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
Authors: Haidong Wang, Mohsen Naghavi, Christine Allen, Ryan M Barber, Zulfiqar A Bhutta, Austin Carter, Daniel C Casey, Fiona J Charlson, Alan Zian Chen, Matthew M Coates, Megan Coggeshall, Lalit Dandona, Daniel J Dicker, Holly E Erskine, Alize J Ferrari, Christina Fitzmaurice, Kyle Foreman, Mohammad H Forouzanfar, Maya S Fraser, Nancy Fullman, Peter W Gething, Ellen M Goldberg, Nicholas Graetz, Juanita A Haagsma, Simon I Hay, Chantal Huynh, Catherine O Johnson, Nicholas J Kassebaum, Yohannes Kinfu, Xie Rachel Kulikoff, Michael Kutz, Hmwe H Kyu, Heidi J Larson, Janni Leung, Xiaofeng Liang, Stephen S Lim, Margaret Lind, Rafael Lozano, Neal Marquez, George A Mensah, Joe Mikesell, Ali H Mokdad, Meghan D Mooney, Grant Nguyen, Elaine Nsoesie, David M Pigott, Christine Pinho, Gregory A Roth, Joshua A Salomon, Logan Sandar, Naris Silpakit, Amber Sligar, Reed J D Sorensen, Jeffrey Stanaway, Caitlyn Steiner, Stephanie Teeple, Bernadette A Thomas, Christopher Troeger, Amelia VanderZanden, Stein Emil Vollset, Valentine Wanga, Harvey A Whiteford, Timothy Wolock, Leo Zoeckler, Kalkidan Hassen Abate, Cristiana Abbafati, Kaja M Abbas, Foad Abd-Allah, Semaw Ferede Abera, Daisy M X Abreu, Laith J Abu-Raddad, Gebre Yitayih Abyu, Tom Achoki, Ademola Lukman Adelekan, Zanfina Ademi, Arsène Kouablan Adou, José C Adsuar, Kossivi Agbelenko Afanvi, Ashkan Afshin, Emilie Elisabet Agardh, Arnav Agarwal, Anurag Agrawal, Aliasghar Ahmad Kiadaliri, Oluremi N Ajala, Ali Shafqat Akanda, Rufus Olusola Akinyemi, Tomi F Akinyemiju, Nadia Akseer, Faris Hasan Al Lami, Samer Alabed, Ziyad Al-Aly, Khurshid Alam, Noore K M Alam, Deena Alasfoor, Saleh Fahed Aldhahri, Robert William Aldridge, Miguel Angel Alegretti, Alicia V Aleman, Zewdie Aderaw Alemu, Lily T Alexander, Samia Alhabib, Raghib Ali, Ala'a Alkerwi, François Alla, Peter Allebeck, Rajaa Al-Raddadi, Ubai Alsharif, Khalid A Altirkawi, Elena Alvarez Martin, Nelson Alvis-Guzman, Azmeraw T Amare, Adeladza Kofi Amegah, Emmanuel A Ameh, Heresh Amini, Walid Ammar, Stephen Marc Amrock, Hjalte H Andersen, Benjamin O Anderson, Gregory M Anderson, Carl Abelardo T Antonio, Atsede Fantahun Aregay, Johan Ärnlöv, Valentina S Arsic Arsenijevic, Al Artaman, Hamid Asayesh, Rana Jawad Asghar, Suleman Atique, Euripide Frinel G Arthur Avokpaho, Ashish Awasthi, Peter Azzopardi, Umar Bacha, Alaa Badawi, Maria C Bahit, Kalpana Balakrishnan, Amitava Banerjee, Aleksandra Barac, Suzanne L Barker-Collo, Till Bärnighausen, Lars Barregard, Lope H Barrero, Arindam Basu, Sanjay Basu, Yibeltal Tebekaw Bayou, Shahrzad Bazargan-Hejazi, Justin Beardsley, Neeraj Bedi, Ettore Beghi, Haileeyesus Adamu Belay, Brent Bell, Michelle L Bell, Aminu K Bello, Derrick A Bennett, Isabela M Bensenor, Adugnaw Berhane, Eduardo Bernabé, Balem Demtsu Betsu, Addisu Shunu Beyene, Neeraj Bhala, Ashish Bhalla, Sibhatu Biadgilign, Boris Bikbov, Aref A Bin Abdulhak, Brian J Biroscak, Stan Biryukov, Espen Bjertness, Jed D Blore, Christopher D Blosser, Megan A