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

Christopher Murray, Haidong wang, Rafael Lozano, Adrian Davis, Xiaofeng Liang, Maigeng Zhou, Stein Vollset, Ayse Abbasoglu Ozgoren, Safa Abdalla, Foad Abd-Allah, Muna Aziz, Semaw Ferede Abera, Victor Aboyans, Biju Abraham, Katrina Abuabara, Ibrahim Abubakar, Laith Abu-Raddad, Niveen Abu-Rmeileh, Tom Achoki, Ademola Adelekan & 271 others Zanfina Ademi, Koranteng Adofo, Arsene Adou, Jose Adsuar, Johan Arnlov, Mazin Al Khabouri, Deena Alasfoor, Mohammed Albittar, Miguel Alegretti, Alicia Aleman, Zewdie Aderaw Alemu, Rafael Alfonso-Cristancho, Samia Alhabib, Mohammed Ali, Raghib Ali, Francois Alla, Faris Al Lami, Peter Allebeck, Mohammad AlMazroa, Rustam Al-Shahi Salman, Ubai Alsharif, Elena Alvarez, Nelson Alviz-Guzman, Adansi Amankwaa, Alaa Badawi, Maria Bahit, Talal Bakfalouni, Kalpana Balakrishnan, Shivanthi Balalla, Amitava Banerjee, Ryan Barber, Suzanne Barker-Collo, Simon Barquera, Lars Barregard, Lope Barrero, Tonatiuh Barrientos-Gutierrez, Arindam Basu, Mohammed Basulaiman, Justin Beardsley, Fiona Charlson, Xuan Che, Honglei Chen, Yingyao Chen, Jian Sheng Chen, Zhengming Chen, Peggy Chiang, Odgerel Chimed-Ochir, Rajiv Chowdhury, Hanne Christensen, Costas Christophi, Kebede Deribe, Don Jarlais, Muluken Dessalegn, Gabrielle DeVeber, Samath Dharmaratne, Jose-Luis Diaz-Ortega, Cesar Diaz-Torne, Daniel Dicker, Eric Ding, Klara Dokova, E Dorsey, Tim Driscoll, Leilei Duan, Karen Edmond, Richard Ellenbogen, Yousef Elshrek, Thomas Furst, Saman Fahimi, Anna Fahrion, Emerito Faraon, Derek Fay, Andrea Feigl, Valery Feigin, Ibrahim Ginawi, Maurice Giroud, Elizabeth Glaser, Shifalika Goenka, Hector Dantes, Philimon Gona, Diego Gonzalez-Medina, Caterina Guinovart, Rahul Gupta, Richard Gosselin, Carolyn Gotay, Atsushi Goto, Juanita Haagsma, Nima Hafezi-Nejad, Holly Hagan, Maria Hagstromer, Yara Halasa, Randah Hamadeh, Hannah Hamavid, Mouhanad Hammami, Jamie Hancock, Graeme Hankey, Gillian Hansen, Takayoshi Ohkubo, Marissa Iannarone, Kim Iburg, Bulat Idrisov, Nayu Ikeda, Kaire Innos, Manami Inoue, Farhad Islami, Kathryn Jacobsen, Simerjot Jassal, Sudha Jayaraman, Paul Jensen, Vivekanand Jha, Guohong Jiang, Ying Jiang, Jost Jonas, Jonathan Joseph, Knud Juel, Edmond Kabagambe, Haidong Kan, Andre Karch, Chante Karimkhani, Ganesan Karthikeyan, Nicholas Kassebaum, Anil Kaul, Norito kawakami, Konstantin Kazanjan, Dhruv Kazi, Andrew Kemp, Andre Kengne, Andre Keren, Maia Kereselidze, Yousef Khader, Yohannes Kinfu, Ratilal Lalloo, Tea Lallukka, Hilton Lam, Qing Lan, Van Lansingh, Heidi Larson, Anders Larsson, Pablo Lavados, Alicia Lawrynowicz, Janet Leasher, Jong-Tae Lee, James Leigh, Mall Leinsalu, Ricky Leung, Carly Levitz, Abbas Mahdi, Marek Majdan, Reza Malekzadeh, Srikanth Mangalam, Christopher Mapoma, Marape Marape, wagner MArcenes, Christopher Margono, Guy Marks, Melvin Marzan, Joseph Masci, Mohammad Mashal, Vinay Nangia, K Narayan, Denis Nash, Chakib Nejjari, Jamal Nasher, Robert Nelson, Marian Neuhouser, Sudan Neupane, Polly Newcomb, Charles Newton, Marie Ng, Frida Ngalesoni, Grant Nguyen, Nhung Nguyen, Muhammad Nisar, Shaun Odell, Martin O'Donnell, Summer Ohno, Bolajoko Olusanya, Saad Omer, John Opio, Orish Orisakwe, Katrina Ortblad, Alberto Ortiz, Maria Otayza, Boris Pavlin, Niel Pearce, Carlos Pellegrini, David Pereira, Sophie Peresson, Rogelio Perez-Padilla, Fernando Perez-Ruiz, Norberto Perico, Aslam Pervaiz, Konrad Pesudovs, Carrie Peterson, Max Petzold, Bryan Phillips, Dima Qato, Amado Quezada, D Quistberg, Murugesan Raju, Ivo Rakovac, Saleem Rana, Amany Refaat, Giuseppe Remuzzi, Antonio Ribeiro, Stefano Ricci, Patricia Riccio, Lee Richardson, Jan Richardus, Bayard Roberts, Sukanta Saha, Ramesh Sahathevan, Mohammad Sahraian, Berhe Sahle, Joshua Salomon, Deborah Salvo, Genesis Samonte, Uchechukwu Sampson, Juan Sanabria, Logan Sandar, Itamar Santos, Eric Tenkorang, Abdullah Terkawi, Bernadette Thomas, Andrew Thorne-Lyman, Amanda Thrift, GEorge Thurston, Taavi Tillmann, David Tirschwell, Imad Tleyjeh, Marcello Tonelli, Fotis Topouzis, Jeffrey Towbin, Clotilde Ubeda, Uche Uchendu, Eduardo Undurraga, Andrew Vallely, Steven Van De Vijver, Coen Van Gool, Yuri Varakin, Tommi Vasankari, Ana Vasconcelos, Gregory Wagner, Stephen Waller, Jianli Wang, Linhong Wang, XiaoRong Wang, Tati Warouw, Scott Weichenthal, Elisabete Weiderpass, Robert Weintraub, Wang Wenzhi, Gelin Xu, Rebecca Yang, Yuichiro Yano, Hiroshi Yatsuya, Paul Yip, Naohiro Yonemoto, Seok-Jun Yoon, Mustafa Younis, Chuanhua Yu, Jun Zhu, Shankuan Zhu, Davies Zonies, Xiao Zou, Joseph Zunt, Theo Vos, Alan lopez, R Gosslin, Nadim Karam, Nsanzimana Sabin, A Temesgen

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    Abstract

    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
    Original languageEnglish
    Pages (from-to)117-171
    Number of pages55
    JournalLancet
    Volume385
    Issue number9963
    DOIs
    Publication statusPublished - 2015

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