|dc.description.abstract||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.||es_ES
|dcterms.references||1 Harkness AG. Age at marriage and at death in the Roman Empire.
Trans Am Philol Assoc 1896; 27: 35–72.
2 Scheidel W. Disease and death in the ancient city of Rome.
Rochester: Social Science Research Network, 2009.
https://papers.ssrn.com/abstract=1347510 (accessed July 13, 2018).
3 UN. Sustainable development knowledge platform.
https://sustainabledevelopment.un.org/sdgs (accessed July 13, 2018).
4 GBD 2016 Mortality Collaborators. 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. Lancet 2017; 390: 1084–150.
5 Ahmad OB, Lopez AD, Inoue M. The decline in child mortality:
a reappraisal. Bull World Health Organ 2000; 78: 1175–91.
6 You D, Jin NR, Wardlaw T. Levels & trends in child mortality. 2012.
http://ihi.eprints.org/714/ (accessed July 13, 2018).
7 Centers for Disease Control and Prevention (CDC). Trends in
aging—United States and worldwide. MMWR Morb Mortal Wkly Rep
2003; 52: 101–04, 106.
8 Roser M. Life expectancy. Our World in Data, 2018.
https://ourworldindata.org/life-expectancy#rising-life-expectancyaround-the-world (accessed July 13, 2018).
9 US Burden of Disease Collaborators. The State of US health,
1990–2016: burden of disease, injuries, and risk factors among
US States. JAMA 2018; 319: 1444–72.
10 Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, et al. Inequalities in
life expectancy among US counties, 1980 to 2014: temporal trends
and key drivers. JAMA Intern Med 2017; 177: 1003–11.
11 Kochanek KD, Murphy SL, Xu J, Arias E. Mortality in the
United States, 2016. NCHS Data Brief No. 293, December 2017.
(accessed April 9, 2018).
12 Newton JN, Briggs ADM, Wolfe CDA. Changes in health in
England, with analysis by English regions and areas of deprivation,
1990–2013: a systematic analysis for the Global Burden of Disease
Study 2013. Lancet 2015; 386: 2257–74.
13 Fransham M, Dorling D. Have mortality improvements stalled in
England? BMJ 2017; 357: j1946.
14 Wang H, Abajobir AA, Abate KH, et al. 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. Lancet 2017;
15 Mokdad AH, Forouzanfar MH, Daoud F, et al. Health in times of
uncertainty in the eastern Mediterranean region, 1990–2013:
a systematic analysis for the Global Burden of Disease Study 2013.
Lancet Glob Health 2016; 4: e704–13.
16 Gómez-Dantés H, Fullman N, Lamadrid-Figueroa H, et al.
Dissonant health transition in the states of Mexico, 1990–2013:
a systematic analysis for the Global Burden of Disease Study 2013.
Lancet 2016; 388: 2386–402.
17 Preston SH, Vierboom YC, Stokes A. The role of obesity in
exceptionally slow US mortality improvement.
Proc Natl Acad Sci USA 2018; 115: 957–61.
18 Walls HL, Backholer K, Proietto J, McNeil JJ. Obesity and trends in
life expectancy. J Obesity 2012; 2012: 107989.
19 Angelantonio ED, Bhupathiraju SN, Wormser D, et al.
Body-mass index and all-cause mortality: individual-participant-data
meta-analysis of 239 prospective studies in four continents.
Lancet 2016; 388: 776–86.
20 Groenewald P, Nannan N, Bourne D, Laubscher R, Bradshaw D.
Identifying deaths from AIDS in South Africa. AIDS 2005;
21 Kahn K, Garenne ML, Collinson MA, Tollman SM. Mortality trends
in a new South Africa: hard to make a fresh start.
Scand J Public Health Suppl 2007; 69: 26–34.
22 National Research Council (US) Committee on Population.
Bobadilla JL, Costello CA, and Mitchell F, eds. Premature death in
the new independent states. Washington: National Academies Press
23 National Research Council (US) Committee on Population,
Bobadilla JL, Costello CA, Mitchell F, eds. Epidemiological transitions
in the formerly socialist economies: divergent patterns of mortality
and causes of death. National Academies Press (US), 1997.
24 UN Department of Economic and Social Affairs. World population
prospects: the 2017 revision. https://www.un.org/development/desa/
(accessed April 7, 2018).
25 United States Census Bureau. International data base. https://www.
html (accessed April 8, 2018).
26 WHO. WHO methods and data sources for global burden of disease
estimates 2000–2011. http://www.who.int/healthinfo/statistics/
GlobalDALYmethods_2000_2011.pdf (accessed April 8, 2018).
27 National Bureau of Statistics of China. National data. http://data.
(accessed April 8, 2018).
28 Government of India. Mortality. Open government data (OGD)
platform India. https://data.gov.in/keywords/mortality
(accessed April 8, 2018).
