Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980-2017: a systematic analysis for the Global Burden of Disease Study 2017
GBD 2017 Causes of Death Collaborators
Abstract
Background: Global development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017.
Methods: The causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries-Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised.
Findings: At the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5-74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9-19·6), and injuries 8·0% (7·7-8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5-23·9), representing an additional 7·61 million (7·20-8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0-8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0-24·0) and the death rate by 31·8% (30·1-33·3). Total deaths from injuries increased by 2·3% (0·5-4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2-15·1) to 57·9 deaths (55·9-59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000-289 000) globally in 2007 to 352 000 (334 000-363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8-148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2-40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2-36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990-neonatal disorders, lower respiratory infections, and diarrhoeal diseases-were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases.
Interpretation: Improvements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade.
Funding: Bill & Melinda Gates Foundation.
Copyright © 2018 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.
Figures
References
- Alter GC, Carmichael AG. Classifying the dead: toward a history of the registration of causes of death. J Hist Med Allied Sci. 1999;54:114–132.
- WHO Family of international classifications. June 18, 2018.
- AbouZahr C, De Savigny D, Mikkelsen L. Civil registration and vital statistics: progress in the data revolution for counting and accountability. Lancet. 2015;386:1373–1385.
- Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW. Trends and patterns of geographic variation in mortality from substance use disorders and intentional injuries among US counties, 1980–2014. JAMA. 2018;319:1013–1023.
- Shkolnikov V, McKee M, Leon DA. Changes in life expectancy in Russia in the mid-1990s. Lancet. 2001;357:917–921.
- Mokdad AH. Intentional injuries in the Eastern Mediterranean Region, 1990–2015: findings from the Global Burden of Disease 2015 study. Int J Public Health. 2017;63:1–8.
- Lefeuvre D, Pavillon G, Aouba A. Quality comparison of electronic versus paper death certificates in France, 2010. Popul Health Metr. 2014;12:3.
- Bancroft EA, Lee S. Use of electronic death certificates for influenza death surveillance. Emerg Infect Dis. 2014;20:78.
- WHO SDG 3: ensure healthy lives and promote wellbeing for all at all ages.
- WHO Moscow Declaration to end TB. November, 2017.
- WHO WHO's First Global Conference on Air Pollution and Health. 30 October – 1 November 2018.
- WHO Noncommunicable diseases and their risk factors. Third UN high-level meeting on NCDs. 2018.
- WHO UN General Assembly high-level meeting on ending TB. Tuberculosis.
- GBD 2017 Population and Fertility Collaborators Population and fertility by age and sex for 195 countries, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1995–2051.
- Stevens GA, Alkema L, Black RE. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. Lancet. 2016;388:e19–e23.
- Naghavi M, Makela S, Foreman K, O'Brien J, Pourmalek F, Lozano R. Algorithms for enhancing public health utility of national causes-of-death data. Popul Health Metr. 2010;8:9.
- Janssen F, Kunst AE. ICD coding changes and discontinuities in trends in cause-specific mortality in six European countries, 1950–99. Bull World Health Organ. 2004;82:904–913.
- GBD 2016 Causes of Death Collaborators Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study. Lancet. 2017;390:1151–1210.
- Kotloff KL, Blackwelder WC, Nasrin D. The Global Enteric Multicenter Study (GEMS) of diarrheal disease in infants and young children in developing countries: epidemiologic and clinical methods of the case/control study. Clin Infect Dis. 2012;55:S232–S245.
- Das Gupta P. Standardization and decomposition of rates: a user's manual. 1993.
- Flaxman AD, Vos T, Murray CJ. University of Washington Press; Seattle: 2015. An integrative metaregression framework for descriptive epidemiology.
- GBD 2017 Mortality Collaborators Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1684–1735.
- GBD 2017 Risk Factor Collaborators Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1923–1994.
- GBD 2015 Obesity Collaborators Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27.
