Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019
Authors: Haidong Wang, Kaja M Abbas, Mitra Abbasifard, Mohsen Abbasi-Kangevari, Hedayat Abbastabar, Foad Abd-Allah, Ahmed Abdelalim, Hassan Abolhassani, Lucas Guimarães Abreu, Michael R M Abrigo, Abdelrahman I Abushouk, Maryam Adabi, Tim Adair, Oladimeji M Adebayo, Isaac Akinkunmi Adedeji, Victor Adekanmbi, Abiodun Moshood Adeoye, Olatunji O Adetokunboh, Shailesh M Advani, Ashkan Afshin, Mohammad Aghaali, Anurag Agrawal, Keivan Ahmadi, Hamid Ahmadieh, Muktar Beshir Ahmed, Ziyad Al-Aly, Khurshid Alam, Tahiya Alam, Fahad Mashhour Alanezi, Turki M Alanzi, Jacqueline Elizabeth Alcalde-Rabanal, Muhammad Ali, Gianfranco Alicandro, Mehran Alijanzadeh, Cyrus Alinia, Vahid Alipour, Hesam Alizade, Syed Mohamed Aljunid, Peter Allebeck, Majid Abdulrahman Hamad Almadi, Amir Almasi-Hashiani, Hesham M Al-Mekhlafi, Khalid A Altirkawi, Arwa Khalid Alumran, Nelson Alvis-Guzman, Mostafa Amini-Rarani, Arya Aminorroaya, Arianna Maever L Amit, Robert Ancuceanu, Catalina Liliana Andrei, Sofia Androudi, Colin Angus, Mina Anjomshoa, Fereshteh Ansari, Iman Ansari, Alireza Ansari-Moghaddam, Carl Abelardo T Antonio, Catherine M Antony, Davood Anvari, Seth Christopher Yaw Appiah, Jalal Arabloo, Morteza Arab-Zozani, Aleksandr Y Aravkin, Olatunde Aremu, Johan Ärnlöv, Krishna K Aryal, Ali A Asadi-Pooya, Samaneh Asgari, Mohammad Asghari Jafarabadi, Madhu Sudhan Atteraya, Marcel Ausloos, Leticia Avila-Burgos, Euripide Frinel Gbenato Arthur Avokpaho, Beatriz Paulina Ayala Quintanilla, Getinet Ayano, Martin Amogre Ayanore, Ghasem Azarian, Ebrahim Babaee, Ashish D Badiye, Eleni Bagli, Mohammad Amin Bahrami, Ahad Bakhtiari, Shelly Balassyano, Maciej Banach, Palash Chandra Banik, Suzanne Lyn Barker-Collo, Till Winfried Bärnighausen, Akbar Barzegar, Sanjay Basu, Bernhard T Baune, Mohsen Bayati, Gholamreza Bazmandegan, Neeraj Bedi, Michellr L Bell, Derrick A Bennett, Isabela M Bensenor, Kidanemaryam Berhe, Adam E Berman, Gregory J Bertolacci, Reshmi Bhageerathy, Neeraj Bhala, Krittika Bhattacharyya, Zulfiqar A Bhutta, Ali Bijani, Antonio Biondi, Donal Bisanzio, Catherine Bisignano, Raaj Kishore Biswas, Tone Bjørge, Somayeh Bohlouli, Mehdi Bohluli, Srinivasa Rao Rao Bolla, Antonio Maria Borzì, Shiva Borzouei, Oliver J Brady, Dejana Braithwaite, Michael Brauer, Andrey Nikolaevich Briko, Nikolay Ivanovich Briko, Blair R Bumgarner, Sharath Burugina Nagaraja, Zahid A Butt, Florentino Luciano Caetano dos Santos, Tianji Cai, Charlton SKH Callender, Luis LA Alberto Cámera, Ismael R Campos-Nonato, Rosario Cárdenas, Giulia Carreras, Juan J Carrero, Felix Carvalho, Joao Mauricio Castaldelli-Maia, Giulio Castelpietra, Franz Castro, Ferrán Catalá-López, Christopher R Cederroth, Ester Cerin, Vijay Kumar Chattu, Ken Lee Chin, Dinh-Toi Chu, Liliana G