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Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019

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dc.contributor.author Abbafati, C.
dc.contributor.author Machado, D.B.
dc.contributor.author Cislaghi, B.
dc.contributor.author Salman, O.M.
dc.contributor.author Karanikolos, M.
dc.contributor.author McKee, M.
dc.contributor.author Abbas, K.M.
dc.contributor.author Brady, O.J.
dc.contributor.author Larson, H.J.
dc.contributor.author Trias-Llimós, S.
dc.contributor.author Cummins, S.
dc.contributor.author Langan, S.M.
dc.contributor.author Sartorius, B.
dc.contributor.author Hafiz, A.
dc.contributor.author Jenabi, E.
dc.contributor.author Mohammad Gholi Mezerji, N.
dc.contributor.author Borzouei, S.
dc.contributor.author Azarian, G.
dc.contributor.author Khazaei, S.
dc.contributor.author Abbasi, M.
dc.contributor.author Asghari, B.
dc.contributor.author Masoumi, S.
dc.contributor.author Komaki, H.
dc.contributor.author Taherkhani, A.
dc.contributor.author Adabi, M.
dc.contributor.author Abbasifard, M.
dc.contributor.author Bazmandegan, G.
dc.contributor.author Kamiab, Z.
dc.contributor.author Vakilian, A.
dc.contributor.author Anjomshoa, M.
dc.contributor.author Mokari, A.
dc.contributor.author Sabour, S.
dc.contributor.author Shahbaz, M.
dc.contributor.author Saeedi, R.
dc.contributor.author Ahmadieh, H.
dc.contributor.author Yousefinezhadi, T.
dc.contributor.author Haj-Mirzaian, A.
dc.contributor.author Nikbakhsh, R.
dc.contributor.author Safi, S.
dc.contributor.author Asgari, S.
dc.contributor.author Irvani, S.N.
dc.contributor.author Jahanmehr, N.
dc.contributor.author Ramezanzadeh, K.
dc.contributor.author Abbasi-Kangevari, M.
dc.contributor.author Khayamzadeh, M.
dc.contributor.author Abbastabar, H.
dc.contributor.author Shirkoohi, R.
dc.contributor.author Fazlzadeh, M.
dc.contributor.author Janjani, H.
dc.contributor.author Hosseini, M.
dc.contributor.author Mansournia, M.
dc.contributor.author Tohidinik, H.
dc.contributor.author Bakhtiari, A.
dc.contributor.author Fazaeli, A.
dc.contributor.author Mousavi, S.
dc.contributor.author Hasanzadeh, A.
dc.contributor.author Nabavizadeh, B.
dc.contributor.author Malekzadeh, R.
dc.contributor.author Hashemian, M.
dc.contributor.author Pourshams, A.
dc.contributor.author Salimzadeh, H.
dc.contributor.author Sepanlou, S.G.
dc.contributor.author Afarideh, M.
dc.contributor.author Esteghamati, A.
dc.contributor.author Esteghamati, S.
dc.contributor.author Ghajar, A.
dc.contributor.author Heidari, B.
dc.contributor.author Rezaei, N.
dc.contributor.author Mohamadi, E.
dc.contributor.author Rahimi-Movaghar, A.
dc.contributor.author Rahim, F.
dc.contributor.author Eskandarieh, S.
dc.contributor.author Sahraian, M.
dc.contributor.author Mohebi, F.
dc.contributor.author Aminorroaya, A.
dc.contributor.author Ebrahimi, H.
dc.contributor.author Farzadfar, F.
dc.contributor.author Mohajer, B.
dc.contributor.author Pishgar, F.
dc.contributor.author Saeedi Moghaddam, S.
dc.contributor.author Shabani, M.
dc.contributor.author Zarafshan, H.
dc.contributor.author Abolhassani, H.
dc.contributor.author Hafezi-Nejad, N.
dc.contributor.author Heidari-Soureshjani, R.
dc.contributor.author Abdollahi, M.
dc.contributor.author Farahmand, M.
dc.contributor.author Salamati, P.
dc.contributor.author Mehrabi Nasab, E.
dc.contributor.author Tajdini, M.
dc.contributor.author Aghamir, S.
dc.contributor.author Mirzaei, R.
dc.contributor.author Dibaji Forooshani, Z.
dc.contributor.author Khater, M.M.
dc.contributor.author Abd-Allah, F.
dc.contributor.author Abdelalim, A.
dc.contributor.author Abualhasan, A.
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dc.contributor.author Hassan, A.
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dc.contributor.author Khater, A.M.
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dc.contributor.author Salem, M.R.R.
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dc.contributor.author Manafi, N.
dc.contributor.author Pazoki Toroudi, H.
dc.contributor.author Dorostkar, F.
dc.contributor.author Alipour, V.
