Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021

Глобальные оценки смертности, ожидаемой продолжительности жизни и численности населения по возрасту и полу для 204 стран и территорий и 811 субнациональных территорий за 1950–2021 годы, а также влияние пандемии COVID-19: комплексный демографический анализ для исследования глобального бремени болезней, травм и факторов риска, 2021 год
Dimitrios Patoulias, Christopher R. Cederroth, Norberto Perico, Giuseppe Remuzzi, William C. Cho, Mohammad Tabish, Christopher J L Murray, Aleksandr Y. Aravkin, Peng Zheng, Cristiana Abbafati, Mohammad Abdollahı, Hassan Abolhassani, Lucas Guimarães Abreu, Michael R.M. Abrigo, Victor Adekanmbi, Tauseef Ahmad, Keivan Ahmadi, Muktar Beshir Ahmed, Ziyad Al‐Aly, Khurshid Alam, Fahad Alanezi, Turki M Alanzi, Khalid F. AlHabib, Gianfranco Alicandro, Syed Mohamed Aljunid, Hesham M. Al‐Mekhlafi, Khalid A Altirkawi, Dickson A Amugsi, Robert Ancuceanu, Deanna Anderlini, Cătălina Liliana Andrei, Tudorel Andrei, Catherine M Antony, Ernoiz Antriyandarti, Seth Christopher Yaw Appiah, Jalal Arabloo, Morteza Arab‐Zozani, Maha Atout, Beatriz Paulina Ayala Quintanilla, Martin Amogre Ayanore, Alaa Badawi, Ashish Badiye, Shankar M Bakkannavar, Maciej Banach, Suzanne Barker‐Collo, Lope H. Barrero, Bernhard T. Baune, Mohsen Bayati, Neeraj Bedi, Isabela M. Benseñor, Adam E. 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Le, Munjae Lee, Chun‐Han Lo, Kashish Malhotra, Andrea Maugeri, Rishi P Mediratta, Hassam Ali, Xin Deng, Maryam Moradi, Mohammad Amin Khadembashiri, Azzam A. Maghazachi, Gerald Chi, Hanqing Zhao, Sana Ullah, Fariba Ghassemi, Pramod Kumar Pal, Mpiko Ntsekhe, Arman Shafiee, Shohreh Alian Samakkhah, Mark Janko, Quique Bassat, Vijay Kumar Prajapati, Robert Adamu Shey, Ashish Bhalla, Berrak Bora Başara, Saman Fahimi, Chakib Nejjari, John Nelson Opio, Payman Salamati, Apostolos Beloukas, Rizwan Qaisar, Asima Karim, Kanaan Hamagharib Abdullah, Kavumpurathu Raman Thankappan, Pugazhenthan Thangaraju, Malihe Rezaee, Rizwan Kalani, Adel Al‐Gheethi, Mohammad Hadi Nematollahi, Gulrez Shah Azhar, Josefina Zakzuk, Sultan Ayoub Meo, Antonella Agodi, Martina Barchitta, Harapan Harapan, Malke Asaad, Luis Alberto Cámera, Shankargouda Patil, Paulo J. G. Bettencourt, Max L. Mehlman, Madineh Abbasi, Auwal Abdullahi, Roberto Ariel Abeldaño Zúñiga, Richard Gyan Aboagye, Salahdein Aburuz, Wirawan Adikusuma, Saryia Adra, Ali Afraz, Saira Afzal, Shahin Aghamiri, Williams Agyemang‐Duah, Amir Mahmoud Ahmadzade, Luai A. Ahmed, Syed Anees Ahmed, Marjan Ajami, Olufemi Ajumobi, Karolina Akinosoglou, Syed Mahfuz Al Hasan, Tareq Mohammed Ali AL-Ahdal, Mohammad T AlBataineh, Sharifullah Alemi, Abid Ali, Rafat Ali, Zahid Ali, Ahmednur Adem Aliyi, Cong Wang, Amirali Aali, Samar Abd ElHafeez, Victor Abiola Adepoju, Shadi Afyouni, Firdos Ahmad, Samer O Alalalmeh, Mohammed Usman Ali, Sabah Al-Marwani, Joseph Uy Almazan, Hassan Alwafi, Tarek Tawfik Amin, Pedro Prata Andrade, Sumadi Lukman Anwar, Mosab Arafat, Benedetta