Ciobanu, Massimo Cirillo, Haley Comfort, Vera Marisa Costa, Richard G Cowden, Elizabeth A Cromwell, Andrew J Croneberger, Matthew Cunningham, Saad M A Dahlawi, Giovanni Damiani, Emanuele D'Amico, Lalit Dandona, Rakhi Dandona, Paul I Dargan, Aso Mohammad Darwesh, Ahmad Daryani, Rajat Das Gupta, José das Neves, Kairat Davletov, Diego De Leo, Edgar Denova-Gutiérrez, Kebede Deribe, Nikolaos Dervenis, Rupak Desai, Govinda Prasad Dhungana, Diana Dias da Silva, Daniel Diaz, Ilse N Dippenaar, Shirin Djalalinia, Hoa Thi Do, Klara Dokova, David Teye Doku, Fariba Dorostkar, Chirag P Doshi, Leila Doshmangir, Kerrie E Doyle, Eleonora Dubljanin, Andre Rodrigues Duraes, David Edvardsson, Andem Effiong, Iman El Sayed, Maha El Tantawi, Iffat Elbarazi, Shaimaa I El-Jaafary, Mohammad Hassan Emamian, Sharareh Eskandarieh, Firooz Esmaeilzadeh, Kara Estep, Mohammad Farahmand, Anwar Faraj, Mohammad Fareed, Roghiyeh Faridnia, Andre Faro, Farshad Farzadfar, Nazir Fattahi, Ali Akbar Fazaeli, Mehdi Fazlzadeh, Valery L Feigin, Seyed-Mohammad Fereshtehnejad, Eduarda Fernandes, Manuela L Ferreira, Irina Filip, Florian Fischer, Carsten Flohr, Nataliya A Foigt, Morenike Oluwatoyin Folayan, Artem Alekseevich Fomenkov, Marisa Freitas, Takeshi Fukumoto, John E Fuller, João M Furtado, Mohamed M Gad, Emmanuela Gakidou, Silvano Gallus, Abiyu Mekonnen Gebrehiwot, Ketema Bizuwork Gebremedhin, Peter W Gething, Farhad Ghamari, Ahmad Ghashghaee, Asadollah Gholamian, Syed Amir Gilani, Mojgan Gitimoghaddam, Ekaterina Vladimirovna Glushkova, Elena V Gnedovskaya, Sameer Vali Gopalani, Alessandra C Goulart, Harish Chander Gugnani, Yuming Guo, Rajeev Gupta, Subodh Sharan Gupta, Juanita A Haagsma, Arvin Haj-Mirzaian, Arya Haj-Mirzaian, Iman Halvaei, Randah R Hamadeh, Kanaan Hamagharib Abdullah, Chieh Han, Demelash Woldeyohannes Handiso, Graeme J Hankey, Hamidreza Haririan, Josep Maria Haro, Ahmed I Hasaballah, Soheil Hassanipour, Hadi Hassankhani, Simon I Hay, Behzad Heibati, Reza Heidari-Soureshjani, Kiana Henny, Nathaniel J Henry, Claudiu Herteliu, Fatemeh Heydarpour, Michael K Hole, Praveen Hoogar, H Dean Hosgood, Naznin Hossain, Mehdi Hosseinzadeh, Mihaela Hostiuc, Sorin Hostiuc, Mowafa Househ, Damian G Hoy, Guoqing Hu, Tanvir M Huda, Segun Emmanuel Ibitoye, Kevin S Ikuta, Olayinka Stephen Ilesanmi, Irena M Ilic, Milena D Ilic, Mohammad Hasan Imani-Nasab, MdMohaimenul Islam, Hiroyasu Iso, Chinwe Juliana Iwu, Jalil Jaafari, Kathryn H Jacobsen, Deepa Jahagirdar, Nader Jahanmehr, Amir Jalali, Farzad Jalilian, Spencer L James, Hosna Janjani, Ensiyeh Jenabi, Ravi Prakash Jha, Vivekanand Jha, John S Ji, Jost B Jonas, Farahnaz Joukar, Jacek Jerzy Jozwiak, Mikk Jürisson, Zubair Kabir, Hamed Kalani, Leila R Kalankesh, Zahra Kamiab, Tanuj Kanchan, Neeti Kapoor, André Karch, Salah Eddin Karimi, Seyed Asaad Karimi, Nicholas