Dataset Information

Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

ABSTRACT: BACKGROUND:Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success. METHODS:We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030. FINDINGS:We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone. INTERPRETATION:Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030. FUNDING:Bill & Melinda Gates Foundation, US Agency for International Development.

SUBMITTER: Wang H

PROVIDER: S-EPMC4165626 | biostudies-literature | 2014 Sep

REPOSITORIES: biostudies-literature

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Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Wang Haidong H Liddell Chelsea A CA Coates Matthew M MM Mooney Meghan D MD Levitz Carly E CE Schumacher Austin E AE Apfel Henry H Iannarone Marissa M Phillips Bryan B Lofgren Katherine T KT Sandar Logan L Dorrington Rob E RE Rakovac Ivo I Jacobs Troy A TA Liang Xiaofeng X Zhou Maigeng M Zhu Jun J Yang Gonghuan G Wang Yanping Y Liu Shiwei S Li Yichong Y Ozgoren Ayse Abbasoglu AA Abera Semaw Ferede SF Abubakar Ibrahim I Achoki Tom T Adelekan Ademola A Ademi Zanfina Z Alemu Zewdie Aderaw ZA Allen Peter J PJ AlMazroa Mohammad AbdulAziz MA Alvarez Elena E Amankwaa Adansi A AA Amare Azmeraw T AT Ammar Walid W Anwari Palwasha P Cunningham Solveig Argeseanu SA Asad Majed Masoud MM Assadi Reza R Banerjee Amitava A Basu Sanjay S Bedi Neeraj N Bekele Tolesa T Bell Michelle L ML Bhutta Zulfiqar Z Blore Jed D JD Basara Berrak Bora BB Boufous Soufiane S Breitborde Nicholas N Bruce Nigel G NG Bui Linh Ngoc LN Carapetis Jonathan R JR Cárdenas Rosario R Carpenter David O DO Caso Valeria V Castro Ruben Estanislao RE Catalá-Lopéz Ferrán F Cavlin Alanur A Che Xuan X Chiang Peggy Pei-Chia PP Chowdhury Rajiv R Christophi Costas A CA Christophi Costas A CA Chuang Ting-Wu TW Cirillo Massimo M da Costa Leite Iuri I Courville Karen J KJ Dandona Lalit L Dandona Rakhi R Davis Adrian A Dayama Anand A Deribe Kebede K Dharmaratne Samath D SD Dherani Mukesh K MK Dilmen Uğur U Ding Eric L EL Edmond Karen M KM Ermakov Sergei Petrovich SP Farzadfar Farshad F Fereshtehnejad Seyed-Mohammad SM Fijabi Daniel Obadare DO Foigt Nataliya N Forouzanfar Mohammad H MH Garcia Ana C AC Geleijnse Johanna M JM Gessner Bradford D BD Goginashvili Ketevan K Gona Philimon P Goto Atsushi A Gouda Hebe N HN Green Mark A MA Greenwell Karen Fern KF Gugnani Harish Chander HC Gupta Rahul R Hamadeh Randah Ribhi RR Hammami Mouhanad M Harb Hilda L HL Hay Simon S Hedayati Mohammad T MT Hosgood H Dean HD Hoy Damian G DG Idrisov Bulat T BT Islami Farhad F Ismayilova Samaya S Jha Vivekanand V Jiang Guohong G Jonas Jost B JB Juel Knud K Kabagambe Edmond Kato EK Kazi Dhruv S DS Kengne Andre Pascal AP Kereselidze Maia M Khader Yousef Saleh YS Khalifa Shams Eldin Ali Hassan SE Khang Young-Ho YH Kim Daniel D Kinfu Yohannes Y Kinge Jonas M JM Kokubo Yoshihiro Y Kosen Soewarta S Defo Barthelemy Kuate BK Kumar G Anil GA Kumar Kaushalendra K Kumar Ravi B RB Lai Taavi T Lan Qing Q Larsson Anders A Lee Jong-Tae JT Leinsalu Mall M Lim Stephen S SS Lipshultz Steven E SE Logroscino Giancarlo G Lotufo Paulo A PA Lunevicius Raimundas R Lyons Ronan Anthony RA Ma Stefan S Mahdi Abbas Ali AA Marzan Melvin Barrientos MB Mashal Mohammad Taufiq MT Mazorodze Tasara T TT McGrath John J JJ Memish Ziad A ZA Mendoza Walter W Mensah George A GA Meretoja Atte A Miller Ted R TR Mills Edward J EJ Mohammad Karzan Abdulmuhsin KA Mokdad Ali H AH Monasta Lorenzo L Montico Marcella M Moore Ami R AR Moschandreas Joanna J Msemburi William T WT Mueller Ulrich O UO Muszynska Magdalena M MM Naghavi Mohsen M Naidoo Kovin S KS Narayan K M Venkat KM Nejjari Chakib C Ng Marie M de Dieu Ngirabega Jean J Nieuwenhuijsen Mark J MJ Nyakarahuka Luke L Ohkubo Takayoshi T Omer Saad B SB Caicedo Angel J Paternina AJ Pillay-van Wyk Victoria V Pope Dan D Pourmalek Farshad F Prabhakaran Dorairaj D Rahman Sajjad U R SU Rana Saleem M SM Reilly Robert Quentin RQ Rojas-Rueda David D Ronfani Luca L Rushton Lesley L Saeedi Mohammad Yahya MY Salomon Joshua A JA Sampson Uchechukwu U Santos Itamar S IS Sawhney Monika M Schmidt Jürgen C JC Shakh-Nazarova Marina M She Jun J Sheikhbahaei Sara S Shibuya Kenji K Shin Hwashin Hyun HH Shishani Kawkab K Shiue Ivy I Sigfusdottir Inga Dora ID Singh Jasvinder A JA Skirbekk Vegard V Sliwa Karen K Soshnikov Sergey S SS Sposato Luciano A LA Stathopoulou Vasiliki Kalliopi VK Stroumpoulis Konstantinos K Tabb Karen M KM Talongwa Roberto Tchio RT Teixeira Carolina Maria CM Terkawi Abdullah Sulieman AS Thomson Alan J AJ Thorne-Lyman Andrew L AL Toyoshima Hideaki H Dimbuene Zacharie Tsala ZT Uwaliraye Parfait P Uzun Selen Begüm SB Vasankari Tommi J TJ Vasconcelos Ana Maria Nogales AM Vlassov Vasiliy Victorovich VV Vollset Stein Emil SE Waller Stephen S Wan Xia X Weichenthal Scott S Weiderpass Elisabete E Weintraub Robert G RG Westerman Ronny R Wilkinson James D JD Williams Hywel C HC Yang Yang C YC Yentur Gokalp Kadri GK Yip Paul P Yonemoto Naohiro N Younis Mustafa M Yu Chuanhua C Jin Kim Yun KY El Sayed Zaki Maysaa M Zhu Shankuan S Vos Theo T Lopez Alan D AD Murray Christopher J L CJ

