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

Mohsen Naghavi, Haidong Wang, Rafael Lozano, Adrian Davis, Xiaofeng Liang, Maigeng Zhou, Stein Emil Vollset, Ayse Abbasoglu Ozgoren, Safa Abdalla, Foad Abd-Allah, Muna I. Abdel Aziz, Semaw Ferede Abera, Victor Aboyans, Biju Abraham, Jerry P. Abraham, Katrina E. Abuabara, Ibrahim Abubakar, Laith J. Abu-Raddad, Niveen M.E. Abu-Rmeileh, Tom AchokiAdemola Adelekan, Zanfina Ademi, Koranteng Adofo, Arséne Kouablan Adou, José C. Adsuar, Johan Ärnlov, Emilie Elisabet Agardh, Dickens Akena, Mazin J. Al Khabouri, Deena Alasfoor, Mohammed Albittar, Miguel Angel Alegretti, Alicia V. Aleman, Zewdie Aderaw Alemu, Rafael Alfonso-Cristancho, Samia Alhabib, Mohammed K. Ali, Raghib Ali, Francois Alla, Faris Al Lami, Peter Allebeck, Mohammad A. AlMazroa, Rustam Al-Shahi Salman, Ubai Alsharif, Elena Alvarez, Nelson Alviz-Guzman, Adansi A. Amankwaa, Azmeraw T. Amare, Omid Ameli, Hassan Amini, Walid Ammar, H. Ross Anderson, Benjamin O. Anderson, Carl Abelardo T. Antonio, Palwasha Anwari, Henry Apfel, Solveig Argeseanu Cunningham, Valentina S. Arsic Arsenijevic, Al Artaman, Majed Masoud Asad, Rana J. Asghar, Reza Assadi, Lydia S. Atkins, Charles Atkinson, Alaa Badawi, Maria C. Bahit, Talal Bakfalouni, Kalpana Balakrishnan, Shivanthi Balalla, Amitava Banerjee, Ryan M. Barber, Suzanne L. Barker-Collo, Simon Barquera, Lars Barregard, Lope H. Barrero, Tonatiuh Barrientos-Gutierrez, Arindam Basu, Sanjay Basu, Mohammed Omar Basulaiman, Justin Beardsley, Neeraj Bedi, Ettore Beghi, Tolesa Bekele, Michelle L. Bell, Corina Benjet, Derrick A. Bennett, Isabela M. Bensenor, Habib Benzian, Amelia Bertozzi-Villa, Tariku Jibat Beyene, Neeraj Bhala, Ashish Bhalla, Zulfiqar A. Bhutta, Boris Bikbov, Aref Bin Abdulhak, Stan Biryukov, Jed D. Blore, Fiona M. Blyth, Megan A. Bohensky, Guilherme Borges, Dipan Bose, Soufiane Boufous, Rupert R. Bourne, Lindsay N. Boyers, Michael Brainin, Michael Brauer, Carol E.G. Brayne, Alexandra Brazinova, Nicholas Breitborde, Hermann Brenner, Adam D.M. Briggs, Jonathan C. Brown, Traolach S. Brugha, Geoffrey C. Buckle, Linh Ngoc Bui, Gene Bukhman, Michael Burch, Ismael Ricardo Campos Nonato, Hélène Carabin, Rosario Cárdenas, Jonathan Carapetis, David O. Carpenter, Valeria Caso, Carlos A. Castañeda-Orjuela, Ruben Estanislao Castro, Ferrán Catalá-López, Fiorella Cavalleri, Jung Chen Chang, Fiona C. Charlson, Xuan Che, Honglei Chen, Yingyao Chen, Jian Sheng Chen, Zhengming Chen, Peggy Pei Chia Chiang, Odgerel Chimed-Ochir, Rajiv Chowdhury, Hanne Christensen, Costas A. Christophi, Ting Wu Chuang, Sumeet S. Chugh, Massimo Cirillo, Matthew M. Coates, Luc Edgar Coffeng, Megan S. Coggeshall, Aaron Cohen, Valentina Colistro, Samantha M. Colquhoun, Mercedes Colomar, Leslie Trumbull Cooper, Cyrus Cooper, Luis M. Coppola, Monica Cortinovis, Karen Courville, Benjamin C. Cowie, Michael H. Criqui, John A. Crump, Lucia