J Kassebaum, Srinivasa Vittal Katikireddi, Norito Kawakami, Gbenga A Kayode, Peter Njenga Keiyoro, Cathleen Keller, Yousef Saleh Khader, Nauman Khalid, Ejaz Ahmad Khan, Maseer Khan, Young-Ho Khang, Amir M Khater, Mona M Khater, Salman Khazaei, Habibolah Khazaie, Mohammad Taghi Khodayari, Jagdish Khubchandani, Neda Kianipour, Cho-il Kim, Young-Eun Kim, Yun Jin Kim, Yohannes Kinfu, Adnan Kisa, Sezer Kisa, Katarzyna Kissimova-Skarbek, Mika Kivimäki, Hamidreza Komaki, Jacek A Kopec, Soewarta Kosen, Parvaiz A Koul, Ai Koyanagi, Michael A Kravchenko, Kewal Krishan, Kris J Krohn, Barthelemy Kuate Defo, G Anil Kumar, Manasi Kumar, Pushpendra Kumar, Vivek Kumar, Dian Kusuma, Hmwe Hmwe Kyu, Carlo La Vecchia, Ben Lacey, Dharmesh Kumar Lal, Ratilal Lalloo, Faris Hasan Lami, Sonia Lansky, Samantha Leigh Larson, Anders O Larsson, Savita Lasrado, Zohra S Lassi, Jeffrey V Lazarus, Paul H Lee, Shaun Wen Huey Lee, Andrew T Leever, Kate E LeGrand, Matilde Leonardi, Shanshan Li, Lee-Ling Lim, Stephen S Lim, Shai Linn, Rakesh Lodha, Giancarlo Logroscino, Alan D Lopez, Platon D Lopukhov, Paulo A Lotufo, Rafael Lozano, Alton Lu, Raimundas Lunevicius, Mohammed Madadin, Emilie R Maddison, Hassan Magdy Abd El Razek, Muhammed Magdy Abd El Razek, Phetole Walter Mahasha, Mokhtar Mahdavi Mahdavi, Reza Malekzadeh, Abdullah A Mamun, Navid Manafi, Fariborz Mansour-Ghanaei, Borhan Mansouri, Mohammad Ali Mansournia, Chabila Christopher Mapoma, Santi Martini, Francisco Rogerlândio Martins-Melo, Anthony Masaka, Claudia I Mastrogiacomo, Manu Raj Mathur, Erin A May, Colm McAlinden, John J McGrath, Martin McKee, Man Mohan Mehndiratta, Fereshteh Mehri, Kala M Mehta, Wahengbam Bigyananda Meitei, Peter T N Memiah, Walter Mendoza, Ritesh G Menezes, Endalkachew Worku Mengesha, George A Mensah, Atte Meretoja, Tuomo J Meretoja, Tomislav Mestrovic, Irmina Maria Michalek, Kebadnew Mulatu Mihretie, Ted R Miller, Edward J Mills, George J Milne, Erkin M Mirrakhimov, Hamed Mirzaei, Maryam Mirzaei, Mehdi Mirzaei-Alavijeh, Awoke Temesgen Misganaw, Babak Moazen, Masoud Moghadaszadeh, Efat Mohamadi, Dara K Mohammad, Yousef Mohammad, Naser Mohammad Gholi Mezerji, Abolfazl Mohammadbeigi, Abdollah Mohammadian-Hafshejani, Reza Mohammadpourhodki, Hussen Mohammed, Shafiu Mohammed, Farnam Mohebi, Mohammad A Mohseni Bandpei, Amin Mokari, Ali H Mokdad, Natalie C Momen, Lorenzo Monasta, Meghan D Mooney, Ghobad Moradi, Masoud Moradi, Mohammad Moradi-Joo, Maziar Moradi-Lakeh, Rahmatollah Moradzadeh, Paula Moraga, Ilais Moreno Velásquez, Joana Morgado-da-Costa, Shane Douglas Morrison, Jonathan F Mosser, Simin Mouodi, Seyyed Meysam Mousavi, Amin Mousavi Khaneghah, Ulrich Otto Mueller, Kamarul Imran Musa, Saravanan Muthupandian, Behnam Nabavizadeh, Mehdi Naderi, Ahamarshan Jayaraman Nagarajan, Mohsen Naghavi, Behshad