, we used multiple decrement life-tables to decompose probabilities of death from birth to exact age 15 years, from exact age 15 years to exact age 50 years, and from exact age 50 years to exact age 75 years, and life expectancy at birth into major causes. For all quantities reported, we computed 95% uncertainty intervals (UIs). We constrained cause-specific fractions within each age-sex-country-year group to sum to all-cause mortality based on draws from the uncertainty distributions. Findings Global life expectancy for both sexes increased from 65.3 years (UI 65.0-65.6) in 1990, to 71.5 years (UI 71.0-71.9) in 2013, while the number of deaths increased from 47.5 million (UI 46.8-48.2) to 54.9 million (UI 53.6-56.3) over the same interval. Global progress masked variation by age and sex: for children, average absolute diff erences between countries decreased but relative diff erences increased. For women aged 25-39 years and older than 75 years and for men aged 20-49 years and 65 years and older, both absolute and relative diff erences increased. Decomposition of global and regional life expectancy showed the prominent role of reductions in age-standardised death rates for cardiovascular diseases and cancers in high-income regions, and reductions in child deaths from diarrhoea, lower respiratory infections, and neonatal causes in low-income regions. HIV/AIDS reduced life expectancy in southern sub-Saharan Africa. For most communicable causes of death both numbers of deaths and age-standardised death rates fell whereas for most non-communicable causes, demographic shifts have increased numbers of deaths but decreased age-standardised death rates. Global deaths from injury increased by 10.7%, from 4.3 million deaths in 1990 to 4.8 million in 2013; but age-standardised rates declined over the same period by 21%. For some causes of more than 100 000 deaths per year in 2013, age-standardised death rates increased between 1990 and 2013, including HIV/AIDS, pancreatic cancer, atrial fibrillation and flutter, drug use disorders, diabetes, chronic kidney disease, and sickle-cell anaemias. Diarrhoeal diseases, lower respiratory infections, neonatal causes, and malaria are still in the top five causes of death in children younger than 5 years. The most important pathogens are rotavirus for diarrhoea and pneumococcus for lower respiratory infections. Country-specific probabilities of death over three phases of life were substantially varied between and within regions. Interpretation For most countries, the general pattern of reductions in age-sex specifi c mortality has been associated with a progressive shift towards a larger share of the remaining deaths caused by non-communicable disease and injuries. Assessing epidemiological convergence across countries depends on whether an absolute or relative measure of inequality is used. Nevertheless, age-standardised death rates for seven substantial causes are increasing, suggesting the potential for reversals in some countries. Important gaps exist in the empirical data for cause of death estimates for some countries; for example, no national data for India are available for the past decade
U2 - 10.1016/S0140-6736(14)61682-2
DO - 10.1016/S0140-6736(14)61682-2
M3 - Article
VL - 385
SP - 117
EP - 171
JO - Lancet
JF - Lancet
SN - 0140-6736
IS - 9963
ER -