Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016
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BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap b
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The GBD 2016 version of the Socio-demographic Index correlates with the GBD 2015 version at 0.977 (p<0.0001).
“the correlation of the GBD 2015 and GBD 2016 versions of SDI is 0·977 (p<0·0001)”
Absolute numbers of YLLs increased for NCDs in all but the high-SDI quintile, alongside steadily increasing life expectancy in most locations.
“While declines in age-standardised YLL rates are an indicator of progress, the absolute numbers of YLLs increased for NCDs in all but the high-SDI quintile; these increases in absolute YLLs from NCDs occurred in tandem with steadily increasing life expectancy in most locations worldwide.21”
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- Wang, H., Abajobir, A. A., Abate, K. H., Abbafati, C., Abbas, K. M., Abd-Allah, F., Abera, S. F., Abraha, H. N., Abu-Raddad, L. J., Abu-Rmeileh, N. M. E., Adedeji, I. A., Adedoyin, R. A., Adetifa, I. M. O., Adetokunboh, O., Afshin, A., Aggarwal, R., Agrawal, A., Agrawal, S., Ahmad Kiadaliri, A., Ahmed, M. B., Aichour, M. T. E., Aichour, A. N., Aichour, I., Aiyar, S., Akanda, A. S., Akinyemiju, T. F., Akseer, N., Al Lami, F. H., Alabed, S., Alahdab, F., Al-Aly, Z., Alam, K., Alam, N., Alasfoor, D., Aldridge, R. W., Alene, K. A., Al-Eyadhy, A., Alhabib, S., Ali, R., Alizadeh-Navaei, R., Aljunid, S. M., Alkaabi, J. M., Alkerwi, A., Alla, F., Allam, S. D., Allebeck, P., Al-Raddadi, R., Alsharif, U., Altirkawi, K. A., Alvis-Guzman, N., Amare, A. T., Ameh, E. A., Amini, E., Ammar, W., Amoako, Y. A., Anber, N., Andrei, C. L., Androudi, S., Ansari, H., Ansha, M. G., Antonio, C. A. T., Anwari, P., Ärnlöv, J., Arora, M., Artaman, A., Aryal, K. K., Asayesh, H., Asgedom, S. W., Asghar, R. J., Assadi, R., Assaye, A. M., Atey, T. M., Atre, S. R., Avila-Burgos, L., Avokpaho, E. F. G. A., Awasthi, A., Babalola, T. K., Bacha, U., Badawi, A., Balakrishnan, K., Balalla, S., Barac, A., Barber, R. M., Barboza, M. A., Barker-Collo, S. L., Bärnighausen, T., Barquera, S., Barregard, L., Barrero, L. H., Baune, B. T., Bazargan-Hejazi, S., Bedi, N., Beghi, E., Béjot, Y., Bekele, B. B., Bell, M. L., Bello, A. K., Bennett, D. A., Bennett, J. R., Bensenor, I. M., Benson, J., Berhane, A., Berhe, D. F., Bernabé, E., Beuran, M., Beyene, A. S., Bhala, N., Bhansali, A., Bhaumik, S., Bhutta, Z. A., Bicer, B. K., Bidgoli, H. H., Bikbov, B., Birungi, C., Biryukov, S., Bisanzio, D., Bizuayehu, H. M., Bjerregaard, P., Blosser, C. D., Boneya, D. J., Boufous, S., Bourne, R. R. A., Brazinova, A., Breitborde, N. J. K., Brenner, H., Brugha, T. S., Bukhman, G., Bulto, L. N. B., Bumgarner, B. R., Burch, M., Butt, Z. A., Cahill, L. E., Cahuana-Hurtado, L., Campos-Nonato, I. R., Car, J., Car, M., Cárdenas, R., Carpenter, D. O., Carrero, J. J., Carter, A., Castañeda-Orjuela, C. A., Castro, F. F., Castro, R. E., Catalá-López, F., Chen, H., Chiang, P. P.-C., Chibalabala, M., Chisumpa, V. H., Chitheer, A. A., Choi, J.