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

Issued Date

2024-05-18

Resource Type

Article

ISSN

01406736

eISSN

1474547X

DOI

10.1016/S0140-6736(24)00476-8

Scopus ID

2-s2.0-85188720479

Pubmed ID

38484753

Journal Title

The Lancet

Volume

403

Issue

10440

Start Page

1989

End Page

2056

Rights Holder(s)

SCOPUS

Bibliographic Citation

The Lancet Vol.403 No.10440 (2024) , 1989-2056

Suggested Citation

Schumacher A.E., Kyu H.H., Antony C.M., Aravkin A.Y., Azhar G.S., Bisignano C., Burkart K., Cercy K.M., Chung E., Coberly K., Comfort H., Cousin E., Culbreth G.T., Cunningham M., Weaver N.D., Degenhardt L., Deitesfeld L., Dirac M.A., Estep K., Feigin V.L., Flaxman A.D., Flor L.S., Force L.M., Fuller J.E., Gakidou E., Hay S.I., Ikuta K.S., Jones D.P., Kassebaum N.J., Kassel M.B., Keller C., Kinzel K.E., Krohn K.J., Lozano R., May E.A., McKowen A.L.W., McLaughlin S.A., Mehlman M.L., Mestrovic T., Mokdad A.H., Mosser J.F., Mougin V., Naghavi M., Nesbit O.D., Novotney A., Ozten Y., Pease S.A., Pigott D.M., Reiner R.C., Robinson-Oden H.E., Shaw D.H., Slepak E.L.N., Sorensen R.J.D., Verghese N.A., Vollset S.E., Vongpradith A., Vos T., Wang D., Watson S., Weaver M.R., Wells K.M., Wilson S., Wool E.E., Zheng P., Lim S.S., Murray C.J.L., Boyko E.J., Chahine Y., Kalani R., Krishnamoorthy V., Khalil I.A., Minja N.W., Morrison S.D., Nafukho F.M., Olivas-Martinez A., Orellana E.R., Tram K.H., Aali A., Rahnavard N., Ahmadzade A.M., Mohammad-Pour S., Morovatdar N., Pourali G., Zafari N., Abbafati C., Cattaruzza M.S., Abbas J., Phillips M.R., Abbasgholizadeh R., Emamverdi M., Friedman J., Abbasi M.A., Daneshvar S., Dashti M., Ghasemzadeh A., Mirza-Aghazadeh-Attari M., Doshmangir L., Ghafourifard M., Lotfi M., Hosseini M.S. 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. The Lancet Vol.403 No.10440 (2024) , 1989-2056. 2056. doi:10.1016/S0140-6736(24)00476-8 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/98896

Title

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

Author(s)

Schumacher A.E.
 Kyu H.H.
 Antony C.M.
 Aravkin A.Y.
 Azhar G.S.
 Bisignano C.
 Burkart K.
 Cercy K.M.
 Chung E.
 Coberly K.
 Comfort H.
 Cousin E.
 Culbreth G.T.
 Cunningham M.
 Weaver N.D.
 Degenhardt L.
 Deitesfeld L.
 Dirac M.A.
 Estep K.
 Feigin V.L.
 Flaxman A.D.
 Flor L.S.
 Force L.M.
 Fuller J.E.
 Gakidou E.
 Hay S.I.
 Ikuta K.S.
 Jones D.P.
 Kassebaum N.J.
 Kassel M.B.
 Keller C.
 Kinzel K.E.
 Krohn K.J.
 Lozano R.
 May E.A.
 McKowen A.L.W.
 McLaughlin S.A.
 Mehlman M.L.
 Mestrovic T.
 Mokdad A.H.
 Mosser J.F.
 Mougin V.
 Naghavi M.
 Nesbit O.D.
 Novotney A.
 Ozten Y.
 Pease S.A.
 Pigott D.M.
 Reiner R.C.
 Robinson-Oden H.E.
 Shaw D.H.
 Slepak E.L.N.
 Sorensen R.J.D.
 Verghese N.A.
 Vollset S.E.
 Vongpradith A.
 Vos T.
 Wang D.
 Watson S.
 Weaver M.R.
 Wells K.M.
 Wilson S.
 Wool E.E.
 Zheng P.
 Lim S.S.
 Murray C.J.L.
 Boyko E.J.
 Chahine Y.
 Kalani R.
 Krishnamoorthy V.
 Khalil I.A.
 Minja N.W.
 Morrison S.D.
 Nafukho F.M.
 Olivas-Martinez A.
 Orellana E.R.
 Tram K.H.
 Aali A.
 Rahnavard N.
 Ahmadzade A.M.
 Mohammad-Pour S.
 Morovatdar N.
 Pourali G.
 Zafari N.
 Abbafati C.
 Cattaruzza M.S.
 Abbas J.
 Phillips M.R.
 Abbasgholizadeh R.
 Emamverdi M.
 Friedman J.
 Abbasi M.A.
 Daneshvar S.
 Dashti M.
 Ghasemzadeh A.
 Mirza-Aghazadeh-Attari M.
 Doshmangir L.
 Ghafourifard M.
 Lotfi M.
 Hosseini M.S.

