Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016
Authors: Mohsen Naghavi, Amanuel Alemu Abajobir, Cristiana Abbafati, Kaja M Abbas, Foad Abd-Allah, Semaw Ferede Abera, Victor Aboyans, Olatunji Adetokunboh, Ashkan Afshin, Anurag Agrawal, Alireza Ahmadi, Muktar Beshir Ahmed, Amani Nidhal Aichour, Miloud Taki Eddine Aichour, Ibtihel Aichour, Sneha Aiyar, Fares Alahdab, Ziyad Al-Aly, Khurshid Alam, Noore Alam, Tahiya Alam, Kefyalew Addis Alene, Ayman Al-Eyadhy, Syed Danish Ali, Reza Alizadeh-Navaei, Juma M Alkaabi, Ala'a Alkerwi, François Alla, Peter Allebeck, Christine Allen, Rajaa Al-Raddadi, Ubai Alsharif, Khalid A Altirkawi, Nelson Alvis-Guzman, Azmeraw T Amare, Erfan Amini, Walid Ammar, Yaw Ampem Amoako, Nahla Anber, Hjalte H Andersen, Catalina Liliana Andrei, Sofia Androudi, Hossein Ansari, Carl Abelardo T Antonio, Palwasha Anwari, Johan Ärnlöv, Megha Arora, Al Artaman, Krishna Kumar Aryal, Hamid Asayesh, Solomon W Asgedom, Tesfay Mehari Atey, Leticia Avila-Burgos, Euripide Frinel G Avokpaho, Ashish Awasthi, Tesleem Kayode Babalola, Umar Bacha, Kalpana Balakrishnan, Aleksandra Barac, Miguel A Barboza, Suzanne L Barker-Collo, Simon Barquera, Lars Barregard, Lope H Barrero, Bernhard T Baune, Neeraj Bedi, Ettore Beghi, Yannick Béjot, Bayu Begashaw Bekele, Michelle L Bell, James R Bennett, Isabela M Bensenor, Adugnaw Berhane, Eduardo Bernabé, Balem Demtsu Betsu, Mircea Beuran, Samir Bhatt, Sibhatu Biadgilign, Kelly Bienhoff, Boris Bikbov, Donal Bisanzio, Rupert R A Bourne, Nicholas J K Breitborde, Lemma Negesa Bulto Bulto, Blair R Bumgarner, Zahid A Butt, Lucero Cahuana-Hurtado, Ewan Cameron, Julio Cesar Campuzano, Josip Car, Rosario Cárdenas, Juan Jesus Carrero, Austin Carter, Daniel C Casey, Carlos A Castañeda-Orjuela, Ferrán Catalá-López, Fiona J Charlson, Chioma Ezinne Chibueze, Odgerel Chimed-Ochir, Vesper Hichilombwe Chisumpa, Abdulaal A Chitheer, Devasahayam Jesudas Christopher, Liliana G Ciobanu, Massimo Cirillo, Aaron J Cohen, Danny Colombara, Cyrus Cooper, Benjamin C Cowie, Michael H Criqui, Lalit Dandona, Rakhi Dandona, Paul I Dargan, José das Neves, Dragos V Davitoiu, Kairat Davletov, Barbora de Courten, Barthelemy Kuate Defo, Louisa Degenhardt, Selina Deiparine, Kebede Deribe, Amare Deribew, Subhojit Dey, Daniel Dicker, Eric L Ding, Shirin Djalalinia, Huyen Phuc Do, David Teye Doku, Dirk Douwes-Schultz, Tim R Driscoll, Manisha Dubey, Bruce Bartholow Duncan, Michelle Echko, Ziad Ziad El-Khatib, Christian Lycke Ellingsen, Ahmadali Enayati, Sergey Petrovich Ermakov, Holly E Erskine, Sharareh Eskandarieh, Alireza Esteghamati, Kara Estep, Carla Sofia e Sa Farinha, André Faro, Farshad Farzadfar, Valery L Feigin, Seyed-Mohammad Fereshtehnejad, João C Fernandes, Alize J Ferrari, Tesfaye Regassa Feyissa, Irina Filip, Samuel Finegold, Florian Fischer, Christina Fitzmaurice, Abraham D Flaxman, Nataliya Foigt, Tahvi Frank, Maya Fraser, Nancy Fullman, Thomas Fürst, Joao M Furtado, Emmanuela Gakidou, Alberto L Garcia-Basteiro, Teshome Gebre, Gebremedhin