Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

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

CIGR E-Journal Volume 9

Rosana G. Moreira, Editor-in-Chief; Texas A&M UniversityThis is Volume 9 (2007) of the International Commission of Agricultural Engineering (CIGR, Commission Internationale du Genie Rural) E-Journal: Peer Reviewed Original Research Articles: 1.) T. Philip and I. Itodo. (EE 06 010 Philip corrected final 30Jan2007.pdf) Nomograph for Determining Temperatures in Anaerobic Digesters from Ambient Temperatures in the Tropics. Manuscript EE 06 010. Vol. IX. January, 2007. 2.) A. Olorunnisola. (EE 06 006 Olorunnisola final 20Feb2007.pdf) Production of Fuel Briquettes from Waste Paper and Coconut Husk Admixtures. Manuscript EE 06 006. Vol. IX. February, 2007. 3.) D. Bochtis, S. Vougioukas, C.Tsatsarelis, and Y. Ampatzidis. (PM 06 021 Dionysis final 22Feb2007.pdf) Field Operation Planning for Agricultural Vehicles: A Hierarchical Modeling Framework. Manuscript PM 06 021. Vol. IX. February, 2007. 4.) S. Manuwa and O. Ademosun. (PM 06 016 Manuwa final 28Feb2007.pdf) Draught and Soil Disturbance of Model Tillage Tines Under Varying Soil Parameters. Manuscript PM 06 016. Vol. IX. March, 2007. 5.) T. Ewemoje. (LW 06 018 Ewemoje final 12March2007.pdf) Variable Irrigation Scheduling Effects on Growth Parameters of Celosia Argentea in Humid Tropical Environment. Manuscript LW 06 018. Vol. IX. March, 2007. 6.) N. Starcevic, M. Bux, T. Rohr, K.Lutz, M. Kostadinov, S. Ritterbusch, and J. Muller. (PM 07 010 Starcevic final 27March2007.pdf) Development of a Robot for Biomass Handling in a Solar Greenhouse Dryer. Manuscript PM 07 010. Vol. IX. March, 2007. 7.) S. Mansoor and G. Tiwari. (BC 06 002 Saleh Alhawtri final 21Mar2007.pdf) Modeling and Experimental Validation of Total Solar Fraction for Even Span Greenhouses by Shadow Area Concept. Manuscript BC 06 002. Vol. IX. March, 2007. 8.) Y. Sun, Y. Lin, K. Zhao, and Y. Lu. (FP 06 006 Lin final 14Feb2007.pdf) Mathematical Modeling of Gas-solid Flow in Turbine Reactor. Manuscript FP 06 006. Vol. IX. March, 2007. 9.) P. Rajkumar, R. Kailappan, R. Viswanathan, K. Parvathi, G.S.V. Raghavan and V. Orsat. (FP 06 024 Rajkumar final 17March2007.pdf) Thin Layer Drying Study on Foamed Mango Pulp. Manuscript FP 06 024. Vol. IX. March, 2007. 10.) R. N. Singh, S. P. Singh and B. S. Pathak. (EE 06 014 Singh-Pathak final 28March2007.pdf) Performance of Renewable Fuel Based CI Engine. Manuscript EE 06 014. Vol. IX. April, 2007. 11.) K. N. Patil, R. L. Huhnke, and D. D. Bellmer. (EE 06 016 Patil final 30March2007.pdf) Influence of Internal Baffles on Mixing Characteristics of Biomass in a Fluidized Sand Bed. Manuscript EE 06 016. Vol. IX. April, 2007. 12.) D. Tooy and H. Murase. (IT 07 002 Tooy-Murase final 10April2007.pdf) Behavioral Interest Identification for Farm Mechanization Development using Path Analysis and Neuro-fuzzy Models. Manuscript IT 07 002. Vol. IX. April, 2007. 13.) F. Sharmin and M. Rahman. (FP 06 009 Sharmin final 9April2007.pdf) Isolation and Characterization of Protease producing Bacillus strain FS-1. Manuscript FP 06 009. Vol. IX. April, 2007. 14.) F. Sharmin, S.K. Rakshit, and H.P.W. Jayasuriya. (FP 06 019 Sharmin final 9April2007.pdf) Enzyme Immobilization on Glass Surface for the Development of Phosphate Detection Biosensors. Manuscript FP 06 019. Vol. IX. April, 2007. 15.) S. D. Hafner and J.J. Bisogni. (EE 06 008 Hafner final 26April2007.pdf) A Simple Method for Measurement of Inorganic Carbon Concentration and Carbonate System Alkalinity in Anaerobic Digesters. Manuscript EE 06 008. Vol. IX. April, 2007. 