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

none782siBackground: Detailed 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. Methods: We 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 into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. Findings: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates - a measure of relative inequality - increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86.9 years (95% UI 86.7-87.2), and for men in Singapore, at 81.3 years (78.8-83.7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. Interpretation Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled.openWang, Haidong; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbas, Kaja M.; Abd-Allah, Foad; Abera, Semaw Ferede; Abraha, Haftom Niguse; Abu-Raddad, Laith J.; Abu-Rmeileh, Niveen M.E.; Adedeji, Isaac Akinkunmi; Adedoyin, Rufus Adesoji; Adetifa, Ifedayo Morayo O.; Adetokunboh, Olatunji; Afshin, Ashkan; Aggarwal, Rakesh; Agrawal, Anurag; Agrawal, Sutapa; Ahmad Kiadaliri, Aliasghar; Ahmed, Muktar Beshir; Aichour, Amani Nidhal; Aichour, Ibthiel; Aichour, Miloud Taki Eddine; Aiyar, Sneha; Akanda, Ali Shafqat; Akinyemiju, Tomi F.; Akseer, Nadia; Al-Eyadhy, Ayman; Al Lami, Faris Hasan; Alabed, Samer; Alahdab, Fares; Al-Aly, Ziyad; Alam, Khurshid; Alam, Noore; Alasfoor, Deena; Aldridge, Robert William; Alene, Kefyalew Addis; Alhabib, Samia; Ali, Raghib; Alizadeh-Navaei, Reza; Aljunid, Syed M.; Alkaabi, Juma M.; Alkerwi, Ala'a; Alla, François; Allam, Shalini D.; Allebeck, Peter; Al-Raddadi, Rajaa; Alsharif, Ubai; Altirkawi, Khalid A.; Martin, Elena Alvarez; Alvis-Guzman, Nelson; Amare, Azmeraw T.; Ameh, Emmanuel A.; Amini, Erfan; Ammar, Walid; Amoako, Yaw Ampem; Anber, Nahla; Andrei, Catalina Liliana; Androudi, Sofia; Ansari, Hossein; Ansha, Mustafa Geleto; Antonio, Carl Abelardo T.; Anwari, Palwasha; Ärnlöv, Johan; Arora, Megha; Artaman, Al; Aryal, Krishna Kumar; Asayesh, Hamid; Asgedom, Solomon Weldegebreal; Asghar, Rana Jawad; Assadi, Reza; Atey, Tesfay Mehari; Atre, Sachin R.; Avila-Burgos, Leticia; Avokpaho, Euripide Frinel G. Arthur; Awasthi, Ashish; Ayala Quintanilla, Beatriz Paulina; Babalola, Tesleem Kayode; Bacha, Umar; Badawi, Alaa; Balakrishnan, Kalpana; Balalla, Shivanthi; Barac, Aleksandra; Barber, Ryan M.; Barboza, Miguel A.; Barker-Collo, Suzanne L.; Bärnighausen, Till; Barquera, Simon; Barregard, Lars; Barrero, Lope H.; Baune, Bernhard T.; Bazargan-Hejazi, Shahrzad; Bedi, Neeraj; Beghi, Ettore; Béjot, Yannick; Bekele, Bayu Begashaw; Bell, Michelle L.; Bello, Aminu K.; Bennett, Derrick A.; Bennett, James R.; Bensenor, Isabela M.; Benson, Jennifer; Berhane, Adugnaw; Berhe, Derbew Fikadu; Bernabé, Eduardo; Beuran, Mircea; Beyene, Addisu