TY - JOUR
T1 - 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
AU - GBD 2021 Causes of Death Collaborators
AU - Naghavi, Mohsen
AU - Ong, Kanyin Liane
AU - Aali, Amirali
AU - Ababneh, Hazim S.
AU - Abate, Yohannes Habtegiorgis
AU - Abbafati, Cristiana
AU - Abbasgholizadeh, Rouzbeh
AU - Abbasian, Mohammadreza
AU - Abbasi-Kangevari, Mohsen
AU - Abbastabar, Hedayat
AU - Abd ElHafeez, Samar
AU - Abdelmasseh, Michael
AU - Abd-Elsalam, Sherief
AU - Abdelwahab, Ahmed
AU - Abdollahi, Mohammad
AU - Abdollahifar, Mohammad Amin
AU - Abdoun, Meriem
AU - Abdulah, Deldar Morad
AU - Abdullahi, Auwal
AU - Abebe, Mesfin
AU - Abebe, Samrawit Shawel
AU - Abedi, Aidin
AU - Abegaz, Kedir Hussein
AU - Abhilash, E. S.
AU - Abidi, Hassan
AU - Abiodun, Olumide
AU - Aboagye, Richard Gyan
AU - Abolhassani, Hassan
AU - Abolmaali, Meysam
AU - Abouzid, Mohamed
AU - Aboye, Girma Beressa
AU - Abreu, Lucas Guimaraes
AU - Abrha, Woldu Aberhe
AU - Abtahi, Dariush
AU - Abu Rumeileh, Samir
AU - Abualruz, Hasan
AU - Abubakar, Bilyaminu
AU - Abu-Gharbieh, Eman
AU - Abu-Rmeileh, Niveen Me
AU - Aburuz, Salahdein
AU - Abu-Zaid, Ahmed
AU - Accrombessi, Manfred Mario Kokou
AU - Adal, Tadele Girum
AU - Adamu, Abdu A.
AU - Addo, Isaac Yeboah
AU - Addolorato, Giovanni
AU - Adebiyi, Akindele Olupelumi
AU - Adekanmbi, Victor
AU - Adepoju, Abiola Victor
AU - Adetunji, Charles Oluwaseun
AU - Adetunji, Juliana Bunmi
AU - Adeyeoluwa, Temitayo Esther
AU - Adeyinka, Daniel Adedayo
AU - Adeyomoye, Olorunsola Israel
AU - Admass, Biruk Adie
AU - Adnani, Qorinah Estiningtyas Sakilah
AU - Adra, Saryia
AU - Afolabi, Aanuoluwapo Adeyimika
AU - Afzal, Muhammad Sohail
AU - Afzal, Saira
AU - Agampodi, Suneth Buddhika
AU - Agasthi, Pradyumna
AU - Aggarwal, Manik
AU - Aghamiri, Shahin
AU - Agide, Feleke Doyore
AU - Agodi, Antonella
AU - Agrawal, Anurag
AU - Agyemang-Duah, Williams
AU - Ahinkorah, Bright Opoku
AU - Ahmad, Aqeel
AU - Ahmad, Danish
AU - Ahmad, Firdos
AU - Ahmad, Muayyad M.
AU - Ahmad, Sajjad
AU - Ahmad, Shahzaib
AU - Ahmad, Tauseef
AU - Ahmadi, Keivan
AU - Ahmadzade, Amir Mahmoud
AU - Ahmed, Ali
AU - Ahmed, Ayman
AU - Ahmed, Haroon
AU - Ahmed, Luai A.
AU - Ahmed, Mehrunnisha Sharif
AU - Ahmed, Meqdad Saleh
AU - Ahmed, Muktar Beshir
AU - Ahmed, Syed Anees
AU - Ajami, Marjan
AU - Aji, Budi
AU - Akara, Essona Matatom
AU - Akbarialiabad, Hossein
AU - Akinosoglou, Karolina
AU - Akinyemiju, Tomi
AU - Akkaif, Mohammed Ahmed
AU - Akyirem, Samuel
AU - Al Hamad, Hanadi
AU - Al Hasan, Syed Mahfuz
AU - Alahdab, Fares
AU - Alalalmeh, Samer O.
AU - Alalwan, Tariq A.
AU - Al-Aly, Ziyad
AU - Alam, Khurshid
AU - Alam, Manjurul
AU - Alam, Noore
AU - Al-Amer, Rasmieh Mustafa
AU - Alanezi, Fahad Mashhour
AU - Alanzi, Turki M.
AU - Al-Azzam, Sayer
AU - Albakri, Almaza
AU - Albashtawy, Mohammed
AU - AlBataineh, Mohammad T.
AU - Alcalde-Rabanal, Jacqueline Elizabeth
AU - Aldawsari, Khalifah A.
AU - Aldhaleei, Wafa A.
AU - Aldridge, Robert W.
AU - Alema, Haileselasie Berhane
AU - Alemayohu, Mulubirhan Assefa
AU - Alemi, Sharifullah
AU - Alemu, Yihun Mulugeta
AU - Al-Gheethi, Adel Ali Saeed
AU - Alhabib, Khalid F.
