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

Issued Date

2024-05-18

Resource Type

Article

ISSN

01406736

eISSN

1474547X

DOI

10.1016/S0140-6736(24)00367-2

Scopus ID

2-s2.0-85189898702

Pubmed ID

38582094

Journal Title

The Lancet

Volume

403

Issue

10440

Start Page

2100

End Page

2132

Rights Holder(s)

SCOPUS

Bibliographic Citation

The Lancet Vol.403 No.10440 (2024) , 2100-2132

Suggested Citation

Naghavi M., Ong K.L., Aali A., Ababneh H.S., Abate Y.H., Abbafati C., Abbasgholizadeh R., Abbasian M., Abbasi-Kangevari M., Abbastabar H., Abd ElHafeez S., Abdelmasseh M., Abd-Elsalam S., Abdelwahab A., Abdollahi M., Abdollahifar M.A., Abdoun M., Abdulah D.M., Abdullahi A., Abebe M., Abebe S.S., Abedi A., Abegaz K.H., Abhilash E.S., Abidi H., Abiodun O., Aboagye R.G., Abolhassani H., Abolmaali M., Abouzid M., Aboye G.B., Abreu L.G., Abrha W.A., Abtahi D., Abu Rumeileh S., Abualruz H., Abubakar B., Abu-Gharbieh E., Abu-Rmeileh N.M., Aburuz S., Abu-Zaid A., Accrombessi M.M.K., Adal T.G., Adamu A.A., Addo I.Y., Addolorato G., Adebiyi A.O., Adekanmbi V., Adepoju A.V., Adetunji C.O., Adetunji J.B., Adeyeoluwa T.E., Adeyinka D.A., Adeyomoye O.I., Admass B.A., Adnani Q.E.S., Adra S., Afolabi A.A., Afzal M.S., Afzal S., Agampodi S.B., Agasthi P., Aggarwal M., Aghamiri S., Agide F.D., Agodi A., Agrawal A., Agyemang-Duah W., Ahinkorah B.O., Ahmad A., Ahmad D., Ahmad F., Ahmad M.M., Ahmad S., Ahmad S., Ahmad T., Ahmadi K., Ahmadzade A.M., Ahmed A., Ahmed A., Ahmed H., Ahmed L.A., Ahmed M.S., Ahmed M.S., Ahmed M.B., Ahmed S.A., Ajami M., Aji B., Akara E.M., Akbarialiabad H., Akinosoglou K., Akinyemiju T., Akkaif M.A., Akyirem S., Al Hamad H., Al Hasan S.M., Alahdab F., Alalalmeh S.O., Alalwan T.A., Al-Aly Z. 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. The Lancet Vol.403 No.10440 (2024) , 2100-2132. 2132. doi:10.1016/S0140-6736(24)00367-2 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/99672

Title

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

Author(s)

Naghavi M.
 Ong K.L.
 Aali A.
 Ababneh H.S.
 Abate Y.H.
 Abbafati C.
 Abbasgholizadeh R.
 Abbasian M.
 Abbasi-Kangevari M.
 Abbastabar H.
 Abd ElHafeez S.
 Abdelmasseh M.
 Abd-Elsalam S.
 Abdelwahab A.
 Abdollahi M.
 Abdollahifar M.A.
 Abdoun M.
 Abdulah D.M.
 Abdullahi A.
 Abebe M.
 Abebe S.S.
 Abedi A.
 Abegaz K.H.
 Abhilash E.S.
 Abidi H.
 Abiodun O.
 Aboagye R.G.
 Abolhassani H.
 Abolmaali M.
 Abouzid M.
 Aboye G.B.
 Abreu L.G.
 Abrha W.A.
 Abtahi D.
 Abu Rumeileh S.
 Abualruz H.
 Abubakar B.
 Abu-Gharbieh E.
 Abu-Rmeileh N.M.
 Aburuz S.
 Abu-Zaid A.
 Accrombessi M.M.K.
 Adal T.G.
 Adamu A.A.
 Addo I.Y.
 Addolorato G.
 Adebiyi A.O.
 Adekanmbi V.
 Adepoju A.V.
 Adetunji C.O.
 Adetunji J.B.
 Adeyeoluwa T.E.
 Adeyinka D.A.
 Adeyomoye O.I.
 Admass B.A.
 Adnani Q.E.S.
 Adra S.
 Afolabi A.A.
 Afzal M.S.
 Afzal S.
 Agampodi S.B.
 Agasthi P.
 Aggarwal M.
 Aghamiri S.
 Agide F.D.
 Agodi A.
 Agrawal A.
 Agyemang-Duah W.
 Ahinkorah B.O.
 Ahmad A.
 Ahmad D.
 Ahmad F.
 Ahmad M.M.
 Ahmad S.
 Ahmad S.
 Ahmad T.
 Ahmadi K.
 Ahmadzade A.M.
 Ahmed A.
 Ahmed A.
 Ahmed H.
 Ahmed L.A.
 Ahmed M.S.
 Ahmed M.S.
 Ahmed M.B.
 Ahmed S.A.
 Ajami M.
 Aji B.
 Akara E.M.
 Akbarialiabad H.
 Akinosoglou K.
 Akinyemiju T.
 Akkaif M.A.
 Akyirem S.
 Al Hamad H.
 Al Hasan S.M.
 Alahdab F.
 Alalalmeh S.O.
 Alalwan T.A.
 Al-Aly Z.

