TY - JOUR
T1 - 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
AU - GBD 2021 Demographics Collaborators
AU - Schumacher, Austin E.
AU - Kyu, Hmwe Hmwe
AU - Antony, Catherine M.
AU - Aravkin, Aleksandr Y.
AU - Azhar, Gulrez Shah
AU - Bisignano, Catherine
AU - Burkart, Katrin
AU - Cercy, Kelly M.
AU - Chung, Eunice
AU - Coberly, Kaleb
AU - Comfort, Haley
AU - Cousin, Ewerton
AU - Culbreth, Garland T.
AU - Cunningham, Matthew
AU - Weaver, Nicole Davis
AU - Degenhardt, Louisa
AU - Deitesfeld, Lee
AU - Dirac, M. Ashworth
AU - Estep, Kara
AU - Feigin, Valery L.
AU - Flaxman, Abraham D.
AU - Flor, Luisa S.
AU - Force, Lisa M.
AU - Fuller, John E.
AU - Gakidou, Emmanuela
AU - Hay, Simon I.
AU - Ikuta, Kevin S.
AU - Jones, Darwin Phan
AU - Kassebaum, Nicholas J.
AU - Kassel, Molly B.
AU - Keller, Cathleen
AU - Kinzel, Kasey E.
AU - Krohn, Kris J.
AU - Lozano, Rafael
AU - May, Erin A.
AU - McKowen, Anna Laura W.
AU - McLaughlin, Susan A.
AU - Mehlman, Max L.
AU - Mestrovic, Tomislav
AU - Mokdad, Ali H.
AU - Mosser, Jonathan F.
AU - Mougin, Vincent
AU - Naghavi, Mohsen
AU - Nesbit, Olivia D.
AU - Novotney, Amanda
AU - Ozten, Yaz
AU - Pease, Spencer A.
AU - Pigott, David M.
AU - Reiner, Robert C.
AU - Robinson-Oden, Hannah Elizabeth
AU - Shaw, David H.
AU - Slepak, Erica Leigh N.
AU - Sorensen, Reed J.D.
AU - Verghese, Nicholas Alexander
AU - Vollset, Stein Emil
AU - Vongpradith, Avina
AU - Vos, Theo
AU - Wang, Denny
AU - Watson, Stefanie
AU - Weaver, Marcia R.
AU - Wells, Katherine M.
AU - Wilson, Shadrach
AU - Wool, Eve E.
AU - Zheng, Peng
AU - Lim, Stephen S.
AU - Murray, Christopher J.L.
AU - Boyko, Edward J.
AU - Chahine, Yaacoub
AU - Kalani, Rizwan
AU - Krishnamoorthy, Vijay
AU - Khalil, Ibrahim A.
AU - Minja, Neema W.
AU - Morrison, Shane Douglas
AU - Nafukho, Fredrick Muyia
AU - Olivas-Martinez, Antonio
AU - Orellana, E. Roberto
AU - Tram, Khai Hoan
AU - Aali, Amirali
AU - Rahnavard, Niloufar
AU - Ahmadzade, Amir Mahmoud
AU - Mohammad-Pour, Saeed
AU - Morovatdar, Negar
AU - Pourali, Ghazaleh
AU - Zafari, Nima
AU - Abbafati, Cristiana
AU - Cattaruzza, Maria Sofia
AU - Abbas, Jaffar
AU - Phillips, Michael R.
AU - Abbasgholizadeh, Rouzbeh
AU - Emamverdi, Mehdi
AU - Friedman, Joseph
AU - Abbasi, Madineh Akram
AU - Daneshvar, Sara
AU - Dashti, Mohsen
AU - Ghasemzadeh, Afsaneh
AU - Mirza-Aghazadeh-Attari, Mohammad
AU - Doshmangir, Leila
AU - Ghafourifard, Mansour
AU - Lotfi, Mojgan
AU - Hosseini, Mohammad Salar
AU - Jadidi-Niaragh, Farhad
AU - Kalankesh, Leila R.
AU - Karimi, Salah Eddin
AU - Mohammad-Alizadeh-Charandabi, Sakineh
AU - Khalafi, Mohammad
AU - Mirghafourvand, Mojgan
AU - Mirinezhad, Seyed Kazem
AU - Heris, Reza Mosaddeghi
AU - Mousavi, Seyed Ehsan
AU - Kafil, Hossein Samadi
AU - Abbasian, Mohammadreza
AU - Momenzadeh, Kaveh
AU - Santos, Florentino Luciano Caetano dos
AU - Carr, Sinclair
AU - Chi, Gerald
AU - Elgendy, Islam Y.
AU - Feroze, Abdullah Hamid
AU - Kempen, John H.
AU - Kubeisy, Connor M.
AU - Li, Zhihui
AU - Rohloff, Peter
AU - Liu, Xiaofeng
AU - Natto, Zuhair S.
AU - Olanipekun, Titilope O.
