MortalityAlan LopezProfessor of Global HealthHead, School of Population HealthThe University of Queensland
Outline GBD 2010 Age- and Sex-specific Mortality for 187 Countries
What is the Global Burden of Disease 2010? 1) A systematic scientific effort to quantify the comparative magnitude of health loss due to major diseases, injuries and risk factors by age, sex, country for 1990 and 2010. 2) By the numbers: 291 diseases and injuries, 1,160 sequelae of these diseases and injuries, and 67 risk factors or clusters of risk factors. 3) GBD 2010 provides uncertainty intervals for all quantities of interest.
GBD 2010 Team1. 486 authors from 302 institutions in 50 countries.
Some GBD Terminology1) Years of life lost due to premature mortality due to a death at age x is the standard life expectancy at age x.2) Years lived with disability for a cause in an age-sex group equals the prevalence of the condition times the disability weight for that condition.3) DALYs = Years of life lost due to premature mortality (YLLs) and years lived with disability (YLDs).4) In the GBD, disability refers to any short-term or long- term health loss.5) In the GBD 2010, DALYs are not discounted or age- weighted
Why Mortality matters• Numbers of male and female deaths at various ages provide important constraint on cause of death estimates/claims• Typically more, and more reliable information on numbers rather than causes of death• Age-distribution of deaths and age-specific risks of death important source of health intelligence for health policy and planning
Progress in Reducing Age and Sex-Specific Mortality 157 of 187 countries had increases in life expectancy at birth from 1990 to 2010 for males and 166 of 187 for females. 9
Change in Male Life Expectancy at Birth,1970 to 2010
Change in Female Life Expectancy at Birth,1970 to 2010
Quantifying Uncertainty in MortalityEstimation 1) Murray et al 2007 study on child mortality was the first effort to quantify uncertainty in country estimates of under-five mortality. 2) This study is the first attempt to quantify 95% uncertainty intervals in age-specific mortality by country across all ages. 3) Uncertainty for many countries is large reflecting the need for better data particularly on adult mortality.
Underestimating Progress in Under-Five Mortality
Use of Sibling Histories to Measure AdultMortality 1) Important aspect of this study is using results from sibling histories in household surveys in the estimation of adult mortality. 2) UN Population Division tends not to use sibling histories. For many countries in sub-Saharan Africa, adult mortality is predicted from child mortality by UNPD. 3) Methods used to analyze sibling histories are on average unbiased but there may be important cultural variation in responses to sibling histories.
Improving Vital Registration • Complete death registration ( with reliable cause of death certification) optimal source of routine mortality statistics • 50-60% of countries worldwide have functioning VR systems, but only half of those are complete and reliable • Substantial global momentum to rapidly improve VR systems, with good progress, but requires leadership and commitment • Meanwhile, wider application of new mortality measurement methods that have emerged from the GBD2010 will reduce uncertainty about mortality levels and trends