Global, regional, and national age-sex-specific mortality and life expectancy, 1950–2017: a systematic analysis for the Global Burden of Disease Study 2017

Authors: Daniel Dicker, Grant Nguyen, Degu Abate, Kalkidan Hassen Abate, Solomón Mequanente Abay, Cristiana Abbafati, Nooshin Abbasi, Hedayat Abbastabar, Foad Abd-Allah, Jemal Abdela, Ahmed Abdelalim, Omar Abdel‐Rahman, Alireza Abdi, Ibrahim Abdollahpour, Rizwan Suliankatchi Abdulkader, Ahmed Abdulahi Abdurahman, Haftom Temesgen Abebe, Molla Abebe, Abebe Zegeye, Teshome Abuka Abebo, Victor Aboyans, Haftom Niguse Abraha, Aklilu Roba Abrham, Laith J. Abu‐Raddad, Niveen ME Abu-Rmeileh, Manfred Accrombessi, Pawan Acharya, Oladimeji Adebayo, Isaac Akinkunmi Adedeji, Rufus Adesoji Adedoyin, Victor Adekanmbi, Olatunji Adetokunboh, Beyene Meressa Adhena, Tara Ballav Adhikari, Mina G Adib, Arsène Kouablan Adou, José Carmelo Adsuar, Mohsen Afarideh, Ashkan Afshin, Gina Agarwal, Rakesh Aggarwal, Sargis A. Aghayan, Sutapa Agrawal, Anurag Agrawal, Mehdi Ahmadi, Alireza Ahmadi, Hamid Ahmadieh, Mohamed Lemine Cheikh Brahim Ahmed, Sayem Ahmed, Muktar Beshir Ahmed, Amani Nidhal Aichour, Ibtihel Aichour, Miloud Taki Eddine Aichour, A. S. Akanda, Mohammad Esmaeil Akbari, Mohammed Akibu, Rufus Akinyemi, Tomi Akinyemiju, Nadia Akseer, Fares Alahdab, Ziyad Al‐Aly, Khurshid Alam, Animut Alebel, Alicia V Aleman, Kefyalew Addis Alene, Ayman Al‐Eyadhy, Raghib Ali, Mehran Alijanzadeh, Reza Alizadeh‐Navaei, Syed Mohamed Aljunid, Ala’a Alkerwi, François Alla, Peter Allebeck, Christine A. Allen, Jordi Alonso, Rajaa Al‐Raddadi, Ubai Alsharif, Khalid A Altirkawi, Nelson Alvis‐Guzmán, Azmeraw T. Amare, Erfan Amini, Walid Ammar, Yaw Ampem Amoako, Nahla Anber, Cătălina Liliana Andrei, Sofia Androudi, Megbaru Debalkie Animut, Mina Anjomshoa, Degefaye Zelalem Anlay, Hossein Ansari, Ansariadi Ansariadi, Mustafa Geleto Ansha, Carl Abelardo T. Antonio, Seth Christopher Yaw Appiah, Olatunde Aremu, Habtamu Abera Areri, Johan Ärnlöv, Megha Arora, Al Artaman, Krishna K Aryal, Mohsen Asadi‐Lari, Hamid Asayesh, Ephrem Tsegay Asfaw, Solomon Weldegebreal Asgedom, Reza Assadi, Zerihun Ataro, Tesfay Mehari Atey, Seyyed Shamsadin Athari, Suleman Atique, Sachin Atre, Madhu Sudhan Atteraya, Engi F. Attia, Marcel Ausloos, Leticia Ávila‐Burgos, Euripide Avokpaho, Ashish Awasthi, Baffour Awuah, Beatriz Paulina Ayala Quintanilla, Henok Tadesse Ayele, Yohanes Ayele, Rakesh Ayer, Ayuk Betrand Tambe, Peter Azzopardi, Natasha Azzopardi‐Muscat, Hamid Badali, Alaa Badawi, Kalpana Balakrishnan, Ayele Geleto Bali, Maciej Banach, Amrit Banstola, Aleksandra Barać, Miguel A. Barboza, Sı́món Barquera, Lope H. Barrero, Huda Basaleem, Quique Bassat, Arindam Basu, Sanjay Basu, Bernhard T. Baune, Shahrzad Bazargan‐Hejazi, Neeraj Bedi, Ettore Beghi, Masoud