29 National Bureau of statistics (Nigeria). Population and vital statistics.
(accessed April 8, 2018).
30 GBD 2015 Mortality and Causes of Death Collaborators.
Global, regional, and national life expectancy, all-cause mortality,
and cause-specific mortality for 249 causes of death, 1980–2015:
a systematic analysis for the Global Burden of Disease Study 2015.
Lancet 2016; 388: 1459–544.
31 GBD 2017 Population and Fertility collaborators. Population and
fertility by age and sex for 195 countries and territories 1950–2017:
a systematic analysis for the Global Burden of Disease 2017. Lancet
2018; 392: 1995–2051.
32 Stevens GA, Alkema L, Black RE, et al. Guidelines for Accurate and
Transparent Health Estimates Reporting: the GATHER statement.
Lancet 2016; 388: e19–23.
33 Murray CJ, Rajaratnam JK, Marcus J, Laakso T, Lopez AD.
What can we conclude from death registration? Improved
methods for evaluating completeness. PLoS Med 2010; 7: e1000262.
34 Brass W. Demographic data analysis in less developed countries:
1946–1996. Pop Stud 1996; 50: 451–67.
35 Hill K. Estimating census and death registration completeness.
Asian Pac Popul Forum 1987; 1: 8–13, 23–4.
36 Vincent P. La mortalité des vieillards. Population 1951; 6: 181–204.
37 Bennett NG, Horiuch S. Estimating the completeness of death
registration in a closed population. Popul Index 1981; 47: 207–21.
38 Hill K, You D, Choi Y. Death distribution methods for estimating
adult mortality: Sensitivity analysis with simulated data errors.
Demogr Res 2009; 21: 235–54.
39 Rajaratnam JK, Tran LN, Lopez AD, Murray CJL. Measuring
under-five mortality: validation of new low-cost methods.
PLoS Med 2010; 7: e1000253.
40 Obermeyer Z, Rajaratnam JK, Park CH, et al. Measuring adult
mortality using sibling survival: a new analytical method and new
results for 44 countries, 1974–2006. PLoS Med 2010; 7: e1000260.
41 Department of International Economic and Social Affairs.
Manual X. Indirect techniques for demographic estimation:
a collaboration of the Population Division of the Department of
International Economic and Social Affairs of the United Nations
Secretariat with the Committee on Population and Demography of
the National Research Council, United States National Academy of
Sciences. New York: United Nations, 1983.
42 Global Burden of Disease Health Financing Collaborator Network.
Trends in future health financing and coverage: future health
spending and universal health coverage in 188 countries, 2016–40.
Lancet 2018; 391: 1783–98.
43 Gakidou E, Cowling K, Lozano R, Murray CJ. Increased educational
attainment and its effect on child mortality in 175 countries between
1970 and 2009: a systematic analysis. Lancet 2010; 376: 959–74.
44 Murray CJL, Ortblad KF, Guinovart C, et al. Global, regional, and
national incidence and mortality for HIV, tuberculosis, and malaria
during 1990–2013: a systematic analysis for the Global Burden of
Disease Study 2013. Lancet 2014; 384: 1005–70.
45 Ghys PD, Brown T, Grassly NC, et al. The UNAIDS Estimation and
Projection Package: a software package to estimate and project
national HIV epidemics. Sex Transm Infect 2004; 80 (suppl 1): i5–9.
46 McKeown T. The role of medicine: dream, mirage, or nemesis?
Princeton: Princeton University Press, 2014.
47 Preston SH. The changing relation between mortality and level of
economic development. Int J Epidemiol 2007; 36: 484–90.
48 EM-DAT. The international disasters database. https://www.emdat.
be/index.php (accessed July 13, 2018).
49 Grangereau P. La Chine creuse ses trous de mémoire. Libération.
June 17, 2011. http://www.liberation.fr/planete/2011/06/17/la-chinecreuse-ses-trous-de-memoire_743211 (accessed July 13, 2018).
50 Emslie C, Hunt K. The weaker sex? Exploring lay understandings of
gender differences in life expectancy: a qualitative study.
Soc Sci Med 2008; 67: 808–16.
51 Coale AJ, Demeny PG, Vaughan B. Regional model life tables and
stable populations. New York: Academic, 1983.
52 United Nations. Age and sex patterns of mortality: model life tables
for under-developed countries. Population Studies, No. 22.
Department of Social Affairs. Sales No. 1955.XIII.9. New York:
United Nations, 1955.
53 Gakidou E, King G. Death by survey: estimating adult mortality
without selection bias from sibling survival data. Demography 2006;
54 Masquelier B. Adult mortality from sibling survival data:
a reappraisal of selection biases. Demography 2013; 50: 207–28.||es_ES