Berhe Gebregergs, Tsegaye Tewelde Gebrehiwot, Delelegn Yilma Gebremichael, Johanna M Geleijnse, Ricard Genova-Maleras, Hailay Abrha Gesesew, Peter W Gething, Richard F Gillum, Ababi Zergaw Giref, Maurice Giroud, Giorgia Giussani, William W Godwin, Audra L Gold, Ellen M Goldberg, Philimon N Gona, Sameer Vali Gopalani, Hebe N Gouda, Alessandra Carvalho Goulart, Max Griswold, Rajeev Gupta, Tanush Gupta, Vipin Gupta, Parkash C Gupta, Juanita A Haagsma, Nima Hafezi-Nejad, Alemayehu Desalegne Hailu, Gessessew Bugssa Hailu, Randah Ribhi Hamadeh, Mitiku Teshome Hambisa, Samer Hamidi, Mouhanad Hammami, Jamie Hancock, Alexis J Handal, Graeme J Hankey, Yuantao Hao, Hilda L Harb, Habtamu Abera Hareri, Mohammad Sadegh Hassanvand, Rasmus Havmoeller, Simon I Hay, Fei He, Mohammad T Hedayati, Nathaniel J Henry, Ileana Beatriz Heredia-Pi, Claudiu Herteliu, Hans W Hoek, Masako Horino, Nobuyuki Horita, H Dean Hosgood, Sorin Hostiuc, Peter J Hotez, Damian G Hoy, Chantal Huynh, Kim Moesgaard Iburg, Chad Ikeda, Bogdan Vasile Ileanu, Asnake Ararsa Irenso, Caleb Mackay Salpeter Irvine, Sheikh Mohammed Shariful Islam, Kathryn H Jacobsen, Nader Jahanmehr, Mihajlo B Jakovljevic, Mehdi Javanbakht, Sudha P Jayaraman, Panniyammakal Jeemon, Vivekanand Jha, Denny John, Catherine O Johnson, Sarah Charlotte Johnson, Jost B Jonas, Mikk Jürisson, Zubair Kabir, Rajendra Kadel, Amaha Kahsay, Ritul Kamal, André Karch, Seyed M Karimi, Chante Karimkhani, Amir Kasaeian, Nigussie Assefa Kassaw, Nicholas J Kassebaum, Srinivasa Vittal Katikireddi, Norito Kawakami, Peter Njenga Keiyoro, Laura Kemmer, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Ejaz Ahmad Khan, Young-Ho Khang, Abdullah Tawfih Abdullah Khoja, Mohammad Hossein Khosravi, Ardeshir Khosravi, Jagdish Khubchandani, Aliasghar Ahmad Kiadaliri, Christian Kieling, Daniel Kievlan, Yun Jin Kim, Daniel Kim, Ruth W Kimokoti, Yohannes Kinfu, Niranjan Kissoon, Mika Kivimaki, Ann Kristin Knudsen, Jacek A Kopec, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Xie Rachel Kulikoff, G Anil Kumar, Pushpendra Kumar, Michael Kutz, Hmwe H Kyu, Dharmesh Kumar Lal, Ratilal Lalloo, Tea Lallukka Nkurunziza Lambert, Qing Lan, Van C Lansingh, Anders Larsson, Paul H Lee, James Leigh, Janni Leung, Miriam Levi, Yongmei Li, Darya Li Kappe, Xiaofeng Liang, Misgan Legesse Liben, Stephen S Lim, Patrick Y Liu, Angela Liu, Yang Liu, Rakesh Lodha, Giancarlo Logroscino, Stefan Lorkowski, Paulo A Lotufo, Rafael Lozano, Timothy C D Lucas, Stefan Ma, Erlyn Rachelle King Macarayan, Emilie R Maddison, Mohammed Magdy Abd El Razek, Marek Majdan, Reza Majdzadeh, Azeem Majeed, Reza Malekzadeh, Rajesh Malhotra, Deborah Carvalho Malta, Helena Manguerra, Tsegahun Manyazewal, Chabila C Mapoma, Laurie B Marczak, Desalegn Markos, Jose Martinez-Raga, Francisco Rogerlândio Martins-Melo, Ira Martopullo, Colm McAlinden, Madeline McGaughey, John J McGrath, Suresh Mehata, Toni Meier, Kidanu Gebremariam Meles, Peter Memiah, Ziad A Memish, Melkamu Merid Mengesha, Desalegn Tadese Mengistu, Bereket