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Austin E Schumacher, Hmwe Hmwe Kyu, Amirali Aali, Cristiana Abbafati, Jaffar Abbas, Rouzbeh Abbasgholizadeh, Madineh Akram Abbasi, Mohammadreza Abbasian, Samar Abd ElHafeez, Michael Abdelmasseh and 1826 more
BACKGROUND: Estimates of demographic metrics are crucial to assess levels and trends of population health outcomes. The profound impact of the COVID-19 pandemic on populations worldwide has underscored the need for timely estimates to understand this unprecedented event within the context of long-term population health trends. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 provides new demographic estimates for 204 countries and territories and 811 additional subnational locations from 1950 to 2021, with a particular emphasis on changes in mortality and life expectancy that occurred during the 2020-21 COVID-19 pandemic period. METHODS: 22 223 data sources from vital registration, sample registration, surveys, censuses, and other sources were used to estimate mortality, with a subset of these sources used exclusively to estimate excess mortality due to the COVID-19 pandemic. 2026 data sources were used for population estimation. Additional sources were used to estimate migration; the effects of the HIV epidemic; and demographic discontinuities due to conflicts, famines, natural disasters, and pandemics, which are used as inputs for estimating mortality and population. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate under-5 mortality rates, which synthesised 30 763 location-years of vital registration and sample registration data, 1365 surveys and censuses, and 80 other sources. ST-GPR was also used to estimate adult mortality (between ages 15 and 59 years) based on information from 31 642 location-years of vital registration and sample registration data, 355 surveys and censuses, and 24 other sources. Estimates of child and adult mortality rates were then used to generate life tables with a relational model life table system. For countries with large HIV epidemics, life tables were adjusted using independent estimates of HIV-specific mortality generated via an epidemiological analysis of HIV prevalence surveys, antenatal clinic serosurveillance, and other data sources. Excess mortality due to the COVID-19 pandemic in 2020 and 2021 was determined by subtracting observed all-cause mortality (adjusted for late registration and mortality anomalies) from the mortality expected in the absence of the pandemic. Expected mortality was calculated based on historical trends using an ensemble of models. In location-years where all-cause mortality data were unavailable, we estimated excess mortality rates using a regression model with covariates pertaining to the pandemic. Population size was computed using a Bayesian hierarchical cohort component model. Life expectancy was calculated using age-specific mortality rates and standard demographic methods. Uncertainty intervals (UIs) were calculated for every metric using the 25th and 975th ordered values from a 1000-draw posterior distribution. FINDINGS: Global all-cause mortality followed two distinct patterns over the study period: age-standardised mortality rates declined between 1950 and 2019 (a 62·8% [95% UI 60·5-65·1] decline), and increased during the COVID-19 pandemic period (2020-21; 5·1% [0·9-9·6] increase). In contrast with the overall reverse in mortality trends during the pandemic period, child mortality continued to decline, with 4·66 million (3·98-5·50) global deaths in children younger than 5 years in 2021 compared with 5·21 million (4·50-6·01) in 2019. An estimated 131 million (126-137) people died globally from all causes in 2020 and 2021 combined, of which 15·9 million (14·7-17·2) were due to the COVID-19 pandemic (measured by excess mortality, which includes deaths directly due to SARS-CoV-2 infection and those indirectly due to other social, economic, or behavioural changes associated with the pandemic). Excess mortality rates exceeded 150 deaths per 100 000 population during at least one year of the pandemic in 80 countries and territories, whereas 20 nations had a negative excess mortality rate in 2020 or 2021, indicating that all-cause mortality in these countries was lower during the pandemic than expected based on historical trends. Between 1950 and 2021, global life expectancy at birth increased by 22·7 years (20·8-24·8), from 49·0 years (46·7-51·3) to 71·7 years (70·9-72·5). Global life expectancy at birth declined by 1·6 years (1·0-2·2) between 2019 and 2021, reversing historical trends. An increase in life expectancy was only observed in 32 (15·7%) of 204 countries and territories between 2019 and 2021. The global population reached 7·89 billion (7·67-8·13) people in 2021, by which time 56 of 204 countries and territories had peaked and subsequently populations have declined. The largest proportion of population growth between 2020 and 2021 was in sub-Saharan Africa (39·5% [28·4-52·7]) and south Asia (26·3% [9·0-44·7]). From 2000 to 2021, the ratio of the population aged 65 years and older to the population aged younger than 15 years increased in 188 (92·2%) of 204 nations. INTERPRETATION: Global adult mortality rates markedly increased during the COVID-19 pandemic in 2020 and 2021, reversing past decreasing trends, while child mortality rates continued to decline, albeit more slowly than in earlier years. Although COVID-19 had a substantial impact on many demographic indicators during the first 2 years of the pandemic, overall global health progress over the 72 years evaluated has been profound, with considerable improvements in mortality and life expectancy. Additionally, we observed a deceleration of global population growth since 2017, despite steady or increasing growth in lower-income countries, combined with a continued global shift of population age structures towards older ages. These demographic changes will likely present future challenges to health systems, economies, and societies. The comprehensive demographic estimates reported here will enable researchers, policy makers, health practitioners, and other key stakeholders to better understand and address the profound changes that have occurred in the global health landscape following the first 2 years of the COVID-19 pandemic, and longer-term trends beyond the pandemic. FUNDING: Bill & Melinda Gates Foundation.