Shunu; Bhala, Neeraj; Bhansali, Anil; Bhaumik, Soumyadeep; Bhutta, Zulfiqar A.; Bikbov, Boris; Birungi, Charles; Biryukov, Stan; Bisanzio, Donal; Bizuayehu, Habtamu Mellie; Bjerregaard, Peter; Blosser, Christopher D.; Boneya, Dube Jara; Boufous, Soufiane; Bourne, Rupert R.A.; Brazinova, Alexandra; Breitborde, Nicholas J.K.; Brenner, Hermann; Brugha, Traolach S.; Bukhman, Gene; Bulto, Lemma Negesa Bulto; Bumgarner, Blair Randal; Burch, Michael; Butt, Zahid A.; Cahill, Leah E.; Cahuana-Hurtado, Lucero; Campos-Nonato, Ismael Ricardo; Car, Josip; Car, Mate; Cárdenas, Rosario; Carpenter, David O.; Carrero, Juan Jesus; Carter, Austin; Castañeda-Orjuela, Carlos A.; Castillo Rivas, Jacqueline; Castro, Franz F.; Castro, Ruben Estanislao; Catalá-López, Ferrán; Chen, Honglei; Chiang, Peggy Pei-Chia; Chibalabala, Mirriam; Chisumpa, Vesper Hichilombwe; Chitheer, Abdulaal A.; Choi, Jee-Young Jasmine; Christensen, Hanne; Christopher, Devasahayam Jesudas; Ciobanu, Liliana G.; Cirillo, Massimo; Cohen, Aaron J.; Colquhoun, Samantha M.; Coresh, Josef; Criqui, Michael H.; Cromwell, Elizabeth A.; Crump, John A.; Dandona, Lalit; Dandona, Rakhi; Dargan, Paul I.; Das Neves, José; Davey, Gail; Davitoiu, Dragos V.; Davletov, Kairat; De Courten, Barbora; De Leo, Diego; Degenhardt, Louisa; Deiparine, Selina; Dellavalle, Robert P.; Deribe, Kebede; Deribew, Amare; Des Jarlais, Don C.; Dey, Subhojit; Dharmaratne, Samath D.; Dherani, Mukesh K.; Diaz-Torné, Cesar; Ding, Eric L.; Dixit, Priyanka; Djalalinia, Shirin; Do, Huyen Phuc; Doku, David Teye; Donnelly, Christl Ann; Dos Santos, Kadine Priscila Bender; Douwes-Schultz, Dirk; Driscoll, Tim R.; Duan, Leilei; Dubey, Manisha; Duncan, Bruce Bartholow; Dwivedi, Laxmi Kant; Ebrahimi, Hedyeh; El Bcheraoui, Charbel; Ellingsen, Christian Lycke; Enayati, Ahmadali; Endries, Aman Yesuf; Ermakov, Sergey Petrovich; Eshetie, Setegn; Eshrati, Babak; Eskandarieh, Sharareh; Esteghamati, Alireza; Estep, Kara; Fanuel, Fanuel Belayneh Bekele; Faro, André; Farvid, Maryam S.; Farzadfar, Farshad; Feigin, Valery L.; Fereshtehnejad, Seyed-Mohammad; Fernandes, Jefferson G.; Fernandes, João C.; Feyissa, Tesfaye Regassa; Filip, Irina; Fischer, Florian; Foigt, Nataliya; Foreman, Kyle J.; Frank, Tahvi; Franklin, Richard C.; Fraser, Maya; Friedman, Joseph; Frostad, Joseph J.; Fullman, Nancy; Fürst, Thomas; Furtado, Joao M.; Futran, Neal D.; Gakidou, Emmanuela; Gambashidze, Ketevan; Gamkrelidze, Amiran; Gankpé, Fortuné Gbètoho; Garcia-Basteiro, Alberto L.; Gebregergs, Gebremedhin Berhe; Gebrehiwot, Tsegaye Tewelde; Gebrekidan, Kahsu Gebrekirstos; Gebremichael, Mengistu Welday; Gelaye, Amha Admasie; Geleijnse, Johanna M.; Gemechu, Bikila Lencha; Gemechu, Kasiye