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
Creators: name: Stöckl, Heidi
name: Anwari, Palwasha
name: Agrawal, Sutapa
name: Al-Raddadi, Rajaa
name: Castañeda-Orjuela, Carlos A.
name: Kim, Daniel
name: Graetz, Nicholas
name: Ali, Raghib
name: Jonas, Jost B.
name: Gibney, Katherine B.
name: Coresh, Josef
name: Kaul, Anil
name: Majdzadeh, Reza
name: Franklin, Richard C.
name: Remuzzi, Giuseppe
name: Mezgebe, Haftay Berhane
name: Silva, João Pedro
name: Yonemoto, Naohiro
name: Kuipers, Ernst J.
name: Ileanu, Bogdan Vasile
name: Massano, João
name: Saxena, Sonia
name: Yip, Paul
name: Majdan, Marek
name: Perez-Ruiz, Fernando
name: Castillo Rivas, Jacqueline
name: Gankpé, Fortuné Gbètoho
name: Kadel, Rajendra
name: Soriano, Joan B.
name: Hambisa, Mitiku Teshome
name: Tuzcu, Emin Murat
name: Karch, André
name: Ciobanu, Liliana G.
name: Esteghamati, Alireza
name: Pourmalek, Farshad
name: Martinez-Raga, Jose
name: Kibret, Getiye Dejenu
name: Das Neves, José
name: Sanchez-Niño, Maria Dolores
name: Sepanlou, Sadaf G.
name: Kulikoff, Xie Rachel
name: Baune, Bernhard T.
name: Mazidi, Mohsen
name: Ayala Quintanilla, Beatriz Paulina
name: Gesesew, Hailay Abrha
name: Gillum, Richard F.
name: Natarajan, Gopalakrishnan
name: Karthikeyan, Ganesan
name: Silberberg, Donald H.
name: Kishawi, Sami
name: Rawaf, Salman
name: Resnikoff, Serge
name: Allebeck, Peter
name: Bärnighausen, Till
name: Bennett, James R.
name: Tarajia, Musharaf
name: Chibalabala, Mirriam
name: Barregard, Lars
name: Cirillo, Massimo
name: Alahdab, Fares
name: McGrath, John J.
name: Lal, Dharmesh Kumar
name: Petri, William Arthur
name: Lachat, Carl
name: Sagar, Rajesh
name: Zeeb, Hajo
name: Alsharif, Ubai
name: Deribew, Amare
name: Herteliu, Claudiu
name: Xu, Gelin
name: Patel, Tejas
name: Ding, Eric L.
name: Shibuya, Kenji
name: Davey, Gail
name: Misganaw, Awoke
name: Tekle, Dejen Yemane
name: Schwendicke, Falk
name: Barrero, Lope H.
name: Mekonnen, Tefera Chane
name: Leigh, James
name: Lee, Paul H.
name: Islam, Sheikh Mohammed Shariful
name: Bell, Michelle L.
name: Car, Josip
name: Balalla, Shivanthi
name: Pishgar, Farhad
name: Kastor, Anshul
name: Feigin, Valery L.
name: Dubey, Manisha
name: Uthman, Olalekan A.
name: Gupta, Rajeev
name: Alkaabi, Juma M.
name: Nachega, Jean B.
name: Mantovani, Lorenzo G.
name: Sharma, Jayendra
name: Hassanvand, Mohammad Sadegh
name: Lipshultz, Steven E.
name: Bhala, Neeraj
name: Mohammadi, Alireza
name: Menon, Geetha R.
name: Sobaih, Badr H.A.
name: Abu-Raddad, Laith J.
name: Kamal, Ritul
name: Adedeji, Isaac Akinkunmi
name: Vollset, Stein Emil
name: Barac, Aleksandra
name: Vasankari, Tommi
name: Lorch, Scott A.
name: Meier, Toni
name: Vladimirov, Sergey K.
