부산대학교 도서관

Background: Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations.
Methods: The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds.
Findings: The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles.
Interpretation: Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere.
Funding: Bill & Melinda Gates Foundation.
Competing Interests: Declaration of interests S Afzal reports support for the present manuscript from King Edward Medical University including study material, research articles, valid data sources and authentic real time information for this manuscript; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from King Edward Medical University and collaborative partners including University of Johns Hopkins, University of California, University of Massachusetts, KEMCAANA, KEMCA-UK Scientific Conferences and Webinars; support for attending meetings and/or travel from King Edward Medical University to attend meetings; participation on a Data Safety Monitoring Board or Advisory Board with National Bioethics Committee Pakistan, King Edward Medical University Ethical Review Board, as well as Ethical Review Board Fatima Jinnah Medical University and Sir Ganga Ram Hospital; leadership or fiduciary roles in board, society, committee or advocacy groups, paid or unpaid with Pakistan Association of Medical Editors, Fellow of Faculty of Public Health Royal Colleges UK (FFPH), and Society of Prevention, Advocacy And Research, King Edward Medical University (SPARK); and other support as Dean of Public Health and Preventive Medicine at King Edward Medical University, as the Chief Editor Annals of King Edward Medical University, as the Director of Quality Enhancement Cell King Edward Medical University, as an international-level Fellow of Faculty of Public Health United Kingdom, as an Advisory Board Member and Chair Scientific Session KEMCA-UK, as a Chairperson of KEMCAANA (the International Scientific Conference), as a national-level member on the Research and Publications Higher Education Commission (HEC Pakistan), as a member of the Research and Journals Committee (Pakistan) the Medical and Dental Council (Pakistan), the National Bioethics Committee (Pakistan), the Corona Experts Advisory Group (Punjab), the Chair of the Dengue Experts Advisory Group, and a member of the Punjab Residency Program Research Committee; all outside the submitted work. R Ancuceanu reports consulting fees from Abbvie; payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing or educational events from Abbvie, Sandoz, B. Braun, Laropharm, and MagnaPharm; all outside the submitted work. J Ärnlöv reports payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing or educational events from AstraZeneca and Novartis for lecture fees; participation on a Data Safety Monitoring Board or Advisory Board with AstraZeneca, Astella, Boehringer Ingelheim; all outside the submitted work. O C Baltatu reports support for the present manuscript from National Council for Scientific and Technological Development (CNPq, 304224/2022-7) and Anima Institute (AI research professor fellowship); Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as Founding Member of the Health and Biotechnology Advisory Board at Technology Park São José dos Campos–Center for Innovation in Health Technologies (CITS), outside the submitted work. T W Bärnighausen reports grants or contracts from National Institutes of Health, Alexander von Humboldt Foundation, German National Research Foundation (DFG), European Union, German Ministry of Education and Research, German Ministry of the Environment, Wellcome, and KfW, all as payments to their institution; participation on a Data Safety Monitoring Board or Advisory Board on two Scientific Advisory Boards for NIH-funded research projects in Africa on Climate Change and Health; stock or stock options in CHEERS, an SME focusing on approaches to measure climate change and health-related variables in population cohorts; all outside the submitted work. S Barteit reports grants from Carl-Zeiss Foundation and the German research foundation (DFG); stock or stock options in CHEERS, a for-profit company focusing on climate change and health evaluation and response systems; all outside the submitted work. M Beghi reports consulting fees from Lundbeck and Angelini, all outside the submitted work. Y Bejot reports consulting fees from Medtronic and Novartis; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from BMS, Pfizer, Medtronic, Amgen, NovoNordisk, and Servier; support for attending meetings and/or travel from Medtronic; leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with the French