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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
Open accessAbstract
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 olde
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“These differences can include access to and quality of health care, timeliness of health system responsiveness, and exposure to causes that are endemic to specific geographical locations.4”
From Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021 (2024) · cites this paper as [4]
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“The methods used to generate these estimates closely followed those for GBD 2019.6 These methods have been extensively peer reviewed over previous rounds of the GBD study4, 6, 7, 8, 9 and as part of the peer-review process for GBD 2021.”
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“Causes of death are not uniformly distributed between populations; rather, large variability in the leading causes often reflects important social and geographical differences.4”
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“These methods have been extensively peer reviewed over previous rounds of GBD14, 15, 16, 17, 18, 19 and concurrently as part of the peer review process for GBD 2023.”
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“The 15–39-years age group is particularly volatile globally, and is the age group most affected by fatal discontinuities such as conflict.45”
From Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021 (2024) · cites this paper as [45]
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“chronic inflammatory diseases have been recognized as the most significant cause of death in the world today, with more than 50% of all deaths being attributable to inflammation-related diseases”
From Chronic inflammation in the etiology of disease across the life span (2019) · cites this paper as [5]
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“These data were segmented by country/region and SDI quintile, which reflects the degree of social development and correlates with total fertility, per capita income, and average years of education [12].”
From Epidemiological trends of maternal hypertensive disorders of pregnancy at the global, regional, and national levels: a population‐based study (2021) · cites this paper as [12]
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“Temporal trends in mortality show that although the overall number of deaths is declining, the gap between deaths in high socio-demographic index (SDI) countries and low SDI countries remains substantial (Fig. 1c) 1 .”
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“Unfortunately, clinical trials for these infectious diseases (IDs) are also lagging compared with conditions such as cancer and cardiovascular diseases (Fig. 1d) 1”
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“Mortality rates are highest in developing countries, where resources such as vaccines and anti-infectives may be limited (Fig. 1b) 1 .”
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“High mortality rates are associated with lower respiratory infections, diarrhoea, tuberculosis (TB), human immunodeficiency virus (HIV) infection and malaria (Fig. 1a) 1 .”
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“Infectious diseases are a major driver of morbidity and mortality globally.”
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Metadata
- Authors