16.) P.K. Gupta, Rakesh Kumar, B.S. Panesar, and V.K. Thapar. (EE 06 017 Gupta final 24April2007.pdf) Parametric Studies on Bio-diesel prepared from Rice Bran Oil. Manuscript EE 06 017. Vol. IX. April, 2007. 17.) M.R. Mostofi, R.G. Godwin, M.J.O'Dogherty, and S. Minaei. (PM 06 031 Mostofi corrected final 30June2007.pdf) Investigations on Performance of a Continuous Mass Flow Rate Measurement System for Potato Harvesting. Manuscript PM 06 031. Vol. IX. May, 2007. 18.) T. Hoffmann, P. Maly and Ch. Furll. (FP 06 014 Hoffmann final 20May2007.pdf) Ventilation of Potatoes in Storage Boxes. Manuscript FP 06 014. Vol. IX. May, 2007. 19.) T. Hoffmann, P. Maly, and Ch. Furll. (FP 06 015 Hoffmann final 20May2007.pdf) Soil Spread in Potato Storage Boxes Filled on the Potato Harvester. Manuscript FP 06 015. Vol. IX. May, 2007. 20.) A. Aragon Ramirez , A. Oida, H. Nakashima, J. Miyasaka, and K. Ohdoi. (PM 07 002 Aragon final 24May2007.pdf) Mechanization Index and Machinery Energy Ratio Assessment by means of an Artificial Neural Network: a Mexican Case Study. Manuscript PM 07 002. Vol. IX. May, 2007. 21.) R. R. Pechon, N. Ito, K. Kito and H. Jinyama. (PM 07 005 Pechon final 23May2007.pdf) Effect of Hand Tractor Implements on Soil Physical Properties in Upland Conditions. Manuscript PM 07 005. Vol. IX. May, 2007. 22.) M. Konstantinovic, S. Wockel, P. Schulze Lammers, J. Sachs and M. Martinov. (IT 06 003 Lammers final 21May2007.pdf) Detection of Root Biomass using Ultra Wideband Radar - an Approach to Potato Nest Positioning. Manuscript IT 06 003. Vol. IX. May, 2007. 23.) M. A. Eltawil and D.V.K. Samuuel. (EE 06 003 Eltawil final 31May2007.pdf) Vapour Compression Cooling System Powered By Solar PV Array for Potato Storage. Manuscript EE 06 003. Vol. IX. May, 2007. 24.) N. Kumari, G. Tiwari, and M. Sodha. (EE 06 011 Tiwari final 14June2007.pdf) Performance Evaluation of Greenhouse Having Passive or Active Heating in Different Climatic Zones of India. Manuscript EE 06 011. Vol. IX. May, 2007. 25.) V. Carvalho, R. A. Bucklin, J. K. Shearer, L. Shearer, I. A. Naas, M. Mollo Neto, S.R.L. Souza, and V. Massafera Jr. (BC 06 006 Carvalho final 3June2007.pdf) Dairy Cattle Linear and Angular Kinematics during the Stance Phase. Manuscript BC 06 006. Vol. IX. June, 2007. 26.) W. Burubai, and G. Dagogo. (BC 06 008 Burubai final 7June2007.pdf) Comparative Study of Inhibitors on the Corrosion of Mild Steel Reinforcement in Concrete. Manuscript BC 06 008. Vol. IX. June, 2007. 27.) W. Burubai, A.J.Akor, M.T. Lilly, and D.T. Ayawari. (BC 06 009 Burubai final 7June2007.pdf) An Evaluation of Septic Tank Performance in Bayelsa State, Nigeria. Manuscript BC 06 009. Vol. IX. June, 2007. 28.) D.A. Adetan, L.O. Adekoya and K. A. Oladejo. (PM 06 027 Adetan final 7June2007.pdf) An Improved Pole-and-Knife Method of Harvesting Oil Palms. Manuscript PM 06 027. Vol. IX. June, 2007. 29.) M. Heinloo. (IT 07 001 Heinloo final 5June2007.pdf) A Virtual Reality Technology - Based Method for the Study of the Working Process of a Blueberry Harvester's Picking Reel. Manuscript IT 07 001. Vol. IX. June, 2007. 30.) S. Jekayinfa. (EE 07 002 Jekayinfa final 12June2007.pdf) Ergonomic Evaluation and Energy Requirements of Bread-baking Operations in South Western Nigeria. Manuscript EE 07 002. Vol. IX. June, 2007. 31.) P.K. Adapa, G.J. Schoenau, L.G. Tabil, E.A. Arinze, A.K. Singh and A.K. Dalai. (FP 07 003 Adapa final 16June2007.pdf) Customized and Value-added High Quality Alfalfa Products: A New Concept. Manuscript FP 07 003. Vol. IX. June, 2007. 