Author's Affiliation

School of Medicine and Psychology
 University of Medical Sciences
 University General Hospital of Patras
 Public Health Foundation of India
 Jhpiego Corporation
 Babcock University
 School of Pharmacy
 Advanced Diagnostic and Interventional Radiology Research Center
 The Institute of Pharmaceutical Sciences (TIPS)
 Research Center for Immunodeficiencies
 Non-Communicable Diseases Research Center
 University of Health and Allied Sciences, Ghana
 Ashoka University
 Majmaah University
 Shaqra University
 Aksum University
 Wachemo University
 Wolkite University
 Madda Walabu University
 Dilla University
 Osun State University
 Alfaisal University
 UCSI University
 Institute for Health Metrics and Evaluation
 COMSATS University Islamabad
 Nigerian Institute of Medical Research
 Cancer Institute NSW
 University of Duhok
 University of Gondar
 Sree Narayana Guru College, Chelannur
 Rajarata University of Sri Lanka
 Fondazione Policlinico Universitario Agostino Gemelli IRCCS
 Rumailah Hospital
 Hamad Medical Corporation
 Birzeit University
 Institute of Endemic Diseases Sudan
 Haramaya University
 Jimma University
 Ajman University
 University of Management and Technology Lahore
 Universitas Jenderal Soedirman
 Universitas Padjadjaran
 Poznan University of Medical Sciences
 Lebanese American University
 Université Ferhat Abbas Sétif 1
 International Vaccine Institute, Seoul
 Al-Zaytoonah University of Jordan
 The University of Jordan
 King Edward Medical University Lahore
 Yasuj University of Medical Sciences
 Alexandria University
 Usmanu Danfodiyo University
 Sapienza Università di Roma
 Università Cattolica del Sacro Cuore, Campus di Roma
 University of South Australia
 London School of Hygiene & Tropical Medicine
 University of Patras
 University of California, San Diego
 Universidade Federal de Minas Gerais
 Massachusetts General Hospital
 University of Southern California
 University of Washington School of Medicine
 UNSW Sydney
 University of California, Los Angeles
 Mayo Clinic Scottsdale-Phoenix, Arizona
 University of Technology Sydney
 U.S. Department of Veterans Affairs
 Universität Basel
 Washington University School of Medicine in St. Louis
 Cleveland Clinic Foundation
 The Brody School of Medicine
 University of Missouri School of Medicine
 University College Hospital, Ibadan
 John Sealy School of Medicine
 Queen’s University
 National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences
 University of Saskatchewan
 Keck School of Medicine of USC
 Imperial College London
 Martin-Luther-Universität Halle-Wittenberg
 UNSW Medicine
 Fudan University
 The Hong Kong Polytechnic University
 United Arab Emirates University
 Yale School of Nursing
 Yakın Doğu Üniversitesi
 University of Ibadan
 Southeast University
 Duke University School of Medicine
 Joan C. Edwards School of Medicine
 Bayero University
 Università degli Studi di Catania, Scuola di Medicina
 Harvard Medical School
 Baylor College of Medicine
 University of Tennessee Health Science Center
 Stellenbosch University
 Mashhad University of Medical Sciences, School of Medicine
 Mashhad University of Medical Sciences
 Faculty of Medicine
 University of Bahrain
 McWilliams School of Biomedical Informatics
 Clinical Sciences Department
 Aleta Wondo Hospital
 Edo State University Uzairue
 Clinical Research Institute of Benin (IRCB)
 Khatam Alanbia Hospital
 Adolescent Friendly Research Initiative and Care
 Abasyn University
 Federal Ministry of Health
 Shefa Neuroscience Research Center
 King Edward Memorial Hospital
 Riphah Institute of Pharmaceutical Sciences
 College of Medicine
 Conservation South Africa
 Miami Cancer Institute
 Ministry of Health
 Institute of Public Health

Corresponding Author(s)

Naghavi M.

Other Contributor(s)

Mahidol University

Abstract

Background: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model—a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates—with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality—which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2–100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1–290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1–211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4–48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3–37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7–9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. Funding: Bill & Melinda Gates Foundation.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/99672

Collections

Scopus 2024