Shiferaw; Genova-Maleras, Ricard; Gesesew, Hailay Abrha; Gething, Peter W.; Gibney, Katherine B.; Gill, Paramjit Singh; Gillum, Richard F.; Giref, Ababi Zergaw; Girma, Bedilu Weji; Giussani, Giorgia; Goenka, Shifalika; Gomez, Beatriz; Gona, Philimon N.; Gopalani, Sameer Vali; Goulart, Alessandra Carvalho; Graetz, Nicholas; Gugnani, Harish Chander; Gupta, Prakash C.; Gupta, Rahul; Gupta, Rajeev; Gupta, Tanush; Gupta, Vipin; Haagsma, Juanita A.; Hafezi-Nejad, Nima; Haghparast Bidgoli, Hassan; Hakuzimana, Alex; Halasa, Yara A.; Hamadeh, Randah Ribhi; Hambisa, Mitiku Teshome; Hamidi, Samer; Hammami, Mouhanad; Hancock, Jamie; Handal, Alexis J.; Hankey, Graeme J.; Hao, Yuantao; Harb, Hilda L.; Hareri, Habtamu Abera; Harikrishnan, Sivadasanpillai; Haro, Josep Maria; Hassanvand, Mohammad Sadegh; Havmoeller, Rasmus; Hay, Roderick J.; Hay, Simon I.; He, Fei; Heredia-Pi, Ileana Beatriz; Herteliu, Claudiu; Hilawe, Esayas Haregot; Hoek, Hans W.; Horita, Nobuyuki; Hosgood, H. Dean; Hostiuc, Sorin; Hotez, Peter J.; Hoy, Damian G.; Hsairi, Mohamed; Htet, Aung Soe; Hu, Guoqing; Huang, Hsiang; Huang, John J.; Iburg, Kim Moesgaard; Igumbor, Ehimario Uche; Ileanu, Bogdan Vasile; Inoue, Manami; Irenso, Asnake Ararsa; Irvine, Caleb M.S.; Islam, Nazrul; Jacobsen, Kathryn H.; Jaenisch, Thomas; Jahanmehr, Nader; Jakovljevic, Mihajlo B.; Javanbakht, Mehdi; Jayatilleke, Achala Upendra; Jeemon, Panniyammakal; Jensen, Paul N.; Jha, Vivekanand; Jin, Ye; John, Denny; John, Oommen; Johnson, Sarah Charlotte; Jonas, Jost B.; Jürisson, Mikk; Kabir, Zubair; Kadel, Rajendra; Kahsay, Amaha; Kalkonde, Yogeshwar; Kamal, Ritul; Kan, Haidong; Karch, André; Karema, Corine Kakizi; Karimi, Seyed M.; Karthikeyan, Ganesan; Kasaeian, Amir; Kassaw, Nigussie Assefa; Kassebaum, Nicholas J.; Kastor, Anshul; Katikireddi, Srinivasa Vittal; Kaul, Anil; Kawakami, Norito; Kazanjan, Konstantin; Keiyoro, Peter Njenga; Kelbore, Sefonias Getachew; Kemp, Andrew Haddon; Kengne, Andre Pascal; Keren, Andre; Kereselidze, Maia; Kesavachandran, Chandrasekharan Nair; Ketema, Ezra Belay; Khader, Yousef Saleh; Khalil, Ibrahim A.; Khan, Ejaz Ahmad; Khan, Gulfaraz; Khang, Young-Ho; Khera, Sahil; Khoja, Abdullah Tawfih Abdullah; Khosravi, Mohammad Hossein; Kibret, Getiye Dejenu; Kieling, Christian; Kim, Cho-Il; Kim, Daniel; Kim, Pauline; Kim, Sungroul; Kim, Yun Jin; Kimokoti, Ruth W.; Kinfu, Yohannes; Kishawi, Sami; Kissimova-Skarbek, Katarzyna A.; Kissoon, Niranjan; Kivimaki, Mika; Knudsen, Ann Kristin; Kokubo, Yoshihiro; Kopec, Jacek A.; Kosen, Soewarta; Koul, Parvaiz A.; Koyanagi, Ai; Kravchenko, Michael; Krohn, Kristopher J.; Kuate Defo, Barthelemy; Kucuk Bicer, Burcu; Kuipers, Ernst J.; Kulikoff, Xie Rachel; Kulkarni, Veena S.; Kumar, G. Anil; Kumar, Pushpendra; Kumsa, Fekede