Bohensky, Rohan Borschmann, Dipan Bose, Rupert R A Bourne, Michael Brainin, Carol E G Brayne, Alexandra Brazinova, Nicholas J K Breitborde, Hermann Brenner, Jerry D Brewer, Alexandria Brown, Jonathan Brown, Traolach S Brugha, Geoffrey Colin Buckle, Zahid A Butt, Bianca Calabria, Ismael Ricardo Campos-Nonato, Julio Cesar Campuzano, Jonathan R Carapetis, Rosario Cárdenas, David O Carpenter, Juan Jesus Carrero, Carlos A Castañeda-Orjuela, Jacqueline Castillo Rivas, Ferrán Catalá-López, Fiorella Cavalleri, Kelly Cercy, Jorge Cerda, Wanqing Chen, Adrienne Chew, Peggy Pei-Chia Chiang, Mirriam Chibalabala, Chioma Ezinne Chibueze, Odgerel Chimed-Ochir, Vesper Hichilombwe Chisumpa, Jee-Young Jasmine Choi, Rajiv Chowdhury, Hanne Christensen, Devasahayam Jesudas Christopher, Liliana G Ciobanu, Massimo Cirillo, Aaron J Cohen, Valentina Colistro, Mercedes Colomar, Samantha M Colquhoun, Cyrus Cooper, Leslie Trumbull Cooper, Monica Cortinovis, Benjamin C Cowie, John A Crump, James Damsere-Derry, Hadi Danawi, Rakhi Dandona, Farah Daoud, Sarah C Darby, Paul I Dargan, José das Neves, Gail Davey, Adrian C Davis, Dragos V Davitoiu, E Filipa de Castro, Pieter de Jager, Diego De Leo, Louisa Degenhardt, Robert P Dellavalle, Kebede Deribe, Amare Deribew, Samath D Dharmaratne, Preet K Dhillon, Cesar Diaz-Torné, Eric L Ding, Kadine Priscila Bender dos Santos, Edem Dossou, Tim R Driscoll, Leilei Duan, Manisha Dubey, Bruce Bartholow Duncan, Richard G Ellenbogen, Christian Lycke Ellingsen, Iqbal Elyazar, Aman Yesuf Endries, Sergey Petrovich Ermakov, Babak Eshrati, Alireza Esteghamati, Kara Estep, Imad D A Faghmous, Saman Fahimi, Emerito Jose Aquino Faraon, Talha A Farid, Carla Sofia e Sa Farinha, André Faro, Maryam S Farvid, Farshad Farzadfar, Valery L Feigin, Seyed-Mohammad Fereshtehnejad, Jefferson G Fernandes, Joao C Fernandes, Florian Fischer, Joseph R A Fitchett, Abraham Flaxman, Nataliya Foigt, F Gerry R Fowkes, Elisabeth Barboza Franca, Richard C Franklin, Joseph Friedman, Joseph Frostad, Thomas Fürst, Neal D Futran, Seana L Gall, Ketevan Gambashidze, Amiran Gamkrelidze, Parthasarathi Ganguly, Fortuné Gbètoho Gankpé, Teshome Gebre, Tsegaye Tsewelde Gebrehiwot, Amanuel Tesfay Gebremedhin, Alemseged Aregay Gebru, Johanna M Geleijnse, Bradford D Gessner, Aloke Gopal Ghoshal, Katherine B Gibney, Richard F Gillum, Stuart Gilmour, Ababi Zergaw Giref, Maurice Giroud, Melkamu Dedefo Gishu, Giorgia Giussani, Elizabeth Glaser, William W Godwin, Hector Gomez-Dantes, Philimon Gona, Amador Goodridge, Sameer Vali Gopalani, Richard A Gosselin, Carolyn C Gotay, Atsushi Goto, Hebe N Gouda, Felix Greaves, Harish Chander Gugnani, Rahul Gupta, Rajeev Gupta, Vipin Gupta, Reyna A Gutiérrez, Nima Hafezi-Nejad, Demewoz Haile, Alemayehu Desalegne Hailu, Gessessew Bugssa Hailu, Yara A Halasa, Randah Ribhi Hamadeh, Samer Hamidi, Jamie Hancock, Alexis J Handal, Graeme J Hankey, Yuantao Hao, Hilda L Harb, Sivadasanpillai Harikrishnan, Josep Maria Haro, Rasmus Havmoeller, Susan R Heckbert, Ileana Beatriz Heredia-Pi, Pouria Heydarpour, Henk