Behzadifar, Meysam Behzadifar, Yannick Béjot, Bayu Begashaw Bekele, Abate Bekele Belachew, Aregawi Gebreyesus Belay, Ezra Belay, Saba Abraham Belay, Yihalem Abebe Belay, Michelle L. Bell, Aminu K. Bello, Derrick Bennett, Isabela M. Benseñor, Adugnaw Berhane, Adam E. Berman, Eduardo Bernabé, Robert S. Bernstein, Gregory J Bertolacci, Mircea Beuran, Tina Beyranvand, Neeraj Bhala, Eesh Bhatia, Samir Bhatt, Suraj Bhattarai, Soumyadeeep Bhaumik, Zulfiqar A Bhutta, Belete Biadgo, Ali Bijani, Boris Bikbov, Nigus Bililign, Muhammad Shahdaat Bin Sayeed, Sait Mentes Birlik, Charles Birungi, Donal Bisanzio, Tuhin Biswas, Tone Bjørge, Archie Bleyer, Berrak Bora Başara, Dipan Bose, Cristina Bosetti, Soufiane Boufous, Rupert Bourne, Oliver J. Brady, Nicola Luigi Bragazzi, Luísa Campos Caldeira Brant, Alexandra Bražinová, Nicholas J. K. Breitborde, Hermann Brenner, Gabrielle B. Britton, Traolach Brugha, Kristin E. Burke, Reinhard Busse, Zahid A Butt, Lucero Cahuana-Hurtado, Charlton Callender, Ismael Campos‐Nonato, Julio César Campuzano, Jorge Cano, Mate Car, Rosario Cárdenas, Giulia Carreras, Juan Jesús Carrero, Austin Carter, Félix Carvalho, Carlos A Castañeda-Orjuela, Jacqueline Castillo Rivas, Franz Castro, Ferrán Catalá-López, Alanur Çavlin, Ester Cerin, Yazan Chaiah, Ana Paula Silva Champs, Hsing‐Yi Chang, Jung‐Chen Chang, Aparajita Chattopadhyay, Pankaj Chaturvedi, Wanqing Chen, Peggy Pei-Chia Chiang, Odgerel Chimed‐Ochir, Ken Lee Chin, Vesper Hichilombwe Chisumpa, Abdulaal Chitheer, Jee-Young Jasmine Choi, Hanne Christensen, Devasahayam Jesudas Christopher, Sheng‐Chia Chung, Flavia Cicuttini, Liliana G Ciobanu, Massimo Círillo, Rafael Moreira Claro, Aarón Cohen, Daniel Collado‐Mateo, María Magdalena Constantin, Sara Conti, Cyrus Cooper, Leslie T. Cooper, Paolo Angelo Cortesi, Monica Cortinovis, Ewerton Cousin, Michael H Criqui, Elizabeth A. Cromwell, Christopher S. Crowe, John A. Crump, Alexandra Cucu, Matthew Cunningham, Alemneh Kabeta Daba, Berihun Assefa Dachew, Abel Fekadu Dadi, Lalit Dandona, Rakhi Dandona, Anh Kim Dang, Paul I. Dargan, Ahmad Daryani, Siddharth Kumar Das, Rajat Das Gupta, José das Neves, Tamirat Tesfaye Dasa, Aditya Prasad Dash, Nicole Davis Weaver, Dragoş Virgil Daviţoiu, Kairat Davletov, Anand Dayama, Barbora de Courten, Fernando de la Hoz, Diego De Leo, Jan‐Walter De Neve, Meaza Girma Degefa, Louisa Degenhardt, Tizta T Degfie, Selina Deiparine, Robert P Dellavalle, Gebre Teklemariam Demoz, Balem Demtsu, Edgar Denova‐Gutiérrez, Kebede Deribe, Nikolaos Dervenis, Don C. Des Jarlais, Getenet Dessie, Subhojit Dey, Samath Dhamminda Dharmaratne, Meghnath Dhimal, Eric L. Ding, Shirin Djalalinia, David Teye Doku, Kate Dolan, Christl A. Donnelly, E. Ray Dorsey, Dirk Douwes‐Schultz, Kerrie Doyle, Thomas M Drake, Tim Driscoll, Manisha Dubey, Eleonora