32.) S. J. Ojolo and B. S. Ogunsina. (PM 06 030 Ojolo final 12June2007.pdf) Development of a Cashew Nut Cracking Device. Manuscript PM 06 030. Vol. IX. June, 2007. 33.) Prastowo, S. Hardjoamidjojo, B. Pramudya, K. Murtilaksono. (LW 07 013 Prastowo final 15June2007.pdf) Performance of Shallow Groundwater Irrigation Schemes in Nganjuk-East Java, Indonesia. Manuscript LW 07 013. Vol. IX. June, 2007. 34.) J. Lungkapin, V. M. Salokhe, R. Kalsirisilp, and H. Nakashima. (PM 07 008 Salokhe final 23July2007.pdf) Development of a Stem Cutting Unit for a Cassava Planter. Manuscript PM 07 008. Vol. IX. July, 2007. 35.) O.J. Alamu, M. A. Waheed, and S. O. Jekayinfa. (EE 07 009 Alamu final 24June2007.pdf) Alkali-catalysed Laboratory Production and Testing of Biodiesel Fuel from Nigerian Palm Kernel Oil. Manuscript EE 07 009. Vol. IX. July, 2007. 36.) P. Amirante, P. Catalano, F. Giametta, A. Leone, and G. Montel. (PM 07 012 Giametta final 5July2007.pdf) Vibration Analysis of an Olive Mechanical Harvesting System. Manuscript PM 07 012. Vol. IX. July, 2007. 37.) Y. Mijinyawa, E. B. Lucas and F. O. Adegunloye. (BC 07 002 Mijinyawa final 29August2007.pdf) Termite Mound Clay as Material for Grain Silo Construction. Manuscript BC 07 002. Vol. IX. July, 2007. 38.) W. Spreer, M. Hegele, Z. Czaczyk, V. Romheld, F. Bangerth and J. Muller. (LW 07 019 Spreer final 23July2007.pdf) Water Consumption of Greenhouse Lychee Trees under Partial Rootzone Drying. Manuscript LW 07 019. Vol. IX. July, 2007. 39.) A. J. Farinde, O. K. Owolarafe, and O. I. Ogungbemi. (MES 07 002 Owolarafe final 31July2007.pdf) An Overview of Production, Processing, Marketing and Utilisation of Okra in Egbedore Local Government Area of Osun State, Nigeria. Manuscript MES 07 002. Vol. IX. July, 2007. 40.) O. B. Adeboye and O. A. Michael. (LW 07 007 Adeboye final 31July2007.pdf) Performance of Probability Distributions and Plotting Positions in Estimating the Flood of River Osun at Apoje Sub-basin, Nigeria. Manuscript LW 07 007. Vol. IX. July, 2007. 41.) H. E. Igbadun, H. F. Mahoo, A.K.P.R. Tarimo and B. A. Salim. (LW 06 015 Igbadun final 3August2007.pdf) Simulation of Moisture Dynamics of the Soil Profile of a Maize Crop under Deficit Irrigation Scheduling. LW 06 015. Vol. IX. July, 2007. 42.) N. Tadesse and E. Bekelle. (LW 06 017 Tadesse final 4August2007.pdf) The Productivity of Shallow Wells Groundwater in Agriculture and Interacting Systems: A Case Study at Debre Kidane Watershed, Eastern Tigray, Northern Ethiopia. Manuscript LW 06 017. Vol. IX. July, 2007. 43.) H. Ortiz-Laurel and P.A. Cowell. (PM 07 001 Ortiz-Laurel final 21August2007.pdf) Power Output Measurement on Draught Horses. Manuscript PM 07 001. Vol. IX. August, 2007. 44.) K. J. Simonyan, A. M. EL-Okene, and Y.D. Yiljep. (FP 07 008 Kayode final 13August2007.pdf) Some Physical Properties of Samaru Sorghum 17 Grains. Manuscript FP 07 008. Vol. IX. August, 2007. 45.) M. O. Ngadi and D-K. Hwang. (FP 04 004 Ngadi final 13August2007.pdf) Modelling Heat Transfer and Heterocyclic Amines Formation in Meat Patties during Frying. Manuscript FP 04 004. Vol. IX. August, 2007. 46.) M.D. Shaw and L.G. Tabil. (FP 07 006 Shaw corrected final 4Dec2007.pdf) Compression, Relaxation, and Adhesion Properties of Selected Biomass Grinds. Manuscript FP 07 006. Vol. IX. August, 2007. 47.) P. K. Jain and P. K. Nema. (FP 07 001 Nema final 17August07.pdf) Processing of Pulp of Various Cultivars of Guava (Psidium guajava L.) for Leather Production. Manuscxript FP 07 001. Vol. IX. August, 2007. 