Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

Abstract

SummaryBackgroundDetailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016.MethodsWe have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15–60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations in...

Burden of disease in Brazil, 1990–2016: a systematic subnational analysis for the Global Burden of Disease Study 2016

“…Much of the interpersonal violence in Brazil is due to homicides with firearms related in part to drug trafficking, availability and circulation of illegal firearms, and consumption of alcohol and drugs 10, 11. Mortality rates are especially high for young males, as is the case in other countries 17 . Although rates remain high in Rio de Janeiro, they represent an impressive decline from 1990, in part due to national policies introduced in 2003 that restricted firearm ownership, carrying, and importation, and increased punishments for violations, alongside disarmament efforts 69, 70.…”

“…The historic relationship between police, crime, and communities in Brazil is complex, 10 and focusing on the top risk factors contributing to interpersonal violence—alcohol and drug use—could be a more productive way to address the problem than increased policing, particularly among males 71 . However, efforts will also need to take into account the role of the drug trade, which has led to increased rates of violence across a belt of countries in Latin America, including comparators Mexico and Colombia 17, 72…”

“…Analyses were done with Python (versions 2.5.4 and 2.7.3), Stata (version 13.1), or R (version 3.1.2), and statistical code is available online. A comprehensive description of data sources, quality, and modelling for GBD 2016 has been reported elsewhere 5, 17, 19, 20, 21, 22…”

“…Disability-adjusted life-years (DALYs), a combined measure of health lost to fatal and non-fatal causes (appendix p 70), are calculated as the sum of YLLs and YLDs for each age-sex-location-year 20 . The calculations for life expectancy at birth (LE) and maximum life expectancy at each age have been previously reported 17 . Healthy life expectancy (HALE) summarises overall population health accounting for length of life and level of health loss by age using YLD estimates and the GBD life tables, as previously described 20 …”

Decreases of Life Expectancy Despite Decreases in Non-Communicable Disease Mortality: The Role of Substance Use and Socioeconomic Status

“…As a consequence of the so-called epidemiologic transition in most parts of the world [1, 2], non-communicable diseases (NCDs) constitute an overwhelming majority of global premature mortality [3, 4]; in fact, the NCDs included as indicators in the World Health Organization Global Action Plan for the Prevention and Control of NCDs 2013–2020 [5] (i.e., cardiovascular disease, cancer, respiratory disease, and diabetes), comprised 70% of all deaths globally, and 80% of all premature NCD deaths in 2010 [6]. The reduction of premature mortality from NCDs is also target 3.4 of the United Nations’ Sustainable Development Goals [7].…”