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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.
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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Kamal;Hiraike, Yuta;Hoffman, Howard J;Holla, Ramesh;Horita, Nobuyuki;Hossain, Md Belal;Hossain, Md Mahbub;Hossain, Sahadat;Hosseini, Mohammad-Salar;Hosseinzadeh, Hassan;Hosseinzadeh, Mehdi;Hostiuc, Mihaela;Hostiuc, Sorin;Hsairi, Mohamed;Hsieh, Vivian Chia-rong;Hu, Chengxi;Huang, Junjie;Huda, Md Nazmul;Hugo, Fernando N;Hultström, Michael;Hussain, Javid;Hussain, Salman;Hussein, Nawfal R;Huy, Le Duc;Huynh, Hong-Han;Hwang, Bing-Fang;Ibitoye, Segun Emmanuel;Idowu, Oluwatope Olaniyi;Ijo, Desta;Ikuta, Kevin S;Ilaghi, Mehran;Ilesanmi, Olayinka Stephen;Ilic, Irena M;Ilic, Milena D;Immurana, Mustapha;Inbaraj, Leeberk Raja;Iradukunda, Arnaud;Iravanpour, Farideh;Iregbu, Kenneth Chukwuemeka;Islam, Md Rabiul;Islam, Mohammad Mainul;Islam, Sheikh Mohammed Shariful;Islami, Farhad;Ismail, Nahlah Elkudssiah;Isola, Gaetano;Iwagami, Masao;Iwu, Chidozie C D;Iwu-Jaja, Chinwe Juliana;Iyer, Mahalaxmi;J, Linda Merin;Jaafari, Jalil;Jacob, Louis;Jacobsen, Kathryn H;Jadidi-Niaragh, Farhad;Jafarinia, Morteza;Jaggi, Khushleen;Jahankhani, Kasra;Jahanmehr, Nader;Jahrami, Haitham;Jain, Akhil;Jain, Nityanand;Jairoun, Ammar Abdulrahman;Jakovljevic, Mihajlo;Jalilzadeh Yengejeh, Reza;Jamshidi, Elham;Jani, Chinmay T;Janko, Mark M;Jatau, Abubakar Ibrahim;Jayapal, Sathish Kumar;Jayaram, Shubha;Jeganathan, Jayakumar;Jema, Alelign Tasew;Jemere, Digisie Mequanint;Jeong, Wonjeong;Jha, Anil K;Jha, Ravi Prakash;Ji, John S;Jiang, Heng;Jin, Yingzhao;Jin, Yinzi;Johnson, Olatunji;Jomehzadeh, Nabi;Jones, Darwin Phan;Joo, Tamas;Joseph, Abel;Joseph, Nitin;Joshua, Charity Ehimwenma;Jozwiak, Jacek Jerzy;Jürisson, Mikk;Kaambwa, Billingsley;Kabir, Ali;Kabir, Hannaneh;Kabir, Zubair;Kadashetti, Vidya;Kahe, Farima;Kakodkar, Pradnya Vishal;Kalani, Rizwan;Kalankesh, Leila R;Kaliyadan, Feroze;Kalra, Sanjay;Kamath, Ashwin;Kamireddy, Arun;Kanagasabai, Thanigaivelan;Kandel, Himal;Kanmiki, Edmund Wedam;Kanmodi, Kehinde Kazeem;Kantar, Rami S;Kapoor, Neeti;Karajizadeh, Mehrdad;Karami Matin, Behzad;Karanth, Shama D;Karaye, Ibraheem M;Karim, Asima;Karimi, Hanie;Karimi, Salah Eddin;Karimi Behnagh, Arman;Karkhah, Samad;Karna, Ajit K;Kashoo, Faizan Zaffar;Kasraei, Hengameh;Kassaw, Nigussie Assefa;Kassebaum, Nicholas J;Kassel, Molly B;Katamreddy, Adarsh;Katikireddi, Srinivasa Vittal;Katoto, Patrick DMC;Kauppila, Joonas H;Kaur, Navjot;Kaydi, Neda;Kayibanda, Jeanne Françoise;Kayode, Gbenga A;Kazemi, Foad;Kazemian, Sina;Kazeminia, sara;Keikavoosi-Arani, Leila;Keller, Cathleen;Kempen, John H;Kerr, Jessica A;Kesse-Guyot, Emmanuelle;Keykhaei, Mohammad;Khadembashiri, Mohamad Mehdi;Khadembashiri, Mohammad Amin;Khafaie, Morteza