48.) M. Keramat Jahromi, A. Jafari, S. Rafiee, A. R. Keyhani, R. Mirasheh and S.S. Mohtasebi. (FP 07 019 Keramat revised final 7October2007.pdf) Some Physical properties of Date Fruit (cv. Lasht). Manuscript FP 07 019. Vol. IX. August, 2007. 49.) R. Malla, Y. Tanaka, K. Mori and K.L. Totawat. (LW 07 006 Malla final 18August2007.pdf) Effect of Short-term Sewage Irrigation on Chemical Build Up in Soils and Vegetables. Manuscript LW 07 006. Vol. IX. August, 2007. 50.) V. K. Tewari, R. Ailavadi, K. N. Dewangan and S. Sharangi. (MES 05 004 Dewangan-Tewari corrected final 6Oct2007.pdf) Rationalized Database of Indian Agricultural Workers for Equipment Design. Manmuscript MES 05 004. Vol. IX. August, 2007. 51.) Y. Lan, X. Lin, M.F. Kocher, W.C. Hoffmann. (IT 06 005 Lan final 4Sept2007.pdf) Development of a PC-based Data Acquisition and Control System. Manuscript IT 06 005. Vol. IX. August, 2007. 52.) P. Tassinari, D. Torreggiani, G. Paolinelli, S. Benni. (LW 07 020 Tassinari final 29August2007.pdf) Rural Buildings and their Integration in Landscape Management. Manuscript LW 07 020. Vol. IX. August, 2007. 53.) A. Isaac Bamgboye and A.O.D. Adejumo. (EE 06 015 Bamgboye final 6Sept2007.pdf) Development of a Sunflower Oil Expeller. Manuscript EE 06 015. Vol. IX. September, 2007. 54.) H. Zhu, Y. Lan, M.C. Lamb and C. L. Butts. (LW 07 005 Zhu final 5Sept2007.pdf) Corn Nutritional Properties and Yields with Surface Drip Irrigation in Topographically Variable Fields. Manuscript LW 07 005. Vol. IX. September, 2007. 55.) M.S. Mirjat, M. Rodgers, and P. Gibbons. (LW 06 022 Mirjat final 6Sept2007.pdf) Appropriate Slurry Application Rates and Timings: A Management Tool to Reduce Nitrate Leaching towards Groundwater. Manuscript LW 06 022. Vol. IX. September, 2007. 56.) C. S. Ima and D. D. Mann. (BC 07 005 Mann final 7Sept2007.pdf) Physical Properties of Woodchip: Compost Mixtures used as Biofilter Media. Manuscript BC 07 005. Vol. IX. September, 2007. 57.) C.N.U. Eke, S.N. Asoegwu and G.I. Nwandikom. (FP 07 014 Asoegwu final 9Sept2007.pdf) Some Physical Properties of Jackbean Seed (Canavalia ensiformis). Manuscript FP 07 014. Vol. IX. September, 2007. 58.) J. Yuan and Y. Lan. (PM 07 009 Yuan-Lan final 6Sept2007.pdf) Development of an Improved Cereal Stripping Harvester. Manuscript PM 07 009. Vol. IX. September, 2007. 59.) L. Ferreira, T. Yanagi Junior, I. Naas and M. Lopes. (IT 06 004 Yanagi-Naas final 11Sept2007.pdf) Development of Algorithm Using Fuzzy Logic to Predict Estrus in Dairy Cows: Part I. Manuscript IT 06 004. Vol. IX. September, 2007. 60.) R. Karoonboonyanan, V.M. Salokhe, T. Niyamapa and Hiroshi Nakashima. (PM 07 018 Salokhe final 28Sept2007.pdf) Vibration Effects on the Performance of a Single-Shank Subsoiler. Manuscript PM 07 018. Vol. IX. September, 2007. 61.) B. S. Blackmore, H.W. Griepentrog, S. Fountas, T.A. Gemtos. (PM 06 032 Fountas-Blackmore final 25Sept2007.pdf) A Specification for an Autonomous Crop Production Mechanization System. Manuscript PM 06 032. Vol. IX. September, 2007. 62.) S. Fountas, B. S. Blackmore, S. Vougioukas, L. Tang, C. G. Sorensen, and R. Jorgensen. (PM 07 006 Blackmore final 2Oct2007.pdf) Decomposition of Agricultural Tasks into Robotic Behaviours. Manuscript PM 07 006. Vol. IX. October, 2007. 63.) R. Yadav and S. Pund. (PM 07 022 Yadav final 18Oct2007.pdf) Development and Ergonomic Evaluation of Manual Weeder. Manuscript PM 07 022. Vol. IX. October, 2007. 64.) M. Keramat Jahromi, S. Rafiee, R. Mirasheh, A. Jafari, S.S. Mohtasebi, and M. Ghasemi Varnamkhasti. (FP 07 029 Keramat revised final 26Nov2007.pdf) Mass and Surface Area Modeling of Bergamot (Citrus medica) Fruit with Some Physical Attributes. Manuscript FP 07 029. Vol. IX. October, 2007. 