- Roth, G. A., Abate, D., Abate, K. H., Abay, S. M., Abbafati, C., Abbasi, N., Abbastabar, H., Abd-Allah, F., Abdela, J., Abdelalim, A., Abdollahpour, I., Abdulkader, R. S., Abebe, H. T., Abebe, M., Abebe, Z., Abejie, A. N., Abera, S. F., Abil, O. Z., Abraha, H. N., Abrham, A. R., Abu-Raddad, L. J., Accrombessi, M. M. K., Acharya, D., Adamu, A. A., Adebayo, O. M., Adedoyin, R. A., Adekanmbi, V., Adetokunboh, O. O., Adhena, B. M., Adib, M. G., Admasie, A., Afshin, A., Agarwal, G., Agesa, K. M., Agrawal, A., Agrawal, S., Ahmadi, A., Ahmadi, M., Ahmed, M. B., Ahmed, S., Aichour, A. N., Aichour, I., Aichour, M. T. E., Akbari, M. E., Akinyemi, R. O., Akseer, N., Al-Aly, Z., Al-Eyadhy, A., Al-Raddadi, R. M., Alahdab, F., Alam, K., Alam, T., Alebel, A., Alene, K. A., Alijanzadeh, M., Alizadeh-Navaei, R., Aljunid, S. M., Alkerwi, A., Alla, F., Allebeck, P., Alonso, J., Altirkawi, K., Alvis-Guzman, N., Amare, A. T., Aminde, L. N., Amini, E., Ammar, W., Amoako, Y. A., Anber, N. H., Andrei, C. L., Androudi, S., Animut, M. D., Anjomshoa, M., Ansari, H., Ansha, M. G., Antonio, C. A. T., Anwari, P., Aremu, O., Ärnlöv, J., Arora, A., Arora, M., Artaman, A., Aryal, K. K., Asayesh, H., Asfaw, E. T., Ataro, Z., Atique, S., Atre, S. R., Ausloos, M., Avokpaho, E. F. G. A., Awasthi, A., Quintanilla, B. P. A., Ayele, Y., Ayer, R., Azzopardi, P. S., Babazadeh, A., Bacha, U., Badali, H., Badawi, A., Bali, A. G., Ballesteros, K. E., Banach, M., Banerjee, K., Bannick, M. S., Banoub, J. A. M., Barboza, M. A., Barker-Collo, S. L., Bärnighausen, T. W., Barquera, S., Barrero, L. H., Bassat, Q., Basu, S., Baune, B. T., Baynes, H. W., Bazargan-Hejazi, S., Bedi, N., Beghi, E., Behzadifar, M., Behzadifar, M., Béjot, Y., Bekele, B. B., Belachew, A. B., Belay, E., Belay, Y. A., Bell, M. L., Bello, A. K., Bennett, D. A., Bensenor, I. M., Berman, A. E., Bernabe, E., Bernstein, R. S., Bertolacci, G. J., Beuran, M., Beyranvand, T., Bhalla, A., Bhattarai, S., Bhaumik, S., Bhutta, Z. A., Biadgo, B., Biehl, M. H., Bijani, A., Bikbov, B., Bilano, V., Bililign, N., Bin Sayeed, M. S., Bisanzio, D., Biswas, T., Blacker, B. F., Basara, B. B., Borschmann, R., Bosetti, C., Bozorgmehr, K., Brady, O. J., Brant, L. C., Brayne, C., Brazinova, A., Breitborde, N. J. K., Brenner, H., Briant, P. S., Britton, G., Brugha, T., Busse, R., Butt, Z. A., Callender, C. S. K. H., Campos-Nonato, I. R., Campuzano Rincon, J. C., Cano, J., Car, M., Cárdenas, R., Carreras, G., Carrero, J. J., Carter, A., Carvalho, F., Castañeda-Orjuela, C. A., Castillo Rivas, J., Castle, C. D., Castro, C., Castro, F., Catalá-López, F., Cerin, E., Chaiah, Y., Chang, J.-C., Charlson, F. J., Chaturvedi, P., Chiang, P. P.-C., Chimed-Ochir, O., Chisumpa, V. H., Chitheer, A., Chowdhury, R., Christensen, H., Christopher, D. J., Chung, S.-C., Cicuttini, F. M., Ciobanu, L. G., Cirillo, M., Cohen, A. J., Cooper, L. T., Cortesi, P. A., Cortinovis, M., Cousin, E., Cowie, B. C., Criqui, M. H., Cromwell, E. A., Crowe, C. 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- Affiliations
- Institute for Health Metrics and Evaluation (US)
- Corresponding author
- Roth, Gregory A
- Wagner, Gregory R
- ORCID
- Roth, Gregory A
- Abate, Degu
- Abate, Kalkidan Hassen
- Abbafati, Cristiana
- Abbasi, Nooshin
- Abbastabar, Hedayat
- Abd-Allah, Foad
- Abdela, Jemal
- Abdelalim, Ahmed
- Abdollahpour, Ibrahim
- Abdulkader, Rizwan Suliankatchi
- Abebe, Haftom Temesgen
- Abebe, Molla
- Abera, Semaw F
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- Abraha, Haftom Niguse
- Abu-Raddad, Laith Jamal
- Accrombessi, Manfred Mario Kokou
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- Adamu, Abdu A
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- Adedoyin, Rufus Adesoji
- Adekanmbi, Victor
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- Adhena, Beyene Meressa
- Admasie, Amha
- Afshin, Ashkan
- Agarwal, Gina
- Agrawal, Anurag
- Agrawal, Sutapa
- Ahmadi, Alireza
- Ahmadi, Mehdi
- Ahmed, Muktar Beshir
- Ahmed, Sayem
- Akbari, Mohammad Esmaeil
- Akinyemi, Rufus Olusola
- Akseer, Nadia
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- Alebel, Animut
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- Alkerwi, Ala'a
- Alla, François
- Alonso, Jordi
- Altirkawi, Khalid