-Y. J., Christensen, H., Christopher, D. J., Ciobanu, L. G., Cirillo, M., Cohen, A. J., Colquhoun, S. M., Coresh, J., Criqui, M. H., Cromwell, E. A., Crump, J. A., Dandona, L., Dandona, R., Dargan, P. I., das Neves, J., Davey, G., Davitoiu, D. V., Davletov, K., de Courten, B., De Leo, D., Degenhardt, L., Deiparine, S., Dellavalle, R. P., Deribe, K., Deribew, A., Des Jarlais, D. C., Dey, S., Dharmaratne, S. D., Dherani, M. K., Diaz-Torné, C., Ding, E. L., Dixit, P., Djalalinia, S., Do, H. P., Doku, D. T., Donnelly, C. A., dos Santos, K. P. B., Douwes-Schultz, D., Driscoll, T. R., Duan, L., Dubey, M., Duncan, B. B., Dwivedi, L. K., Ebrahimi, H., El Bcheraoui, C., Ellingsen, C. L., Enayati, A., Endries, A. Y., Ermakov, S. P., Eshetie, S., Eshrati, B., Eskandarieh, S., Esteghamati, A., Estep, K., Fanuel, F. B. B., Faro, A., Farvid, M. S., Farzadfar, F., Feigin, V. L., Fereshtehnejad, S.-M., Fernandes, J. G., Fernandes, J. C., Feyissa, T. R., Filip, I., Fischer, F., Foigt, N., Foreman, K. J., Frank, T., Franklin, R. C., Fraser, M., Friedman, J., Frostad, J. J., Fullman, N., Fürst, T., Furtado, J. M., Futran, N. D., Gakidou, E., Gambashidze, K., Gamkrelidze, A., Gankpé, F. G., Garcia-Basteiro, A. L., Gebregergs, G. B., Gebrehiwot, T. T., Gebrekidan, K. G., Gebremichael, M. W., Gelaye, A. A., Geleijnse, J. M., Gemechu, B. L., Gemechu, K. S., Genova-Maleras, R., Gesesew, H. A., Gething, P. W., Gibney, K. B., Gill, P. S., Gillum, R. F., Giref, A. Z., Girma, B. W., Giussani, G., Goenka, S., Gomez, B., Gona, P. N., Gopalani, S. V., Goulart, A. C., Graetz, N., Gugnani, H. C., Gupta, P. C., Gupta, R., Gupta, R., Gupta, T., Gupta, V., Haagsma, J. A., Hafezi-Nejad, N., Hakuzimana, A., Halasa, Y. A., Hamadeh, R. R., Hambisa, M. T., Hamidi, S., Hammami, M., Hancock, J., Handal, A. J., Hankey, G. J., Hao, Y., Harb, H. L., Hareri, H. A., Harikrishnan, S., Haro, J. M., Hassanvand, M. S., Havmoeller, R., Hay, R. J., Hay, S. I., He, F., Heredia-Pi, I. B., Herteliu, C., Hilawe, E. H., Hoek, H. W., Horita, N., Hosgood, H. D., Hostiuc, S., Hotez, P. J., Hoy, D. G., Hsairi, M., Htet, A. S., Hu, G., Huang, J. J., Huang, H., Iburg, K. M., Igumbor, E. U., Ileanu, B. V., Inoue, M., Irenso, A. A., Irvine, C. M. S., Islam, S. M. S., Islam, N., Jacobsen, K. H., Jaenisch, T., Jahanmehr, N., Jakovljevic, M. B., Javanbakht, M., Jayatilleke, A. U., Jeemon, P., Jensen, P. N., Jha, V., Jin, Y., John, D., John, O., Johnson, S. C., Jonas, J. B., Jürisson, M., Kabir, Z., Kadel, R., Kahsay, A., Kalkonde, Y., Kamal, R., Kan, H., Karch, A., Karema, C. K., Karimi, S. M., Karthikeyan, G., Kasaeian, A., Kassaw, N. A., Kassebaum, N. J., Kastor, A., Katikireddi, S. V., Kaul, A., Kawakami, N., Kazanjan, K., Keiyoro, P. N., Kelbore, S. G., Kemp, A. H., Kengne, A. P., Keren, A., Kereselidze, M., Kesavachandran, C. N., Ketema, E. B., Khader, Y. S., Khalil, I. A., Khan, E. A., Khan, G., Khang, Y.-H., Khera, S., Khoja, A. T. A., Khosravi, M. H., Kibret, G. D., Kieling, C., Kim, Y. J., Kim, C.-I., Kim, D., Kim, P., Kim, S., Kimokoti, R. W., Kinfu, Y., Kishawi, S., Kissoon, N., Kivimaki, M., Knudsen, A. K., Kokubo, Y., Kopec, J. A., Kosen, S., Koul, P. A., Koyanagi, A., Kravchenko, M., Krohn, K. J., Kuate Defo, B., Kuipers, E. J., Kulikoff, X. R., Kulkarni, V. S., Kumar, G. A., Kumar, P., Kumsa, F. A., Kutz, M., Lachat, C., Lagat, A. K., Lager, A. C. J., Lal, D. K., Lalloo, R., Lambert, N., Lan, Q., Lansingh, V. C., Larson, H. J., Larsson, A., Laryea, D. O., Lavados, P. M., Laxmaiah, A., Lee, P. H., Leigh, J., Leung, J., Leung, R., Levi, M., Li, Y., Liao, Y., Liben, M. L., Lim, S. S., Linn, S., Lipshultz, S. E., Liu, S., Lodha, R., Logroscino, G., Lorch, S. A., Lorkowski, S., Lotufo, P. 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- Corresponding author