Lancet (London, England) 20140502 9947

<h4>Background</h4>Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success.<h4>Methods</h4>We generated updated estimates of child mortality in early neonatal (age 0-6 days), late ...[more]

PMID: 24797572

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Project description:BackgroundThe fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100,000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery.MethodsWe used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values.Findings292,982 (95% UI 261,017-327,792) maternal deaths occurred in 2013, compared with 376,034 (343,483-407,574) in 1990. The global annual rate of change in the MMR was -0·3% (-1·1 to 0·6) from 1990 to 2003, and -2·7% (-3·9 to -1·5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0·4% (0·2-0·6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956·8 (685·1-1262·8) in South Sudan to 2·4 (1·6-3·6) in Iceland.InterpretationGlobal rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.FundingBill & Melinda Gates Foundation.

Project description:BackgroundSepsis is life-threatening organ dysfunction due to a dysregulated host response to infection. It is considered a major cause of health loss, but data for the global burden of sepsis are limited. As a syndrome caused by underlying infection, sepsis is not part of standard Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) estimates. Accurate estimates are important to inform and monitor health policy interventions, allocation of resources, and clinical treatment initiatives. We estimated the global, regional, and national incidence of sepsis and mortality from this disorder using data from GBD 2017.MethodsWe used multiple cause-of-death data from 109 million individual death records to calculate mortality related to sepsis among each of the 282 underlying causes of death in GBD 2017. The percentage of sepsis-related deaths by underlying GBD cause in each location worldwide was modelled using mixed-effects linear regression. Sepsis-related mortality for each age group, sex, location, GBD cause, and year (1990-2017) was estimated by applying modelled cause-specific fractions to GBD 2017 cause-of-death estimates. We used data for 8·7 million individual hospital records to calculate in-hospital sepsis-associated case-fatality, stratified by underlying GBD cause. In-hospital sepsis-associated case-fatality was modelled for each location using linear regression, and sepsis incidence was estimated by applying modelled case-fatality to sepsis-related mortality estimates.FindingsIn 2017, an estimated 48·9 million (95% uncertainty interval [UI] 38·9-62·9) incident cases of sepsis were recorded worldwide and 11·0 million (10·1-12·0) sepsis-related deaths were reported, representing 19·7% (18·2-21·4) of all global deaths. Age-standardised sepsis incidence fell by 37·0% (95% UI 11·8-54·5) and mortality decreased by 52·8% (47·7-57·5) from 1990 to 2017. Sepsis incidence and mortality varied substantially across regions, with the highest burden in sub-Saharan Africa, Oceania, south Asia, east Asia, and southeast Asia.InterpretationDespite declining age-standardised incidence and mortality, sepsis remains a major cause of health loss worldwide and has an especially high health-related burden in sub-Saharan Africa.FundingThe Bill & Melinda Gates Foundation, the National Institutes of Health, the University of Pittsburgh, the British Columbia Children's Hospital Foundation, the Wellcome Trust, and the Fleming Fund.