name: Rubagotti, Enrico
name: Campos-Nonato, Ismael Ricardo
name: Horita, Nobuyuki
name: Polinder, Suzanne
name: Woldeyes, Belete Getahun
name: Vasconcelos, Ana Maria Nogales
name: Kim, Pauline
name: Bisanzio, Donal
name: Dandona, Rakhi
name: Fanuel, Fanuel Belayneh Bekele
name: Johnson, Sarah Charlotte
name: Lansingh, Van C.
name: Larsson, Anders
name: Mengistu, Desalegn Tadese
name: Kesavachandran, Chandrasekharan Nair
name: Khosravi, Mohammad Hossein
name: Mooney, Meghan D.
name: Cahuana-Hurtado, Lucero
name: Murthy, Gudlavalleti Venkata Satyanarayana
name: Genova-Maleras, Ricard
name: Liben, Misgan Legesse
name: Bazargan-Hejazi, Shahrzad
name: Laryea, Dennis Odai
name: Deribe, Kebede
name: Shigematsu, Mika
name: Jensen, Paul N.
name: Brenner, Hermann
name: Nong, Vuong Minh
name: Nagel, Gabriele
name: Gambashidze, Ketevan
name: Stein, Dan J.
name: Gona, Philimon N.
name: Htet, Aung Soe
name: Geleijnse, Johanna M.
name: Dandona, Lalit
name: Shiue, Ivy
name: Chiang, Peggy Pei-Chia
name: Haghparast Bidgoli, Hassan
name: Bumgarner, Blair Randal
name: Skiadaresi, Eirini
name: Okoro, Anselm
name: Frank, Tahvi
name: Irvine, Caleb M.S.
name: Asayesh, Hamid
name: Mackay, Mark T.
name: Kahsay, Amaha
name: Gopalani, Sameer Vali
name: Katikireddi, Srinivasa Vittal
name: Alizadeh-Navaei, Reza
name: Mokdad, Ali H.
name: Al-Eyadhy, Ayman
name: Park, Eun-Kee
name: Pereira, David M.
name: Satpathy, Maheswar
name: Yan, Lijing L.
name: Bulto, Lemma Negesa Bulto
name: Islam, Nazrul
name: Djalalinia, Shirin
name: Donnelly, Christl Ann
name: Mehndiratta, Man Mohan
name: Topor-Madry, Roman
name: Yirsaw, Biruck Desalegn
name: Bacha, Umar
name: Rajsic, Sasa
name: Abajobir, Amanuel Alemu
name: Varughese, Santosh
name: Alla, François
name: Avila-Burgos, Leticia
name: Tadakamadla, Santosh Kumar
name: Kabir, Zubair
name: Tekelab, Tesfalidet
name: Alvis-Guzman, Nelson
name: Afshin, Ashkan
name: Lodha, Rakesh
name: Duncan, Bruce Bartholow
name: Lotufo, Paulo A.
name: Endries, Aman Yesuf
name: Nomura, Marika
name: Gupta, Vipin
name: Nguyen, Quyen Le
name: Mohammad, Karzan Abdulmuhsin
name: Sanabria, Juan Ramon
name: Ameh, Emmanuel A.
name: Swaminathan, Soumya
name: Popova, Svetlana
name: Krohn, Kristopher J.
name: Anber, Nahla
name: Martin, Elena Alvarez
name: Seid, Abdulbasit Musa
name: Stathopoulou, Vasiliki
name: Thomson, Alan J.
name: Rezaei, Satar
name: Ahmad Kiadaliri, Aliasghar
name: Lunevicius, Raimundas
name: Carpenter, David O.
name: Sarmiento-Suarez, Rodrigo
name: Keiyoro, Peter Njenga
name: Douwes-Schultz, Dirk
name: Uzochukwu, Benjamin S. Chudi
name: Noubiap, Jean Jacques N.
name: Sur, Patrick J.
name: Mohammed, Kedir Endris
name: Macarayan, Erlyn Rachelle King
name: Farzadfar, Farshad
name: Aichour, Ibthiel
name: Hammami, Mouhanad
name: Gemechu, Kasiye Shiferaw
name: Hareri, Habtamu Abera
name: Hao, Yuantao
name: Dos Santos, Kadine Priscila Bender
name: Nguyen, Grant
name: Hostiuc, Sorin
name: Sligar, Amber
name: Roshandel, Gholamreza
name: Safdarian, Mahdi
name: Brazinova, Alexandra
name: Rabiee, Rynaz H.S.
