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 - PubMed (original) (raw)

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

GBD 2016 Mortality Collaborators. Lancet. 2017.

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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.

Funding: Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.

Copyright © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.

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Figures

Figure 1

Figure 1

Estimated completeness of death registration, 1990–2016. Each square represents one location-year. Location-years in blue show complete vital registration systems. Shades of green show 80–95% completeness, whereas yellow, orange, and red show lower levels of completeness. Blank white squares indicate location-years without vital registration data in the GBD 2016 mortality database. Countries that are not shown have 0 years of VR data in the GBD 2016 mortality database.

Figure 1

Figure 1

Estimated completeness of death registration, 1990–2016. Each square represents one location-year. Location-years in blue show complete vital registration systems. Shades of green show 80–95% completeness, whereas yellow, orange, and red show lower levels of completeness. Blank white squares indicate location-years without vital registration data in the GBD 2016 mortality database. Countries that are not shown have 0 years of VR data in the GBD 2016 mortality database.

Figure 1

Figure 1

Estimated completeness of death registration, 1990–2016. Each square represents one location-year. Location-years in blue show complete vital registration systems. Shades of green show 80–95% completeness, whereas yellow, orange, and red show lower levels of completeness. Blank white squares indicate location-years without vital registration data in the GBD 2016 mortality database. Countries that are not shown have 0 years of VR data in the GBD 2016 mortality database.

Figure 1

Figure 1

Estimated completeness of death registration, 1990–2016. Each square represents one location-year. Location-years in blue show complete vital registration systems. Shades of green show 80–95% completeness, whereas yellow, orange, and red show lower levels of completeness. Blank white squares indicate location-years without vital registration data in the GBD 2016 mortality database. Countries that are not shown have 0 years of VR data in the GBD 2016 mortality database.

Figure 1

Figure 1

Estimated completeness of death registration, 1990–2016. Each square represents one location-year. Location-years in blue show complete vital registration systems. Shades of green show 80–95% completeness, whereas yellow, orange, and red show lower levels of completeness. Blank white squares indicate location-years without vital registration data in the GBD 2016 mortality database. Countries that are not shown have 0 years of VR data in the GBD 2016 mortality database.

Figure 1

Figure 1

Estimated completeness of death registration, 1990–2016. Each square represents one location-year. Location-years in blue show complete vital registration systems. Shades of green show 80–95% completeness, whereas yellow, orange, and red show lower levels of completeness. Blank white squares indicate location-years without vital registration data in the GBD 2016 mortality database. Countries that are not shown have 0 years of VR data in the GBD 2016 mortality database.

Figure 2

Figure 2

Global deaths by age group, 1970, 2000, and 2016 Each bar represents the total number of deaths in the given year in the specified age group.

Figure 3

Figure 3

Annualised rates of change in age-specific mortality rates for 195 countries and territories Each point represents the annualised rate of change for a location grouped by age group and sex for (A) 1970–80, (B) 1980–90, (C) 1990–2000, and (D) 2000–16.

Figure 4

Figure 4

Age-standardised mortality rates, 1970–2016 Each line represents the trend in age-standardised mortality rates from 1970 to 2016 by SDI quintile. Values shown above the lines are ratios between the given SDI quintile and high SDI.

Figure 5

Figure 5

Correlation between the log of age-specific mortality rates in 1970 and (A) annualised (relative) rates of change and (B) absolute change, 1970–2016 Each bar represents the correlation between the log of age-specific mortality rate in 1970 and the change in the age-specific mortality rate from 1970 to 2016, for 195 countries and territories, by sex. Black lines represent 95% uncertainty intervals.

Figure 6

Figure 6

Life expectancy at birth, by sex, and fit of expected value based on SDI, 1970–2016 Each point represents life expectancy at birth in a single location-year by that location's SDI in the given year, coloured by decade. SDI in most locations has increased year on year, so points from earlier years are associated with lower SDI in most cases. The black lines indicate expected values based on SDI. SDI=Socio-demographic Index.