Dubljanin, Eyasu Ejeta Duken, Bruce Bartholow Duncan, André Rodrigues Durães, Hedyeh Ebrahimi, Soheil Ebrahimpour, Dumessa Edessa, David Edvardsson, Anne Elise Eggen, Charbel El Bcheraoui, Maysaa El Sayed Zaki, Mohammed Elfaramawi, Ziad El‐Khatib, Christian Lycke Ellingsen, Iqbal Elyazar, Ahmadali Enayati, Aman Yesuf Endries, Benjamin Er, Sergey Petrovich Ermakov, Babak Eshrati, Sharareh Eskandarieh, Reza Esmaeili, Alireza Esteghamati, Sadaf Esteghamati, Mahdi Fakhar, Hamed Fakhim, Tamer H. Farag, Mahbobeh Faramarzi, Mohammad Fareed, Farzaneh Farhadi, Talha Farid, Carla Sofia e Sá Farinha, Andrea Farioli, André Faro, Maryam S. Farvid, Farshad Farzadfar, Mohammad Hosein Farzaei, Mir Sohail Fazeli, Valery L. Feigin, Andrea B Feigl, Fariba Feizy, Netsanet Fentahun, Seyed‐Mohammad Fereshtehnejad, Eduarda Fernandes, João Carlos Fernandes, Garumma Tolu Feyissa, Daniel Obadare Fijabi, Irina Filip, Samuel Finegold, Florian Fischer, Luísa Sório Flor, Nataliya A Foigt, John Ford, Kyle J Foreman, Carla Fornari, Tahvi Frank, Richard C. Franklin, Takeshi Fukumoto, John E Fuller, Nancy Fullman, Thomas Fürst, João M. Furtado, Neal D. Futran, Adriana Galan, Silvano Gallus, Кетеван Гамбашидзе, Amiran Gamkrelidze, Fortuné Gbètoho Gankpé, Alberto L. García‐Basteiro, Miguel Ángel García-Gordillo, Teshome Gebre, Abadi Kahsu Gebre, Gebremedhin Berhe Gebregergs, Tsegaye Tewelde Gebrehiwot, Amanuel Tesfay Gebremedhin, Tilayie Feto Gelano, Yalemzewod Assefa Gelaw, Johanna M. Geleijnse, Ricard Gènova-Maleras, Bradford D. Gessner, Sefonias Getachew, Peter W. Gething, Kebede Embaye Gezae, Mohammad Rasoul Ghadami, Reza Ghadimi, Khalil Ghasemi Falavarjani, Maryam Ghasemi‐Kasman, Hesam Ghiasvand, Mamata Ghimire, Aloke Gopal Ghoshal, Paramjit Gill, Tiffany K Gill, Richard F Gillum, Giorgia Giussani, Shifalika Goenka, Srinivas Goli, Ricardo Santiago Gomez, Mari Carmen Gómez‐Cabrera, Hector Gómez‐Dantés, Philimon Gona, Amador Goodridge, Sameer Vali Gopalani, Atsushi Goto, Alessandra C. Goulart, Bárbara Niegia Garcia de Goulart, Ayman Grada, Giuseppe Grosso, H. C. Gugnani, André Luiz Sena Guimarães, Yuming Guo, Prakash Chandra Gupta, Rahul Gupta, Rajeev Gupta, Tanush Gupta, Bishal Gyawali, Juanita A. Haagsma, Vladimir Hachinski, Nima Hafezi‐Nejad, Tekleberhan B Hagos, Tewodros Tesfa Hailegiyorgis, Gessessew Bugssa Hailu, Arya Haj‐Mirzaian, Arvin Haj‐Mirzaian, Randah R Hamadeh, Samer Hamidi, Alexis J. Handal, Graeme J. Hankey, Hilda L Harb, S Harikrishnan, Hamidreza Haririan, Josep María Haro, Mehedi Hasan, Hadi Hassankhani, Hamid Yimam Hassen, Rasmus Havmoeller, Roderick J. Hay, Simon I Hay, Yihua He, Akbar Hedayatizadeh‐Omran, Mohamed Hegazy, Behzad Heibati, Mohsen Heidari, Delia Hendrie, Andualem Henok, Nathaniel J Henry, Ileana Heredia-Pi, Claudiu Herţeliu, Fatemeh