Asefa; Kutz, Michael; Lachat, Carl; Lagat, Abraham K.; Lager, Anton Carl Jonas; Lal, Dharmesh Kumar; Lalloo, Ratilal; Lambert, Nkurunziza; Lan, Qing; Lansingh, Van C.; Larson, Heidi J.; Larsson, Anders; Laryea, Dennis Odai; Lavados, Pablo M.; Laxmaiah, Avula; Lee, Paul H.; Leigh, James; Leung, Janni; Leung, Ricky; Levi, Miriam; Li, Yongmei; Liao, Yu; Liben, Misgan Legesse; Lim, Stephen S.; Linn, Shai; Lipshultz, Steven E.; Liu, Shiwei; Lodha, Rakesh; Logroscino, Giancarlo; Lorch, Scott A.; Lorkowski, Stefan; Lotufo, Paulo A.; Lozano, Rafael; Lunevicius, Raimundas; Lyons, Ronan A.; Ma, Stefan; Macarayan, Erlyn Rachelle King; Machado, Isis Eloah; Mackay, Mark T.; Magdy Abd El Razek, Mohammed; Magis-Rodriguez, Carlos; Mahdavi, Mahdi; Majdan, Marek; Majdzadeh, Reza; Majeed, Azeem; Malekzadeh, Reza; Malhotra, Rajesh; Malta, Deborah Carvalho; Mantovani, Lorenzo G.; Manyazewal, Tsegahun; Mapoma, Chabila C.; Marczak, Laurie B.; Marks, Guy B.; Martinez-Raga, Jose; Martins-Melo, Francisco Rogerlândio; Massano, João; Maulik, Pallab K.; Mayosi, Bongani M.; Mazidi, Mohsen; McAlinden, Colm; McGarvey, Stephen Theodore; McGrath, John J.; McKee, Martin; Mehata, Suresh; Mehndiratta, Man Mohan; Mehta, Kala M.; Meier, Toni; Mekonnen, Tefera Chane; Meles, Kidanu Gebremariam; Memiah, Peter; Memish, Ziad A.; Mendoza, Walter; Mengesha, Melkamu Merid; Mengistie, Mubarek Abera; Mengistu, Desalegn Tadese; Menon, Geetha R.; Menota, Bereket Gebremichael; Mensah, George A.; Meretoja, Atte; Meretoja, Tuomo J.; Mezgebe, Haftay Berhane; Micha, Renata; Mikesell, Joseph; Miller, Ted R.; Mills, Edward J.; Minnig, Shawn; Mirarefin, Mojde; Mirrakhimov, Erkin M.; Misganaw, Awoke; Mishra, Shiva Raj; Mohammad, Karzan Abdulmuhsin; Mohammadi, Alireza; Mohammed, Kedir Endris; Mohammed, Shafiu; Mohan, Murali B.V.; Mohanty, Sanjay K.; Mokdad, Ali H.; Molla Assaye, Ashagre; Mollenkopf, Sarah K.; Molokhia, Mariam; Monasta, Lorenzo; Montañez Hernandez, Julio Cesar; Montico, Marcella; Mooney, Meghan D.; Moore, Ami R.; Moradi-Lakeh, Maziar; Moraga, Paula; Morawska, Lidia; Moreno Velasquez, Ilais; Mori, Rintaro; Morrison, Shane D.; Mruts, Kalayu Birhane; Mueller, Ulrich O.; Mullany, Erin; Muller, Kate; Murthy, Gudlavalleti Venkata Satyanarayana; Murthy, Srinivas; Musa, Kamarul Imran; Nachega, Jean B.; Nagata, Chie; Nagel, Gabriele; Naghavi, Mohsen; Naidoo, Kovin S.; Nanda, Lipika; Nangia, Vinay; Nascimento, Bruno Ramos; Natarajan, Gopalakrishnan; Negoi, Ionut; Nguyen, Cuong Tat; Nguyen, Grant; Nguyen, Quyen Le; Nguyen, Trang Huyen; Ningrum, Dina Nur Anggraini; Nisar, Muhammad Imran; Nomura, Marika; Nong, Vuong Minh; Norheim, Ole F.; Norrving, Bo; Noubiap, Jean Jacques N.; Nyakarahuka, Luke; Obermeyer, Carla