Cuevas-Nasu, Iuri Da Costa Leite, Kaustubh C. Dabhadkar, Lalit Dandona, Rakhi Dandona, Emily Dansereau, Paul I. Dargan, Anand Dayama, Vanessa De La Cruz-Góngora, Shelley F. De La Vega, Diego De Leo, Louisa Degenhardt, Borja Del Pozo-Cruz, Robert P. Dellavalle, Kebede Deribe, Don C. Des Jarlais, Muluken Dessalegn, Gabrielle A. De Veber, Samath D. Dharmaratne, Mukesh Dherani, Jose Luis Diaz-Ortega, Cesar Diaz-Torne, Daniel Dicker, Eric L. Ding, Klara Dokova, E. Ray Dorsey, Tim R. Driscoll, Leilei Duan, Herbert C. Duber, Adnan M. Durrani, Beth E. Ebel, Karen M. Edmond, Richard G. Ellenbogen, Yousef Elshrek, Sergey Petrovich Ermakov, Holly E. Erskine, Babak Eshrati, Alireza Esteghamati, Kara Estep, Thomas Fürst, Saman Fahimi, Anna S. Fahrion, Emerito Jose A. Faraon, Farshad Farzadfar, Derek F.J. Fay, Andrea B. Feigl, Valery L. Feigin, Manuela Mendonca Felicio, Seyed Mohammad Fereshtehnejad, Jefferson G. Fernandes, Alize J. Ferrari, Thomas D. Fleming, Nataliya Foigt, Kyle Foreman, Mohammad H. Forouzanfar, F. Gerry R. Fowkes, Urbano Fra Paleo, Richard C. Franklin, Neal D. Futran, Lynne Gaffikin, Ketevan Gambashidze, Fortuné Gbètoho Gankpé, Francisco Armando García-Guerra, Ana Cristina Garcia, Johanna M. Geleijnse, Bradford D. Gessner, Katherine B. Gibney, Richard F. Gillum, Stuart Gilmour, Ibrahim Abdelmageem Mohamed Ginawi, Maurice Giroud, Elizabeth L. Glaser, Shifalika Goenka, Hector Gomez Dantes, Philimon Gona, Diego Gonzalez-Medina, Caterina Guinovart, Rahul Gupta, Rajeev Gupta, Richard A. Gosselin, Carolyn C. Gotay, Atsushi Goto, Hebe N. Gouda, Nicholas Graetz, K. Fern Greenwell, Harish Chander Gugnani, David Gunnell, Reyna A. Gutiérrez, Juanita Haagsma, Nima Hafezi-Nejad, Holly Hagan, Maria Hagstromer, Yara A. Halasa, Randah Ribhi Hamadeh, Hannah Hamavid, Mouhanad Hammami, Jamie Hancock, Graeme J. Hankey, Gillian M. Hansen, Hilda L. Harb, Heather Harewood, Josep Maria Haro, Rasmus Havmoeller, Roderick J. Hay, Simon I. Hay, Mohammad T. Hedayati, Ileana B. Heredia Pi, Kyle R. Heuton, Pouria Heydarpour, Hideki Higashi, Martha Hijar, Hans W. Hoek, Howard J. Hoffman, John C. Hornberger, H. Dean Hosgood, Mazeda Hossain, Peter J. Hotez, Damian G. Hoy, Mohamed Hsairi, Guoqing Hu, John J. Huang, Mark D. Huffman, Andrew J. Hughes, Abdullatif Husseini, Chantal Huynh, Marissa Iannarone, Kim M. Iburg, Bulat T. Idrisov, Nayu Ikeda, Kaire Innos, Manami Inoue, Farhad Islami, Samaya Ismayilova, Kathryn H. Jacobsen, Simerjot Jassal, Sudha P. Jayaraman, Paul N. Jensen, Vivekanand Jha, Guohong Jiang, Ying Jiang, Jost B. Jonas, Jonathan Joseph, Knud Juel, Edmond Kato Kabagambe, Haidong Kan, André Karch, Chante Karimkhani, Ganesan Karthikeyan, Nicholas Kassebaum, Anil Kaul, Norito Kawakami, Konstantin Kazanjan, Dhruv S. Kazi, Andrew H. Kemp, Andre Pascal Kengne, Andre Keren, Maia Kereselidze, Yousef Saleh Khader, Shams Eldin Ali Hassan Khalifa, Ejaz Ahmed Khan, Gulfaraz