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AuthorNaghavi, Mohsen
AuthorOng, Kanyin Liane
AuthorAali, Amirali
AuthorAbabneh, Hazim S.
AuthorAbate, Yohannes Habtegiorgis
AuthorAbbafati, Cristiana
AuthorAbbasgholizadeh, Rouzbeh
AuthorAbbasian, Mohammadreza
AuthorAbbasi-Kangevari, Mohsen
AuthorAbbastabar, Hedayat
AuthorAbd ElHafeez, Samar
AuthorAbdelmasseh, Michael
AuthorAbd-Elsalam, Sherief
AuthorAbdelwahab, Ahmed
AuthorAbdollahi, Mohammad
AuthorAbdollahifar, Mohammad Amin
AuthorAbdoun, Meriem
AuthorAbdulah, Deldar Morad
AuthorAbdullahi, Auwal
AuthorAbebe, Mesfin
AuthorAbebe, Samrawit Shawel
AuthorAbedi, Aidin
AuthorAbegaz, Kedir Hussein
AuthorAbhilash, E. S.
AuthorAbidi, Hassan
AuthorAbiodun, Olumide
AuthorAboagye, Richard Gyan
AuthorAbolhassani, Hassan
AuthorAbolmaali, Meysam
AuthorAbouzid, Mohamed
AuthorAboye, Girma Beressa
AuthorAbreu, Lucas Guimarães
AuthorAbrha, Woldu Aberhe
AuthorAbtahi, Dariush
AuthorAbu Rumeileh, Samir
AuthorAbualruz, Hasan
AuthorAbubakar, Bilyaminu
AuthorAbu-Gharbieh, Eman
AuthorAbu-Rmeileh, Niveen ME
AuthorAburuz, Salahdein
AuthorAbu-Zaid, Ahmed
AuthorAccrombessi, Manfred Mario Kokou
AuthorAdal, Tadele Girum
AuthorAdamu, Abdu A.
AuthorAddo, Isaac Yeboah
AuthorAddolorato, Giovanni
AuthorAdebiyi, Akindele Olupelumi
AuthorAdekanmbi, Victor
AuthorAdepoju, Abiola Victor
AuthorAdetunji, Charles Oluwaseun
AuthorAdetunji, Juliana Bunmi
AuthorAdeyeoluwa, Temitayo Esther
AuthorAdeyinka, Daniel Adedayo
AuthorAdeyomoye, Olorunsola Israel
AuthorAdmass, Biruk Adie Adie
AuthorAdnani, Qorinah Estiningtyas Sakilah
AuthorAdra, Saryia
AuthorAfolabi, Aanuoluwapo Adeyimika
AuthorAfzal, Muhammad Sohail
AuthorAfzal, Saira
AuthorAgampodi, Suneth Buddhika
AuthorAgasthi, Pradyumna
AuthorAggarwal, Manik
AuthorAghamiri, Shahin
AuthorAgide, Feleke Doyore
AuthorAgodi, Antonella
AuthorAgrawal, Anurag
AuthorAgyemang-Duah, Williams
AuthorAhinkorah, Bright Opoku
AuthorAhmad, Aqeel
AuthorAhmad, Danish
AuthorAhmad, Firdos
AuthorAhmad, Muayyad M.
AuthorAhmad, Sajjad
AuthorAhmad, Shahzaib
AuthorAhmad, Tauseef
AuthorAhmadi, Keivan
AuthorAhmadzade, Amir Mahmoud
AuthorAhmed, Ali
AuthorAhmed, Ayman
AuthorAhmed, Haroon
AuthorAhmed, Luai A.
AuthorAhmed, Mehrunnisha Sharif
AuthorAhmed, Meqdad Saleh
AuthorAhmed, Muktar Beshir
AuthorAhmed, Syed Anees
AuthorAjami, Marjan
AuthorAji, Budi
AuthorAkara, Essona Matatom
AuthorAkbarialiabad, Hossein
AuthorAkinosoglou, Karolina
AuthorAkinyemiju, Tomi
AuthorAkkaif, Mohammed Ahmed
AuthorAkyirem, Samuel
AuthorAl Hamad, Hanadi
AuthorAl Hasan, Syed Mahfuz
AuthorAlahdab, Fares
AuthorAlalalmeh, Samer O.
AuthorAlalwan, Tariq A.
AuthorAl-Aly, Ziyad
Available date2024-04-16T06:41:10Z
Publication Date2024-01-01
Publication NameThe Lancet
Identifierhttp://dx.doi.org/10.1016/S0140-6736(24)00367-2
ISSN01406736
URIhttps://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85189898702&origin=inward
URIhttp://hdl.handle.net/10576/53897
AbstractBackground: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Funding: Bill & Melinda Gates Foundation.
Languageen
PublisherElsevier
SubjectGlobal burden
life expectancy decomposition
Disease Study 2021
TitleGlobal burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021
TypeArticle
ESSN1474-547X
dc.accessType Open Access


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