Armocida, Mahwish Arooj, Raphael Taiwo Aruleba, Mubarek Yesse Ashemo, Muhammad Ashraf, Juan Acuña, Oyelola A. Adegboye, Beriwan Abdulqadir Ali, Sameh Attia, Muhammad Badar, Hiba Jawdat Barqawi, Tim Adair, Pramila Rai, Chinmoy Sarkar, Yimeng Song, Ravi Rohilla, Τaxiarchis Κonstantinos Νikolouzakis, Dharmesh Kumar Lal, Jeanne Françoise Kayibanda, Rouzbeh Abbasgholizadeh, Meriem Abdoun, Mesfin Abebe, Armita Abedi, Mohamed Abouzid, Bashir Aden, Temitayo Esther Adeyeoluwa, Rishan Adha, Amin Adibi, Essona Matatom Akara, Sreelatha Akkala, Dariush Abtahi, Olorunsola Adeyomoye, Mohammad Al Qadire, Yashendra Sethi, Aleš Tichopád, Haitham Jahrami, Sandeep Maharaj, Elena A. Varavikova, Stefano Guicciardi, Colin R Simpson, Demetris Lamnisos, Adewale Oluwaseun Fadaka, Omar Kujan, Esam Halboub, Thanigaivelan Kanagasabai, Sachin C. Sarode, Gargi S. 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Mahjoub, Elaheh Malakan Rad, Yosef Manla, Parham Mardi, Abdoljalal Marjani, Entezar Mehrabi Nasab, Fateme Montazeri, Negar Morovatdar, Shayan Rahmani, Sina Rashedi, Aly M A Saad, Saeid Sadeghian, Sarvenaz Salahi, Mohd Shanawaz, Seyed‐Amir Tabatabaeizadeh, Yasaman Taheri Abkenar, Moslem Taheri Soodejani, Arzu Yiğit, Vahit Yiğit, Burhan Abdullah Zaman, Nasser Bagheri, Sulaiman Bah, Ruhai Bai, Saurav Basu, Bagas Suryo Bintoro, Saeid Bitaraf, Virgínia Bodolica, Alyssa Columbus, Saswati Das, Nihar Ranjan Dash, Mohsen Dashti, Hardik Dineshbhai Desai, Arkadiusz Dziedzic, Hisham Atan Edinur, Omar El Meligy, MoezAlIslam E. Faris, Santosh Gaihre, Rupesh K. Gautam, Fariba Ghassemi, Md. Abdul Hannan, Yuta Hiraike, Sahadat Hossain, Hassan Hosseinzadeh, Md. 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Wojewodzic, Dongze Wu, Sajad Yaghoubi, Gesila Endashaw Yesera, Renjulal Yesodharan, Subah Abderehim Yesuf, Siddhesh Zadey, Vesna Zadnik, Nima Zafari, Mohammad Javad Zahedi, Muhammad Zahid, Fathiah Zakham, Giulia Zamagni, Milad Zandi, Ghazal G Z Zandieh, Aurora Zanghì, Mohammed G M Zeariya, Youjie Zeng, Chunxia Zhai, Chen Zhang, Haijun Zhang, Hong-Wei Zhang, Zhaofeng Zhang, Yang Zhao, Bin Zhu, Pardis Ziaeefar, Elric Zweck, Seyed Mohammad Tavangar, Zemene Demelash Kifle, Nafise Noroozi, Ibrahim A Khalil, Stein Emil Vollset, Stefanie Watson, Ahamarshan Jayaraman Nagarajan, David H Shaw, Ame Mehadi Abdurehman, Woldu Aberhe Abrha, Sajad Yaghoubi, Behzad Karami Matin, Rahul Kumar, Sathish Kumar Jayapal, Soleiman Mahjoub, Abrha Hailay Weldemariam, Demisu Zenbaba Heyi, Ganesh Kumar Saya, Pritish Baskaran, Derek S Chew, Vinoth Gnana Chellaiyan Devanbu, Pooria Fazeli, Mesay Dechasa Gudeta, Olatunji Johnson, Hakimeh Mostafavi, Jorge Piano Simões, Muhammad Nauman Zahid, Carlos Alberto Cardenas
2024-03-11
SCID:  54.1/7yfa6w4e Discuss with AI
COVID-19 excess mortalityGlobal Burden of Disease Study 2021age-sex-specific mortalitylife expectancyspatiotemporal Gaussian process regression
Abstract (AI)
BACKGROUND: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING: Bill & Melinda Gates Foundation.