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Schumacher, A. E., Kyu, H. H., Aali, A., Abbafati, C., Abbas, J., Abbasgholizadeh, R., Abbasi, M. A., Abbasian, M., ElHafeez, S. A., Abdelmasseh, M., Abd-Elsalam, S. M., Abdel‐Wahab, A., Abdollahi, M. R., Abdoun, M., Abdullahi, A., Abdurehman, A. M., Abebe, M., Abedi, A., Abedi, A., … Murray, C. J. L. (2024). Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021. The Lancet, 403(10440), 1989–2056. https://doi.org/10.1016/s0140-6736(24)00476-8
Schumacher, Austin E, et al. "Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021." The Lancet, vol. 403, no. 10440, 2024, pp. 1989–2056, https://doi.org/10.1016/s0140-6736(24)00476-8.
Schumacher, Austin E, Hmwe Hmwe Kyu, Amirali Aali, Cristiana Abbafati, Jaffar Abbas, Rouzbeh Abbasgholizadeh, Madineh Akram Abbasi, et al. "Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021." The Lancet 403, no. 10440 (2024): 1989–2056. https://doi.org/10.1016/s0140-6736(24)00476-8.
Schumacher A. E., Kyu H. H., Aali A. [и др.] Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021 // The Lancet. — 2024. — Vol. 403, № 10440. — P. 1989–2056. — URL: https://doi.org/10.1016/s0140-6736(24)00476-8
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title = {{Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950–2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021}},
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Criqui and Natália Alves Martins and Garland T Culbreth and Patricia Cullen and Matthew W. Cunningham and Daniel da Silva e Silva and Sriharsha Dadana and Omid Dadras and Zhaoli Dai and Koustuv Dalal and Lachlan L. Dalli and Giovanni Battista Damiani and Emanuele D’Amico and Sara Daneshvar and Aso Mohammad Darwesh and Jai K Das and Saswati Das and Nihar Ranjan Dash and Mohsen Dashti and Claudio Alberto Dávila-Cervantes and Nicole Davis Weaver and Kairat Davletov and Diego De Leo and Aklilu Tamire Debele and Louisa J Degenhardt and Reza Dehbandi and Lee Deitesfeld and Iván Delgado‐Enciso and Laura Delgado‐Ortiz and Daniel Demant and Berecha Hundessa Demessa and Andreas Kyriacou Demetriades and Xin Deng and Edgar Denova‐Gutiérrez and Kebede Deribe and Nikolaos Dervenis and Don C. 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Tabb and Mohammad Tabish and Luís Taborda‐Barata and Takahiro Tabuchi and Birkneh Tilahun Tadesse and Amirmasoud Taheri and Yasaman Taheri Abkenar and Moslem Taheri Soodejani and Amir Taherkhani and Jabeen Taiba and Ardeshir Tajbakhsh and Iman Mamdouh Talaat and Ashis Talukder and Jacques Lukenze Tamuzi and Ker‐Kan Tan and Haosu Tang and Hong Tang and Nathan Y Tat and Vivian Y Tat and Razieh Tavakoli Oliaee and Seyed Mohammad Tavangar and Nuno Taveira and Tsion Mulat Tebeje and Yibekal Manaye Tefera and Mojtaba Teimoori and Mohamad-Hani A. Temsah and Reem Mohamad Hani Temsah and Masayuki Teramoto and Solomon Hailemariam Tesfaye and Pugazhenthan Thangaraju and Kavumpurathu Raman Thankappan and Rajshree Thapa and Rekha Thapar and Nihal Thomas and Amanda Gay Thrift and Chern Choong Chern Thum and Jing Tian and Aleš Tichopád and Jansje Henny Vera Ticoalu and Tenaw Yimer Tiruye and Seyed Abolfazl Tohidast and Marcello A. 