Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.
Rafael Lozano
,
Mohsen Naghavi
,
Kyle Foreman
,
Stephen Lim
,
Kenji Shibuya
,
Victor Aboyans
(1, 2)
,
Jerry Abraham
,
Timothy Adair
,
Rakesh Aggarwal
,
Stephanie y Ahn
,
Miriam Alvarado
,
H Ross Anderson
,
Laurie M Anderson
,
Kathryn G Andrews
,
Charles Atkinson
,
Larry M Baddour
,
Suzanne Barker-Collo
,
David H Bartels
,
Michelle L Bell
,
Emelia J Benjamin
,
Derrick Bennett
,
Kavi Bhalla
,
Boris Bikbov
,
Aref Bin Abdulhak
,
Gretchen Birbeck
,
Fiona Blyth
,
Ian Bolliger
,
Soufiane Boufous
,
Chiara Bucello
,
Michael Burch
,
Peter Burney
(3)
,
Jonathan Carapetis
,
Honglei Chen
,
David Chou
,
Sumeet S Chugh
,
Luc E Coffeng
,
Steven D Colan
,
Samantha Colquhoun
,
K Ellicott Colson
,
John Condon
,
Myles D Connor
,
Leslie T Cooper
,
Matthew Corriere
,
Monica Cortinovis
,
Karen Courville de Vaccaro
,
William Couser
,
Benjamin C Cowie
,
Michael H Criqui
,
Marita Cross
,
Kaustubh C Dabhadkar
,
Nabila Dahodwala
,
Diego de Leo
,
Louisa Degenhardt
,
Allyne Delossantos
,
Julie Denenberg
,
Don C Des Jarlais
,
Samath D Dharmaratne
,
E Ray Dorsey
,
Tim Driscoll
,
Herbert Duber
,
Beth Ebel
,
Patricia J Erwin
,
Patricia Espindola
,
Majid Ezzati
,
Valery Feigin
,
Abraham D Flaxman
,
Mohammad H Forouzanfar
,
Francis Gerry R Fowkes
,
Richard Franklin
,
Marlene Fransen
,
Michael K Freeman
,
Sherine E Gabriel
,
Emmanuela Gakidou
,
Flavio Gaspari
,
Richard F Gillum
,
Diego Gonzalez-Medina
,
Yara A Halasa
,
Diana Haring
,
James E Harrison
,
Rasmus Havmoeller
,
Roderick J Hay
,
Bruno Hoen
(4, 5)
,
Peter J Hotez
,
Damian Hoy
,
Kathryn H Jacobsen
,
Spencer L James
,
Rashmi Jasrasaria
,
Sudha Jayaraman
,
Nicole Johns
,
Ganesan Karthikeyan
,
Nicholas Kassebaum
,
Andre Keren
,
Jon-Paul Khoo
,
Lisa Marie Knowlton
,
Olive Kobusingye
,
Adofo Koranteng
,
Rita Krishnamurthi
,
Michael Lipnick
,
Steven E Lipshultz
,
Summer Lockett Ohno
,
Jacqueline Mabweijano
,
Michael F Macintyre
,
Leslie Mallinger
,
Lyn March
,
Guy B Marks
,
Robin Marks
,
Akira Matsumori
,
Richard Matzopoulos
,
Bongani M Mayosi
,
John H Mcanulty
,
Mary M Mcdermott
,
John Mcgrath
,
George A Mensah
,
Tony R Merriman
,
Catherine Michaud
,
Matthew Miller
(6)
,
Ted R Miller
,
Charles Mock
,
Ana Olga Mocumbi
,
Ali A Mokdad
,
Andrew Moran
,
Kim Mulholland
,
M Nathan Nair
,
Luigi Naldi
(7)
,
K M Venkat Narayan
,
Kiumarss Nasseri
,
Paul Norman
,
Martin O'Donnell
,
Saad B Omer
,
Katrina Ortblad
,
Richard Osborne
,
Doruk Ozgediz
,
Bishnu Pahari
,
Jeyaraj Durai Pandian
,
Andrea Panozo Rivero
,
Rogelio Perez Padilla
,
Fernando Perez-Ruiz
,
Norberto Perico
,
David Phillips
(8)
,
Kelsey Pierce
,
C Arden Pope
,
Esteban Porrini
,
Farshad Pourmalek
,
Murugesan Raju
,
Dharani Ranganathan
,
Jürgen T Rehm
,
David B Rein
,
Guiseppe Remuzzi
,
Frederick P Rivara
,
Thomas Roberts
,
Felipe Rodriguez de León
,
Lisa C Rosenfeld
,
Lesley Rushton
,
Ralph L Sacco
(9)
,
Joshua A Salomon
,
Uchechukwu Sampson
,
Ella Sanman
,
David C Schwebel
,
Maria Segui-Gomez
,
Donald S Shepard
,
David Singh
,
Jessica Singleton
,
Karen Sliwa
,
Emma Smith
,
Andrew Steer
,
Jennifer A Taylor
,
Bernadette Thomas
(10)
,
Imad M Tleyjeh
,
Jeffrey A Towbin
,
Thomas Truelsen
,
Eduardo A Undurraga