Author's Affiliation

College of Engineering and Computing
 University of Medical Sciences
 University General Hospital of Patras
 College of Medicine
 Infectious and Tropical Diseases Research Center
 Murdoch Business School
 St. Paul‘s Hospital Millennium Medical College
 Public Health Foundation of India
 Jhpiego Corporation
 School of Pharmacy
 The Institute of Pharmaceutical Sciences (TIPS)
 Research Center for Immunodeficiencies
 Antai College of Economics and Management
 Cleveland Clinic Abu Dhabi
 Melbourne School of Population and Global Health
 University of Health and Allied Sciences, Ghana
 Shaqra University
 Aksum University
 Dilla University
 Imam Abdulrahman Bin Faisal University
 Khalifa University of Science and Technology
 Alfaisal University
 Institute for Health Metrics and Evaluation
 COMSATS University Islamabad
 Cancer Institute NSW
 University of Gondar
 Sree Narayana Guru College, Chelannur
 American University of Antigua
 Rumailah Hospital
 Hamad Medical Corporation
 Birzeit University
 Institute of Endemic Diseases Sudan
 Haramaya University
 Jimma University
 Addis Ababa University
 University of Sharjah
 Ajman University
 Universitas Jenderal Soedirman
 University of Mataram
 Universitas Padjadjaran
 Poznan University of Medical Sciences
 Université Ferhat Abbas Sétif 1
 The University of Jordan
 Yarmouk University
 Al Al-Bayt University
 Alexandria University
 Sapienza Università di Roma
 University of South Australia
 Federal Medical Centre Nigeria
 University of Patras
 Universidade Federal de Minas Gerais
 University of Southern California
 University of Washington School of Medicine
 UNSW Sydney
 Tehran University of Medical Sciences
 University of California, Los Angeles
 University of Texas Health Science Center at Houston
 Florida Agricultural and Mechanical University
 Mayo Clinic Scottsdale-Phoenix, Arizona
 Menzies School of Health Research
 University of Technology Sydney
 U.S. Department of Veterans Affairs
 Universität Basel
 Washington University School of Medicine in St. Louis
 University College London
 Shahid Beheshti University of Medical Sciences
 The Brody School of Medicine
 University College Hospital, Ibadan
 Western Sydney University
 Kerman University of Medical Sciences
 John Sealy School of Medicine
 Universität Heidelberg
 Queen’s University
 National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences
 Florida International University
 Keck School of Medicine of USC
 Imperial College London
 Martin-Luther-Universität Halle-Wittenberg
 Zanjan University of Medical Sciences (ZUMS)
 Karolinska Institutet
 The University of British Columbia
 Università degli Studi di Catania
 The Australian National University
 The Hong Kong Polytechnic University
 United Arab Emirates University
 Yale School of Nursing
 University of Ibadan
 Southeast University
 Joan C. Edwards School of Medicine
 Bayero University
 Tokyo Medical and Dental University
 Harvard Medical School
 Baylor College of Medicine
 University of Tennessee Health Science Center
 University of Nevada, Reno
 Mashhad University of Medical Sciences, School of Medicine
 Mashhad University of Medical Sciences
 Faculty of Medicine
 Johns Hopkins University School of Medicine
 Walden University
 University of Sierra Sur
 National Technological Institute of Mexico
 Edo State University Uzairue
 Adolescent Friendly Research Initiative and Care
 Federal Ministry of Health
 Philippine Institute for Development Studies
 Institute of Public Health
 King Edward Memorial Hospital
 Ministry of Health

Corresponding Author(s)

Schumacher A.E.

Other Contributor(s)

Mahidol University

Abstract

Background: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020–21 COVID-19 pandemic period. Methods: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. Findings: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5–65·1] decline), and increased during the COVID-19 pandemic period (2020–21; 5·1% [0·9–9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98–5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50–6·01) in 2019. An estimated 131 million (126–137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7–17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8–24·8), from 49·0 years (46·7–51·3) to 71·7 years (70·9–72·5). Global life expectancy at birth declined by 1·6 years (1·0–2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67–8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4–52·7]) and south Asia (26·3% [9·0–44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. Interpretation: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. Funding: Bill & Melinda Gates Foundation.

Keyword(s)

Medicine

Availability

URI

https://repository.li.mahidol.ac.th/handle/20.500.14594/98896

Collections

Scopus 2024