B M Hilderink, Hans W Hoek, Robert S Hogg, Masako Horino, Nobuyuki Horita, H Dean Hosgood, Peter J Hotez, Damian G Hoy, Mohamed Hsairi, Aung Soe Htet, Maung Maung Than Htike, Guoqing Hu, Cheng Huang, Hsiang Huang, Laetitia Huiart, Abdullatif Husseini, Inge Huybrechts, Grace Huynh, Kim Moesgaard Iburg, Kaire Innos, Manami Inoue, Veena J Iyer, Troy A Jacobs, Kathryn H Jacobsen, Nader Jahanmehr, Mihajlo B Jakovljevic, Peter James, Mehdi Javanbakht, Sudha P Jayaraman, Achala Upendra Jayatilleke, Panniyammakal Jeemon, Paul N Jensen, Vivekanand Jha, Guohong Jiang, Ying Jiang, Tariku Jibat, Aida Jimenez-Corona, Jost B Jonas, Tushar Kant Joshi, Zubair Kabir, Ritul Kamal, Haidong Kan, Surya Kant, André Karch, Corine Kakizi Karema, Chante Karimkhani, Dimitris Karletsos, Ganesan Karthikeyan, Amir Kasaeian, Marzieh Katibeh, Anil Kaul, Norito Kawakami, Jeanne Françoise Kayibanda, Peter Njenga Keiyoro, Laura Kemmer, Andrew Haddon Kemp, Andre Pascal Kengne, Andre Keren, Maia Kereselidze, Chandrasekharan Nair Kesavachandran, Yousef Saleh Khader, Ibrahim A Khalil, Abdur Rahman Khan, Ejaz Ahmad Khan, Young-Ho Khang, Sahil Khera, Tawfik Ahmed Muthafer Khoja, Christian Kieling, Daniel Kim, Yun Jin Kim, Brett M Kissela, Niranjan Kissoon, Luke D Knibbs, Ann Kristin Knudsen, Yoshihiro Kokubo, Dhaval Kolte, Jacek A Kopec, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Norun Hjertager Krog, Barthelemy Kuate Defo, Burcu Kucuk Bicer, Andreas A Kudom, Ernst J Kuipers, Veena S Kulkarni, G Anil Kumar, Gene F Kwan, Aparna Lal, Dharmesh Kumar Lal, Ratilal Lalloo, Tea Lallukka, Hilton Lam, Jennifer O Lam, Sinead M Langan, Van C Lansingh, Anders Larsson, Dennis Odai Laryea, Asma Abdul Latif, Alicia Elena Beatriz Lawrynowicz, James Leigh, Miriam Levi, Yongmei Li, M Patrice Lindsay, Steven E Lipshultz, Patrick Y Liu, Shiwei Liu, Yang Liu, Loon-Tzian Lo, Giancarlo Logroscino, Paulo A Lotufo, Robyn M Lucas, Raimundas Lunevicius, Ronan A Lyons, Stefan Ma, Vasco Manuel Pedro Machado, Mark T Mackay, Jennifer H MacLachlan, Hassan Magdy Abd El Razek, Mohammed Magdy, Abd El Razek, Marek Majdan, Azeem Majeed, Reza Malekzadeh, Wondimu Ayele Ayele Manamo, John Mandisarisa, Srikanth Mangalam, Chabila C Mapoma, Wagner Marcenes, David Joel Margolis, Gerard Robert Martin, Jose Martinez-Raga, Melvin Barrientos Marzan, Felix Masiye, Amanda J Mason-Jones, João Massano, Richard Matzopoulos, Bongani M Mayosi, Stephen Theodore McGarvey, John J McGrath, Martin McKee, Brian J McMahon, Peter A Meaney, Alem Mehari, Man Mohan Mehndiratta, Fabiola Mejia-Rodriguez, Alemayehu B Mekonnen, Yohannes Adama Melaku, Peter Memiah, Ziad A Memish, Walter Mendoza, Atte Meretoja, Tuomo J Meretoja, Francis Apolinary Mhimbira, Renata Micha, Anoushka Millear, Ted R Miller, Mojde Mirarefin, Awoke Misganaw, Charles N Mock, Karzan Abdulmuhsin Mohammad, Alireza Mohammadi, Shafiu Mohammed, Viswanathan Mohan, Glen Liddell D Mola, Lorenzo Monasta, Julio Cesar Montañez Hernandez, Pablo Montero, Marcella Montico, Thomas J Montine, Maziar Moradi-Lakeh, Lidia