Project description:ObjectivesTo use the estimates from the Global Burden of Disease Study 2016 to describe patterns of suicide mortality globally, regionally, and for 195 countries and territories by age, sex, and Socio-demographic index, and to describe temporal trends between 1990 and 2016.DesignSystematic analysis.Main outcome measuresCrude and age standardised rates from suicide mortality and years of life lost were compared across regions and countries, and by age, sex, and Socio-demographic index (a composite measure of fertility, income, and education).ResultsThe total number of deaths from suicide increased by 6.7% (95% uncertainty interval 0.4% to 15.6%) globally over the 27 year study period to 817?000 (762?000 to 884?000) deaths in 2016. However, the age standardised mortality rate for suicide decreased by 32.7% (27.2% to 36.6%) worldwide between 1990 and 2016, similar to the decline in the global age standardised mortality rate of 30.6%. Suicide was the leading cause of age standardised years of life lost in the Global Burden of Disease region of high income Asia Pacific and was among the top 10 leading causes in eastern Europe, central Europe, western Europe, central Asia, Australasia, southern Latin America, and high income North America. Rates for men were higher than for women across regions, countries, and age groups, except for the 15 to 19 age group. There was variation in the female to male ratio, with higher ratios at lower levels of Socio-demographic index. Women experienced greater decreases in mortality rates (49.0%, 95% uncertainty interval 42.6% to 54.6%) than men (23.8%, 15.6% to 32.7%).ConclusionsAge standardised mortality rates for suicide have greatly reduced since 1990, but suicide remains an important contributor to mortality worldwide. Suicide mortality was variable across locations, between sexes, and between age groups. Suicide prevention strategies can be targeted towards vulnerable populations if they are informed by variations in mortality rates.

Project description:Objective: To estimate the burden of myocarditis (MC), alcoholic cardiomyopathy (AC), and other cardiomyopathy (OC) for 195 countries and territories from 1990 to 2017. Methods: We collected detailed information on MC, AC, and OC between 1990 and 2017 from the Global Burden of Disease study 2017, which was designed to provide a systematic assessment of health loss due to diseases and injuries in 21 regions, covering 195 countries and territories. Estimates of MC, AC, and OC burden were produced using a standard Cause of Death Ensemble model and a Bayesian mixed-effects meta-regression tool, and included prevalence, deaths, years lived with disability (YLDs), and years of life lost (YLLs). All estimates were presented as counts, age-standardized rates per 100,000 people and percentage change, with 95% uncertainty intervals (UIs). Results: Worldwide, there were 1.80 million (95% UI 1.64-1.98) cases of MC, 1.62 million (95% UI 1.37-1.90) cases of AC and 4.21 million (95% UI 3.63-4.87) cases of OC, contributing to 46,486 (95% UI 39,709-51,824), 88,890 (95% UI 80,935-96,290), and 233,159 (95% UI 213,677-248,289) deaths in 2017, respectively. Furthermore, globally, there were 131,376 (95% UI 90,113-183,001) YLDs and 1.26 million (95% UI 1.10-1.42) YLLs attributable to MC, 139,087 (95% UI 95,134-196,130) YLDs and 2.84 million (95% UI 2.60-3.07) YLLs attributable to AC, and 353,325 (95% UI 237,907-493,908) YLDs and 5.51 million (95% UI 4.95-5.99) YLLs attributable to OC in 2017. At the national level, the age-standardized prevalence rates varied by 10.4 times for MC, 252.6 times for AC and 38.1 times for OC; the age-standardized death rates varied by 43.9 times for MC, 531.0 times for AC and 43.3 times for OC; the age-standardized YLD rates varied by 12.4 times for MC, 223.7 times for AC, and 34.1 times for OC; and the age-standardized YLL rates varied by 38.4 times for MC, 684.8 times for AC, and 36.2 times for OC. Between 1990 and 2017, despite the decreases in age-standardized rates, the global numbers of prevalent cases, deaths, YLDs, and YLLs have increased for all the diseases. Conclusion: Accurate assessment of the burden of MC, AC, and OC is essential for formulating effective preventative prevention and treatment programs and optimizing health system resource allocation. Our results suggest that MC, AC, and OC remain important global public health problems with increasing numbers of prevalent cases, deaths, YLDs, and YLLs over the past decades, and there are significant geographic variations in the burden of these diseases. Further research is warranted to expand our knowledge of potential risk factors and to improve the prevention, early detection and treatment of these diseases.

