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Cited by 1,971Insurance, Mortality, Demography, Risk ManagementGlobal Maternal and Child Healthdemographic modeling and climate adaptation

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

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Wang, Haidong, Abbas, Kaja M, Abbasifard, Mitra, Abbasi-Kangevari, Mohsen, Abbastabar, Hedayat, Abd-Allah, Foad, Abdelalim, Ahmed, Abolhassani, Hassan +720 more·2020·The Lancet
DOI 10.1016/s0140-6736(20)30977-6PMC PMC7566045
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Abstract

BACKGROUND: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. METHODS: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10-14 and 50-54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. FINDINGS: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66-2·79) in 2000 to 2·31 (2·17-2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5-137·8) in 2000 to a peak of 139·6 million (133·0-146·9) in 2016. Global livebirths then declined to 135·3 million (127·2-144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4-27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8-67·6) in 2000 to 73·5 years (72·8-74·3) in 2019. The total number of deaths increased from 50·7 million (49·5-51·9) in 2000 to 56·5 million (53·7-59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1-10·3) in 2000 to 5·0 million (4·3-6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0-6·3) in 2000 to 7·7 billion (7·5-8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1-60·8) in 2000 to 63·5 years (60·8-66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. INTERPRETATION: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. FUNDING: Bill & Melinda Gates Foundation.

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  • The SDI is a proxy for development that combines multiple indicators and has been shown to be well correlated with health outcomes.

    “The SDI is a proxy for development that combines multiple indicators and has been shown to be well correlated with health outcomes.14,15”

    From Societal Costs of Dementia: 204 Countries, 2000–2019 (2024) · cites this paper as [14]

  • Between 1990 and 2019, a reduction in DALYs from communicable, maternal, neonatal, and nutritional diseases has been offset by an increase in burden due to non-communicable diseases, including mental disorders.

    “Between 1990 and 2019, a reduction in DALYs from communicable, maternal, neonatal, and nutritional diseases has been offset by an increase in burden due to non-communicable diseases, including mental disorders.3, 4, 5”

    From Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. (2022) · cites this paper as [3]

    The Results (Mortality and HALE; page unavailable) report changes in survival and years lived in poor health, while the Discussion (Global population health improvement; page unavailable) describes overall improvements in mortality and HALE. Searches for DALYs and the named disease categories found no passage assessing whether declining communicable-disease DALYs were offset by rising non-communicable-disease burden, including mental disorders. (LLM, conf=0.73)