65.) S. Agostini. (MES 07 001 Agostini final 8Oct2007.pdf) Learning Sustainability of Rural Tourism: Farm Competitiveness and Landscape Health Risk Assessment. Manuscript MES 07 001. Vol. IX. October, 2007. 66.) S. K. Chapagain, G. Du Laing, M. Verloo, S. Shrestha and F. Kazama. (LW 07 009 Chapagain final 5Oct2007.pdf) Monitoring of Arsenic Occurrence in Intertidal Sediments of River Scheldt (Belgium). Manuscript LW 07 009. Vol. IX. October, 2007. 67.) J. Uziak and I. A. Loukanov. (PM 07 019 Uziak final 16Oct2007.pdf) Performance Evaluation of Commonly Used Oil Ram Press Machines. Manuscript PM 07 019. Vol. IX. October, 2007. 68.) M.S. Sevda and N.S. Rathore. (EE 07 001 Sevda final 29Oct2007.pdf) Studies on Semi-Cylindrical Solar Tunnel Dryer for Drying Di-basic Calcium Phosphate. Manuscript EE 07 001. Vol. IX. October, 2007. 69.) F. Oluwole, A. Abdulrahim and R. Olalere. (PM 07 007 Oluwole final 29Oct2007.pdf) Evaluation of Some Centrifugal Impaction Devices for Shelling Bambara Groundnut. Manuscript PM 07 007. Vol. IX. October, 2007. 70.) F. Oluwole, N. Aviara, and M. Haque. (FP 07 002 Aviara final 22Oct2007.pdf) Effect of Moisture Content and Impact Energy on the Crackability of Sheanut. Manuscript FP 07 002. Vol. IX. October, 2007. 71.) M. A. Eltawil and D.V.K. Samuel. (EE 07 008 Eltawil final 30Oct2007.pdf) Performance and Economic Evaluation of Solar Photovoltaic Powered Cooling System for Potato Storage. Manuscript EE 07 008. Vol. IX. November, 2007. 72.) O.K. Owolarafe and C. Arumughan. (MES 07 003 Owolarafe final 7Nov2007.pdf) Technological Capability of Palm Oil Mills under the Contract-Growers Scheme in India. Manuscript MES 07 003. Vol. IX. November, 2007. 73.) S.E. Obetta, O.J. Ijabo and A.A. Satimehin. (FP 07 017 Obetta final 7Nov2007.pdf) Evaluation of a Ventilated Underground Storage for Cocoyams (Taro). Manuscript FP 07 017. Vol. IX. November, 2007. 74.) X. Zheng and Y. Lan. (FP 07 023 Zheng final 23Nov2007.pdf) Effects of Drying Temperature and Moisture Content on Rice Taste Quality. Manuscript FP 07 023. Vol. IX. November, 2007. 75.) S. Nayak, M.K. Ghosal and G.N. Tiwari. (EE 07 015 Nayak final 17Dec2007.pdf) Performance of Winter Greenhouse Coupled with Solar Photovoltaic and Earth Air Heat Exchanger. Manuscript EE 07 015. Vol. IX. November, 2007. 76.) T.Y. Tunde-Akintunde and B.O. Akintunde. (FP 07 021 Tunde-Akintunde final 29Nov2007.pdf) Effect of Moisture Content and Variety on Selected Physical Properties of Beniseed. Manuscript FP 07 021. Vol. IX. November, 2007. 77.) T.Y. Tunde-Akintunde, B.O. Akintunde and O.J. Oyelade. (FP 07 022 Tunde-Akintunde Melon final 29Nov2007.pdf) Effect of Moisture Content on Terminal Velocity, Compressive Force and Frictional Properties of Melon Seeds. Manuscript FP 07 022. Vol. IX. November, 2007. 78.) H. Q. Wang and P. Chen. (IT 07 005 Wang final 25Nov2007.pdf) Fault Diagnosis of Centrifugal Pump Using Symptom Parameters in Frequency Domain. Manuscript IT 07 005. Vol. IX. November, 2007. 79.) A.A. M. Haque, H. P. W. Jayasuriya, V. M. Salokhe, N.K. Tripathi and P. Parkpian. (LW 07 022 Jayasuriya-Salokhe final 28Nov2007.pdf) Assessment of Influence and Inter-Relationships of Soil Properties in Irrigated Rice Fields of Bangladesh by GIS and Factor Analysis. Manuscript LW 07 022. Vol. IX. November, 2007. 80.) J.A. Hogan, D.G. Watson, and T.V. Harrison. (PM 07 017 Watson final 28Nov2007.pdf) Data Points and Duration for Estimating Fuel Consumption of a LPG Engine. Manuscript PM 07 017. Vol. IX. November, 2007. 