Naghshtabrizi, Gurudatta Naik, Farid Najafi, Vinay Nangia, Jobert Richie Nansseu, Duduzile Edith Ndwandwe, Ionut Negoi, Ruxandra Irina Negoi, Josephine W Ngunjiri, Huong Lan Thi Nguyen, Trang Huyen Nguyen, Yeshambel T Nigatu, Rajan Nikbakhsh, Amin Reza Nikpoor, Molly R Nixon, Chukwudi A Nnaji, Shuhei Nomura, Jean Jacques Noubiap, Soraya Nouraei Motlagh, Christoph Nowak, Adrian Oţoiu, Christopher M Odell, In-Hwan Oh, Morteza Oladnabi, Andrew T Olagunju, Bolajoko Olubukunola Olusanya, Jacob Olusegun Olusanya, Ahmed Omar Bali, Kanyin L Ong, Obinna E Onwujekwe, Alberto Ortiz, Nikita Otstavnov, Stanislav S Otstavnov, Simon Øverland, Mayowa O Owolabi, Mahesh P A, Jagadish Rao Padubidri, Keyvan Pakshir, Raffaele Palladino, Adrian Pana, Songhomitra Panda-Jonas, James Park, Deepak Kumar Pasupula, Jenil R Patel, Sangram Kishor Patel, George C Patton, Katherine R Paulson, Hamidreza Pazoki Toroudi, Spencer A Pease, Amy E Peden, Veincent Christian Filipino Pepito, Emmanuel K Peprah, Alexandre Pereira, David M Pereira, Norberto Perico, David M Pigott, Thomas Pilgrim, Tessa M Pilz, Michael A Piradov, Meghdad Pirsaheb, Khem Narayan Pokhrel, Maarten J Postma, Hadi Pourjafar, Farshad Pourmalek, Akram Pourshams, Anna Poznańska, Sergio I Prada, Sanjay Prakash, Liliana Preotescu, Zahiruddin Quazi Syed, Mohammad Rabiee, Navid Rabiee, Amir Radfar, Alireza Rafiei, Alberto Raggi, Muhammad Aziz Rahman, Ali Rajabpour-Sanati, Pradhum Ram, Chhabi Lal Ranabhat, Sowmya J Rao, Davide Rasella, Vahid Rashedi, Prateek Rastogi, Priya Rathi, Lal Rawal, Giuseppe Remuzzi, Vishnu Renjith, Andre M N Renzaho, Serge Resnikoff, Nima Rezaei, Mohammad sadegh Rezai, Aziz Rezapour, Jennifer Rickard, Leonardo Roever, Luca Ronfani, Gholamreza Roshandel, Morteza Rostamian, Enrico Rubagotti, Godfrey M Rwegerera, Siamak Sabour, Basema Saddik, Ehsan Sadeghi, Masoumeh Sadeghi, Sahar Saeedi Moghaddam, Yahya Safari, Sare Safi, Saeid Safiri, Rajesh Sagar, Amirhossein Sahebkar, Mohammad Ali Sahraian, S Mohammad Sajadi, Mohammad Reza Salahshoor, Joseph S Salama, Payman Salamati, Marwa R Rashad Salem, Yahya Salimi, Joshua A Salomon, Inbal Salz, Zainab Samad, Abdallah M Samy, Juan Sanabria, Milena M Santric-Milicevic, Sivan Yegnanarayana Iyer Saraswathy, Benn Sartorius, Arash Sarveazad, Brijesh Sathian, Thirunavukkarasu Sathish, Davide Sattin, Mete Saylan, Lauren E Schaeffer, Silvia Schiavolin, David C Schwebel, Falk Schwendicke, Mario Sekerija, Anbissa Muleta Senbeta, Subramanian Senthilkumaran, Sadaf G Sepanlou, Edson Serván-Mori, Mahsima Shabani, Saeed Shahabi, Mohammad Shahbaz, Amira A Shaheen, Masood Ali Shaikh, Ali S Shalash, Mehran Shams-Beyranvand, MohammadBagher Shamsi, Morteza Shamsizadeh, Mohammed Shannawaz, Kiomars Sharafi, Zeinab Sharafi, Fablina Sharara, Rajesh Sharma, David H Shaw, Aziz Sheikh, Jae Il