AU - Alhalaiqa, Fadwa Alhalaiqa Naji
AU - Al-Hanawi, Mohammed Khaled
AU - Ali, Abid
AU - Ali, Amjad
AU - Ali, Liaqat
AU - Ali, Mohammed Usman
AU - Ali, Rafat
AU - Ali, Shahid
AU - Ali, Syed Shujait Shujait
AU - Alicandro, Gianfranco
AU - Alif, Sheikh Mohammad
AU - Alikhani, Reyhaneh
AU - Alimohamadi, Yousef
AU - Aliyi, Ahmednur Adem
AU - Aljasir, Mohammad A.M.
AU - Aljunid, Syed Mohamed
AU - Alla, Francois
AU - Allebeck, Peter
AU - Al-Marwani, Sabah
AU - Al-Maweri, Sadeq Ali Ali
AU - Almazan, Joseph Uy
AU - Al-Mekhlafi, Hesham M.
AU - Almidani, Louay
AU - Almidani, Omar
AU - Alomari, Mahmoud A.
AU - Al-Omari, Basem
AU - Alonso, Jordi
AU - Alqahtani, Jaber S.
AU - Alqalyoobi, Shehabaldin
AU - Alqutaibi, Ahmed Yaseen
AU - Al-Sabah, Salman Khalifah
AU - Altaany, Zaid
AU - Altaf, Awais
AU - Al-Tawfiq, Jaffar A.
AU - Altirkawi, Khalid A.
AU - Aluh, Deborah Oyine
AU - Alvis-Guzman, Nelson
AU - Alwafi, Hassan
AU - Al-Worafi, Yaser Mohammed
AU - Aly, Hany
AU - Aly, Safwat
AU - Alzoubi, Karem H.
AU - Amani, Reza
AU - Amare, Azmeraw T.
AU - Amegbor, Prince M.
AU - Ameyaw, Edward Kwabena
AU - Amin, Tarek Tawfik
AU - Amindarolzarbi, Alireza
AU - Amiri, Sohrab
AU - Amirzade-Iranaq, Mohammad Hosein
AU - Amu, Hubert
AU - Amugsi, Dickson A.
AU - Amusa, Ganiyu Adeniyi
AU - Ancuceanu, Robert
AU - Anderlini, Deanna
AU - Anderson, David B.
AU - Andrade, Pedro Prata
AU - Andrei, Catalina Liliana
AU - Andrei, Tudorel
AU - Angus, Colin
AU - Anil, Abhishek
AU - Anil, Sneha
AU - Anoushiravani, Amir
AU - Ansari, Hossein
AU - Ansariadi, Ansariadi
AU - Ansari-Moghaddam, Alireza
AU - Antony, Catherine M.
AU - Antriyandarti, Ernoiz
AU - Anvari, Davood
AU - Anvari, Saeid
AU - Anwar, Saleha
AU - Anwar, Sumadi Lukman
AU - Anwer, Razique
AU - Anyasodor, Anayochukwu Edward
AU - Aqeel, Muhammad
AU - Arab, Juan Pablo
AU - Arabloo, Jalal
AU - Arafat, Mosab
AU - Aravkin, Aleksandr Y.
AU - Areda, Demelash
AU - Aremu, Abdulfatai
AU - Aremu, Olatunde
AU - Ariffin, Hany
AU - Arkew, Mesay
AU - Armocida, Benedetta
AU - Arndt, Michael Benjamin
AU - Arnlov, Johan
AU - Arooj, Mahwish
AU - Artamonov, Anton A.
AU - Arulappan, Judie
AU - Aruleba, Raphael Taiwo
AU - Arumugam, Ashokan
AU - Asaad, Malke
AU - Asadi-Lari, Mohsen
AU - Asgedom, Akeza Awealom
AU - Asghariahmadabad, Mona
AU - Asghari-Jafarabadi, Mohammad
AU - Ashraf, Muhammad
AU - Aslani, Armin
AU - Astell-Burt, Thomas
AU - Athar, Mohammad
AU - Athari, Seyyed Shamsadin
AU - Atinafu, Bantalem Tilaye Tilaye
AU - Atlaw, Habtamu Wondmagegn
AU - Atorkey, Prince
AU - Atout, Maha Moh d.Wahbi
AU - Atreya, Alok
AU - Aujayeb, Avinash
AU - Ausloos, Marcel
AU - Avan, Abolfazl
AU - Awedew, Atalel Fentahun
AU - Aweke, Amlaku Mulat
AU - Ayala Quintanilla, Beatriz Paulina
AU - Ayatollahi, Haleh
AU - Ayuso-Mateos, Jose L.
AU - Ayyoubzadeh, Seyed Mohammad
AU - Azadnajafabad, Sina
AU - Azevedo, Rui M.S.
AU - Azzam, Ahmed Y.
AU - Darshan, B. B.
AU - Babu, Abraham Samuel
AU - Badar, Muhammad
AU - Chan, Raymond N.C.
AU - Kelly, Jaimon Terence
AU - Kerr, Jessica A.
AU - Le, Thao Thi Thu
AU - Lee, Wei Chen
AU - Marx, Wolfgang
AU - Shah, Syed Mahboob
AU - Wang, Cong
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: 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=85189898702&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(24)00367-2
DO - 10.1016/S0140-6736(24)00367-2
M3 - Article
C2 - 38582094
AN - SCOPUS:85189898702
SN - 0140-6736
VL - 403
SP - 2100
EP - 2132
JO - The Lancet
JF - The Lancet
IS - 10440
ER -