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Wang, H., Abbas, K. M., Abbasifard, M., Abbasi-Kangevari, M., Abbastabar, H., Abd-Allah, F., Abdelalim, A., Abolhassani, H., Abreu, L. G., Abrigo, M. R. M., Abushouk, A. I., Adabi, M., Adair, T., Adebayo, O. M., Adedeji, I. A., Adekanmbi, V., Adeoye, A. M., Adetokunboh, O. O., Advani, S. M., Afshin, A., Aghaali, M., Agrawal, A., Ahmadi, K., Ahmadieh, H., Ahmed, M. B., Al-Aly, Z., Alam, K., Alam, T., Alanezi, F. M., Alanzi, T. M., Alcalde-Rabanal, J. E., Ali, M., Alicandro, G., Alijanzadeh, M., Alinia, C., Alipour, V., Alizade, H., Aljunid, S. M., Allebeck, P., Almadi, M. A. H., Almasi-Hashiani, A., Al-Mekhlafi, H. M., Altirkawi, K. A., Alumran, A. K., Alvis-Guzman, N., Amini-Rarani, M., Aminorroaya, A., Amit, A. M. L., Ancuceanu, R., Andrei, C. L., Androudi, S., Angus, C., Anjomshoa, M., Ansari, F., Ansari, I., Ansari-Moghaddam, A., Antonio, C. A. T., Antony, C. M., Anvari, D., Appiah, S. C. Y., Arabloo, J., Arab-Zozani, M., Aravkin, A. Y., Aremu, O., Ärnlöv, J., Aryal, K. K., Asadi-Pooya, A. A., Asgari, S., Asghari Jafarabadi, M., Atteraya, M. S., Ausloos, M., Avila-Burgos, L., Avokpaho, E. F. G. A., Ayala Quintanilla, B. P., Ayano, G., Ayanore, M. A., Azarian, G., Babaee, E., Badiye, A. D., Bagli, E., Bahrami, M. A., Bakhtiari, A., Balassyano, S., Banach, M., Banik, P. C., Barker-Collo, S. L., Bärnighausen, T. W., Barzegar, A., Basu, S., Baune, B. T., Bayati, M., Bazmandegan, G., Bedi, N., Bell, M. L., Bennett, D. A., Bensenor, I. M., Berhe, K., Berman, A. E., Bertolacci, G. J., Bhageerathy, R., Bhala, N., Bhattacharyya, K., Bhutta, Z. A., Bijani, A., Biondi, A., Bisanzio, D., Bisignano, C., Biswas, R. K., Bjørge, T., Bohlouli, S., Bohluli, M., Bolla, S. R. R., Borzì, A. M., Borzouei, S., Brady, O. J., Braithwaite, D., Brauer, M., Briko, A. N., Briko, N. I., Bumgarner, B. R., Burugina Nagaraja, S., Butt, Z. A., Caetano dos Santos, F. L., Cai, T., Callender, C. S., Cámera, L. L. A., Campos-Nonato, I. R., Cárdenas, R., Carreras, G., Carrero, J. J., Carvalho, F., Castaldelli-Maia, J. M., Castelpietra, G., Castro, F., Catalá-López, F., Cederroth, C. R., Cerin, E., Chattu, V. K., Chin, K. L., Chu, D.-T., Ciobanu, L. G., Cirillo, M., Comfort, H., Costa, V. M., Cowden, R. G., Cromwell, E. A., Croneberger, A. J., Cunningham, M., Dahlawi, S. M. A., Damiani, G., D'Amico, E., Dandona, L., Dandona, R., Dargan, P. I., Darwesh, A. M., Daryani, A., Das Gupta, R., das Neves, J., Davletov, K., De Leo, D., Denova-Gutiérrez, E., Deribe, K., Dervenis, N., Desai, R., Dhungana, G. P., Dias da Silva, D., Diaz, D., Dippenaar, I. N., Djalalinia, S., Do, H. T., Dokova, K., Doku, D. T., Dorostkar, F., Doshi, C. P., Doshmangir, L., Doyle, K. E., Dubljanin, E., Duraes, A. R., Edvardsson, D., Effiong, A., El Sayed, I., El Tantawi, M., Elbarazi, I., El-Jaafary, S. I., Emamian, M. H., Eskandarieh, S., Esmaeilzadeh, F., Estep, K., Farahmand, M., Faraj, A., Fareed, M., Faridnia, R., Faro, A., Farzadfar, F., Fattahi, N., Fazaeli, A. 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Affiliations
  • University of Groningen (NL)
  • University of Washington (US)
Corresponding author
  • Wang, Haidong
  • Do, Hoa Thi
  • Koyanagi, Ai
  • Wang, Hongbo
  • Wang, Yuan-Pang
ORCID
Venue
The Lancet
Publisher
Elsevier BV
Published
2020-10
Volume
396
Issue
10258
Pages
1160-1203
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
DOI
10.1016/s0140-6736(20)30977-6
PMC
PMC7566045
OpenAlex
W3093298383
Cited by
1,971
References
9
Citations by year
2026: 171 · 2025: 408 · 2024: 460 · 2023: 404 · 2022: 323 · 2021: 181 · 2020: 21 · 2019: 1
FWCI
350.08
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, cc-by)
  • Repositori digital de la UPF (Universitat Pompeu Fabra) (publishedVersion, cc-by)
  • University of Twente Research Information (publishedVersion, cc-by)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
  • Lincoln Repository (University of Lincoln) (acceptedVersion)
  • White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
  • Research Open (London South Bank University) (acceptedVersion, cc-by)
  • Pure (Coventry University) (acceptedVersion, cc-by)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • City Research Online (City University London) (acceptedVersion)
  • DSPACE System - Metalibrary (University of the Coast) (acceptedVersion, public-domain)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (acceptedVersion)
  • ANU Open Research (Australian National University) (submittedVersion, cc-by)
  • UNSWorks (University of New South Wales, Sydney, Australia) (submittedVersion, cc-by-nc-nd)
  • Minerva Access (University of Melbourne) (submittedVersion, cc-by)
  • Tuwhera (Auckland University of Technology) (submittedVersion, cc-by)
  • Queen Mary Research Online (Queen Mary University of London) (submittedVersion, cc-by)
  • Florida International University Digital Commons (Florida International University) (submittedVersion)
  • QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by)
  • NSUWorks (Nova Southeastern University) (submittedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion, cc-by)
  • Repositorio Institucional Universidad El Bosque (submittedVersion, cc-by)
  • Rare & Special e-Zone (The Hong Kong University of Science and Technology) (submittedVersion)
  • FedUni ResearchOnline (Federation University Australia) (submittedVersion, cc-by)
  • EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
  • Dalarna University College Electronic Archive (submittedVersion, other-oa)
  • Uppsala University Publications (Uppsala University) (submittedVersion, other-oa)
  • ArTS Archivio della ricerca di Trieste (University of Trieste https://www.units.it/) (submittedVersion, cc-by)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
  • BRAC University Institutional Repository (BRAC University) (submittedVersion, cc-by)
  • Lancaster EPrints (Lancaster University) (submittedVersion)
  • Research Repository Portal (Ilam University of Medical Sciences) (submittedVersion, cc-by)
  • Figshare (submittedVersion, cc-by)
  • Työväentutkimus Vuosikirja (submittedVersion)
  • University of Thessaly Institutional Repository (University of Thessaly) (submittedVersion, cc-by)
  • Scholarship@Western (Western University) (submittedVersion)
  • Institutional Repositories DataBase (IRDB) (submittedVersion)
  • Site cant be reached (submittedVersion)
  • Technical University of Denmark, DTU Orbit (Technical University of Denmark, DTU) (submittedVersion, other-oa)
  • University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
  • Qatar University QSpace (Qatar University) (submittedVersion, cc-by-nc-nd)
  • Repositorio - Universidad de Ciencias Aplicadas y Ambientales UDCA. (submittedVersion, cc-by-nc-nd)
  • Griffith Research Online (submittedVersion, cc-by)
  • Seoul National University Open Repository (Seoul National University) (submittedVersion)
  • Spiral (Imperial College London) (submittedVersion, other-oa)
  • Tampere University Institutional Repository (Tampere University) (submittedVersion, cc-by)
  • UEA Digital Repository (University of East Anglia) (submittedVersion)
  • NOVA (University of Newcastle Australia) (submittedVersion, cc-by)
  • University of Twente Research Information (submittedVersion, other-oa)
Funders
  • Conselho Nacional de Desenvolvimento Científico e Tecnológico
  • Vetenskapsrådet (2019-01059, UID/MULTI/04378/2019, UID/QUI/50006/2019)
  • Universiti Kebangsaan Malaysia
  • Russian Academy of Sciences
  • Ministero della Salute
  • Public Health England
  • Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
  • Bundesministerium für Bildung und Forschung (01ER1801D)
  • University of Western Australia
  • Fundação para a Ciência e a Tecnologia (DL57/2016/CP1334/CT0006)
  • National Institute of Mental Health (R01AG030153, R01MH110163, R03AG043052, R21AG032572, SLN2014-3-170)
  • National Institutes of Health (P30AG047845)
  • Programa Operacional Temático Factores de Competitividade (POCI-01-0145-FEDER-029248, PTDC/NAN-MAT/29248/2017, P_40_382)
  • National Institute on Aging (U01AG009740)
  • NIHR Oxford Biomedical Research Centre
  • Fogarty International Center (K43 TW 010716-03)
  • Bill and Melinda Gates Foundation
  • Ministério da Ciência, Tecnologia e Ensino Superior (SFRH/BHD/110001/2015)
  • Secretaria Nacional de Ciencia y Tecnología
  • European Regional Development Fund
  • BHF Centre of Research Excellence, Oxford
  • Autoritatea Natională pentru Cercetare Stiintifică
  • Ministarstvo Prosvete, Nauke i Tehnološkog Razvoja (175087)
  • Instituto de Salud Carlos III
  • European Social Fund (CP18/00074)
  • Comunidad de Madrid (B2017/BMD-3686 CIFRA2-CM)
  • Manchester Biomedical Research Centre
  • Department of Science and Innovation, South Africa
  • Manipal Academy of Higher Education
  • Chandigarh University
  • National Rosacea Society (SCAF/15/02)
  • Alexander von Humboldt-Stiftung
  • Duke University
  • University of Michigan
  • Queensland Health
  • Wellcome Trust (201900/Z/16/Z)
  • Sistema Nacional de Investigadores
  • Norwegian Institute of Public Health
  • Ministry of Education, Culture, Sports, Science and Technology (18K10082, DTS18/00032, ISCIII-RETIC REDinREN RD016/0009, PI19/00815)
  • European and Developing Countries Clinical Trials Partnership (RIA2016MC-1615)
  • Danmarks Grundforskningsfond
  • University of Melbourne
  • South African Medical Research Council
  • Medical Research Council (MC_UU_12017/13, MC_UU_12017/15)
  • Department of Health and Social Care
  • European Commission
  • National Health and Medical Research Council
  • National Research Foundation
  • National Institute for Health and Care Research
Topics
  • Social Sciences › Demography › Insurance, Mortality, Demography, Risk Management
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
  • Social Sciences › Decision Sciences › Management Science and Operations Research › demographic modeling and climate adaptation
Keywords
age-specific fertility, total fertility rate, age-specific mortality, under-five mortality, adult mortality, healthy life expectancy, population estimates, net migration, cohort-component model, Global Burden of Disease Study 2019, civil registration, sample registration, sibling history
MeSH terms
Global Burden of Disease, Adolescent, Adult, Aged, Aged, 80 and over, Birth Rate, Child, Child, Preschool, Demography, Female, Humans, Infant, Infant, Newborn, Life Expectancy, Male, Middle Aged, Mortality, Surveys and Questionnaires, Risk Factors, Censuses, Live Birth, Young Adult, Spatial Analysis

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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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