- Younossi Z, Anstee QM, Marietti M. Global burden of NAFLD and NASH: trends, predictions, risk factors and prevention. Nat Rev Gastroenterol Hepatol. 2018;15:11.
- Swinburn BA, Sacks G, Hall KD. The global obesity pandemic: shaped by global drivers and local environments. Lancet. 2011;378:804–814.
- Roth GA, Nguyen G, Forouzanfar MH, Mokdad AH, Naghavi M, Murray CJ. Estimates of global and regional premature cardiovascular mortality in 2025. Circulation. 2015;132:1270–1282.
- Roberto CA, Swinburn B, Hawkes C. Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. Lancet. 2015;385:2400–2409.
- WHO . World Health Organization; Geneva: 2013. Global nutrition policy review: what does it take to scale up nutrition action?
- Fleming DM, Elliot AJ. Lessons from 40 years' surveillance of influenza in England and Wales. Epidemiol Infect. 2008;136:866–875.
- Lessa FC, Mu Y, Bamberg WM. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372:825–834.
- Van Boeckel TP, Gandra S, Ashok A. Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data. Lancet Infect Dis. 2014;14:742–750.
- Hay SI, Rao PC, Dolecek C. Measuring and mapping the global burden of antimicrobial resistance. BMC Med. 2018;16:78.
- Fujita K, Shinomoto S, Rocha LE. Correlations and forecast of death tolls in the Syrian conflict. Sci Rep. 2017;7:15737.
- Murray CJ, King G, Lopez AD, Tomijima N, Krug EG. Armed conflict as a public health problem. BMJ. 2002;324:346–349.
- Nkengasong JN, Maiyegun O, Moeti M. Establishing the Africa Centres for Disease Control and Prevention: responding to Africa's health threats. Lancet Glob Health. 2017;5:e246–e247.
- Blencowe H, Kancherla V, Moorthie S, Darlison MW, Modell B. Estimates of global and regional prevalence of neural tube defects for 2015: a systematic analysis. Ann NY Acad Sci. 2018;1414:31–46.
- WHO . World Health Organization; Geneva: 2013. Global action plan for the prevention and control of NCDs 2013–2020.
- Tian M, Ajay V, Dunzhu D. A cluster-randomized controlled trial of a simplified multifaceted management program for individuals at high cardiovascular risk (SimCard Trial) in rural Tibet, China, and Haryana, India. Circulation. 2015;132:815–824.
- Wirtz VJ, Hogerzeil HV, Gray AL. Essential medicines for universal health coverage. Lancet. 2017;389:403–476.
- Wong JQ, Uy J, Haw NJL. Priority setting for health service coverage decisions supported by public spending: experience from the Philippines. Health Syst Reform. 2018;4:19–29.
- British Columbia Coroner's Service . Office of the Chief Coroner, Ministry of Public Safety and Solicitor; Burnaby, British Columbia: 2018. Fentanyl-detected illicit drug overdose deaths January 1, 2012 to March 31, 2018.
- Mounteney J, Giraudon I, Denissov G, Griffiths P. Fentanyls: are we missing the signs? Highly potent and on the rise in Europe. Int J Drug Policy. 2015;26:626–631.
- Berterame S, Erthal J, Thomas J. Use of and barriers to access to opioid analgesics: a worldwide, regional, and national study. Lancet. 2016;387:1644–1656.
- Prekupec MP, Mansky PA, Baumann MH. Misuse of novel synthetic opioids: a deadly new trend. J Addict Med. 2017;11:256.
- Kickbusch I. Global health governance challenges 2016—are we ready? Int J Health Policy Manag. 2016;5:349–353.
- Reinhart K, Daniels R, Kissoon N, Machado FR, Schachter RD, Finfer S. Recognizing sepsis as a global health priority—a WHO resolution. N Engl J Med. 2017;377:414–417.
- Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health. 2011;11:770.
- Taylor AL. Addressing the global tragedy of needless pain: rethinking the United Nations single convention on narcotic drugs. J Law Med Ethics. 2007;35:556–570. 511.