Abdullatif;Khajuria, Himanshu;Khalafi, Mohammad;Khalaji, Amirmohammad;Khalid, Nauman;Khalil, Ibrahim A;Khamesipour, Faham;Khan, Asaduzzaman;Khan, Gulfaraz;Khan, Ikramullah;Khan, Imteyaz A;Khan, Maseer;Khan, Moien AB;Khan, Taimoor;Khan suheb, Mahammed Ziauddin;Khanmohammadi, Shaghayegh;Khatab, Khaled;Khatami, Fatemeh;Khavandegar, Armin;Khayat Kashani, Hamid Reza;Kheirallah, Khalid A;Khidri, Feriha Fatima;Khodadoust, Elaheh;Khormali, Moein;Khosrowjerdi, Mahmood;Khubchandani, Jagdish;Khusun, Helda;Kifle, Zemene Demelash;Kim, Grace;Kim, Jihee;Kimokoti, Ruth W;Kinzel, Kasey E;Kiross, Girmay Tsegay;Kisa, Adnan;Kisa, Sezer;Kiss, Juniper Boroka;Kivimäki, Mika;Klu, Desmond;Knudsen, Ann Kristin Skrindo;Kolahi, Ali-Asghar;Kompani, Farzad;Koren, Gerbrand;Kosen, Soewarta;Kostev, Karel;Kotnis, Ashwin Laxmikant;Koul, Parvaiz A;Koulmane Laxminarayana, Sindhura Lakshmi;Koyanagi, Ai;Kravchenko, Michael A;Krishan, Kewal;Krishna, Hare;Krishnamoorthy, Vijay;Krishnamoorthy, Yuvaraj;Krohn, Kris J;Kuate Defo, Barthelemy;Kubeisy, Connor M;Kucuk Bicer, Burcu;Kuddus, Md Abdul;Kuddus, Mohammed;Kuitunen, Ilari;Kujan, Omar;Kulimbet, Mukhtar;Kulkarni, Vishnutheertha;Kumar, Ashish;Kumar, Harish;Kumar, Nithin;Kumar, Rahul;Kumar, Shiv;Kumari, Madhulata;Kurmanova, Almagul;Kurmi, Om P;Kusnali, Asep;Kusuma, Dian;Kutluk, Tezer;Kuttikkattu, Ambily;Kyei, Evans F;Kyriopoulos, Ilias;La Vecchia, Carlo;Ladan, Muhammad Awwal;Laflamme, Lucie;Lahariya, Chandrakant;Lahmar, Abdelilah;Lai, Daphne Teck Ching;Laksono, Tri;Lal, Dharmesh Kumar;Lalloo, Ratilal;Lallukka, Tea;Lám, Judit;Lamnisos, Demetris;Lan, Tuo;Lanfranchi, Francesco;Langguth, Berthold;Lansingh, Van Charles;Laplante-Lévesque, Ariane;Larijani, Bagher;Larsson, Anders O;Lasrado, Savita;Latief, Kamaluddin;Latif, Mahrukh;Latifinaibin, Kaveh;Lauriola, Paolo;Le, Long Khanh Dao;Le, Nhi Huu Hanh;Le, Thao Thi Thu;Le, Trang Diep Thanh;Lee, Munjae;Lee, Paul H;Lee, Sang-woong;Lee, Seung Won;Lee, Wei-Chen;Lee, Yo Han;Legesse, Samson Mideksa;Leigh, James;Lenzi, Jacopo;Leong, Elvynna;Lerango, Temesgen L;Li, Ming-Chieh;Li, Wei;Li, Xiaopan;Li, Yichong;Li, Zhihui;Libra, Massimo;Ligade, Virendra S;Likaka, Andrew Tiyamike Makhiringa;Lim, Lee-Ling;Lin, Ro-Ting;Lin, Shuzhi;Lioutas, Vasileios-Arsenios;Listl, Stefan;Liu, Jue;Liu, Simin;Liu, Xiaofeng;Livingstone, Katherine M;Llanaj, Erand;Lo, Chun-Han;Loreche, Arianna Maever;Lorenzovici, László;Lotfi, Mojgan;Lotfizadeh, Masoud;Lozano, Rafael;Lubinda, Jailos;Lucchetti, Giancarlo;Lugo, Alessandra;Lunevicius, Raimundas;Ma, Jianing;Ma, Stefan;Ma, Zheng Feei;Mabrok, Mahmoud;Machairas, Nikolaos;Machoy, Monika;Madsen, Christian;Magaña Gómez, Javier A;Maghazachi, Azzam A;Maharaj, Sandeep B;Maharjan, Preeti;Mahjoub, Soleiman;Mahmoud, Mansour Adam;Mahmoudi, Elham;Mahmoudi, Morteza;Makram, Omar Mohamed;Malagón-Rojas, Jeadran N;Malakan Rad, Elaheh;Malekzadeh, Reza;Malhotra, Armaan K;Malhotra, Kashish;Malik, Ahmad