Figure 7

Figure 7

Differences between male and female life expectancy at birth by SDI, 1970–2016 Each point represents the gap in life expectancy at birth between males and females in a single location and year. The black line shows the global trend by SDI. SDI=Socio-demographic Index.

Figure 8

Figure 8

Difference between observed and expected life expectancy at birth on the basis of SDI alone for countries and territories, and subnational units in Brazil, China, India, Indonesia, and the USA, by sex, 1970–2016 Each point represents the observed minus the expected life expectancy for each location in the given year, by sex. Points are colour-coded by range of years with squares representing males and triangles representing females. The 0 line represents no difference between observed life expectancy and the value expected on the basis of SDI. Solid points represent significant differences and hollow points represent differences that are not significant. Locations are in decreasing order by average male and female difference between observed and expected life expectancy at birth in 2016. SDI=Socio-demographic Index.

Figure 8

Figure 8

Difference between observed and expected life expectancy at birth on the basis of SDI alone for countries and territories, and subnational units in Brazil, China, India, Indonesia, and the USA, by sex, 1970–2016 Each point represents the observed minus the expected life expectancy for each location in the given year, by sex. Points are colour-coded by range of years with squares representing males and triangles representing females. The 0 line represents no difference between observed life expectancy and the value expected on the basis of SDI. Solid points represent significant differences and hollow points represent differences that are not significant. Locations are in decreasing order by average male and female difference between observed and expected life expectancy at birth in 2016. SDI=Socio-demographic Index.

Figure 8

Figure 8

Difference between observed and expected life expectancy at birth on the basis of SDI alone for countries and territories, and subnational units in Brazil, China, India, Indonesia, and the USA, by sex, 1970–2016 Each point represents the observed minus the expected life expectancy for each location in the given year, by sex. Points are colour-coded by range of years with squares representing males and triangles representing females. The 0 line represents no difference between observed life expectancy and the value expected on the basis of SDI. Solid points represent significant differences and hollow points represent differences that are not significant. Locations are in decreasing order by average male and female difference between observed and expected life expectancy at birth in 2016. SDI=Socio-demographic Index.

Figure 8

Figure 8

Difference between observed and expected life expectancy at birth on the basis of SDI alone for countries and territories, and subnational units in Brazil, China, India, Indonesia, and the USA, by sex, 1970–2016 Each point represents the observed minus the expected life expectancy for each location in the given year, by sex. Points are colour-coded by range of years with squares representing males and triangles representing females. The 0 line represents no difference between observed life expectancy and the value expected on the basis of SDI. Solid points represent significant differences and hollow points represent differences that are not significant. Locations are in decreasing order by average male and female difference between observed and expected life expectancy at birth in 2016. SDI=Socio-demographic Index.

Figure 8

Figure 8

Difference between observed and expected life expectancy at birth on the basis of SDI alone for countries and territories, and subnational units in Brazil, China, India, Indonesia, and the USA, by sex, 1970–2016 Each point represents the observed minus the expected life expectancy for each location in the given year, by sex. Points are colour-coded by range of years with squares representing males and triangles representing females. The 0 line represents no difference between observed life expectancy and the value expected on the basis of SDI. Solid points represent significant differences and hollow points represent differences that are not significant. Locations are in decreasing order by average male and female difference between observed and expected life expectancy at birth in 2016. SDI=Socio-demographic Index.

Figure 8

Figure 8

Difference between observed and expected life expectancy at birth on the basis of SDI alone for countries and territories, and subnational units in Brazil, China, India, Indonesia, and the USA, by sex, 1970–2016 Each point represents the observed minus the expected life expectancy for each location in the given year, by sex. Points are colour-coded by range of years with squares representing males and triangles representing females. The 0 line represents no difference between observed life expectancy and the value expected on the basis of SDI. Solid points represent significant differences and hollow points represent differences that are not significant. Locations are in decreasing order by average male and female difference between observed and expected life expectancy at birth in 2016. SDI=Socio-demographic Index.

