Abstract
Background Up-to-date evidence on levels and trends for age-sex-specific all-cause and cause-specific 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-specific 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-specific 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 differences between countries decreased but relative differences 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 differences 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 specific 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. Funding Bill & Melinda Gates Foundation.
| Original language | English |
|---|---|
| Pages (from-to) | 117-171 |
| Number of pages | 55 |
| Journal | The Lancet |
| Volume | 385 |
| Issue number | 9963 |
| DOIs | |
| Publication status | Published - 10 Jan 2015 |
Bibliographical note
Funding Information:BDG works for AMP, which receives grant support for vaccine and immunisation related work from Crucell, GlaxoSmithKline, Merck, Novartis, Pfizer, and Sanofi Pasteur; however, none of this support is for work related to the present report. KJ reports has consulted for GlaxoSmithKline on projects outside the submitted work. WM is program analyst at the UNFPA country office in Peru, which does not necessarily endorse the study. JAS has received research grants from Takeda and Savient and consultant fees from Savient, Takeda, Regeneron, and Allergan. JAS is a member of the executive of OMERACT, which receives funding from 36 companies; a member of the American College of Rheumatology's Guidelines Subcommittee of the Quality of Care Committee; and a member of the Veterans Affairs Rheumatology Field Advisory Committee. RFG is associate editor of Annals of Epidemiology for which he receives a stipend. CK receives research grants from Brazilian public funding agencies Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), and Fundação de Amparo à Pesquisa do Estado do Rio Grande do Sul (FAPERGS). He has also received authorship royalties from publishers Artmed and Manole. GR has consultancy agreements with Alexion Pharmaceuticals, Reata Pharmaceuticals, Bayer Healthcare, and Novartis Pharma, and is a member of the Abbvie Atrasentan Steering Committee; GR does not accept personal remuneration, compensations are paid to his institution for research and educational activities. MDH has received research support from the National Heart, Lung, and Blood Institute and World Heart Federation for its Emerging Leaders program, which is supported by unrestricted educational grants from AstraZeneca and Boehringer Ingelheim. FP-R has received investigation grants from Ministerio de Sanidad, Gobierno de España, Asociación de Reumatólogos del Hospital de Cruces, Fundación Española de Reumatología; has been a consultant (with or without payment) for Astra-Zeneca, Menarini, Metabolex, Ardea Biosciences, SOBI, Novartis, and Pfizer; and has been a speaker for AstraZeneca and Menarini. KBG received the NHMRC-Gustav Nossai scholarship sponsored by CSL Behring in 2013. MGS has previously served as consultant for Ethicon on global surgery. PJ is supported by a career development fellowship from the Wellcome Trust, Public Health Foundation of India, and a consortium of UK universities. DAQ was supported by The Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (number 5T32HD057822). AK has received institutional support (intramural funding) from the Oklahoma State University Center for Health Sciences. RAL receives funding through the Farr Institute of Health Informatics Research. The Farr Institute is supported by Arthritis Research UK, British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Engineering and Physical Sciences Research Council, Medical Research Council, National Institute of Health Research, National Institute for Social Care and Health Research (Welsh Government), and the Chief Scientist Office (Scottish Government Health Directorates), (MRC grant MR/K006525/1). DM reports ad hoc honoraria from Bunge, Pollock Institute, and Quaker Oats; ad hoc consulting for Foodminds, Nutrition Impact, Amarin, AstraZeneca, Winston and Strawn LLP, and Life Sciences Research Organization; membership of Unilever North America Scientific Advisory Board; and chapter royalties from UpToDate. RD and LB are employed by the US Department of Veterans Affairs. VC is on the speaker bureau for Boehringer Ingelheim Baker. MS is an employee of Novartis Pharma. All other authors declare no competing interests. The authors alone are responsible for the views expressed in this Article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.
Funding Information:
We thank the countless individuals who have contributed to the Global Burden of Disease Study 2013 in various capacities. We acknowledge the extensive support from all staff members at the Institute for Health Metrics and Evaluation and specifically thank: Kelsey Pierce for her valuable guidance; James Bullard, Serkan Yalcin, Evan Laurie, and Andrew Ernst for their tireless support of the computational infrastructure required to produce the results; Linda A Ettinger for her expert administrative support; and Peter Speyer and Eden Stork for their persistent and invaluable work to gain access to and catalogue as much data as possible to inform the estimates. We also acknowledge the support of the Rwandan Ministry of Health's GBD Team, led by Agnes Binagwaho, for their collaboration and for reviewing the manuscript: Uwaliraye Parfait, Karema Corine, Jean Pierre Nyemazi, Sabin Nsanzimana, Yvonne Kayiteshonga, Marie Aimee Muhimpundu, Jean de Dieu Ngirabega, Ida Kankindi, Sayinzoga Felix, and Gasana Evariste. The following individuals acknowledge various forms of institutional support. RA-SS was funded by a UK MRC senior clinical fellowship. SB acknowledges additional funding or institutional support from International Development Research Center of Canada, Stanford University, and Rosenkranz Price for health-care research in developing countries. AR was supported by research grants from Brazilian research agencies CNPq and FAPEMIG. MK was supported by a NIDDK T32 grant through June 2014. RGN acknowledges that this work was supported in part by the Intramural Research Program of the National Institute of Diabetes and Digestive and Kidney Diseases. KK acknowledges the Government of India for giving him a University Grant Commission Junior Research Fellowship. GDT acknowledges support from NYU's US National Institute of Environmental Health Sciences Center grant ( number ES00260 ). HC and SJL are supported by the intramural programme of NIH, the National Institute of Environmental Health Sciences. KD is supported by a Wellcome Trust Fellowship in Public Health and Tropical Medicine ( grant number 099876 ). HW, AF, HE, and FC are affiliated with the Queensland Centre for Mental Health Research, which receives funding from the Queensland Department of Health. LAR acknowledges the support of Qatar National Research Fund ( 04-924-3-251 ). TF is grateful to the Swiss National Science Foundation for an Early and an Advanced Postdoc Mobility fellowship (project number PBBSP3-146869 and P300P3-154634). IA acknowledges the UK National Institute for Health Research and the Medical Research Council for funding. HWH acknowledges support from Parnassia Psychiatric Institute, The Hague, Netherlands; the Department of Psychiatry, University of Groningen, University Medical Center Groningen, Netherlands; and the Department of Epidemiology, Columbia University, New York, NY, USA. JM has received support from the National Health and Medical Research Council John Cade Fellowship APP1056929 . UM acknowledges funding from the German National Cohort Consortium. BOA acknowledges a Susan G. Komen for the Cure Research Program – Leadership Grant (number SAC110001). AJC's work on GBD was funded by Health Effects Institute and the William and Flora Hewlett Foundation. RD acknowledges that funding from the US Deptartment of Veterans Affairs supports his salary. RD acknowledges funding from the American Parkinson's Disease Association for support of this work. MK receives research support from the Academy of Finland, the Swedish Research Council, Alzheimer Association, and AXA Research Fund. SS receives postdoctoral funding from the Fonds de la recherche en santé du Québec. GA-C acknowledges funding and support from Health Sciences and Neurosciences (CISNEURO) Research Group, Cartagena de Indias, Colombia. No authors received additional compensation for their efforts.
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