Key Findings
1
Adult mortality estimates used 31,642 location-years of registration data, 355 surveys and censuses, and 24 other sources.
2
GBD 2021 provides demographic estimates for mortality, life expectancy, and population across 204 countries, 811 subnational locations, and 1950–2021.
3
Spatiotemporal Gaussian process regression estimated under-5 mortality using 30,763 location-years of registration data, 1,365 surveys and censuses, and 80 other sources.
4
The analysis integrates 22,223 mortality data sources and 2,026 population data sources, supplemented by migration, HIV, conflict, famine, disaster, and pandemic information.
5
The study specifically quantifies changes in mortality and life expectancy during the 2020–2021 COVID-19 pandemic within long-term demographic trends.
Research Object

Global population in 204 countries and territories and 811 subnational locations from 1950 to 2021

Research Subject

Age- and sex-specific mortality, life expectancy, population size and structure, and the impact of the COVID-19 pandemic on these demographic metrics

Publication Details
Publication Date
2024-03-11
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Authors
Dimitrios Patoulias
Christopher R. Cederroth
Norberto Perico
Giuseppe Remuzzi
William C. Cho
Mohammad Tabish
Christopher J L Murray
Aleksandr Y. Aravkin
Peng Zheng
Cristiana Abbafati
Mohammad Abdollahı
Hassan Abolhassani
Lucas Guimarães Abreu
Michael R.M. Abrigo
Victor Adekanmbi
Tauseef Ahmad
Keivan Ahmadi
Muktar Beshir Ahmed
Ziyad Al‐Aly
Khurshid Alam
Fahad Alanezi
Turki M Alanzi
Khalid F. AlHabib
Gianfranco Alicandro
Syed Mohamed Aljunid
Hesham M. Al‐Mekhlafi
Khalid A Altirkawi
Dickson A Amugsi
Robert Ancuceanu
Deanna Anderlini
Cătălina Liliana Andrei
Tudorel Andrei
Catherine M Antony
Ernoiz Antriyandarti
Seth Christopher Yaw Appiah
Jalal Arabloo
Morteza Arab‐Zozani
Maha Atout
Beatriz Paulina Ayala Quintanilla
Martin Amogre Ayanore
Alaa Badawi
Ashish Badiye
Shankar M Bakkannavar
Maciej Banach
Suzanne Barker‐Collo
Lope H. Barrero
Bernhard T. Baune
Mohsen Bayati
Neeraj Bedi
Isabela M. Benseñor
Adam E. Berman
Akshaya Srikanth Bhagavathula
Bhageerathy Reshmi
Neeraj Bhala
Dinesh Bhandari
Zulfiqar A Bhutta
Boris Bikbov
Antonio Biondi
Catherine Bisignano
Raaj Kishore Biswas
Dejana Braithwaite
Hermann Brenner
Gabrielle B. Britton
Katrin Burkart
Sharath Burugina Nagaraja
Zahid A Butt
Florentino Luciano Caetano dos Santos
Ismael Campos‐Nonato
Rosario Cárdenas
Giulia Carreras
Juan Jesús Carrero
Félix Carvalho
João Maurício Castaldelli-Maia
Carlos A Castañeda-Orjuela
Giulio Castelpietra
Kelly Cercy
Ester Cerin
Vijay Kumar Chattu
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Fanny Emily Petermann-Rocha
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Rizwan Qaisar
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Pugazhenthan Thangaraju
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Mohammad Hadi Nematollahi
Gulrez Shah Azhar
Josefina Zakzuk
Sultan Ayoub Meo
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Harapan Harapan
