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.
Bibliographical noteFunding Information:
Ettore Beghi reports personal fees from MA-Provider and grants from the Italian Ministry of Health, UCB-PHARMA, American ALS Association, EISAI, and Shire. Yannick Bejot reports grants and personal fees from AstraZeneca and Boehringer Ingelheim and personal fees from Daiichi-Sankyo, Bristol-Myers Squibb (BMS), Pfizer, Medtronic, Bayer, Novex pharma, and Merck Sharpe & Dohme (MSD). Adam Berman reports personal fees from Philips. Louisa Degenhardt reports grants from Indivior, Mundipharma, and Seqirus. Panniyammakal Jeemon reports a Clinical and Public Health Intermediate Fellowship from the Wellcome Trust–DBT India Alliance (2015–20). Jacek Jóźwiak reports a grant from Valeant, personal fees from Valeant, ALAB Laboratoria and Amgen, and non-financial support from Microlife and Servier. Nicholas Kassebaum reports personal fees and other support from Vifor Pharmaceuticals. Srinivasa Vittal Katikireddi reports grants from NHS Research Scotland, the Medical Research Council, and the Scottish Government Chief Scientist Office. Jeffrey Lazarus reports personal fees from Janssen and CEPHEID and grants and personal fees from AbbVie, Gilead Sciences, and MSD. Stefan Lorkowski reports personal fees from Amgen, Berlin-Chemie, MSD, Novo Nordisk, Sanofi-Aventis, Synlab, Unilever, and non-financial support from Preventicus. Winfried März reports grants and personal fees from Siemens Diagnostics, Aegerion Pharmaceuticals, Amgen, AstraZeneca, Danone Research, Pfizer, BASF, Numares, and Berline-Chemie; personal fees from Hoffmann LaRoche, MSD, Sanofi, and Synageva; grants from Abbott Diagnostics; and other support from Synlab. Walter Mendoza is currently a Program Analyst for Population and Development at the Peru Country Office of the United Nations Population Fund. Ted Miller reports an evaluation contract from AB InBev Foundation. Frédéric Piel reports personal fees from Novartis. Postma Maarten reports grants from Mundipharma, Bayer, BMS, AstraZeneca, ARTEG, and AscA; grants and personal fees from Sigma Tau, MSD, GlaxoSmithKline, Pfizer, Boehringer-Ingelheim, Novavax, Ingress Health, AbbVie, and Sanofi; personal fees from Quintiles, Astellas, Mapi, OptumInsight, Novartis, Swedish Orphan, Innoval, Jansen, Intercept, and Pharmerit, and stock ownership in Ingress Health and Pharmacoeconomics Advice Groningen. Kazem Rahimi reports grants from the National Insitute for Health Research Biomedical Research Centre, Economic and Social Research Council, and Oxford Martin School. Mark Shrime reports grants from Mercy Ships and Damon Runyon Cancer Research Foundation. Jasvinder Singh reports consulting for Horizon, Fidia, UBM, Medscape, WebMD, the National Institutes of Health, and the American College of Rheumatology; they serve as the principal investigator for an investigator-initiated study funded by Horizon pharmaceuticals through a grant to DINORA, a 501c3 entity; they are on the steering committee of OMERACT, an international organization that develops measures for clinical trials and receives arms-length funding from 36 pharmaceutical companies. Jeffrey Stanaway reports a grant from Merck & Co. Cassandra Szoeke reports a grant from the National Medical Health Research Council, Lundbeck, Alzheimer's Association, and the Royal Australasian College of Practicioners; she holds patent PCT/AU2008/001556. Amanda Thrift reports grants from National Health and Medical Research Council, Australia. Muthiah Vaduganathan receives research support from the NIH/National Heart, Lung, and Blood Institute and serves as a consultant for Bayer and Baxter Healthcare. Marcel Yotebieng reports grants from the US National Institutes of Health. All other authors declare no competing interests.
Research reported in this publication was supported by the Bill & Melinda Gates Foundation, the University of Melbourne, Public Health England, the Norwegian Institute of Public Health, St Jude Children's Research Hospital, the National Institute on Ageing of the National Institutes of Health (award P30AG047845) , and the National Institute of Mental Health of the National Institutes of Health (award R01MH110163) . The content is solely the responsibility of the authors and does not necessarily represent the official views of the funders. Data for this research was provided by MEASURE Evaluation, funded by the United States Agency for International Development (USAID). Views expressed do not necessarily reflect those of USAID, the US Government, or MEASURE Evaluation. Collection of these data was made possible by USAID under the terms of cooperative agreement GPO-A-00-08-000_D3-00. The opinions expressed are those of the authors and do not necessarily reflect the views of USAID or the US Government. The data reported here have been supplied by the US Renal Data System. The interpretation and reporting of these data are the responsibility of the authors and in no way should be seen as an official policy or interpretation of the US Government.
© 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license