81.) P.G. Oguntunde, O.J. Olukunle, O.A. Ijatuyi, and A.A. Olufayo. (LW 06 019 Oguntunde final 28Nov07.pdf) A Semi-Empirical Model for Estimating Surface Albedo of Wetland Rice Field. Manuscript LW 06 019. Vol. IX. November, 2007. 82.) S. Sule, M.G. Yisa, and C.N. Ohanwe. (PM 07 029 Sule final 7Dec2007.pdf) Effect of Ploughing Speed on Stress Development on the Steyr Tractor Lift System on Clay Loam Soil Of Bauchi-Nigeria in the Northern Guinea Savannah. Manuscript PM 07 029. Vol. IX. November, 2007. 83.) S. Sule, J. S. Jatau, and M. G. Yisa. (PM 07 030 Sule final 28Nov2007.pdf) Development of a Model Stress Equation for the Steyr Tractor Lift System. Manuscript PM 07 030. Vol. IX. November, 2007. 84.) J. S. Alakali and A. A. Satimehin. (FP 07 005 Satimehin final 29Nov2007.pdf) Moisture Adsorption Characteristics of Bambara Groundnut (Vigna subterranea) Powders. Manuscript FP 07 005. Vol. IX. November, 2007. 85.) P. Tassinari, D. Torreggiani, and S. Benni. (MES 07 005 Tassinari final Part I 3Dec2007.pdf) Agriculture and Development Processes: Critical Aspects, Potential and Multilevel Analysis of Periurban Landscapes. Part I. Manuscript MES 07 005. Vol. IX. November, 2007. 86.) P. Tassinari, D. Torreggiani, and S. Benni. (MES 07 006 Tassinari final Part II 7Dec2007.pdf) Periurban Landscapes: Critical Aspects, Potential and Multilevel Analysis of Development Processes. Part II. Manuscript MES 07 006. Vol. IX. November, 2007. 87.) H. Tanaka, A. Oida , M. Daikoku, K. Inooku, O. Sumikawa, Y. Nagasaki and M. Miyazaki. (PM 05 010 Tanaka final 3Dec2007.pdf) DEM Simulation of Soil Loosening Process Caused by a Vibrating Subsoiler. Manuscript PM 05 010. Vol. IX. November, 2007. 88.) M. Fadel. (IT 07 003 Fadel final 26Dec2007.pdf) Date Fruits Classification Using Probabilistic Neural Networks. Manuscript IT 07 003. Vol. IX. December, 2007. 89.) M.Z. Hossain, and T. Sakai. (LW 07 011 Hossain final 18Dec2007.pdf) A Study on Pullout Behavior of Reinforcement Due to Variation of Water Content of Soil. Manuscript LW 07 011. Vol. IX. December, 2007. 90.) O.J. Alamu, M.A. Waheed, S.O. Jekayinfa, and T.A. Akintola. (EE 07 018 Alamu final 3Jan2008.pdf) Optimal Transesterification Duration for Biodiesel Production from Nigerian Palm Kernel Oil. Manuscript EE 07 018. Vol. IX. December, 2007. 91.) R. Remesan, M.S. Roopesh, N. Remya and P.S. Preman. (PM 07 011 Remesan final 4Jan2008.pdf) Wet Land Paddy Weeding - A Comprehensive Comparative Study from South India. Manuscript PM 07 011. Vol. IX. December, 2007. Automation Technology for Off-Road Equipment - 2006: (ATOE 07 Preface Auernhammer-Ehrl 21July2007.pdf) Preface to Special Section "ATOE 2006". Vol. IX. July, 2007. 1.) D. Bochtis, S. Vougioukas, C. Tsatsarelis, and Y. Ampatzidis. (ATOE 07 001 Bochtis 11July2007.pdf) Optimal Dynamic Motion Sequence Generation for Multiple Harvesters. Manuscript ATOE 07 001. Vol. IX. July, 2007. 2.) M. Ehrl and H. Auernhammer. (ATOE 07 002 Ehrl 11July2007.pdf) X-By-Wire via ISOBUS Communication Network. Manuscript ATOE 07 002. Vol. IX. July, 2007. 3.) R. Freimann. (ATOE 07 003 Freimann 11July2007.pdf) A Basic Approach to Implement Guided Tractor Control. Manuscript ATOE 07 003. Vol. IX. July, 2007. 4.) M. Gavric and M. Martinov. (ATOE 07 004 Gavric 11July2007.pdf) Low Cost GPS-Based System for Site-Specific Farming at Flat Terrains - Case Study. Manuscript ATOE 07 004. Vol. IX. July, 2007. 5.) H. W. Griepentrog, M. Noerremark, J. Nielsen, and J. S. Ibarra. (ATOE 07 005 Griepentrog 11July2007.pdf) Autonomous Inter-Row Hoeing using GPS-based side-shift control. Manuscript ATOE 07 005. Vol. IX. July, 2007. 6.) R.N. Jorgensen, C.G. Sorensen, J. Maagaard, I. Havn, K. Jensen, H.T. Sogaard, and L.B. Sorensen. (ATOE 07 006 Jorgensen 11July2007.pdf) HortiBot: A System Design of a Robotic Tool Carrier for High-tech Plant Nursing. Manuscript ATOE 07 006. Vol. IX. July, 2007. 7.) J. Lenz, R. Landman, and A. Mishra. (ATOE 07 007 Lenz 11July2007.pdf) Cu