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Shankargouda Patil
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Max L. Mehlman
Madineh Abbasi
Auwal Abdullahi
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Richard Gyan Aboagye
Salahdein Aburuz
Wirawan Adikusuma
Saryia Adra
Ali Afraz
Saira Afzal
Shahin Aghamiri
Williams Agyemang‐Duah
Amir Mahmoud Ahmadzade
Luai A. Ahmed
Syed Anees Ahmed
Marjan Ajami
Olufemi Ajumobi
Karolina Akinosoglou
Syed Mahfuz Al Hasan
Tareq Mohammed Ali AL-Ahdal
Mohammad T AlBataineh
Sharifullah Alemi
Abid Ali
Rafat Ali
Zahid Ali
Ahmednur Adem Aliyi
Cong Wang
Amirali Aali
Samar Abd ElHafeez
Victor Abiola Adepoju
Shadi Afyouni
Firdos Ahmad
Samer O Alalalmeh
Mohammed Usman Ali
Sabah Al-Marwani
Joseph Uy Almazan
Hassan Alwafi
Tarek Tawfik Amin
Pedro Prata Andrade
Sumadi Lukman Anwar
Mosab Arafat
Benedetta Armocida
Mahwish Arooj
Raphael Taiwo Aruleba
Mubarek Yesse Ashemo
Muhammad Ashraf
Juan Acuña
Oyelola A. Adegboye
Beriwan Abdulqadir Ali
Sameh Attia
Muhammad Badar
Hiba Jawdat Barqawi
Tim Adair
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Chinmoy Sarkar
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Ravi Rohilla
Τaxiarchis Κonstantinos Νikolouzakis
Dharmesh Kumar Lal
Jeanne Françoise Kayibanda
Rouzbeh Abbasgholizadeh
Meriem Abdoun
Mesfin Abebe
Armita Abedi
Mohamed Abouzid
Bashir Aden
Temitayo Esther Adeyeoluwa
Rishan Adha
Amin Adibi
Essona Matatom Akara
Sreelatha Akkala
Dariush Abtahi
Olorunsola Adeyomoye
Mohammad Al Qadire
Yashendra Sethi
Aleš Tichopád
Haitham Jahrami
Sandeep Maharaj
Elena A. Varavikova
Stefano Guicciardi
Colin R Simpson
Demetris Lamnisos
Adewale Oluwaseun Fadaka
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Thanigaivelan Kanagasabai
Sachin C. Sarode
Gargi S. Sarode
Bryan Chong
Tuan Thanh Nguyen
Ahmed Yaseen Alqutaibi
Luı́s Belo
Mazyar Zahir
Sofiane Boudalia
Izza Shahid
Mahalaxmi Iyer
Gláucia Maria Moraes de Oliveira
Amir Hossein Goudarzian
Maha Saber-Ayad
Fang Wang
Zhiyong Zou
Vinoth Gnana Chellaiyan
Narjes Saheb Sharif‐Askari
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Desalegn Shiferaw
Tianji Cai
Haley Comfort
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Erin A May
Amin Reza Nikpoor
Spencer A Pease
Morteza Rostamian
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Stefan Listl
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Nuwan Darshana Wickramasinghe
Nelson Zamora
Mihaela Hostiuc
Sokking Ong
Kate Francis
Mahsa Heidari‐Foroozan
Luciana Aparecida Campos
Hossein Farrokhpour
Yaseen Galali
Parham Habibzadeh
Elham Jamshidi
Neda Kaydi
S. Mahjoub
Elaheh Malakan Rad
Yosef Manla
Parham Mardi
Abdoljalal Marjani
Entezar Mehrabi Nasab
Fateme Montazeri
Negar Morovatdar
Shayan Rahmani
Sina Rashedi
Aly M A Saad
Saeid Sadeghian
Sarvenaz Salahi
Mohd Shanawaz
Seyed‐Amir Tabatabaeizadeh
Yasaman Taheri Abkenar
Moslem Taheri Soodejani
Arzu Yiğit
Vahit Yiğit
Burhan Abdullah Zaman
Nasser Bagheri
Sulaiman Bah
Ruhai Bai
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