Gebremichael Menota, George A Mensah, Tuomo J Meretoja, Atte Meretoja, Anoushka Millear, Ted R Miller, Shawn Minnig, Mojde Mirarefin, Erkin M Mirrakhimov, Awoke Misganaw, Shiva Raj Mishra, Ibrahim Abdelmageem Mohamed, Karzan Abdulmuhsin Mohammad, Alireza Mohammadi, Shafiu Mohammed, Ali H Mokdad, Glen Liddell D Mola, Sarah K Mollenkopf, Mariam Molokhia, Lorenzo Monasta, Julio C Montañez, Marcella Montico, Meghan D Mooney, Maziar Moradi-Lakeh, Paula Moraga, Lidia Morawska, Chloe Morozoff, Shane D Morrison, Cliff Mountjoy-Venning, Kalayu Birhane Mruts, Kate Muller, Gudlavalleti Venkata Satyanarayana Murthy, Kamarul Imran Musa, Jean B Nachega, Aliya Naheed, Luigi Naldi, Vinay Nangia, Bruno Ramos Nascimento, Jamal T Nasher, Gopalakrishnan Natarajan, Ionut Negoi, Josephine Wanjiku Ngunjiri, Cuong Tat Nguyen, Quyen Le Nguyen, Trang Huyen Nguyen, Grant Nguyen, Minh Nguyen, Emma Nichols, Dina Nur Anggraini Ningrum, Vuong Minh Nong, Jean Jacques N Noubiap, Felix Akpojene Ogbo, In-Hwan Oh, Anselm Okoro, Andrew Toyin Olagunju, Helen E Olsen, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Kanyin Ong, John Nelson Opio, Eyal Oren, Alberto Ortiz, Majdi Osman, Erika Ota, Mahesh PA, Rosana E Pacella, Smita Pakhale, Adrian Pana, Basant Kumar Panda, Songhomitra Panda-Jonas, Christina Papachristou, Eun-Kee Park, Scott B Patten, George C Patton, Deepak Paudel, Katherine Paulson, David M Pereira, Fernando Perez-Ruiz, Norberto Perico, Aslam Pervaiz, Max Petzold, Michael Robert Phillips, David M Pigott, Christine Pinho, Dietrich Plass, Martin A Pletcher, Suzanne Polinder, Maarten J Postma, Farshad Pourmalek, Caroline Purcell, Mostafa Qorbani, Beatriz Paulina Ayala Quintanilla, Amir Radfar, Anwar Rafay, Vafa Rahimi-Movaghar, Mohammad Hifz Ur Rahman, Mahfuzar Rahman, Rajesh Kumar Rai, Chhabi Lal Ranabhat, Zane Rankin, Puja C Rao, Goura Kishor Rath, Salman Rawaf, Sarah E Ray, Jürgen Rehm, Robert C Reiner, Marissa B Reitsma, Giuseppe Remuzzi, Satar Rezaei, Mohammad Sadegh Rezai, Mohammad Bagher Rokni, Luca Ronfani, Gholamreza Roshandel, Gregory A Roth, Dietrich Rothenbacher, George Mugambage Ruhago, Rizwan SA, Soheil Saadat, Perminder S Sachdev, Nafis Sadat, Mahdi Safdarian, Sare Safi, Saeid Safiri, Rajesh Sagar, Ramesh Sahathevan, Joseph Salama, Payman Salamati, Joshua A Salomon, Abdallah M Samy, Juan Ramon Sanabria, Maria Dolores Sanchez-Niño, Damian Santomauro, Itamar S Santos, Milena M Santric Milicevic, Benn Sartorius, Maheswar Satpathy, Maria Inês Schmidt, Ione J C Schneider, Sam Schulhofer-Wohl, Aletta E Schutte, David C Schwebel, Falk Schwendicke, Sadaf G Sepanlou, Edson E Servan-Mori, Katya Anne Shackelford, Saeid Shahraz, Masood Ali Shaikh, Mansour Shamsipour, Morteza Shamsizadeh, Jayendra Sharma, Rajesh Sharma, Jun She, Sara Sheikhbahaei, Muki Shey, Peilin Shi, Chloe Shields, Mika Shigematsu, Rahman Shiri, Shreya Shirude, Ivy Shiue, Haitham Shoman, Mark G Shrime, Inga Dora Sigfusdottir, Naris Silpakit, João Pedro Silva, Jasvinder A Singh, Abhishek Singh, Eirini