Figure 8

Figure 8

Difference between observed and expected life expectancy at birth on the basis of SDI alone for countries and territories, and subnational units in Brazil, China, India, Indonesia, and the USA, by sex, 1970–2016 Each point represents the observed minus the expected life expectancy for each location in the given year, by sex. Points are colour-coded by range of years with squares representing males and triangles representing females. The 0 line represents no difference between observed life expectancy and the value expected on the basis of SDI. Solid points represent significant differences and hollow points represent differences that are not significant. Locations are in decreasing order by average male and female difference between observed and expected life expectancy at birth in 2016. SDI=Socio-demographic Index.

Figure 8

Figure 8

Difference between observed and expected life expectancy at birth on the basis of SDI alone for countries and territories, and subnational units in Brazil, China, India, Indonesia, and the USA, by sex, 1970–2016 Each point represents the observed minus the expected life expectancy for each location in the given year, by sex. Points are colour-coded by range of years with squares representing males and triangles representing females. The 0 line represents no difference between observed life expectancy and the value expected on the basis of SDI. Solid points represent significant differences and hollow points represent differences that are not significant. Locations are in decreasing order by average male and female difference between observed and expected life expectancy at birth in 2016. SDI=Socio-demographic Index.

Figure 8

Figure 8

Difference between observed and expected life expectancy at birth on the basis of SDI alone for countries and territories, and subnational units in Brazil, China, India, Indonesia, and the USA, by sex, 1970–2016 Each point represents the observed minus the expected life expectancy for each location in the given year, by sex. Points are colour-coded by range of years with squares representing males and triangles representing females. The 0 line represents no difference between observed life expectancy and the value expected on the basis of SDI. Solid points represent significant differences and hollow points represent differences that are not significant. Locations are in decreasing order by average male and female difference between observed and expected life expectancy at birth in 2016. SDI=Socio-demographic Index.

Figure 9

Figure 9

Difference in estimates of life expectancy at birth between GBD 2016 and other sources, 2015 Each point represents the difference between GBD 2016 estimates of life expectancy at birth minus the life expectancy at birth estimated by the indicated sources for each country in 2015, the most recent year with estimates by all sources, by sex. Points are colour-coded by source with squares representing males and triangles representing females. The line at 0 represents no difference between the life expectancy at birth calculated in GBD 2016 and that calculated by the indicated source.

Figure 9

Figure 9

Difference in estimates of life expectancy at birth between GBD 2016 and other sources, 2015 Each point represents the difference between GBD 2016 estimates of life expectancy at birth minus the life expectancy at birth estimated by the indicated sources for each country in 2015, the most recent year with estimates by all sources, by sex. Points are colour-coded by source with squares representing males and triangles representing females. The line at 0 represents no difference between the life expectancy at birth calculated in GBD 2016 and that calculated by the indicated source.

Figure 9

Figure 9

Difference in estimates of life expectancy at birth between GBD 2016 and other sources, 2015 Each point represents the difference between GBD 2016 estimates of life expectancy at birth minus the life expectancy at birth estimated by the indicated sources for each country in 2015, the most recent year with estimates by all sources, by sex. Points are colour-coded by source with squares representing males and triangles representing females. The line at 0 represents no difference between the life expectancy at birth calculated in GBD 2016 and that calculated by the indicated source.

Figure 9

Figure 9

Difference in estimates of life expectancy at birth between GBD 2016 and other sources, 2015 Each point represents the difference between GBD 2016 estimates of life expectancy at birth minus the life expectancy at birth estimated by the indicated sources for each country in 2015, the most recent year with estimates by all sources, by sex. Points are colour-coded by source with squares representing males and triangles representing females. The line at 0 represents no difference between the life expectancy at birth calculated in GBD 2016 and that calculated by the indicated source.

Figure 9

Figure 9

Difference in estimates of life expectancy at birth between GBD 2016 and other sources, 2015 Each point represents the difference between GBD 2016 estimates of life expectancy at birth minus the life expectancy at birth estimated by the indicated sources for each country in 2015, the most recent year with estimates by all sources, by sex. Points are colour-coded by source with squares representing males and triangles representing females. The line at 0 represents no difference between the life expectancy at birth calculated in GBD 2016 and that calculated by the indicated source.

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