Project description:BACKGROUND:In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. METHODS:We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality and coverage of specific reproductive health-care services as well as assessment of observed versus expected maternal mortality as a function of Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. FINDINGS:Only ten countries achieved MDG 5, but 122 of 195 countries have already met SDG 3.1. Geographical disparities widened between 1990 and 2015 and, in 2015, 24 countries still had a maternal mortality ratio greater than 400. The proportion of all maternal deaths occurring in the bottom two SDI quintiles, where haemorrhage is the dominant cause of maternal death, increased from roughly 68% in 1990 to more than 80% in 2015. The middle SDI quintile improved the most from 1990 to 2015, but also has the most complicated causal profile. Maternal mortality in the highest SDI quintile is mostly due to other direct maternal disorders, indirect maternal disorders, and abortion, ectopic pregnancy, and/or miscarriage. Historical patterns suggest achievement of SDG 3.1 will require 91% coverage of one antenatal care visit, 78% of four antenatal care visits, 81% of in-facility delivery, and 87% of skilled birth attendance. INTERPRETATION:Several challenges to improving reproductive health lie ahead in the SDG era. Countries should establish or renew systems for collection and timely dissemination of health data; expand coverage and improve quality of family planning services, including access to contraception and safe abortion to address high adolescent fertility; invest in improving health system capacity, including coverage of routine reproductive health care and of more advanced obstetric care-including EmOC; adapt health systems and data collection systems to monitor and reverse the increase in indirect, other direct, and late maternal deaths, especially in high SDI locations; and examine their own performance with respect to their SDI level, using that information to formulate strategies to improve performance and ensure optimum reproductive health of their population. FUNDING:Bill & Melinda Gates Foundation.

Project description:IMPORTANCE:The literature focuses on mortality among children younger than 5 years. Comparable information on nonfatal health outcomes among these children and the fatal and nonfatal burden of diseases and injuries among older children and adolescents is scarce. OBJECTIVE:To determine levels and trends in the fatal and nonfatal burden of diseases and injuries among younger children (aged <5 years), older children (aged 5-9 years), and adolescents (aged 10-19 years) between 1990 and 2013 in 188 countries from the Global Burden of Disease (GBD) 2013 study. EVIDENCE REVIEW:Data from vital registration, verbal autopsy studies, maternal and child death surveillance, and other sources covering 14,244 site-years (ie, years of cause of death data by geography) from 1980 through 2013 were used to estimate cause-specific mortality. Data from 35,620 epidemiological sources were used to estimate the prevalence of the diseases and sequelae in the GBD 2013 study. Cause-specific mortality for most causes was estimated using the Cause of Death Ensemble Model strategy. For some infectious diseases (eg, HIV infection/AIDS, measles, hepatitis B) where the disease process is complex or the cause of death data were insufficient or unavailable, we used natural history models. For most nonfatal health outcomes, DisMod-MR 2.0, a Bayesian metaregression tool, was used to meta-analyze the epidemiological data to generate prevalence estimates. FINDINGS:Of the 7.7 (95% uncertainty interval [UI], 7.4-8.1) million deaths among children and adolescents globally in 2013, 6.28 million occurred among younger children, 0.48 million among older children, and 0.97 million among adolescents. In 2013, the leading causes of death were lower respiratory tract infections among younger children (905.059 deaths; 95% UI, 810,304-998,125), diarrheal diseases among older children (38,325 deaths; 95% UI, 30,365-47,678), and road injuries among adolescents (115,186 deaths; 95% UI, 105,185-124,870). Iron deficiency anemia was the leading cause of years lived with disability among children and adolescents, affecting 619 (95% UI, 618-621) million in 2013. Large between-country variations exist in mortality from leading causes among children and adolescents. Countries with rapid declines in all-cause mortality between 1990 and 2013 also experienced large declines in most leading causes of death, whereas countries with the slowest declines had stagnant or increasing trends in the leading causes of death. In 2013, Nigeria had a 12% global share of deaths from lower respiratory tract infections and a 38% global share of deaths from malaria. India had 33% of the world's deaths from neonatal encephalopathy. Half of the world's diarrheal deaths among children and adolescents occurred in just 5 countries: India, Democratic Republic of the Congo, Pakistan, Nigeria, and Ethiopia. CONCLUSIONS AND RELEVANCE:Understanding the levels and trends of the leading causes of death and disability among children and adolescents is critical to guide investment and inform policies. Monitoring these trends over time is also key to understanding where interventions are having an impact. Proven interventions exist to prevent or treat the leading causes of unnecessary death and disability among children and adolescents. The findings presented here show that these are underused and give guidance to policy makers in countries where more attention is needed.

Dataset Information

Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Publications

Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Similar Datasets

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