ArticlesGlobal, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013
Introduction
The Global Burden of Disease (GBD) study provides a unique comprehensive framework to systematically assess national trends in age-specific and sex-specific all-cause and cause-specific mortality. Up-to-date and comprehensive evidence for levels and trends for each country is critical for informed priority setting. Trends quantify progress against explicit health targets, whether local, national, or global, and help to evaluate where programmes are working or not. Quantification across populations and over time using comparable definitions and methods can also enable benchmarking. Regular comprehensive updates about causes of death will identify emerging public health challenges. The GBD 2013 study provides the first GBD study to use a continuously updated approach to global health surveillance.1
The GBD 2010 study, a collaboration of 488 investigators, showed important global and regional trends for all-cause and cause-specific mortality.2, 3, 4, 5, 6, 7, 8 The GBD 2010 reported substantial decreases in child mortality driven by reductions in diarrhoea, lower respiratory infections, and more recently, malaria. The lowest income regions had progressed in combating maternal mortality, HIV/AIDS, tuberculosis, and malaria. Nevertheless, much work remains to be done for these Millennium Development Goal-related diseases. Outside sub-Saharan Africa, 1990–2010 saw rapid shifts towards a larger share of death from non-communicable diseases and injuries and a rising mean age of death. Country analyses using the GBD 2010 database have been reported for China, Iran, Mexico, UK, and USA, taking advantage of the comparable methods and definitions of the GBD to benchmark these countries against their peers.9, 10, 11, 12, 13, 14, 15, 16
Much debate surrounds what should follow the Millennium Development Goals; objective, timely, and comprehensive evidence for the levels and trends in causes of death can be a useful input. Ambitious goals have been discussed,16 such as the elimination of preventable child and maternal mortality in a generation. Targets of zero disease have been formulated for HIV/AIDS, tuberculosis, and malaria by various groups.17, 18, 19, 20, 21, 22, 23 The Lancet Commission on Global health 2035: a world converging within a generation24 suggested that a grand convergence in health can be achieved between poor and rich countries by 2035. Advocates for non-communicable disease programmes argue25 that rapid epidemiological transitions in many regions of the world require broader health goals for the development community. Movements to focus on universal health coverage in the post-2015 health agenda emphasise the consequences of failure to meet basic health-care needs.24, 25, 26, 27
Broad interest in the GBD 2010 has led to the expansion of the GBD collaboration to include more than 1000 investigators in 106 countries. The GBD 2013 not only incorporates newly published or released datasets, particularly from the past 5 years, but also expands the analysis in other ways. We included subnational assessments for provinces of China, states of Mexico, and regions of the UK. These subnational assessments will help national decision makers to identify inequalities and local variation in leading diseases, injuries, and risk factors. The list of causes has been expanded and many new and more detailed data sources incorporated. We report the new findings for the first time at the country-level for 1990–2013.
Section snippets
Study design
The GBD approach to estimating all-cause mortality and cause-specific mortality has been previously described.2, 3 Here, we describe several refinements.28 Figure 1 shows the general analysis of all-cause mortality and cause-specific mortality and their interactions. GBD 2010 included 291 causes of death or disability, of which 235 were causes of death; we have expanded the list to include 306 causes of death or disability, of which 240 are causes of death. The extra causes were added on the
Global all-cause mortality
Global life expectancy at birth for both sexes increased from 65·3 years in 1990, to 71·5 years in 2013, an average increase of 0·27 years per calendar year. Life expectancy increased over this period by 6·6 years for females and 5·8 years for males. Figure 4 shows the yearly change in global life expectancy at birth, with a large drop in the 1990s as a result of the Rwanda genocide and famine in North Korea and the return to increases of about 0·3 years or more per year since 2003. If the
Main findings
The GBD 2013 incorporates many new datasets for cause of death, particularly from China, and new data for 155 other countries. Compared with the GBD 2010, it provides the most comprehensive and up-to-date assessment of causes of death. The results for the GBD 2013 are based on re-estimation of all causes from 1990 to 2013, and thus supersede all previously published GBD time series (panel). Publication of country-level results provides many opportunities for comparing a country's performance
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