- Amare, Azmeraw T
- Amini, Erfan
- Ammar, Walid
- Amoako, Yaw Ampem
- Anber, Nahla Hamed
- Androudi, Sofia
- Animut, Megbaru Debalkie
- Ansari, Hossein
- Ansha, Mustafa Geleto
- Antonio, Carl Abelardo T
- Anwari, Palwasha
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- Chitheer, Abdulaal
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- Chung, Sheng-Chia
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- Daba, Alemneh Kabeta
- Dadi, Abel Fekadu
- Dandona, Lalit
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- Dang, Anh Kim
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- Gupta, Rajat Das
- Neves, José Das
- Dasa, Tamirat Tesfaye
- Dash, Aditya Prasad
- Davis, Adrian C
- Davletov, Kairat
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- Degenhardt, Louisa
- Deiparine, Selina
- Demoz, Gebre Teklemariam
- Deribe, Kebede
- Dervenis, Nikolaos
- Dessie, Getenet Ayalew
- Dey, Subhojit
- Dharmaratne, Samath D
- Ding, Eric L
- Dirac, M Ashworth
- Djalalinia, Shirin
- Dokova, Klara
- Doku, David Teye
- Donnelly, Christl A
- Doyle, Kerrie E
- Driscoll, Tim R
- Dubey, Manisha
- Dubljanin, Eleonora
- Duncan, Bruce B
- Ebrahimi, Hedyeh
- Ebrahimpour, Soheil
- Edessa, Dumessa
- Eggen, Anne Elise
- Elkout, Hajer
- Ellingsen, Christian Lycke
- Endres, Matthias
- Endries, Aman Yesuf
- Er, Benjamin
- Erskine, Holly E
- Eskandarieh, Sharareh
- Esteghamati, Alireza
- Fakhar, Mahdi
- Fakhim, Hamed
- Faramarzi, Mahbobeh
- Fareed, Mohammad
- Farhadi, Farzaneh
- Farinha, Carla Sofia E sá
- Farvid, Maryam S
- Farzadfar, Farshad
- Farzaei, Mohammad Hosein
- Feigin, Valery L
- Feigl, Andrea B
- Fentahun, Netsanet
- Fereshtehnejad, Seyed-Mohammad
- Fernandes, Eduarda
- Ferrari, Alize J
- Feyissa, Garumma Tolu
- Filip, Irina
- Fischer, Florian
- Fitzmaurice, Christina
- Foigt, Nataliya A
- Fornari, Carla
- Frank, Tahvi D
- Fukumoto, Takeshi
- Fullman, Nancy
- Fürst, Thomas
- Furtado, João M
- Futran, Neal D
- Gallus, Silvano
- Gardner, William M
- Gebre, Abadi Kahsu
- Gebrehiwot, Tsegaye Tewelde
- Gebremedhin, Amanuel Tesfay
- Gebremichael, Bereket
- Gebremichael, Teklu Gebrehiwo
- Gelano, Tilayie Feto
- Geleijnse, Johanna M
- Gething, Peter W
- Gezae, Kebede Embaye
- Ghadimi, Reza
- Ghimire, Mamata
- Gibney, Katherine B
- Gill, Paramjit Singh
- Gill, Tiffany K
- Ginawi, Ibrahim Abdelmageed
- Giroud, Maurice
- Giussani, Giorgia
- Goenka, Shifalika
- Goldberg, Ellen M
- Goli, Srinivas
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- Gopalani, Sameer Vali
- Goto, Atsushi
- Goulart, Alessandra C
- Gnedovskaya, Elena V
- Grada, Ayman
- Grosso, Giuseppe
- Gugnani, Harish Chander
- Guo, Yuming
- Gupta, Prakash C
- Gyawali, Bishal
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- Hamadeh, Randah R
- Hamidi, Samer
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- Harb, Hilda L
- Harikrishnan, Sivadasanpillai
- Haro, Josep Maria
- Hassankhani, Hadi
- Hassen, Hamid Yimam
- Hay, Roderick J
- Hay, Simon I
- Hegazy, Mohamed I
- Heibati, Behzad
- Heidari, Mohsen
- Hendrie, Delia
- Henok, Andualem
- Henry, Nathaniel J
- Heydarpour, Fatemeh
- Heydarpour, Pouria
- Heydarpour, Sousan
- Hibstu, Desalegn Tsegaw
- Hoek, Hans W
- Hoogar, Praveen
- Hosseinzadeh, Mehdi
- Hostiuc, Mihaela
- Hostiuc, Sorin
- Hotez, Peter J
- Hsiao, Thomas
- Hu, Guoqing
- Husseini, Abdullatif
- Hutfless, Susan
- Idrisov, Bulat
- Ilesanmi, Olayinka Stephen
- Iqbal, Usman
- Irvani, Seyed Sina Naghibi
- Irvine, Caleb Mackay Salpeter
- Islam, Nazrul
- Islam, Sheikh Mohammed Shariful
- Islami, Farhad
- Jacobsen, Kathryn H
- Jahangiry, Leila
- Jahanmehr, Nader
- Jain, Sudhir Kumar
- James, Spencer L
- Javanbakht, Mehdi
- Jayatilleke, Achala Upendra
- Jeemon, Panniyammakal
- Jenkins, Kathy J
- Jha, Ravi Prakash
- Jha, Vivekanand
- Johnson, Sarah C
- Jonas, Jost B
- Joshi, Ankur
- Jozwiak, Jacek Jerzy
- Jungari, Suresh Banayya
