Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017.
Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017.
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DOI：
10.1016/s0140-6736(18)31891-9
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发表时间：
2018-11-10
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影响因子：
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通讯作者：
GBD 2017 Mortality Collaborators
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作者：
GBD 2017 Mortality Collaborators
联合国人口司、经济和社会事务部（UNPOP）、美国人口普查局、世卫组织以及作为全球疾病、伤害和风险因素研究（GBD）先前迭代的一部分，对特定年龄死亡率和预期寿命进行了评估。GBD的前几次迭代使用了联合国持久性有机污染物方案的人口估计数，这些估计数的得出方式与GBD中的死亡人数估计数不一致。GBD的当前版本GBD 2017改进了以前的评估，并及时估计了全球人口的死亡率。GBD使用所有可用数据对1950年至2017年期间23个年龄组（包括男性和女性）和918个地点（包括195个国家和地区以及16个国家的国家以下地点）的死亡率进行了估计。使用的数据包括生命登记系统、抽样登记系统、家庭调查（完整出生史、简要出生史、兄弟姐妹史）、人口普查（简要出生史、家庭死亡）和人口监测点。总的来说，这项分析使用了8259个数据源。对出生至5岁之间和15至60岁之间的死亡概率进行估计，然后输入一个模型生命表系统，生成所有地点和年份的完整生命表。艾滋病毒/艾滋病造成的死亡中断和死亡率分别进行分析，然后纳入估计数。我们使用社会人口指数分析了年龄别死亡率与发展状况之间的关系，社会人口指数是基于25岁以下生育率、教育和收入的综合衡量指标。与GBD 2016相比，GBD 2017有四个主要的方法改进：纳入了622个额外的数据来源;使用了GBD研究产生的新人口估计;分析不同组成部分中使用的统计方法得到了进一步标准化和改进;分析时间向后延伸了20年，从1950年开始。在全球范围内，1950年登记的死亡人数占18.7%（95%不确定性区间18.4 - 19.0），此后这一比例一直稳步上升，2015年登记的死亡人数占所有死亡人数的58.8%（58.2 - 59.3）。在全球范围内，1950年至2017年，男性预期寿命从48.1岁（46.5 - 49.6）增加到70.5岁（70.1 - 70.8），女性从52.9岁（51.7 - 54.0）增加到75.6岁（75.3 - 75.9）。尽管取得了这一总体进展，但2017年出生时预期寿命仍存在很大差异，范围从中非共和国男性的49.1岁（46.5 - 51.7）到女性的87.6岁（86.9 - 88.1）。新加坡。各年龄组的进步最大的是5岁以下的儿童; 5岁以下儿童死亡率从1950年的每1000例活产死亡216.0例（196.3 - 238.1）下降到2017年的每1000例活产死亡38.9例（35.6 - 42.83），各国都有大幅下降。尽管如此，2017年全球仍有540万（5.2 - 5.6）5岁以下儿童死亡。成年人，特别是成年男性的进展不太明显，变化更大，在几个国家，他们的死亡率停滞不前或不断上升。1950年至2017年期间，男性和女性预期寿命之间的差距虽然在全球范围内相对稳定，但在超级区域之间显示出独特的模式，并且一直是中欧，东欧和中亚最大，南亚最小。与根据发展预测的死亡率相比，观察到的死亡率在不同国家和时间的表现也各不相同。对按年龄和性别分列的死亡率的分析表明，各国的人口死亡率模式非常复杂。这项研究的结果突出了全球的成功，如5岁以下儿童死亡率大幅下降，这反映了几十年来地方、国家和全球的重大承诺和投资。然而，它们也提请注意令人关切的死亡率模式，特别是成年男子和妇女的死亡率，在本研究期间，许多国家的死亡率停滞不前，在某些情况下还在上升。比尔和梅林达·盖茨基金会。
Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing. Bill & Melinda Gates Foundation.