,
N. Venketasubramanian
,
Lakshmi Vijayakumar
,
Theo Vos
,
Gregory R Wagner
,
Mengru Wang
,
Wenzhi Wang
,
Kerrianne Watt
,
Martin A Weinstock
,
Robert Weintraub
,
James D Wilkinson
,
Anthony D Woolf
,
Sarah Wulf
,
Pon-Hsiu Yeh
,
Paul Yip
,
Azadeh Zabetian
,
Zhi-Jie Zheng
,
Alan D Lopez
,
Christopher J L Murray
,
Mohammad A Almazroa
,
Ziad A Memish
1
NET -
Neuroépidémiologie Tropicale
2 Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges]
3 Respiratory Epidemiology and Public Health
4 LCE - Laboratoire Chrono-environnement (UMR 6249)
5 Service des maladies infectieuses et tropicales
6 Cisco Systems
7 Department of dermatology
8 centre for photomolecular science
9 Department of neurology
10 CDM/CDS - Département Cité des métiers - Cité de la santé - Universcience
2 Service de Chirurgie Thoracique et Vasculaire - Médecine vasculaire [CHU Limoges]
3 Respiratory Epidemiology and Public Health
4 LCE - Laboratoire Chrono-environnement (UMR 6249)
5 Service des maladies infectieuses et tropicales
6 Cisco Systems
7 Department of dermatology
8 centre for photomolecular science
9 Department of neurology
10 CDM/CDS - Département Cité des métiers - Cité de la santé - Universcience
Rafael Lozano
- Function : Author
- PersonId : 768594
- ORCID : 0000-0001-5458-2075
Mohsen Naghavi
- Function : Author
Kyle Foreman
- Function : Author
Stephen Lim
- Function : Author
Kenji Shibuya
- Function : Author
Victor Aboyans
- Function : Author
- PersonId : 848537
Jerry Abraham
- Function : Author
Timothy Adair
- Function : Author
Rakesh Aggarwal
- Function : Author
Stephanie y Ahn
- Function : Author
Miriam Alvarado
- Function : Author
H Ross Anderson
- Function : Author
Laurie M Anderson
- Function : Author
Kathryn G Andrews
- Function : Author
Charles Atkinson
- Function : Author
Larry M Baddour
- Function : Author
Suzanne Barker-Collo
- Function : Author
David H Bartels
- Function : Author
Michelle L Bell
- Function : Author
Emelia J Benjamin
- Function : Author
Derrick Bennett
- Function : Author
Kavi Bhalla
- Function : Author
Boris Bikbov
- Function : Author
Aref Bin Abdulhak
- Function : Author
Gretchen Birbeck
- Function : Author
Fiona Blyth
- Function : Author
Ian Bolliger
- Function : Author
Soufiane Boufous
- Function : Author
Chiara Bucello
- Function : Author
Michael Burch
- Function : Author
Jonathan Carapetis
- Function : Author
Honglei Chen
- Function : Author
David Chou
- Function : Author
Sumeet S Chugh
- Function : Author
Luc E Coffeng
- Function : Author
Steven D Colan
- Function : Author
Samantha Colquhoun
- Function : Author
K Ellicott Colson
- Function : Author
John Condon
- Function : Author
Myles D Connor
- Function : Author
Leslie T Cooper
- Function : Author
Matthew Corriere
- Function : Author
Monica Cortinovis
- Function : Author
Karen Courville de Vaccaro
- Function : Author
William Couser
- Function : Author
Benjamin C Cowie
- Function : Author
Michael H Criqui
- Function : Author
Marita Cross
- Function : Author
Kaustubh C Dabhadkar
- Function : Author
Nabila Dahodwala
- Function : Author
Diego de Leo
- Function : Author
Louisa Degenhardt
- Function : Author
Allyne Delossantos
- Function : Author
Julie Denenberg