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Varavikova and Orsolya Varga and Siddhartha Alluri Varma and Priya Vart and Shoban Babu Varthya and Tommi Juhani Vasankari and Lennert J Veerman and Narayanaswamy Venketasubramanian and Deneshkumar Venugopal and Nicholas Alexander Verghese and Madhur Verma and Pratibha Verma and Massimiliano Veroux and Georgios‐Ioannis Verras and Dominique Vervoort and Rafael José Vieira and Jorge Hugo Villafañe and Leonardo Villani and Gabriela Ines Villanueva and Paul J. Villeneuve and Francesco Saverio Violante and Rachel Visontay and Vasily Vlassov and Bay Vo and Stein Emil Vollset and Simona Ruxandra Volovăț and Victor Volovici and Avina Vongpradith and Theo Vos and Isidora S Vujcic and Rade Vuković and Yohannes Dibaba Wado and Hatem A Wafa and Yasir Waheed and Richard G. Wamai and Cong Wang and Denny Wang and Fang Wang and Shu Wang and Song Wang and Yanzhong Wang and Yuan‐Pang Wang and Paul Ward and Stefanie Watson and Marcia R. Weaver and Kosala Weerakoon and Daniel J. Weiss and Abrha Hailay and Katherine M Wells and Yi Feng Wen and Andrea Werdecker and Ronny Westerman and Dakshitha Praneeth Wickramasinghe and Nuwan Darshana Wickramasinghe and Tissa Wijeratne and Shadrach Wilson and Marcin Wlodzimierz Wojewodzic and Eve E Wool and Anthony D. Woolf and Dongze Wu and Ratna Dwi Wulandari and Hong Xiao and Bin Xu and Xiaoyue Xu and Lalit Yadav and Sajad Yaghoubi and Lin Yang and Yuichiro Yano and Yao Yao and Pengpeng Ye and Gesila Endashaw Yesera and Renjulal Yesodharan and Subah Abderehim Yesuf and Arzu Yiğit and Vahit Yiğit and PAUL S. F. YIP and Dong Keon Yon and Naohiro Yonemoto and Yuyi You and Mustafa Z Younis and Chuanhua Yu and Siddhesh Zadey and Vesna Zadnik and Nima Zafari and Mohammad Zahedi and Muhammad Nauman Zahid and Mazyar Zahir and Fathiah Zakham and Nazar Zaki and Josefina Zakzuk and Giulia Zamagni and Burhan Abdullah Zaman and Sojib Bin Zaman and Nelson Zamora and Ramin Zand and Milad Zandi and Ghazal G Z Zandieh and Aurora Zanghì and Iman Zare and Михаил Сергеевич Застрожин and Mohammed G M Zeariya and Youjie Zeng and Chunxia Zhai and Chen Zhang and Haijun Zhang and Hongwei Zhang and Yunquan Zhang and Zhaofeng Zhang and Zhen‐Yu Zhang and Hanqing Zhao and Yang Zhao and Yong Zhao and Peng Zheng and Chenwen Zhong and Juexiao Zhou and Bin Zhu and Zhaohua Zhu and Pardis Ziaeefar and Magdalena Zielińska and Zhiyong Zou and Alimuddin I. Zumla and Elric Zweck and Samer H. Zyoud and Stephen S Lim and Christopher J L Murray},
journal = {The Lancet},
year = {2024},
volume = {403},
number = {10440},
pages = {1989--2056},
doi = {10.1016/s0140-6736(24)00476-8},
url = {https://doi.org/10.1016/s0140-6736(24)00476-8}
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