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dc.contributor.author Arabloo, J.
dc.contributor.author Azari, S.
dc.contributor.author Ghashghaee, A.
dc.contributor.author Rezapour, A.
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dc.contributor.author Mehri, F.
dc.contributor.author Yousefifard, M.
dc.contributor.author Asadi-Aliabadi, M.
dc.contributor.author Babaee, E.
dc.contributor.author Eshrati, B.
dc.contributor.author Goharinezhad, S.
dc.contributor.author Moradi-Lakeh, M.
dc.contributor.author Abedi, P.
dc.contributor.author Rashedi, V.
dc.contributor.author Kumar, V.
dc.contributor.author Elgendy, I.Y.
dc.contributor.author Basu, S.
dc.contributor.author Park, J.
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dc.contributor.author Norheim, O.F.
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dc.contributor.author Gomez, R.S.
dc.contributor.author Abreu, L.G.
dc.contributor.author Abrigo, M.R.M.
dc.contributor.author Almulhim, A.M.
dc.contributor.author Dahlawi, S.M.A.
dc.contributor.author Pottoo, F.H.
dc.contributor.author Menezes, R.G.
dc.contributor.author Alanzi, T.M.
dc.contributor.author Alumran, A.K.
dc.contributor.author Abu Haimed, A.K.
dc.contributor.author Madadin, M.
dc.contributor.author Alanezi, F.M.
dc.contributor.author Abu-Gharbieh, E.
dc.contributor.author Saddik, B.
dc.contributor.author Abu-Raddad, L.J.
dc.contributor.author Samy, A.M.
dc.contributor.author El Nahas, N.
dc.contributor.author Shalash, A.S.
dc.contributor.author Nabhan, A.F.
dc.contributor.author Kamath, A.M.
dc.contributor.author Kassebaum, N.J.
dc.contributor.author Aravkin, A.Y.
dc.contributor.author Kochhar, S.
dc.contributor.author Sorensen, R.J.D.
dc.contributor.author Afshin, A.
dc.contributor.author Burkart, K.
dc.contributor.author Cromwell, E.A.
dc.contributor.author Dandona, L.
dc.contributor.author Dharmaratne, S.D.
dc.contributor.author Gakidou, E.
dc.contributor.author Hay, S.I.
dc.contributor.author Kyu, H.H.
dc.contributor.author Lopez, A.D.
dc.contributor.author Lozano, R.
dc.contributor.author Misganaw, A.T.
dc.contributor.author Mokdad, A.H.
dc.contributor.author Naghavi, M.
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dc.contributor.author Reiner Jr, R.C.
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dc.contributor.author Stanaway, J.D.
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dc.contributor.author Vos, T.
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dc.contributor.author Cercy, K.M.
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dc.contributor.author Charlson, F.J.
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dc.contributor.author Comfort, H.
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dc.contributor.author Croneberger, A.J.
dc.contributor.author Cruz, J.A.
dc.contributor.author Cunningham, M.
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dc.contributor.author Dingels, Z.V.
dc.contributor.author Dippenaar, I.N.
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dc.contributor.author Dolgert, A.J.
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dc.contributor.author Feigin, V.L.
dc.contributor.author Feldman, R.
dc.contributor.author Ferrara, G.
dc.contributor.author Ferrari, A.J.
dc.contributor.author Fitzgerald, R.
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dc.contributor.author Fullman, N.
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dc.contributor.author GBD 2019 Demographics Collaborators
dc.date.accessioned 2020-12-14T16:05:58Z
dc.date.available 2020-12-14T16:05:58Z
dc.date.issued 2020
dc.identifier.uri https://hdl.handle.net/20.500.12866/8647
dc.description.abstract Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019. Interpretation: Over the past 20 years, fertility rates have been dropping steadily and life expectancy has been increasing, with few exceptions. Much of this change follows historical patterns linking social and economic determinants, such as those captured by the GBD Socio-demographic Index, with demographic outcomes. More recently, several countries have experienced a combination of low fertility and stagnating improvement in mortality rates, pushing more populations into the late stages of the demographic transition. Tracking demographic change and the emergence of new patterns will be essential for global health monitoring. en_US
dc.language.iso eng
dc.publisher Elsevier
dc.relation.ispartof urn:issn:1474-547X
dc.rights info:eu-repo/semantics/restrictedAccess
dc.rights.uri https://creativecommons.org/licenses/by-nc-nd/4.0/deed.es
dc.subject UNAVAILABLE en_US
dc.title Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950–2019: a comprehensive demographic analysis for the Global Burden of Disease Study 2019 en_US
dc.type info:eu-repo/semantics/article
dc.identifier.doi https://doi.org/10.1016/S0140-6736(20)30977-6
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00 es_PE
dc.subject.ocde https://purl.org/pe-repo/ocde/ford#3.02.00


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