- Function : Author
Don C Des Jarlais
- Function : Author
Samath D Dharmaratne
- Function : Author
E Ray Dorsey
- Function : Author
Tim Driscoll
- Function : Author
Herbert Duber
- Function : Author
Beth Ebel
- Function : Author
Patricia J Erwin
- Function : Author
Patricia Espindola
- Function : Author
Majid Ezzati
- Function : Author
Valery Feigin
- Function : Author
Abraham D Flaxman
- Function : Author
Mohammad H Forouzanfar
- Function : Author
Francis Gerry R Fowkes
- Function : Author
Richard Franklin
- Function : Author
Marlene Fransen
- Function : Author
Michael K Freeman
- Function : Author
Sherine E Gabriel
- Function : Author
Emmanuela Gakidou
- Function : Author
Flavio Gaspari
- Function : Author
Richard F Gillum
- Function : Author
Diego Gonzalez-Medina
- Function : Author
Yara A Halasa
- Function : Author
Diana Haring
- Function : Author
James E Harrison
- Function : Author
Rasmus Havmoeller
- Function : Author
Roderick J Hay
- Function : Author
Bruno Hoen
- Function : Author
- PersonId : 11357
- IdHAL : bruno-hoen
- ORCID : 0000-0003-3070-3017
- IdRef : 058486194
Peter J Hotez
- Function : Author
Damian Hoy
- Function : Author
Kathryn H Jacobsen
- Function : Author
Spencer L James
- Function : Author
Rashmi Jasrasaria
- Function : Author
Sudha Jayaraman
- Function : Author
Nicole Johns
- Function : Author
Ganesan Karthikeyan
- Function : Author
Nicholas Kassebaum
- Function : Author
Andre Keren
- Function : Author
Jon-Paul Khoo
- Function : Author
Lisa Marie Knowlton
- Function : Author
Olive Kobusingye
- Function : Author
Adofo Koranteng
- Function : Author
Rita Krishnamurthi
- Function : Author
Michael Lipnick
- Function : Author
Steven E Lipshultz
- Function : Author
Summer Lockett Ohno
- Function : Author
Jacqueline Mabweijano
- Function : Author
Michael F Macintyre
- Function : Author
Leslie Mallinger
- Function : Author
Lyn March
- Function : Author
Guy B Marks
- Function : Author
Robin Marks
- Function : Author
Akira Matsumori
- Function : Author
Richard Matzopoulos
- Function : Author
Bongani M Mayosi
- Function : Author
John H Mcanulty
- Function : Author
Mary M Mcdermott
- Function : Author
John Mcgrath
- Function : Author
- PersonId : 760336
- ORCID : 0000-0002-4792-6068
George A Mensah
- Function : Author
Tony R Merriman
- Function : Author
Catherine Michaud
- Function : Author
Ted R Miller
- Function : Author
Charles Mock
- Function : Author
Ana Olga Mocumbi
- Function : Author
Ali A Mokdad
- Function : Author
Andrew Moran
- Function : Author
Kim Mulholland
- Function : Author
M Nathan Nair
- Function : Author
K M Venkat Narayan
- Function : Author
Kiumarss Nasseri
- Function : Author
Paul Norman
- Function : Author
Martin O'Donnell
- Function : Author
Saad B Omer
- Function : Author
Katrina Ortblad
- Function : Author
Richard Osborne
- Function : Author
Doruk Ozgediz
- Function : Author
Bishnu Pahari
- Function : Author
Jeyaraj Durai Pandian
- Function : Author
Andrea Panozo Rivero
- Function : Author
Rogelio Perez Padilla
- Function : Author
Fernando Perez-Ruiz
- Function : Author
Norberto Perico
- Function : Author
Kelsey Pierce
- Function : Author
C Arden Pope
- Function : Author