Skiadaresi, Amber Sligar, David L Smith, Alison Smith, Mari Smith, Badr H A Sobaih, Samir Soneji, Reed J D Sorensen, Joan B Soriano, Chandrashekhar T Sreeramareddy, Vinay Srinivasan, Jeffrey D Stanaway, Vasiliki Stathopoulou, Nicholas Steel, Dan J Stein, Caitlyn Steiner, Sabine Steinke, Mark Andrew Stokes, Mark Strong, Bryan Strub, Michelle Subart, Muawiyyah Babale Sufiyan, Bruno F Sunguya, Patrick J Sur, Soumya Swaminathan, Bryan L Sykes, Rafael Tabarés-Seisdedos, Santosh Kumar Tadakamadla, Ken Takahashi, Jukka S Takala, Roberto Tchio Talongwa, Mohammed Rasoul Tarawneh, Mohammad Tavakkoli, Nuno Taveira, Teketo Kassaw Tegegne, Arash Tehrani-Banihashemi, Mohamad-Hani Temsah, Abdullah Sulieman Terkawi, J S Thakur, Ornwipa Thamsuwan, Kavumpurathu Raman Thankappan, Katie E Thomas, Alex H Thompson, Alan J Thomson, Amanda G Thrift, Ruoyan Tobe-Gai, Roman Topor-Madry, Anna Torre, Miguel Tortajada, Jeffrey Allen Towbin, Bach Xuan Tran, Christopher Troeger, Thomas Truelsen, Derrick Tsoi, Emin Murat Tuzcu, Stefanos Tyrovolas, Kingsley N Ukwaja, Eduardo A Undurraga, Rachel Updike, Olalekan A Uthman, Benjamin S Chudi Uzochukwu, Job F M van Boven, Tommi Vasankari, Narayanaswamy Venketasubramanian, Francesco S Violante, Vasiliy Victorovich Vlassov, Stein Emil Vollset, Theo Vos, Tolassa Wakayo, Mitchell T Wallin, Yuan-Pang Wang, Elisabete Weiderpass, Robert G Weintraub, Daniel J Weiss, Andrea Werdecker, Ronny Westerman, Brian Whetter, Harvey A Whiteford, Tissa Wijeratne, Charles Shey Wiysonge, Belete Getahun Woldeyes, Charles D A Wolfe, Rachel Woodbrook, Abdulhalik Workicho, Denis Xavier, Qingyang Xiao, Gelin Xu, Mohsen Yaghoubi, Bereket Yakob, Yuichiro Yano, Mehdi Yaseri, Hassen Hamid Yimam, Naohiro Yonemoto, Seok-Jun Yoon, Marcel Yotebieng, Mustafa Z Younis, Zoubida Zaidi, Maysaa El Sayed Zaki, Elias Asfaw Zegeye, Zerihun Menlkalew Zenebe, Taddese Alemu Zerfu, Anthony Lin Zhang, Xueying Zhang, Ben Zipkin, Sanjay Zodpey, Alan D Lopez, Christopher J L Murray
Journal: The Lancet (2017)

<h2>Summary</h2><h3>Background</h3> Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. <h3>Methods</h3> We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. <h3>Findings</h3> The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72·3% (95% uncertainty interval [UI] 71·2–73·2) of deaths in 2016 with 19·3% (18·5–20·4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8·43% (8·00–8·67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006–16—age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1·80 million deaths (95% UI 1·59 million to 1·89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176–181) increase in deaths in ages 90–94 years and a 210% (208–212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2·89%); the median annualised rate of change for all other causes was lower (a decrease of 1·59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe. <h3>Interpretation</h3> The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems. <h3>Funding</h3> Bill & Melinda Gates Foundation.