Neurovascular Society; all outside the submitted work. M Bell reports grants or contracts from US EPA, NIH, High Tide Foundation, Health Effects Institute, Yale Women Faculty Forum, Environmental Defense Fund, Yale Climate Change and Health Center, Wellcome Trust Foundation, Robert Wood Johnson Foundation, and the Hutchinson Postdoctoral Fellowship (all paid to their institution); Consulting fees from Clinique; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or education events from Colorado School of Public Health, Duke University, University of Texas, Data4Justice, Korea University, Organization of Teratology Information Specialists, University of Pennsylvania, Boston University, IOP Publishing, NIH, Health Canada, PAC-10, UKRI, AXA Research Fund Fellowship, Harvard University and the University of Montana; Support for attending meeting and/or travel from Colorado School of Public Health, University of Texas, Duke University, Boston University, University of Pennsylvania, Harvard University, American Journal of Public Health, Columbia University and Harvard University; Leadership or fiduciary role in other board, society, committee or advocacy group, unpaid with Fifth National Climate Assessment and Lancet Countdown, Johns Hopkins Advisory Board, Harvard external advisory committee for training grant, WHO Global Air Pollution and Health Technical Advisory group and the National Academies Panels and Committee; and paid with the US EPA Clean Air Scientific Advisory Committee (CASAC); outside the submitted work. L Belo reports other financial or non-financial interests with UCIBIO – FFUP through support from FCT in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of UCIBIO and the project LA/P/0140/2020 of i4HB, all outside the submitted work. R S Bernstein reports other financial or non-financial support as a full-time Medical Consultant employee of the California Department of Public Health in the Center for Heal Care Quality; outside the submitted work. P J G Bettencourt reports patents planned, issued, or pending (WO2020229805A1, BR112021022592A2, EP3965809A1, OA1202100511, US2023173050A1, EP4265271A2, and EP4275700A2); other financial or non-financial interests with the Botnar Foundation as project reviewer, outside the submitted work. S Bhaskar reports grants or contracts from the Japan Society for the Promotion of Science (JSPS), Japanese Ministry of Education, Culture, Sports, Science and Technology (MEXT) and JSPS and the Australian Academy of Science; Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid with Rotary District 9675 as the district chair, Global Health & Migration Hub Community as Chair and Manager (Berlin, Germany), PLOS One, BMC Neurology, Frontiers in Neurology, Frontiers in Stroke, Frontiers in Public Health and the BMC Medical Research Methodology as an Editorial Board Member, and as a Member of the College of Reviewers (Canadian Institutes of Health Research, Canada); outside the submitted work. 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E J Boyko reports payment or Honoria for lectures, presentations, speakers bureaus, manuscript writing or education events from the Korean Diabetes Association, Diabetes Association of the R.O.C (Taiwan), the American Diabetes Association, and the International Society for the Diabetic Foot; Support for attending meetings and/or travel from the Korean Diabetes Association; Diabetes Association of the R.O.C (Taiwan), International Society for the Diabetic Foot; outside the submitted work. M Carvalho reports other financial or non-financial interests from LAQV/REQUIMTE, University of Porto (Porto, Portugal) and acknowledges the support from FCT under the scope of the project UIDP/50006/2020; outside the submitted work. E Chung reports support for the present manuscript from the National Institute of Health NICHD T32HD007233. J Conde reports grants or contracts form the European Research Council Starting Grant ERC-StG-2019-848325 (funding 1.5M Euro), outside the submitted work. 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A Ortiz reports grants or contracts from Sanofi as payments to their institution; consulting fees, speaker fees or support for travel from, Advicciene, Astellas, Astrazeneca, Amicus, Amgen, Boehringer Ingelheim, Fresenius Medical, Care, GSK, Bayer, Sanofi-Genzyme, Menarini, Mundipharma, Kyowa Kirin, Lilly, Alexion, Freeline, Idorsia, Chiesi, Otsuka, Novo-Nordisk, Sysmex and Vifor Fresenius Medical Care Renal, Pharma and is Director of the Catedra, Mundipharma-UAM of diabetic kidney disease, and the Catedra Astrazeneca-UAM of chronic, kidney disease and electrolytes; Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with the European Renal Association; stock or stock options with Telara Farma; all outside the submitted work. 