Esteban Porrini
- Function : Author
Farshad Pourmalek
- Function : Author
Murugesan Raju
- Function : Author
Dharani Ranganathan
- Function : Author
Jürgen T Rehm
- Function : Author
David B Rein
- Function : Author
Guiseppe Remuzzi
- Function : Author
Frederick P Rivara
- Function : Author
Thomas Roberts
- Function : Author
Felipe Rodriguez de León
- Function : Author
Lisa C Rosenfeld
- Function : Author
Lesley Rushton
- Function : Author
Joshua A Salomon
- Function : Author
Uchechukwu Sampson
- Function : Author
Ella Sanman
- Function : Author
David C Schwebel
- Function : Author
Maria Segui-Gomez
- Function : Author
Donald S Shepard
- Function : Author
David Singh
- Function : Author
Jessica Singleton
- Function : Author
Karen Sliwa
- Function : Author
Emma Smith
- Function : Author
Andrew Steer
- Function : Author
Jennifer A Taylor
- Function : Author
Bernadette Thomas
- Function : Author
- PersonId : 1202636
Imad M Tleyjeh
- Function : Author
Jeffrey A Towbin
- Function : Author
Thomas Truelsen
- Function : Author
Eduardo A Undurraga
- Function : Author
N. Venketasubramanian
- Function : Author
Lakshmi Vijayakumar
- Function : Author
Theo Vos
- Function : Author
Gregory R Wagner
- Function : Author
Mengru Wang
- Function : Author
Wenzhi Wang
- Function : Author
Kerrianne Watt
- Function : Author
Martin A Weinstock
- Function : Author
Robert Weintraub
- Function : Author
James D Wilkinson
- Function : Author
Anthony D Woolf
- Function : Author
Sarah Wulf
- Function : Author
Pon-Hsiu Yeh
- Function : Author
Paul Yip
- Function : Author
Azadeh Zabetian
- Function : Author
Zhi-Jie Zheng
- Function : Author
Alan D Lopez
- Function : Author
Christopher J L Murray
- Function : Author
Mohammad A Almazroa
- Function : Author
Ziad A Memish
- Function : Author
Abstract
BACKGROUND: Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex. METHODS: We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions. FINDINGS: In 2010, there were 52*8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24*9% of deaths worldwide in 2010, down from 15*9 million (34*1%) of 46*5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2*5 to 1*4 million), lower respiratory infections (from 3*4 to 2*8 million), neonatal disorders (from 3*1 to 2*2 million), measles (from 0*63 to 0*13 million), and tetanus (from 0*27 to 0*06 million). Deaths from HIV/AIDS increased from 0*30 million in 1990 to 1*5 million in 2010, reaching a peak of 1*7 million in 2006. Malaria mortality also rose by an estimated 19*9% since 1990 to 1*17 million deaths in 2010. Tuberculosis killed 1*2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34*5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1*5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12*9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1*3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5*1 million deaths) was marginally higher in 2010 (9*6%) compared with two decades earlier (8*8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1*3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted. INTERPRETATION: Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis. FUNDING: Bill & Melinda Gates Foundation.