Shin, Rahman Shiri, Mark G Shrime, Kerem Shuval, Soraya Siabani, Inga Dora Sigfusdottir, Rannveig Sigurvinsdottir, Diego Augusto Santos Silva, Biagio Simonetti, Kyle E Simpson, Jasvinder A Singh, Eirini Skiadaresi, Valentin Yurievich Skryabin, Amin Soheili, Anton Sokhan, Reed J D Sorensen, Joan B Soriano, Muluken Bekele Sorrie, Ireneous N Soyiri, Emma Elizabeth Spurlock, Chandrashekhar T Sreeramareddy, Leo Stockfelt, Mark A Stokes, Jacob L Stubbs, Agus Sudaryanto, Mu'awiyyah Babale Sufiyan, Rizwan Suliankatchi Abdulkader, Bryan L Sykes, Rafael Tabarés-Seisdedos, Karen M Tabb, Santosh Kumar Tadakamadla, Amir Taherkhani, Muming Tang, Nuno Taveira, Heather Jean Taylor, Whitney L Teagle, Arash Tehrani-Banihashemi, Berhane Fseha Teklehaimanot, Zemenu Tadesse Tessema, Kavumpurathu Raman Thankappan, Nihal Thomas, Amanda G Thrift, Mariya Vladimirovna Titova, Hamid Reza Tohidinik, Marcello Tonelli, Roman Topor-Madry, Fotis Topouzis, Marcos Roberto Roberto Tovani-Palone, Eugenio Traini, Bach Xuan Tran, Ravensara Travillian, Sergi Trias-Llimós, Thomas Clement Truelsen, Lorainne Tudor Car, Bhaskaran Unnikrishnan, Era Upadhyay, Marco Vacante, Alireza Vakilian, Pascual R Valdez, Alessandro Valli, Constantine Vardavas, Tommi Juhani Vasankari, Ana Maria Nogales Vasconcelos, Yasser Vasseghian, Yousef Veisani, Narayanaswamy Venketasubramanian, Simone Vidale, Francesco S Violante, Vasily Vlassov, Stein Emil Vollset, Theo Vos, Isidora S Vujcic, Ana Vukovic, Rade Vukovic, Yasir Waheed, Mitchell Taylor Wallin, Magdalene K Walters, Hongbo Wang, Yuan-Pang Wang, Stefanie Watson, Jingkai Wei, Jordan Weiss, Girmay Teklay Weldesamuel, Andrea Werdecker, Ronny Westerman, Harvey A Whiteford, Taweewat Wiangkham, Kirsten E Wiens, Tissa Wijeratne, Charles Shey Wiysonge, Bogdan Wojtyniak, Charles D A Wolfe, Adam Belay Wondmieneh, Eve E Wool, Ai-Min Wu, Junjie Wu, Gelin Xu, Tomohide Yamada, Kazumasa Yamagishi, Yuichiro Yano, Sanni Yaya, Vahid Yazdi-Feyzabadi, Jamal A Yearwood, Tomas Y Yeheyis, Christopher Sabo Yilgwan, Paul Yip, Naohiro Yonemoto, Seok-Jun Yoon, Javad Yoosefi Lebni, Hunter W York, Mustafa Z Younis, Theodore Patrick Younker, Zabihollah Yousefi, Taraneh Yousefinezhadi, Abdilahi Yousuf Yousuf, Hasan Yusefzadeh, Telma Zahirian Moghadam, Josefina Zakzuk, Sojib Bin Zaman, Mohammad Zamani, Maryam Zamanian, Hamed Zandian, Zhi-Jiang Zhang, Peng Zheng, Maigeng Zhou, Arash Ziapour, Christopher J L Murray
Journal: The Lancet (2020)

<h2>Summary</h2><h3>Background</h3> Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. <h3>Methods</h3> 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. <h3>Findings</h3> The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. <h3>Interpretation</h3> Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. <h3>Funding</h3> Bill & Melinda Gates Foundation.