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, Mahsen Naghavi, Kyle Foreman, Stephen Lim, Kenji Shibuya, Victor Aboyans, Jerry Abraham, Timothy Adair, Rakesh Aggarwal, Stephanie Ahn, Jacqueline Mabweijano, Michael MacIntyre, Leslie Mallinger, Lyn March, G MARKS, Robin Marks, Akira Matsumori, Richard Matzopoulos, Bongani Mayosi, John McAnultyMiriam Alvarado, Mary McDermott, John McGrath, George Mensah, Tony Merriman, Catherine Michaud, M Miller, Ted Miller, Charles Mock, Ana Olga Mocumbi, Ali A Mokdad, H Ross Anderson, Andrew Moran, M Nathan Nair, Luigi Naldi, KM Venkat Narayan, Kiumarss Nasseri, Paul Norman, Martin O'Donnell, Saad B Omer, Katrina Ortblad, Laurie Anderson, Richard Osborne, Doruk Ozgediz, Bishnu Pahari, Jeyaraj Durai Pandian, Andrea Panozo Rivero, Rogelio Perez Padilla, Fernando Perez-Ruiz, Norberto Perico, David Phillips, Kelsey Pierce, Kathryn Andrews, C Arden Pope III, Esteban Porrini, Farshad Pourmalek, Murugesan Raju, Dharani Ranganathan, Jurgen Rehm, David B Rein, Guiseppe Remuzzi, Fredrick Rivara, Thomas Roberts, Charles Atkinson, Felipe Rodriguez De Leon, Lisa Rosenfeld, Lesley Rushton, Ralph Sacco, Joshua Salomon, Uchechukwu Sampson, Ella Sanman, David Schwebel, Maria Segui-Gomez, Donald Shepard, Larry Baddour, David Singh, Jessica Singleton, Karen Sliwa, Emma Smith, Andrew Steer, Jennifer Taylor, Bernadette Thomas, Imad Tleyjeh, Jeffrey Towbin, Thomas Truelsen, Suzanne Barker-Collo, Eduardo Undurraga, N Venketasubramanian, Lakshmi Vijayakumar, Theo Vos, Gregory Wagner, Mengru Wang, Wenzhi Wang, Kerrianne Watt, Martin Weinstock, Robert Weintraub, David Bartels, J Wilkinson, Anthony Woolf, Sarah Wulf, Pon-Hsiu Yeh, Paul Yip, Azadeh Zabetian, Zhi-Jie Zheng, Alan Lopez, Christopher Murray, Michelle Bell, Emelia Benjamin, D Bennett, Kavi Bhalla, Boris Bikbov, Aref Bin Abdulhak, Gretchen Birbeck, Fiona Blyth, Ian Bolliger, Soufiane Boufous, Chiara Bucello, Michael Burch, Peter Burney, Jonathan Carapetis, Edward (Kim) MULHOLLAND, Honglei Chen, David Chou, Sumeet Chugh, Luc Coffeng, Steven Colan, Samantha Colquhoun, K Ellicott Colson, John Condon, Myles Connor, Leslie Cooper, Matthew Corriere, Monica Cortinovis, Karen Courville de Vaccaro, William Couser, Benjamin Cowie, Michael Criqui, Marita Cross, Nabila Dahodwala, Diego De Leo, Louisa Degenhardt, Allyne Delossantos, Julie Denenberg, Don Des Jarlais, Samath Dharmarante, E Ray Dorsey, Tim Driscoll, Herbert Duber, Beth Ebel, Patricia Erwin, Patricia Espindola, Majid Ezzati, Valery Feigin, Abraham Flaxman, Mohammad Forouzanfar, Francis Fowkes, Richard Franklin, Marlene Fransen, Michael Freeman, S Gabriel, Emmanuela Gakidou, Flavio Gaspari, Richard Gillum, Diego Gonzalez-Medina, Yara Halasa, Diana Haring, James Harrison, Rasmus Havmoeller, Rodrick Hay, Bruno Hoen, Peter Hotez, Damian Hoy, Kathryn Jacobsen, Spencer 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 Lipshultz, Summer Ohno

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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.

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.
Original languageEnglish
Pages (from-to)2095-2128
Number of pages34
Issue number9859
Publication statusPublished - 2012


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