- Murray, Christopher J L
- ORCID
- Wang, Haidong
- Abajobir, Amanuel Alemu
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- Tuzcu, Emin Murat
- Tyrovolas, Stefanos
- Ukwaja, Kingsley Nnanna
- Undurraga, Eduardo A
- Uthman, Olalekan A
- Uzochukwu, Benjamin S Chudi
- Varughese, Santosh
- Vasankari, Tommi
- Vasconcelos, Ana Maria Nogales
- Venketasubramanian, Narayanaswamy
- Vidavalur, Ramesh
- Violante, Francesco S
- Vishnu, Abhishek
- Vladimirov, Sergey K
- Vos, Theo
- Waid, Jillian L
- Wang, Yuan-Pang
- Weichenthal, Scott
- Weiderpass, Elisabete
- Werdecker, Andrea
- Wesana, Joshua
- Wijeratne, Tissa
- Wilkinson, James D
- Wiysonge, Charles Shey
- Wolfe, Charles D A
- Workicho, Abdulhalik
- Workie, Shimelash Bitew
- Xavier, Denis
- Xu, Gelin
- Yaghoubi, Mohsen
- Yakob, Bereket
- Yalew, Ayalnesh Zemene
- Yan, Lijing L
- Yano, Yuichiro
- Yaseri, Mehdi
- Ye, Pengpeng
- Yip, Paul
- Yirsaw, Biruck Desalegn
- Yonemoto, Naohiro
- Yoon, Seok-Jun
- Yotebieng, Marcel
- Younis, Mustafa Z
- Zaidi, Zoubida
- Zaki, Maysaa El Sayed
- Zeeb, Hajo
- Zerfu, Taddese Alemu
- Zhang, Anthony Lin
- Zhang, Xueying
- Zodpey, Sanjay
- Zuhlke, Liesl Joanna
- Murray, Christopher J L
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2017-09
- Volume
- 390
- Issue
- 10100
- Pages
- 1084-1150
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC5605514
- OpenAlex
- W2743318307
- Cited by
- 801
- References
- 90
- Citations by year
- 2026: 16 · 2025: 60 · 2024: 73 · 2023: 67 · 2022: 84 · 2021: 115 · 2020: 115 · 2019: 119 · 2018: 137 · 2017: 14 · 2016: 1
- FWCI
- 272.09
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
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- Queensland Brain Institute
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- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences
- Norwegian Institute of Public Health
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- National Cancer Institute
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- Fogarty International Center (D43TW009775)
- National Institute on Minority Health and Health Disparities
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD084233, R01HD087993, P2CHD041020)
- David Geffen School of Medicine, University of California, Los Angeles
- Mailman School of Public Health, Columbia University
- Institute of Genetics
- Sandia National Laboratories
- Topics
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
- Keywords
- under-five mortality, adult mortality, age-specific mortality, sex differences in mortality, life expectancy, all-cause mortality, HIV mortality, natural disasters, mortality trends, global burden of disease, child mortality
- MeSH terms
- Global Burden of Disease, Adolescent, Adult, Aged, Aged, 80 and over, Birth Rate, Cause of Death, Child, Child, Preschool, Educational Status, Female, Humans, Infant, Infant, Newborn, Life Expectancy, Male, Middle Aged, Socioeconomic Factors, Global Health, HIV Infections, Survival Rate, Age Distribution, Stillbirth, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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