Khan, Young Ho Khang, Christian Kieling, Yohannes Kinfu, Jonas M. Kinge, Daniel Kim, Sungroul Kim, Miia Kivipelto, Luke Knibbs, Ann Kristin Knudsen, Yoshihiro Kokubo, Sowarta Kosen, Meera Kotagal, Michael A. Kravchenko, Sanjay Krishnaswami, Hans Krueger, Barthelemy Kuate Defo, Ernst J. Kuipers, Burcu Kucuk Bicer, Chanda Kulkarni, Veena S. Kulkarni, Kaushalendra Kumar, Ravi B. Kumar, Gene F. Kwan, Hmwe Kyu, Taavi Lai, Arjun Lakshmana Balaji, Ratilal Lalloo, Tea Lallukka, Hilton Lam, Qing Lan, Van C. Lansingh, Heidi J. Larson, Anders Larsson, Pablo M. Lavados, Alicia E.B. Lawrynowicz, Janet L. Leasher, Jong Tae Lee, James Leigh, Mall Leinsalu, Ricky Leung, Carly Levitz, Bin Li, Yichong Li, Yongmei Li, Chelsea Liddell, Stephen S. Lim, Graça Maria Ferreira De Lima, Maggie L. Lind, Steven E. Lipshultz, Shiwei Liu, Yang Liu, Belinda K. Lloyd, Katherine T. Lofgren, Giancarlo Logroscino, Stephanie J. London, Joannie Lortet-Tieulent, Paulo A. Lotufo, Robyn M. Lucas, Raimundas Lunevicius, Ronan Anthony Lyons, Stefan Ma, Vasco Manuel Pedro Machado, Michael F. MacIntyre, Mark T. Mackay, Jennifer H. MacLachlan, Carlos Magis-Rodriguez, Abbas A. Mahdi, Marek Majdan, Reza Malekzadeh, Srikanth Mangalam, Christopher Chabila Mapoma, Marape Marape, Wagner Marcenes, Christopher Margono, Guy B. Marks, Melvin Barrientos Marzan, Joseph R. Masci, Mohammad Taufiq Mashal, Felix Masiye, Amanda J. Mason-Jones, Richard Matzopolous, Bongani M. Mayosi, Tasara T. Mazorodze, John J. McGrath, Abigail C. McKay, Martin McKee, Abigail McLain, Peter A. Meaney, Man Mohan Mehndiratta, Fabiola Mejia-Rodriguez, Yohannes Adama Melaku, Michele Meltzer, Ziad A. Memish, Walter Mendoza, George A. Mensah, Atte Meretoja, Francis A. Mhimbira, Ted R. Miller, Edward J. Mills, Awoke Misganaw, Santosh K. Mishra, Charles N. Mock, Terrie E. Moffitt, Norlinah Mohamed Ibrahim, Karzan Abdulmuhsin Mohammad, Ali H. Mokdad, Glen Liddell Mola, Lorenzo Monasta, Jonathan De La Cruz Monis, Julio C. Montañez Hernandez, Marcella Montico, Thomas J. Montine, Meghan D. Mooney, Ami R. 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Yang, Yuichiro Yano, Hiroshi Yatsuya, Paul Yip, Naohiro Yonemoto, Seok Jun Yoon, Mustafa Younis, Chuanhua Yu, Kim Yun Jin, Maysaa El Sayed Zaki, Mohammed Fouad Zamakhshary, Hajo Zeeb, Yong Zhang, Yong Zhao, Yingfeng Zheng, Jun Zhu, Shankuan Zhu, David Zonies, Xiao Nong Zou, Joseph R. Zunt, Theo Vos, Alan D. Lopez, Christopher J.L. Murray*, G. Alcalá-Cerra, H. Hu, N. Karam, N. Sabin, A. M. Temesgen

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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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 languageEnglish
Pages (from-to)117-171
Number of pages55
JournalThe Lancet
Volume385
Issue number9963
DOIs
Publication statusPublished - 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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