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dc.contributor.authorWang, Haidongen_US
dc.contributor.authorAbajobir, Amanuel Alemuen_US
dc.contributor.authorAbate, Kalkidan Hassenen_US
dc.contributor.authorAbbafati, Cristianaen_US
dc.contributor.authorAbbas, Kaja M.en_US
dc.contributor.authorAbd-Allah, Foaden_US
dc.contributor.authorAbera, Semaw Feredeen_US
dc.contributor.authorAbraha, Haftom Niguseen_US
dc.contributor.authorAbu-Raddad, Laith J.en_US
dc.contributor.authorAbu-Rmeileh, Niveen M. E.en_US
dc.contributor.authorAdedeji, Isaac Akinkunmien_US
dc.contributor.authorAdedoyin, Rufus Adesojien_US
dc.contributor.authorAdetifa, Ifedayo Morayo O.en_US
dc.contributor.authorAdetokunboh, Olatunjien_US
dc.contributor.authorAfshin, Ashkanen_US
dc.contributor.authorAggarwal, Rakeshen_US
dc.contributor.authorAgrawal, Anuragen_US
dc.contributor.authorAgrawal, Sutapaen_US
dc.contributor.authorKiadaliri, Aliasghar Ahmaden_US
dc.contributor.authorAhmed, Muktar Beshiren_US
dc.contributor.authorAichour, Amani Nidhalen_US
dc.contributor.authorAichour, Ibthielen_US
dc.contributor.authorAichour, Miloud Taki Eddineen_US
dc.contributor.authorAiyar, Snehaen_US
dc.contributor.authorAkanda, Shafqaten_US
dc.contributor.authorAkinyemiju, Tomi F.en_US
dc.contributor.authorAkseer, Nadiaen_US
dc.contributor.authorAl-Eyadhy, Aymanen_US
dc.contributor.authorAl Lami, Faris Hasanen_US
dc.contributor.authorAlabed, Sameren_US
dc.contributor.authorAlahdab, Faresen_US
dc.contributor.authorAl-Aly, Ziyaden_US
dc.contributor.authorAlam, Khurshiden_US
dc.contributor.authorAlam, Nooreen_US
dc.contributor.authorAlasfoor, Deenaen_US
dc.contributor.authorAldridge, Robert Williamen_US
dc.contributor.authorAlene, Kefyalew Addisen_US
dc.contributor.authorAlhabib, Samiaen_US
dc.contributor.authorAli, Raghiben_US
dc.contributor.authorAlizadeh-Navaei, Rezaen_US
dc.contributor.authorAljunid, Syed M.en_US
dc.contributor.authorAlkaabi, Juma M.en_US
dc.contributor.authorAlkerwi, Ala'aen_US
dc.contributor.authorAlla, Francoisen_US
dc.contributor.authorAllam, Shalini D.en_US
dc.contributor.authorAllebeck, Peteren_US
dc.contributor.authorAl-Raddadi, Rajaaen_US
dc.contributor.authorAlsharif, Ubaien_US
dc.contributor.authorAltirkawi, Khalid A.en_US
dc.contributor.authorMartin, Elena Alvarezen_US
dc.contributor.authorAlvis-Guzman, Nelsonen_US
dc.contributor.authorAmare, Azmeraw T.en_US
dc.contributor.authorAmeh, Emmanuel A.en_US
dc.contributor.authorAmini, Erfanen_US
dc.contributor.authorAmmar, Waliden_US
dc.contributor.authorAmoako, Yaw Ampemen_US
dc.contributor.authorAnber, Nahlaen_US
dc.contributor.authorAndrei, Catalina Lilianaen_US
dc.contributor.authorAndroudi, Sofiaen_US
dc.contributor.authorAnsari, Hosseinen_US
dc.contributor.authorAnsha, Mustafa Geletoen_US
dc.contributor.authorAntonio, Carl Abelardo T.en_US
dc.contributor.authorAnwari, Palwashaen_US
dc.contributor.authorArnlöv, Johanen_US
dc.contributor.authorArora, Meghaen_US
dc.contributor.authorAl Artaman, A.en_US
dc.contributor.authorAryal, Krishna Kumaren_US
dc.contributor.authorAsayesh, Hamiden_US
dc.contributor.authorAsgedom, Solomon Weldegebrealen_US
dc.contributor.authorAsghar, Rana Jawaden_US
dc.contributor.authorAssadi, Rezaen_US
dc.contributor.authorAtey, Tesfay Meharien_US
dc.contributor.authorAtre, Sachin R.en_US
dc.contributor.authorAvila-Burgos, Leticiaen_US
dc.contributor.authorAvokpaho, Euripide Frinel G. Arthuren_US
dc.contributor.authorAwasthi, Ashishen_US
dc.contributor.authorQuintanilla, Beatriz Paulina Ayalaen_US
dc.contributor.authorBabalola, Tesleem Kayodeen_US
dc.contributor.authorBacha, Umaren_US
dc.contributor.authorBadawi, Alaaen_US
dc.contributor.authorBalakrishnan, Kalpanaen_US
dc.contributor.authorBalalla, Shivanthien_US
dc.contributor.authorBarac, Aleksandraen_US
dc.contributor.authorBarber, Ryan M.en_US
dc.contributor.authorBarboza, Miguel A.en_US
dc.contributor.authorBarker-Collo, Suzanne L.en_US
dc.contributor.authorEllingsen, Christian Lyckeen_US
dc.contributor.authorHtet, Aung Soeen_US
dc.contributor.authorKnudsen, Ann Kristinen_US
dc.contributor.authorNorheim, Ole Frithjofen_US
dc.contributor.authorVollset, Stein Emilen_US
dc.contributor.authorWeiderpass, Elisabeteen_US
dc.description.abstractBackground: 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 the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. Interpretation: Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled.en_US
dc.rightsAttribution CC BYeng
dc.titleGlobal, 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 2016en_US
dc.typePeer reviewed
dc.typeJournal article
dc.rights.holderCopyright 2017 The Author(s)
dc.source.journalThe Lancet

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