Global, 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 2016

BACKGROUND: 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, an

Benefits and Risks of Using “Diminished Capacity” Mitigation in Death Penalty Proceedings

A sample of capital trials in North Carolina was analyzed to determine the impact on death sentencing of introducing mitigators related to diminished capacity on behalf of defendants. The results show that mitigators of this type were frequently submitted to the jury for consideration, and if accepted, the chances of a defendant being sentenced to death were diminished. However, when these mitigators were submitted but not accepted, the defendant\u27s likelihood of receiving a death sentence was substantially escalated. These findings suggest a need for attorneys to carefully weigh the advantages and disadvantages of presenting diminished capacity mitigators in capital trials, and if choosing to do so, the absolute necessity of convincing the jury of their validity

Examining the Impact of Proximate Culpability Mitigation in Capital Punishment Sentencing Recommendations: The Influence of Mental Health Mitigators

In spite of the ruling in Atkins v. Virginia (2002), concerns remain that individuals with mental illness and reduced capacity are eligible for the death penalty. When mental illness or reduced capacity is not enough to preclude death-eligibility, these factors are often discussed at the sentencing phase as mitigators. Mitigation remains an under-researched avenue in the sentencing literature, particularly when it comes to the influence of specific types of mitigation. The present study contributes to knowledge on mental health mitigation by examining five mitigators relevant to the mental health and capacity of defendants. Using data from 834 capital sentences in North Carolina, the influence of these proximate culpability mitigators on jury sentence recommendations is examined. Results indicate that acceptance of certain mental health mitigators reduces the probability of death, but acceptance of others is not significantly related to death recommendations. These findings and their implications are discussed

When Domestic goes Capital: Juror Decision Making in Capital Murder trials involving Domestic Homicide

Prior research suggests that homicide cases involving familial offenders and victims are subject to a “domestic discount” that reduces sentencing severity. However, the operation of a domestic discount in regard to death penalty sentencing has been rarely examined. The current research uses a near-population of jury decisions in capital murder trials conducted in North Carolina from 1991 to 2009 (n = 800), and a series of logistic regression analyses to determine whether there is (a) a direct effect between offender–victim relationship (e.g., domestic, friend/acquaintance, and stranger) and jury decision making, and/or (b) whether domestic offender-victim relationship (as well as other offender–victim relationships) moderates the effect of legal and extralegal case characteristics on jury assessment of the death penalty. Our findings revealed no empirical support for a “domestic discount” whereby juries are less likely to impose death sentences in cases involving domestic homicides. However, substantial differences in predictors of death sentencing were found across offender–victim dyads; most notably, domestic homicide cases demonstrated the most legalistic model of jury decisions to impose death sentences

The Role of Mitigating Factors in Capital Sentencing Before and After McKoy v. North Carolina

In 1990, the United States Supreme Court ruled that capital jurors do not have to be unanimous in deciding whether or not to accept any particular mitigating circumstance presented to them by the defense during the penalty phase of a capital murder trial. This study examines whether this shift in procedure may have altered the role of mitigation in predicting capital sentencing outcomes by comparing death sentencing predictors before and after the McKoy decision with data from an extensive sample of capital cases in North Carolina tried between 1977 and 2002. The results indicate that (1) both the number of aggravating and mitigating circumstances accepted by capital jurors had statistically significant and substantial effects on capital sentencing outcomes both before and after the McKoy decision; (2) the number of mitigating circumstances presented to and accepted by capital juries in North Carolina doubled during the post‐McKoy period; and (3) the influence of mitigating circumstance on capital sentencing outcomes was attenuated in the post‐McKoy period. Implications of these findings are discussed

Predictors of Death Sentencing for Minority, Equal, and Majority Female Juries in Capital Murder Trials

The relatively small body of prior research investigating whether the sex composition of juries impacts sentencing decisions has produced equivocal results. Exploring this topic further, the current study used a large sample of capital cases from North Carolina (n = 675) to examine (a) whether jury sex composition predicted jury capital punishment sentencing decisions; and (b) whether there were different models of sentencing for male-majority, equal male-female, and female-majority juries. When we controlled for a number of legal and extralegal factors, our findings indicated that jury sex composition was independently related to sentencing outcomes. Specifically, equal male-female juries were significantly more likely and female-majority juries were significantly less likely to choose the death penalty versus a sentence of life in prison. In addition, different models (predictors) of sentencing were revealed for each of the jury sex compositions. Implications for future research and policy are discussed