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D Prieto-Alhambra reports support for the present manuscript from European Medicines Agency and Innovative Medicines Initiative, through their institution; grants or contracts from Amgen, Chiesi-Taylor, Lilly, Janssen, Novartis, and UCB Biopharma through their institution; consulting fees from Astra Zeneca and UCB Biopharma; other financial or non-financial interest in Amgen, Astellas, Janssen, Synapse Management Partners and UCB Biopharma for supported training programmes; outside the submitted work. A Radfar reports support for the present manuscript from Avicenna Medical and Clinical Research Institute. A Rane reports stock or stock options as a full-time employee at Agios Pharmaceuticals; outside the submitted work. L F Reyes reports grants or contracts form MSD and Pfizer; consulting fees from GSK, MSD, and Pfizer; Payment or honoraria for lectures, presentations, speakers' bureaus, manuscript writing or educational events from GSK and Pfizer; payment for expert testimony from GSK and MSD; support for attending meetings and/or travel from GSK; outside the submitted work. T G Rhee reports grants or contracts from the NIH (R21AG070666; R21DA057540; R21AG078972; R01MH131528; R01AG080647); outside the submitted work. S Sacco reports grants or contracts from Novartis and Uriach; consulting fees from Novartis, Allergan-Abbvie, Teva, Lilly, Lundbeck, Pfizer, Novo Nordisk, Abbott, AstraZeneca; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Allergan-Abbvie, Teva, Lilly, Lundbeck, Pfizer, Novo Nordisk, Abbott, AstraZeneca; support for attending meetings and/or travel from Lilly, Novartis, Teva, Lundbeck; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, as the President elect of the European Stroke Organization, and the Second vice-president of the European Headache Federation; receipt of equipment, materials, drugs, medical writing, gifts or other services from Allergan-Abbvie, Novo Nordisk; all outside the submitted work. P Sachdev reports grants or contracts from national Health and Medical Research Council of Australia and the US National Institutes of Health; Payment or honoraria for lectures from Alkem Labs for the Frontiers of Psychiatry June 2023 Seminar, Mumbai, India; Participation on a Data Safety Monitoring Board or Advisory Board with Biogen Australia and Roche Australia; leadership or fiduciary role in other board, society, committee or advocacy group, unpaid, with the VASCOG Society and the World Psychiatric Association; all outside the submitted work. Y L Samodra reports grants or contracts from Taipei Medical University; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with the Benang Merah Research Center; all outside the submitted work. J Sanabria reports support for attending meetings and/or travel from the Department of Surgery, Marshall University School of Medicine; three patents pending; participation in quality assessment and assurance for surgeries of the Department of Surgery; leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid with SSAT, ASTS, AHPBA, IHPBA, and AASLD; all outside the submitted work. N Scarmeas reports grants or contracts with Novo Nordisk as the Local PI of recruiting site for multinational, multicenter industry sponsored phase III treatment trial for Alzheimer's disease with funding paid to the institution; Participation on a Data Safety Monitoring Board or Advisory Board with Albert Einstein College of Medicine (NIH funded study) as the Chair of Data Safety Monitoring Board; all outside the submitted work. A E Schutte reports Speaker Honoraria from Servier, Novartis, Sanofi, Medtronic, Abbott, Omron, Aktiia; Support for attending meetings and/or travel from Servier, Medtronic, and Abbott; Participation on a Data Safety Monitoring Board or Advisory Board with Abbott Pharmaceuticals Advisory Board, Skylabs devices Advisory Board; Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with Co-Chair: National Hypertension Taskforce of Australia, Board Member: Hypertension Australia, Company Secretary: Australian Cardiovascular Alliance; all outside the submitted work. B M Schaarschmidt reports research grants from Else Kröner-Fresenius Foundatuin, DFG, and PharmaCept; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AstraZeneca; support for attending meetings and/or travel from Bayer AG; all outside the submitted work. M Šekerija reports consulting fees from Roche; Payment or Honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Johnson