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. Funding: Bill & Melinda Gates Foundation. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Background: Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods: We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the health-related SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings: The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation: The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030. Funding: Bill & Melinda Gates Foundation. © 2018 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Measuring progress from 1990 to 2017 and projecting attainment to 2030 of the health-related Sustainable Development Goals for 195 countries and territories: a systematic analysis for the Global Burden of Disease Study 2017

Background Efforts to establish the 2015 baseline and monitor early implementation of the UN Sustainable Development Goals (SDGs) highlight both great potential for and threats to improving health by 2030. To fully deliver on the SDG aim of “leaving no one behind”, it is increasingly important to examine the health-related SDGs beyond national-level estimates. As part of the Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017), we measured progress on 41 of 52 health-related SDG indicators and estimated the health-related SDG index for 195 countries and territories for the period 1990–2017, projected indicators to 2030, and analysed global attainment. Methods We measured progress on 41 health-related SDG indicators from 1990 to 2017, an increase of four indicators since GBD 2016 (new indicators were health worker density, sexual violence by non-intimate partners, population census status, and prevalence of physical and sexual violence [reported separately]). We also improved the measurement of several previously reported indicators. We constructed national-level estimates and, for a subset of health-related SDGs, examined indicator-level differences by sex and Socio-demographic Index (SDI) quintile. We also did subnational assessments of performance for selected countries. To construct the healthrelated SDG index, we transformed the value for each indicator on a scale of 0–100, with 0 as the 2·5th percentile and 100 as the 97·5th percentile of 1000 draws calculated from 1990 to 2030, and took the geometric mean of the scaled indicators by target. To generate projections through 2030, we used a forecasting framework that drew estimates from the broader GBD study and used weighted averages of indicator-specific and country-specific annualised rates of change from 1990 to 2017 to inform future estimates. We assessed attainment of indicators with defined targets in two ways: first, using mean values projected for 2030, and then using the probability of attainment in 2030 calculated from 1000 draws. We also did a global attainment analysis of the feasibility of attaining SDG targets on the basis of past trends. Using 2015 global averages of indicators with defined SDG targets, we calculated the global annualised rates of change required from 2015 to 2030 to meet these targets, and then identified in what percentiles the required global annualised rates of change fell in the