AU - Pigeolet, Manon
AU - Pradhan, Pranil Man Singh
AU - Zweck, Elric
AU - Sharfaei, Sadaf
AU - Sheikh, Aziz
AU - Abtahi, Dariush
AU - Salimi, Sohrab
AU - Shakeri, Alireza
AU - Tajbakhsh, Ardeshir
AU - Aghamiri, Shahin
AU - Ahmadzade, Mohadese
AU - Hashemi, Milad Bonakdar
AU - Ajami, Marjan
AU - Asgary, Saeed
AU - Ghasemi, Mohammad Reza
AU - Hassanian-Moghaddam, Hossein
AU - Kolahi, Ali Asghar
AU - Nikoobar, Ali
AU - Heidari-Foroozan, Mahsa
AU - Montazeri, Fateme
AU - Nejadghaderi, Seyed Aria
AU - Rahmani, Shayan
AU - Ziaeefar, Pardis
AU - Hesami, Hamed
AU - Zahir, Mazyar
AU - Jahankhani, Kasra
AU - Rasouli-Saravani, Ashkan
AU - Jahanmehr, Nader
AU - Kashani, Hamid Reza Khayat
AU - Nasiri, Mohammad Javad
AU - Raee, Pourya
AU - Rezaee, Malihe
AU - Safi, Sare
AU - Shool, Sina
AU - Tabatabai, Shima
AU - ElHafeez, Samar Abd
AU - Tantawi, Maha El
AU - Elmeligy, Omar Abdelsadek Abdou
AU - Ghazy, Ramy Mohamed
AU - Talaat, Iman M.
AU - Abdelmasseh, Michael
AU - Sanabria, Juan
AU - Abd-Elsalam, Sherief
AU - Abdelwahab, Ahmed
AU - Abdollahi, Mohammad
AU - Abolhassani, Hassan
AU - Rezaei, Nima
AU - Saghazadeh, Amene
AU - Ala, Moein
AU - Noroozi, Nafise
AU - Bahri, Razman Arabzadeh
AU - Khatami, Fatemeh
AU - Ayyoubzadeh, Seyed Mohammad
AU - Azadnajafabad, Sina
AU - Keykhaei, Mohammad
AU - Momtazmanesh, Sara
AU - Mousavi, Parsa
AU - Rezaei, Nima
AU - Behnoush, Amir Hossein
AU - Farrokhpour, Hossein
AU - Karimi, Hanie
AU - Khalaji, Amirmohammad
AU - Khanmohammadi, Shaghayegh
AU - Mayeli, Mahsa
AU - Mohammadi, Soheil
AU - Eskandarieh, Sharareh
AU - Sahraian, Mohammad Ali
AU - Fahimi, Saman
AU - Malekzadeh, Reza
AU - Mansouri, Vahid
AU - Sepanlou, Sadaf G.
AU - Ghassemi, Fariba
AU - Haddadi, Mohammad
AU - Kazemian, Sina
AU - Khadembashiri, Mohamad Mehdi
AU - Khamesipour, Faham
AU - Khavandegar, Armin
AU - Khormali, Moein
AU - Salamati, Payman
AU - Kompani, Farzad
AU - Larijani, Bagher
AU - Mirdamadi, Niloofar
AU - Seyedi, Seyed Arsalan
AU - Malazy, Ozra Tabatabaei
AU - Mahmoudi, Elham
AU - Rashedi, Sina
AU - Rad, Elaheh Malakan
AU - Mansournia, Mohammad Ali
AU - Nasab, Entezar Mehrabi
AU - Mohammadshahi, Marita
AU - Mostafavi, Hakimeh
AU - SeyedAlinaghi, Seyed Ahmad
AU - Shafie, Mahan
AU - Shahbandi, Ataollah
AU - Vahdani, Amir Mohammad
AU - Sharifan, Amin
AU - Shirkoohi, Reza
AU - Sohrabi, Hanye
AU - Tavangar, Seyed Mohammad
AU - Heidari-Soureshjani, Reza
AU - Khadembashiri, Mohamad Mehdi
AU - Abdoun, Meriem
AU - Abdullahi, Auwal
AU - Awotidebe, Adedapo Wasiu
AU - Borodo, Safiya Bala
AU - Gadanya, Muktar A.
AU - Ladan, Muhammad Awwal
AU - Ali, Mohammed Usman
AU - Tyrovolas, Stefanos
AU - Abdurehman, Ame Mehadi
AU - Debele, Aklilu Tamire
AU - Getachew, Tamirat
AU - Gudeta, Mesay Dechasa
AU - Misgana, Tadesse
AU - Sertsu, Addisu
AU - Abebe, Mesfin
AU - Ayele, Getnet Melaku
AU - Afework, Abel
AU - Wang, Cong
AU - Sawyer, Susan M.
AU - Ali, Syed Shujait Shujait
AU - Kerr, Jessica A.
AU - Marx, Wolfgang
AU - Le, Thao Thi Thu
AU - Le, Thao Thi Thu
AU - Lee, Wei Chen
N1 - Publisher Copyright:
© 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2024/5/18
Y1 - 2024/5/18
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85188720479&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(24)00476-8
DO - 10.1016/S0140-6736(24)00476-8
M3 - Article
C2 - 38484753
AN - SCOPUS:85188720479
SN - 0140-6736
VL - 403
SP - 1989
EP - 2056
JO - The Lancet
JF - The Lancet
IS - 10440
ER -