name: Sahathevan, Ramesh
name: Cromwell, Elizabeth A.
name: Olagunju, Andrew Toyin
name: Perico, Norberto
name: Renzaho, Andre M.N.N.
name: Rahimi-Movaghar, Afarin
name: Magdy Abd El Razek, Mohammed
name: Musa, Kamarul Imran
name: Rahman, Mahfuzar
name: Rana, Saleem M.
name: Bensenor, Isabela M.
name: Pervaiz, Aslam
name: Ronfani, Luca
name: Weintraub, Robert G.
name: Zhang, Anthony Lin
name: Jeemon, Panniyammakal
name: Strong, Mark
name: Martins-Melo, Francisco Rogerlândio
name: Kissoon, Niranjan
name: Mills, Edward J.
name: Terkawi, Abdullah Sulieman
name: Li, Yongmei
name: Mehta, Kala M.
name: Thrift, Amanda G.
name: Moore, Ami R.
name: Driscoll, Tim R.
name: Poulton, Richie G.
name: Yalew, Ayalnesh Zemene
name: Kucuk Bicer, Burcu
name: Kokubo, Yoshihiro
name: Castro, Franz F.
name: Yotebieng, Marcel
name: Pakhale, Smita
name: Kulkarni, Veena S.
name: Tavakkoli, Mohammad
name: Tehrani-Banihashemi, Arash
name: Machado, Isis Eloah
name: Malekzadeh, Reza
name: Silpakit, Naris
name: Hosgood, H. Dean
name: Barker-Collo, Suzanne L.
name: Marczak, Laurie B.
name: Gebrekidan, Kahsu Gebrekirstos
name: Javanbakht, Mehdi
name: Carrero, Juan Jesus
name: Montañez Hernandez, Julio Cesar
name: Foreman, Kyle J.
name: Hamidi, Samer
name: Pana, Adrian
name: Sreeramareddy, Chandrashekhar T.
name: Zodpey, Sanjay
name: Tobe-Gai, Ruoyan
name: Estep, Kara
name: Ketema, Ezra Belay
name: Mirarefin, Mojde
name: Karimi, Seyed M.
name: Sahebkar, Amirhossein
name: Akanda, Ali Shafqat
name: Murthy, Srinivas
name: Ellingsen, Christian Lycke
name: Kissimova-Skarbek, Katarzyna A.
name: Kassaw, Nigussie Assefa
name: Nascimento, Bruno Ramos
name: Micha, Renata
name: Zuhlke, Liesl Joanna
name: Meretoja, Atte
name: Amare, Azmeraw T.
name: Piel, Frédéric B.
name: Norrving, Bo
name: Wang, Haidong
name: Chisumpa, Vesper Hichilombwe
name: Leung, Ricky
name: Hafezi-Nejad, Nima
name: Amoako, Yaw Ampem
name: Levi, Miriam
name: Undurraga, Eduardo A.
name: Menota, Bereket Gebremichael
name: Rai, Rajesh Kumar
name: Mahdavi, Mahdi
name: Allam, Shalini D.
name: Silveira, Dayane Gabriele Alves
name: Tadese, Fentaw
name: Soneji, Samir
name: Weichenthal, Scott
name: Doku, David Teye
name: Gill, Paramjit Singh
name: Varakin, Yuri Y.
name: Deiparine, Selina
name: Barquera, Simon
name: Mahesh, 
name: Foigt, Nataliya
name: Saylan, Mete I.
name: Shiri, Rahman
name: Van Boven, Job F.M.
name: Des Jarlais, Don C.
name: Dwivedi, Laxmi Kant
name: Gupta, Tanush
name: Ningrum, Dina Nur Anggraini
name: Kelbore, Sefonias Getachew
name: Dherani, Mukesh K.
name: Lalloo, Ratilal
name: Artaman, Al
name: Davletov, Kairat
name: Kutz, Michael
name: Mollenkopf, Sarah K.