distribution of country-level rates of change from 1990 to 2015. We took the mean of these global percentile values across indicators and applied the past rate of change at this mean global percentile to all health-related SDG indicators, irrespective of target definition, to estimate the equivalent 2030 global average value and percentage change from 2015 to 2030 for each indicator. Findings The global median health-related SDG index in 2017 was 59·4 (IQR 35·4–67·3), ranging from a low of 11·6 (95% uncertainty interval 9·6–14·0) to a high of 84·9 (83·1–86·7). SDG index values in countries assessed at the subnational level varied substantially, particularly in China and India, although scores in Japan and the UK were more homogeneous. Indicators also varied by SDI quintile and sex, with males having worse outcomes than females for non-communicable disease (NCD) mortality, alcohol use, and smoking, among others. Most countries were projected to have a higher health-related SDG index in 2030 than in 2017, while country-level probabilities of attainment by 2030 varied widely by indicator. Under-5 mortality, neonatal mortality, maternal mortality ratio, and malaria indicators had the most countries with at least 95% probability of target attainment. Other indicators, including NCD mortality and suicide mortality, had no countries projected to meet corresponding SDG targets on the basis of projected mean values for 2030 but showed some probability of attainment by 2030. For some indicators, including child malnutrition, several infectious diseases, and most violence measures, the annualised rates of change required to meet SDG targets far exceeded the pace of progress achieved by any country in the recent past. We found that applying the mean global annualised rate of change to indicators without defined targets would equate to about 19% and 22% reductions in global smoking and alcohol consumption, respectively; a 47% decline in adolescent birth rates; and a more than 85% increase in health worker density per 1000 population by 2030. Interpretation The GBD study offers a unique, robust platform for monitoring the health-related SDGs across demographic and geographic dimensions. Our findings underscore the importance of increased collection and analysis of disaggregated data and highlight where more deliberate design or targeting of interventions could accelerate progress in attaining the SDGs. Current projections show that many health-related SDG indicators, NCDs, NCD-related risks, and violence-related indicators will require a concerted shift away from what might have driven past gains—curative interventions in the case of NCDs—towards multisectoral, prevention-oriented policy action and investments to achieve SDG aims. Notably, several targets, if they are to be met by 2030, demand a pace of progress that no country has achieved in the recent past. The future is fundamentally uncertain, and no model can fully predict what breakthroughs or events might alter the course of the SDGs. What is clear is that our actions—or inaction—today will ultimately dictate how close the world, collectively, can get to leaving no one behind by 2030.</p

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, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. Interpretation Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. Copyright © The Author(s)

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, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. Interpretation Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. Copyright © The Author(s)