Morawska, Katherine Morgan, Rintaro Mori, Dariush Mozaffarian, Ulrich O Mueller, Gudlavalleti Venkata Satyanarayana Murthy, Srinivas Murthy, Kamarul Imran Musa, Jean B Nachega, Gabriele Nagel, Kovin S Naidoo, Nitish Naik, Luigi Naldi, Vinay Nangia, Denis Nash, Chakib Nejjari, Subas Neupane, Charles R Newton, John N Newton, Marie Ng, Frida Namnyak Ngalesoni, Jean de Dieu Ngirabega, Quyen Le Nguyen, Muhammad Imran Nisar, Patrick Martial Nkamedjie Pete, Marika Nomura, Ole F Norheim, Paul E Norman, Bo Norrving, Luke Nyakarahuka, Felix Akpojene Ogbo, Takayoshi Ohkubo, Foluke Adetola Ojelabi, Pedro R Olivares, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, John Nelson Opio, Eyal Oren, Alberto Ortiz, Majdi Osman, Erika Ota, Raziye Ozdemir, Mahesh PA, Amanda Pain, Jeyaraj D Pandian, Puspa Raj Pant, Christina Papachristou, Eun-Kee Park, Jae-Hyun Park, Charles D Parry, Mahboubeh Parsaeian, Angel J Paternina Caicedo, Scott B Patten, George C Patton, Vinod K Paul, Neil Pearce, João Mário Pedro, Ljiljana Pejin Stokic, David M Pereira, Norberto Perico, Konrad Pesudovs, Max Petzold, Michael Robert Phillips, Frédéric B Piel, Julian David Pillay, Dietrich Plass, James A Platts-Mills, Suzanne Polinder, C Arden Pope, Svetlana Popova, Richie G Poulton, Farshad Pourmalek, Dorairaj Prabhakaran, Mostafa Qorbani, Justice Quame-Amaglo, D Alex Quistberg, Anwar Rafay, Kazem Rahimi, Vafa Rahimi-Movaghar, Mahfuzar Rahman, Mohammad Hifz Ur Rahman, Sajjad Ur Rahman, Rajesh Kumar Rai, Zhale Rajavi, Sasa Rajsic, Murugesan Raju, Ivo Rakovac, Saleem M Rana, Chhabi L Ranabhat, Thara Rangaswamy, Puja Rao, Sowmya R Rao, Amany H Refaat, Jürgen Rehm, Marissa B Reitsma, Giuseppe Remuzzi, Serge Resnikoff, Antonio L Ribeiro, Stefano Ricci, Maria Jesus Rios Blancas, Bayard Roberts, Anna Roca, David Rojas-Rueda, Luca Ronfani, Gholamreza Roshandel, Dietrich Rothenbacher, Ambuj Roy, Nawal K Roy, George Mugambage Ruhago, Rajesh Sagar, Sukanta Saha, Ramesh Sahathevan, Muhammad Muhammad Saleh, Juan R Sanabria, Maria Dolores Sanchez-Niño, Lidia Sanchez-Riera, Itamar S Santos, Rodrigo Sarmiento-Suarez, Benn Sartorius, Maheswar Satpathy, Miloje Savic, Monika Sawhney, Michael P Schaub, Maria Inês Schmidt, Ione J C Schneider, Ben Schöttker, Aletta E Schutte, David C Schwebel, Soraya Seedat, Sadaf G Sepanlou, Edson E Servan-Mori, Katya A Shackelford, Gavin Shaddick, Amira Shaheen, Saeid Shahraz, Masood Ali Shaikh, Marina Shakh-Nazarova, Rajesh Sharma, Jun She, Sara Sheikhbahaei, Jiabin Shen, Ziyan Shen, Donald S Shepard, Kevin N Sheth, Balakrishna P Shetty, Peilin Shi, Kenji Shibuya, Min-Jeong Shin, Rahman Shiri, Ivy Shiue, Mark G Shrime, Inga Dora Sigfusdottir, Donald H Silberberg, Diego Augusto Santos Silva, Dayane Gabriele Alves Silveira, Jonathan I Silverberg, Edgar P Simard, Abhishek Singh, Gitanjali M Singh, Jasvinder A Singh, Om Prakash Singh, Prashant Kumar Singh, Virendra Singh, Samir Soneji, Kjetil Søreide, Joan B Soriano, Luciano A Sposato, Chandrashekhar T Sreeramareddy, Vasiliki Stathopoulou, Dan J Stein, Murray