- Chaudhary NK, Connolly J, Tison J, Solomon M, Elliott KR. National Highway Traffic Safety Administration; Washington, DC: 2015. Evaluation of NHTSA distracted driving high-visibility enforcement demonstration projects in California and Delaware.
- Wang SY, Li YH, Chi GB. Injury-related fatalities in China: an under-recognised public-health problem. Lancet. 2008;372:1765–1773.
- Plummer M, de Martel C, Vignat J, Ferlay J, Bray F, Franceschi S. Global burden of cancers attributable to infections in 2012: a synthetic analysis. Lancet Glob Health. 2016;4:e609–e616.
- Foreman K, Marquez N, Dolgert A. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories. Lancet. 2018;392:2052–2090.
- Goff DA, Kullar R, Goldstein EJC. A global call from five countries to collaborate in antibiotic stewardship: united we succeed, divided we might fail. Lancet Infect Dis. 2017;17:e56–e63.
- Martyn CN, Pippard EC. Usefulness of mortality data in determining the geography and time trends of dementia. J Epidemiol Community Health. 1988;42:134–137.
- GBD 2015 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1545–1602.
- Langa KM. Is the risk of Alzheimer's disease and dementia declining? Alzheimers Res Ther. 2015;7:34.
- Brookmeyer R, Evans DA, Hebert L. National estimates of the prevalence of Alzheimer's disease in the United States. Alzheimers Dement. 2011;7:61–73.
- Matthews FE, Arthur A, Barnes LE. A two-decade comparison of prevalence of dementia in individuals aged 65 years and older from three geographical areas of England: results of the Cognitive Function and Ageing Study I and II. Lancet. 2013;382:1405–1412.
- Rocca WA, Petersen RC, Knopman DS. Trends in the incidence and prevalence of Alzheimer's disease, dementia, and cognitive impairment in the United States. Alzheimers Dement. 2011;7:80–93.
- Adewemimo A, Kalter HD, Perin J, Koffi AK, Quinley J, Black RE. Direct estimates of cause-specific mortality fractions and rates of under-five deaths in the northern and southern regions of Nigeria by verbal autopsy interview. PLoS One. 2017;12:e0178129.
- Bray F, Colombet M, Mery L, editors. Cancer incidence in five continents. International Agency for Research on Cancer; Lyon: 2017.
- Mahy M, Penazzato M, Ciaranello A. Improving estimates of children living with HIV from the Spectrum AIDS Impact Model. AIDS. 2017;31:S13–S22.
- WHO . World Health Organization; Geneva: 2018. World malaria report 2017. WHO Global Malaria Programme.
- WHO Global hepatitis report. 2017.
- WHO MCEE-WHO methods and data sources for child causes of death 2000–2015. Department of Evidence, Information and Research (WHO, Geneva) and Maternal Child Epidemiology Estimation (MCEE) February, 2018.
- Iuliano AD, Roguski KM, Chang HH. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study. Lancet. 2018;391:1285–1300.
- WHO . World Health Organization; Geneva: 2015. Trends in maternal mortality: 1990–2015: estimates from WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division.
- Ferlay J, Soerjomataram I, Ervik M. International Agency for Research on Cancer; Lyon: 2017. GLOBOCAN 2012 v1.0: Estimated cancer incidence, mortality and prevalence worldwide in 2012.
- Manthey J, Probst C, Rylett M, Rehm J. National, regional and global mortality due to alcoholic cardiomyopathy in 2015. Heart. 2018 doi: 10.1136/heartjnl-2017-312384. published online March 13.
- WHO Road safety: estimated number of road traffic deaths. 2013.
- WHO Falls. Jan 16, 2018.
- WHO Suicide data.
- Riley WJ, Beitsch LM, Parsons HM, Moran JW. Quality improvement in public health: where are we now? J Public Health Manag Pract. 2010;16:1–2.
Source: PubMed