and Johnson, and Astellas; outside the submitted work. A Sharifan reports leadership or fiduciary role in other board, society, committee or advocacy group, unpaid with Cochrane as a steering member of the Cochrane Early Career Professionals Network; and receipt of thirty days of complimentary access to ScienceDirect, Scopus, Reaxys, and Geofacets after reviewing manuscripts for two journals published by Elsevier; outside the submitted work. S Sharma reports support for the present manuscript from the John J. Bonica Postdoctoral Fellowship from the International Association for the Study of Pain (IASP; 2021-2023); Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events and a travel grant for delivering a talk on “Technologies for pain education in developing countries” conducted by the Pain Education SIG of the IASP at the World Pain Congress in Toronto (2022); outside the submitted work. V Sharma reports other financial or non-financial support from DFSS (MHA)'s research project (DFSS28(1)2019/EMR/6) at Institute of Forensic Science & Criminology, Panjab University, Chandigarh, India, outside the submitted work. K Shibuya reports support for the present manuscript from Tokyo Foundation for Policy Research. V Shivarov reports one patent and one utility model with the Bulgarian Patent Office; stock or stock options from ICONplc (RSUs); and other financial interests from an ICONplc salary; all outside the submitted work. S Shrestha reports other financial interests from the Graduate Research Merit Scholarship from the School of Pharmacy at Monash University Malaysia, outside the submitted work. J P Silva reports support for the present manuscript from the Portuguese Foundation for Science and Technology through payment of their salary (contract with reference 2021.01789.CEECIND/CP1662/CT0014). L M L R Silva reports grants or contracts from CENTRO-04-3559-FSE-000162, Fundo Social Europeu (FSE), outside the submitted work. C R Simpson reports grants or contracts from MBIE (NZ), HRC (NZ), Ministry of Health (NZ), MRC (UK), and CSO (UK); Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid with the New Zealand Government Data Ethics Advisory Group as the Chair; outside the submitted work. D J Stein reports consulting fees from Discovery Vitality, Johnson & Johnson, Kanna, L'Oreal, Lundbeck, Orion, Sanofi, Servier, Takeda, and Vistagen, outside the submitted work. K Stibrant Sunnerhagen reports Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid as the head of the scientific committee of the Sweidhs Stroke Foundation; outside the submitted work. S Stortecky reports grants or contracts paid to their institution from Edwards Lifesciences, Medtronic, Abbott, and Boston Scientific; consulting fees from Teleflex; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Boston Scientific/BTG; outside the submitted work. A G Thrift reports grants or contracts paid to their institution from the National Health & Medical Research Council (Australia) (grant numbers 1171966, 1182071), Heart Foundation (Aus) and the Stroke Foundation (Australia); outside the submitted work. J H V Ticoalu reports Leadership or fiduciary role in other board, society, committee or advocacy group, paid or unpaid, with Benang Merah Research Center as co-founder, outside the submitted work. M V Titova reports support for the present manuscript from the Ministry of Science and Higher Education of the Russian Federation (theme No. 122042600086-7). S J Tromans reports grants or contracts from the 2023 Adult Psychiatric Morbidity Survey team, collecting epidemiological data on community-based adults living in England. This is a contracted study from NHS Digital, via the Department of Health and Social Care; outside the submitted work. P Willeit reports consulting fees from Novartis; outside the submitted work. M Zielińska reports other financial interest as an AstraZeneca employee, outside the submitted work. A Zumla reports grants or contracts from The Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET, CANTAM-3, and EACCR-3) funded by the European and Developing Countries Clinical Trials Partnership, the EU Horizon 2020 Framework Programme, UK National Institute for Health and Care Research Senior Investigator, and Mahathir Science Award and EU-EDCTP Pascoal Mocumbi Prize Laureate; Participation on a Data Safety Monitoring Board or Advisory Board member of the WHO Mass Gatherings Expert Group and WHO Health Emergencies Programme in Geneva, a member of the EU-EDCTP3-Global Health (Brussels) Scientific Committee; all outside the submitted work.
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