Heydarpour, Pouria Heydarpour, Sousan Heydarpour, Desalegn Tsegaw Hibstu, Hans W. Hoek, Michael K. Hole, Enayatollah Homaie Rad, Praveen Hoogar, Masako Horino, Hung Chak Ho, Seyed Mostafa Hosseini, Mehdi Hosseinzadeh, Sorin Hostiuc, Mihaela Hostiuc, Peter J. Hotez, Damian G Hoy, Mohamed Hsaïri, Aung Soe Htet, Guoqing Hu, John J. Huang, Abdullatif Husseini, Mohammedaman Mama Hussen, Susan Hutfless, Kim Moesgaard Iburg, Ehimario Igumbor, Chad Ikeda, Olayinka Stephen Ilesanmi, Usman Iqbal, Seyed Sina Naghibi Irvani, Oluwaseyi O. 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Newton, Frida Ngalesoni, Josephine W Ngunjiri, Ha Nguyen, Huong Thanh Nguyen, Long Hoang Nguyen, Huong Lan Thi Nguyen, Trang Huyen Nguyen, Dina Nur Anggraini Ningrum, Yirga Legesse Nirayo, Muhammad Imran Nisar, Molly R Nixon, Nomonde Nolutshungu, Shuhei Nomura, Ole Frithjof Norheim, Mehdi Noroozi, Bo Norrving, Jean Jacques Noubiap, Hamid Reza Nouri, Malihe Nourollahpour Shiadeh, Mohammad Reza Nowroozi, Elaine O. Nsoesie, Peter S. Nyasulu, Richard Ofori‐Asenso, Okechukwu S. Ogah, Felix Akpojene Ogbo, In‐Hwan Oh, Anselm Okoro, Olanrewaju Oladimeji, Andrew T Olagunju, Tinuke O Olagunju, Pedro R. Olivares, Bolajoko O. Olusanya, Jacob Olusegun Olusanya, Sok King Ong, John Nelson Opio, Eyal Oren, Justin R. 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Alex Quistberg, Amir Radfar, Anwar Rafay, Alireza Rafiei, Fakher Rahim, Kazem Rahimi, Afarin Rahimi‐Movaghar, Vafa Rahimi‐Movaghar, Mahfuzar Rahman, Mohammad Hifz Ur Rahman, Muhammad Aziz Rahman, Sajjad Ur Rahman, Rajesh Kumar, Fatemeh Rajati, Saša Rajšić, Sree Bhushan Raju, Usha Ram, Chhabi Lal Ranabhat, Prabhat Ranjan, Annemarei Ranta, Davide Rasella, David Laith Rawaf, Salman Rawaf, Sarah E. Ray, Christian Razo-García, Maria Albertina Santiago Rego, Jürgen Rehm, Robert C. Reiner, Nickolas Reinig, Cesar Reis, Giuseppe Remuzzi, André M. N. Renzaho, Serge Resnikoff, Satar Rezaei, Shahab Rezaeian, Mohammad Sadegh Rezai, Seyed Mohammad Riahi, Antônio Luiz Pinho Ribeiro, Horacio Riojas, María Jesús Ríos-Blancas, Kedir Teji Roba, Stephen R. Robinson, Leonardo Roever, Luca Ronfani, Gholamreza Roshandel, Denis O Roshchin, Ali Rostami, Dietrich Rothenbacher, Enrico Rubagotti, George Mugambage Ruhago, Soheil Saadat, Yogesh Sabde, Perminder S. Sachdev, Basema Saddik, Ehsan Sadeghi, Sahar Saeedi Moghaddam, Hosein Safari, Yahya Safari, Roya Safari‐Faramani, Mahdi Safdarian, Sare Safi, Saeid Safiri, Rajesh Sagar, Amirhossein Sahebkar, Mohammad Ali Sahraian, Haniye Sadat Sajadi, Mohammad Reza Salahshoor, Nasir Salam, Joseph S Salama, Payman Salamati, Raphael de Freitas Saldanha, Yahya Salimi, Hamideh Salimzadeh, Inbal Salz, Evanson Zondani Sambala, Abdallah M Samy, Juan Sanabria, María Dolores Sánchez-Niño, Itamar S Santos, João Vasco Santos, Milena