B Stein, Saverio Stranges, Konstantinos Stroumpoulis, Bruno F Sunguya, Patrick Sur, Soumya Swaminathan, Bryan L Sykes, Cassandra E I Szoeke, Rafael Tabarés-Seisdedos, Karen M Tabb, Ken Takahashi, Jukka S Takala, Roberto Tchio Talongwa, Nikhil Tandon, Mohammad Tavakkoli, Bineyam Taye, Hugh R Taylor, Braden J Te Ao, Bemnet Amare Tedla, Worku Mekonnen Tefera, Margreet Ten Have, Abdullah Sulieman Terkawi, Fisaha Haile Tesfay, Gizachew Assefa Tessema, Alan J Thomson, Andrew L Thorne-Lyman, Amanda G Thrift, George D Thurston, Taavi Tillmann, David L Tirschwell, Marcello Tonelli, Roman Topor-Madry, Fotis Topouzis, Jeffrey Allen Towbin, Jefferson Traebert, Bach Xuan Tran, Thomas Truelsen, Ulises Trujillo, Abera Kenay Tura, Emin Murat Tuzcu, Uche S Uchendu, Kingsley N Ukwaja, Eduardo A Undurraga, Olalekan A Uthman, Rita Van Dingenen, Aaron van Donkelaar, Tommi Vasankari, Ana Maria Nogales Vasconcelos, Narayanaswamy Venketasubramanian, Ramesh Vidavalur, Lakshmi Vijayakumar, Salvador Villalpando, Francesco S Violante, Vasiliy Victorovich Vlassov, Joseph A Wagner, Gregory R Wagner, Mitchell T Wallin, Linhong Wang, David A Watkins, Scott Weichenthal, Elisabete Weiderpass, Robert G Weintraub, Andrea Werdecker, Ronny Westerman, Richard A White, Tissa Wijeratne, James D Wilkinson, Hywel C Williams, Charles Shey Wiysonge, Solomon Meseret Woldeyohannes, Charles D A Wolfe, Sungho Won, John Q Wong, Anthony D Woolf, Denis Xavier, Qingyang Xiao, Gelin Xu, Bereket Yakob, Ayalnesh Zemene Yalew, Lijing L Yan, Yuichiro Yano, Mehdi Yaseri, Pengpeng Ye, Henock Gebremedhin Yebyo, Paul Yip, Biruck Desalegn Yirsaw, Naohiro Yonemoto, Gerald Yonga, Mustafa Z Younis, Shicheng Yu, Zoubida Zaidi, Maysaa El Sayed Zaki, Faiez Zannad, Diego E Zavala, Hajo Zeeb, Berihun M Zeleke, Hao Zhang, Sanjay Zodpey, David Zonies, Liesl Joanna Zuhlke, Theo Vos, Alan D Lopez, Christopher J L Murray
Journal: The Lancet (2016)

<h2>Summary</h2><h3>Background</h3> Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. <h3>Methods</h3> We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography–year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). <h3>Findings</h3> Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4–61·9) in 1980 to 71·8 years (71·5–72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7–17·4), to 62·6 years (56·5–70·2). Total deaths increased by 4·1% (2·6–5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8–18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6–16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9–14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1–44·6), malaria (43·1%, 34·7–51·8), neonatal preterm birth complications (29·8%, 24·8–34·9), and maternal disorders (29·1%, 19·3–37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000–183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000–532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. <h3>Interpretation</h3> At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. <h3>Funding</h3> Bill & Melinda Gates Foundation.