- Jürisson, Mikk
- Kabir, Zubair
- Kadel, Rajendra
- Kahsay, Amaha
- Karami, Manoochehr
- Karch, André
- Kasaeian, Amir
- Kassa, Getachew Mullu
- Kassa, Tesfaye Dessale
- Kassebaum, Nicholas J
- Katikireddi, Srinivasa Vittal
- Karyani, Ali Kazemi
- Kazi, Dhruv Satish
- Kefale, Adane Teshome
- Kemp, Grant Rodgers
- Keren, Andre
- Khader, Yousef Saleh
- Khafaie, Morteza Abdullatif
- Khajavi, Alireza
- Khalid, Nauman
- Khan, Ejaz Ahmad
- Khan, Muhammad Shahzeb
- Khan, Muhammad Ali
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- Khosravi, Ardeshir
- Khosravi, Mohammad Hossein
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- Limenih, Miteku Andualem
- Linn, Shai
- Liu, Shiwei
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- Macarayan, Erlyn Rachelle King
- Mackay, Mark T
- MacLachlan, Jennifer H
- Maddison, Emilie R
- Madotto, Fabiana
- Majdzadeh, Reza
- Majeed, Azeem
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- Mukhopadhyay, Satinath
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- Nagel, Gabriele
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- Prasad, Narayan
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- Roever, Leonardo
- Ronfani, Luca
- Roshandel, Gholamreza
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- Ullah, Irfan
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- Venketasubramanian, Narayanaswamy
- Villafaina, Santos
- Violante, Francesco S
- Vladimirov, Sergey Konstantinovitch
- Vlassov, Vasily
- Vos, Theo
- Wagner, Gregory R
- Wagnew, Fasil Shiferaw
- Waheed, Yasir
- Wallin, Mitchell Taylor
- Walson, Judd L
- Wang, Yanping
- Wang, Yuan-Pang
- Wassie, Molla Mesele
- Weiderpass, Elisabete
- Weldegebreal, Fitsum
- Werdecker, Andrea
- Werkneh, Adhena Ayaliew
- West, T Eoin
- Westerman, Ronny
- Whiteford, Harvey A
- Wilner, Lauren B
- Winkler, Andrea Sylvia
- Wiysonge, Charles Shey
- Wolfe, Charles D A
- Wu, Shouling
- Wyper, Grant M A
- Xavier, Denis
- Xu, Gelin
- Yadgir, Simon
- Yadollahpour, Ali
- Yakob, Bereket
- Yan, Lijing L
- Yano, Yuichiro
- Yaseri, Mehdi
- Yasin, Yasin Jemal
- Yeshaneh, Alex
- Yimer, Ebrahim M
- Yip, Paul
- Yirsaw, Biruck Desalegn
- Yisma, Engida
- Yonemoto, Naohiro
- Yoon, Seok-Jun
- Yotebieng, Marcel
- Younis, Mustafa Z
- Yousefifard, Mahmoud
- Yu, Chuanhua
- Zadnik, Vesna
- Zaidi, Zoubida
- Zaman, Sojib Bin
- Zamani, Mohammad
- Zhang, Anthony Lin
- Zhang, Kai
- Zhou, Maigeng
- Zodpey, Sanjay
- Zuhlke, Liesl Joanna
- Naghavi, Mohsen
- Murray, Christopher J L
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2018-11
- Volume
- 392
- Issue
- 10159
- Pages
- 1736-1788
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC6227606
- OpenAlex
- W2899736836
- Cited by
- 8,600
- References
- 58
- Citations by year
- 2026: 389 · 2025: 780 · 2024: 1092 · 2023: 1205 · 2022: 1189 · 2021: 1697 · 2020: 1414 · 2019: 667 · 2018: 148
- FWCI
- 2024.62
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- The Lancet (publishedVersion, cc-by)
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- edoc (University of Basel)
- Funders
- National Institutes of Health ((award P30AG047845), (award R01MH110163))
- Topics
- Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health and Epidemiology
- Health Sciences › Medicine › Epidemiology › Healthcare Systems and Public Health
- Keywords
- cause-specific mortality, causes of death, years of life lost, non-communicable diseases, verbal autopsy, civil registration, Global Burden of Disease Study 2017
- MeSH terms
- Global Burden of Disease, Adolescent, Adult, Aged, Aged, 80 and over, Cause of Death, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Life Expectancy, Male, Middle Aged, Socioeconomic Factors, Global Health, Age Distribution, Sex Distribution, 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.
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