M Santric-Milicevic, Bruno Piassi Sâo José, Mayank Sardana, Abdur Razzaque Sarker, Nizal Sarrafzadegan, Benn Sartorius, Shahabeddin Sarvi, Brijesh Sathian, Maheswar Satpathy, Miloje Savic, Arundhati R Sawant, Monika Sawhney, Sonia Saxena, Mehdi Sayyah, Vinod Scaria, Elke Schäeffner, Kathryn Schelonka, María Inês Schmidt, Ione Jayce Ceola Schneider, Ben Schöttker, Aletta E. Schutte, David C. Schwebel, Falk Schwendicke, James G. 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Varavikova, Santosh Varughese, Tommi Vasankari, Ana Maria Nogales Vasconcelos, Narayanaswamy Venketasubramanian, Ramesh Vidavalur, Santos Villafaina, Francesco Saverio Violante, Sergey Konstantinovitch Vladimirov, Vasily Vlassov, Stein Emil Vollset, Theo Vos, Kia Vosoughi, Isidora S Vujcic, Gregory R. Wagner, Fasil Wagnew, Yasir Waheed, Yanping Wang, Yuan‐Pang Wang, Molla Mesele Wassie, Elisabete Weiderpass, Robert G Weintraub, Daniel J. Weiss, Jordan Weiss, Fitsum Weldegebreal, Kidu Gidey Weldegwergs, Andrea Werdecker, Ronny Westerman, Harvey Whiteford, Justyna Widecka, Katarzyna Widecka, Tissa Wijeratne, Andrea Sylvia Winkler, Charles Shey Wiysonge, Charles Wolfe, Sintayehu Ambachew Wondemagegn, Shouling Wu, Grant M. A. Wyper, Gelin Xu, Rajaram Yadav, Bereket Yakob, Tomohide Yamada, Lijing L. Yan, Yuichiro Yano, Mehdi Yaseri, Yasin Jemal Yasin, Pengpeng Ye, Jamal A Yearwood, Gökalp Kadri Yentür, Alex Yeshaneh, Ebrahim M Yimer, Paul Yip, Engida Yisma, Naohiro Yonemoto, Seok‐Jun Yoon, Hunter York, Marcel Yotebieng, Mustafa Z Younis, Mahmoud Yousefifard, Chuanhua Yu, Geevar Zachariah, Vesna Zadnik, Shamsa Zafar, Zoubida Zaidi, Sojib Bin Zaman, Mohammad Zamani, Zohreh Zare, Hajo Zeeb, Mulugeta Molla Zeleke, Zerihun Menlkalew Zenebe, Taddese Alemu Zerfu, Kai Zhang, Xueying Zhang, Maigeng Zhou, Jun Zhu, Sanjay Zodpey, Inbar Zucker, Liesl Zühlke, Alan D Lopez, Emmanuela Gakidou, Christopher J L Murray - The Lancet 2018 cited by 1,215

BACKGROUND: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. METHODS: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. FINDINGS: Globally, 18·7% (95% uncertainty interval 18·4-19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2-59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5-49·6) to 70·5 years (70·1-70·8) for men and from 52·9 years (51·7-54·0) to 75·6 years (75·3-75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5-51·7) for men in the Central African Republic to 87·6 years (86·9-88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3-238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6-42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2-5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. INTERPRETATION: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. FUNDING: Bill & Melinda Gates Foundation.