name: Haagsma, Juanita A.
name: Salamati, Payman
name: Yaghoubi, Mohsen
name: Vlassov, Vasiliy Victorovich
name: De Courten, Barbora
name: Wilkinson, James D.
name: Suliankatchi, Rizwan Abdulkader
name: Sufiyan, Muawiyyah Babale
name: Assadi, Reza
name: Sunguya, Bruno F.
name: Choi, Jee-Young Jasmine
name: Schneider, Ione J.C.
name: Oh, In-Hwan
name: Shackelford, Katya Anne
name: Nangia, Vinay
name: Rahimi-Movaghar, Vafa
name: Cahill, Leah E.
name: Yimam, Hassen Hamid
name: Bourne, Rupert R.A.
name: Tesema, Cheru Leshargie
name: Mullany, Erin
name: Salvi, Sundeep Santosh
name: Aljunid, Syed M.
name: Abate, Kalkidan Hassen
name: Fürst, Thomas
name: Davitoiu, Dragos V.
name: Montico, Marcella
name: Stokes, Mark Andrew
name: Hay, Simon I.
name: Hoek, Hans W.
name: Sabde, Yogesh Damodar
name: Cárdenas, Rosario
name: Malta, Deborah Carvalho
name: Kemp, Andrew Haddon
name: Liao, Yu
name: Ota, Erika
name: Hay, Roderick J.
name: Leung, Janni
name: Rothenbacher, Dietrich
name: Boufous, Soufiane
name: Irenso, Asnake Ararsa
name: Khera, Sahil
name: Smith, David L.
name: Gebregergs, Gebremedhin Berhe
name: Mehata, Suresh
name: Bhutta, Zulfiqar A.
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name: Alkerwi, Ala'a
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name: Degenhardt, Louisa
name: Frostad, Joseph J.
name: Alam, Khurshid
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name: Fereshtehnejad, Seyed-Mohammad
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name: Kopec, Jacek A.
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name: Babalola, Tesleem Kayode
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name: McAlinden, Colm
name: Waid, Jillian L.
name: Majeed, Azeem
name: Heredia-Pi, Ileana Beatriz
name: Morrison, Shane D.
name: Owolabi, Mayowa O.
name: Knudsen, Ann Kristin
name: Singh, Abhishek
name: Amini, Erfan
name: Criqui, Michael H.
name: Singh, Prashant Kumar
name: Topouzis, Fotis
name: Shetty, Balakrishna P.
name: Kieling, Christian
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name: Bennett, Derrick A.
name: Meretoja, Tuomo J.
name: Kassebaum, Nicholas J.
name: Ranabhat, Chhabi Lal
name: Zaidi, Zoubida
name: Petzold, Max
name: Abbafati, Cristiana
name: Logroscino, Giancarlo
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name: Balakrishnan, Kalpana
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name: Sharma, Rajesh
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name: Bhaumik, Soumyadeep
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name: Kivimaki, Mika
name: Lagat, Abraham K.
name: Wiysonge, Charles Shey
name: Khan, Ejaz Ahmad
name: Dargan, Paul I.
name: Zenebe, Zerihun Menlkalew
name: Alam, Noore
name: Lan, Qing
name: Rahman, Sajjad Ur
name: Biryukov, Stan
name: Purwar, Manorama
name: Younis, Mustafa Z.
name: Workie, Shimelash Bitew
name: Qorbani, Mostafa
name: Fernandes, Jefferson G.
name: Androudi, Sofia
name: Ahmed, Muktar Beshir
name: Schmidt, Maria Inês
name: Panda-Jonas, Songhomitra
name: Karema, Corine Kakizi
name: Harikrishnan, Sivadasanpillai
name: Carter, Austin
name: Ermakov, Sergey Petrovich
name: Wijeratne, Tissa
name: Lorkowski, Stefan
name: Inoue, Manami
name: Kan, Haidong
name: Gupta, Prakash C.