Makhlouf; O'Donnell, Martin J.; Ogbo, Felix Akpojene; Oh, In-Hwan; Okoro, Anselm; Oladimeji, Olanrewaju; Olagunju, Andrew Toyin; Olusanya, Bolajoko Olubukunola; Olusanya, Jacob Olusegun; Oren, Eyal; Ortiz, Alberto; Osgood-Zimmerman, Aaron; Ota, Erika; Owolabi, Mayowa O.; 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Shaheen, Amira; Shahraz, Saeid; Shaikh, Masood Ali; Shamsipour, Mansour; Shamsizadeh, Morteza; Islam, Sheikh Mohammed Shariful; Sharma, Jayendra; Sharma, Rajesh; She, Jun; Shen, Jiabin; Shetty, Balakrishna P.; Shi, Peilin; Shibuya, Kenji; Shigematsu, Mika; Shiri, Rahman; Shiue, Ivy; Shrime, Mark G.; Sigfusdottir, Inga Dora; Silberberg, Donald H.; Silpakit, Naris; Silva, Diego Augusto Santos; Silva, João Pedro; Silveira, Dayane Gabriele Alves; Sindi, Shireen; Singh, Abhishek; Singh, Jasvinder A.; Singh, Prashant Kumar; Singh, Virendra; Sinha, Dhirendra Narain; Skiadaresi, Eirini; Sligar, Amber; Smith, David L.; Sobaih, Badr H.A.; Sobngwi, Eugene; Soneji, Samir; Soriano, Joan B.; Sreeramareddy, Chandrashekhar T.; Srinivasan, Vinay; Stathopoulou, Vasiliki; Steel, Nicholas; Stein, Dan J.; Steiner, Caitlyn; Stöckl, Heidi; Stokes, Mark Andrew; Strong, Mark; Sufiyan, Muawiyyah Babale; Suliankatchi, Rizwan Abdulkader; Sunguya, Bruno F.; Sur, Patrick J.; Swaminathan, Soumya; Sykes, Bryan L.; Szoeke, Cassandra E.I.; 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Chudi; Van Boven, Job F.M.; Varakin, Yuri Y.; Varughese, Santosh; Vasankari, Tommi; Vasconcelos, Ana Maria Nogales; Venketasubramanian, Narayanaswamy; Vidavalur, Ramesh; Violante, Francesco S.; Vishnu, Abhishek; Vladimirov, Sergey K.; Vlassov, Vasiliy Victorovich; Vollset, Stein Emil; Vos, Theo; Waid, Jillian L.; Wakayo, Tolassa; Wang, Yuan-Pang; Weichenthal, Scott; Weiderpass, Elisabete; Weintraub, Robert G.; Werdecker, Andrea; Wesana, Joshua; Wijeratne, Tissa; Wilkinson, James D.; Wiysonge, Charles Shey; Woldeyes, Belete Getahun; Wolfe, Charles D.A.; Workicho, Abdulhalik; Workie, Shimelash Bitew; Xavier, Denis; Xu, Gelin; Yaghoubi, Mohsen; Yakob, Bereket; Yalew, Ayalnesh Zemene; Yan, Lijing L.; Yano, Yuichiro; Yaseri, Mehdi; Ye, Pengpeng; Yimam, Hassen Hamid; Yip, Paul; Yirsaw, Biruck Desalegn; Yonemoto, Naohiro; Yoon, Seok-Jun; Yotebieng, Marcel; Younis, Mustafa Z.; Zaidi, Zoubida; El Sayed Zaki, Maysaa; Zeeb, Hajo; Zenebe, Zerihun Menlkalew; Zerfu, Taddese Alemu; Zhang, Anthony Lin; Zhang, Xueying; Zodpey, Sanjay; Zuhlke, Liesl Joanna; Lopez, Alan D.; Murray, Christopher J.L.*Wang, Haidong; Abajobir, Amanuel Alemu; Abate, Kalkidan Hassen; Abbafati, Cristiana; Abbas, Kaja M.; Abd-Allah, Foad; Abera, Semaw Ferede; Abraha, Haftom Niguse; Abu-Raddad, Laith J.; Abu-Rmeileh, Niveen M.E.; Ad