name: Beyene, Addisu Shunu
name: Beuran, Mircea
name: Shen, Jiabin
name: Keren, Andre
name: Arora, Megha
name: Berhe, Derbew Fikadu
name: Futran, Neal D.
name: Gebremichael, Mengistu Welday
name: Shaheen, Amira
name: Mensah, George A.
name: Safi, Sare
name: Hamadeh, Randah Ribhi
name: Bernabé, Eduardo
name: Sindi, Shireen
name: Bukhman, Gene
name: Gebrehiwot, Tsegaye Tewelde
name: Perez-Padilla, Rogelio
name: Moraga, Paula
name: Seedat, Soraya
name: Schwebel, David C.
name: Asghar, Rana Jawad
name: Steiner, Caitlyn
name: Shamsipour, Mansour
name: Jahanmehr, Nader
name: Kravchenko, Michael
name: Nguyen, Cuong Tat
name: Akinyemiju, Tomi F.
name: Hilawe, Esayas Haregot
name: Faro, André
name: Manyazewal, Tsegahun
name: Iburg, Kim Moesgaard
name: Singh, Virendra
name: Adetifa, Ifedayo Morayo O.
name: Kumar, G. Anil
name: Phillips, Michael Robert
name: Al-Aly, Ziyad
name: Khoja, Abdullah Tawfih Abdullah
name: Monasta, Lorenzo
name: Jacobsen, Kathryn H.
name: Bjerregaard, Peter
name: Negoi, Ionut
name: Moreno Velasquez, Ilais
name: Workicho, Abdulhalik
name: Kumsa, Fekede Asefa
name: Obermeyer, Carla Makhlouf
name: Fernandes, João C.
name: Brugha, Traolach S.
name: Hoy, Damian G.
name: Sigfusdottir, Inga Dora
name: Panda, Basant Kumar
name: Minnig, Shawn
name: Safiri, Saeid
name: Rego, Maria Albertina Santiago
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name: Oyekale, Abayomi Samuel
name: Tabarés-Seisdedos, Rafael
name: Bhansali, Anil
name: Gething, Peter W.
name: Barber, Ryan M.
name: Zhang, Xueying
name: Kim, Yun Jin
name: Ruhago, George Mugambage
name: Samy, Abdallah M.
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name: McGarvey, Stephen Theodore
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name: Miller, Ted R.
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name: Salomon, Joshua A.
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name: Trujillo, Ulises
name: Sobngwi, Eugene
name: Khalil, Ibrahim A.
name: Béjot, Yannick
name: Tonelli, Marcello
name: Christensen, Hanne
name: Truelsen, Thomas
name: Morawska, Lidia
name: Kim, Sungroul
name: Ray, Sarah E.
name: Tandon, Nikhil
name: Kuate Defo, Barthelemy
name: Kimokoti, Ruth W.
name: Mikesell, Joseph
name: Oladimeji, Olanrewaju
name: Muller, Kate
name: Jin, Ye
name: Ammar, Walid
name: Jayatilleke, Achala Upendra
name: Colquhoun, Samantha M.
name: Altirkawi, Khalid A.
name: Crump, John A.
name: Hu, Guoqing
name: Roy, Ambuj
name: Abbas, Kaja M.
name: Tyrovolas, Stefanos
name: Catalá-López, Ferrán
name: Wakayo, Tolassa
name: Shaikh, Masood Ali
name: Temsah, Mohamad-Hani
name: Huang, Hsiang
name: Kazanjan, Konstantin
name: Norheim, Ole F.
name: Kinfu, Yohannes
name: Gakidou, Emmanuela
name: He, Fei
name: Bekele, Bayu Begashaw
name: Feyissa, Tesfaye Regassa
name: Srinivasan, Vinay
name: Enayati, Ahmadali
name: Memiah, Peter
name: Pigott, David M.
name: Atre, Sachin R.
name: Ogbo, Felix Akpojene
name: Weiderpass, Elisabete
name: Chen, Honglei
name: Cohen, Aaron J.
name: Parsaeian, Mahboubeh
name: Liu, Shiwei
name: She, Jun
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2017

description: BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016.

METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone.

FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and