Azam;Malik, Iram;Malinga, Lesibana Anthony;Malta, Deborah Carvalho;Mamun, Abdullah A;Manla, Yosef;Mannan, Fahmida;Mansoori, Yasaman;Mansour, Ali;Mansouri, Vahid;Mansournia, Mohammad Ali;Mantovani, Lorenzo Giovanni;Marasini, Bishnu P;Marateb, Hamid Reza;Maravilla, Joemer C;Marconi, Agustina M;Mardi, Parham;Marino, Mirko;Marjani, Abdoljalal;Marrugo Arnedo, Carlos Alberto;Martinez-Guerra, Bernardo Alfonso;Martinez-Piedra, Ramon;Martins, Cleodice A;Martins-Melo, Francisco Rogerlândio;Martorell, Miquel;Marx, Wolfgang;Maryam, Sharmeen;Marzo, Roy Rillera;Mate, Kedar K V;Matei, Clara N;Mathioudakis, Alexander G;Maude, Richard James;Maugeri, Andrea;May, Erin A;Mayeli, Mahsa;Mazaheri, Maryam;Mazidi, Mohsen;Mazzotti, Antonio;McAlinden, Colm;McGrath, John J;McKee, Martin;McKowen, Anna Laura W;McLaughlin, Susan A;McPhail, Michael A;McPhail, Steven M;Mechili, Enkeleint A;Mediratta, Rishi P;Meena, Jitendra Kumar;Mehari, Medhin;Mehlman, Max L;Mehra, Rahul;Mehrabani-Zeinabad, Kamran;Mehrabi Nasab, Entezar;Mehrotra, Ravi;Mekonnen, Mathewos M;Mendoza, Walter;Menezes, Ritesh G;Mengesha, Endalkachew Worku;Mensah, George A;Mensah, Laverne G;Mentis, Alexios-Fotios A;Meo, Sultan Ayoub;Meretoja, Atte;Meretoja, Tuomo J;Mersha, Abera M;Mesfin, Bezawit Afework;Mestrovic, Tomislav;Mhlanga, Adquate;Mhlanga, Laurette;Mi, Tianyue;Micha, Georgia;Michalek, Irmina Maria;Miller, Ted R;Mindlin, Sergey Nikolaevich;Minelli, Giada;Minh, Le Huu Nhat;Mini, GK;Minja, Neema W;Mirdamadi, Niloofar;Mirghafourvand, Mojgan;Mirica, Andreea;Mirinezhad, Seyed Kazem;Mirmosayyeb, Omid;Mirutse, Mizan Kiros;Mirza-Aghazadeh-Attari, Mohammad;Mirzaei, Maryam;Misgana, Tadesse;Misra, Sanjeev;Mitchell, Philip B;Mithra, Prasanna;Mittal, Chaitanya;Mittal, Madhukar;Moazen, Babak;Mohamed, Ahmed Ismail;Mohamed, Jama;Mohamed, Mouhand F H;Mohamed, Nouh Saad;Mohammad-Alizadeh-Charandabi, Sakineh;Mohammadi, Soheil;Mohammadian-Hafshejani, Abdollah;Mohammad-pour, Saeed;Mohammadshahi, Marita;Mohammed, Mustapha;Mohammed, Salahuddin;Mohammed, Shafiu;Mojiri-forushani, Hoda;Mokdad, Ali H;Mokhtarzadehazar, Peyman;Momenzadeh, Kaveh;Momtazmanesh, Sara;Monasta, Lorenzo;Moni, Mohammad Ali;Montazeri, Fateme;Moodi Ghalibaf, AmirAli;Moradi, Maryam;Moradi, Yousef;Moradi-Lakeh, Maziar;Moradinazar, Mehdi;Moradpour, Farhad;Moraga, Paula;Morawska, Lidia;Moreira, Rafael Silveira;Morovatdar, Negar;Morrison, Shane Douglas;Morze, Jakub;Mosaddeghi Heris, Reza;Mosser, Jonathan F;Mossialos, Elias;Mostafavi, Hakimeh;Mostofinejad, Amirmahdi;Mougin, Vincent;Mouodi, Simin;Mousavi, Parsa;Mousavi, Seyed Ehsan;Mousavi Khaneghah, Amin;Mpundu-Kaambwa, Christine;Mrejen, Matías;Mubarik, Sumaira;Muccioli, Lorenzo;Mueller, Ulrich Otto;Mughal, Faraz;Mukherjee, Sumoni;Mukoro, George Duke;Mulita, Admir;Mulita, Francesk;Muniyandi, Malaisamy;Munjal, Kavita;Musaigwa, Fungai;Musallam, Khaled M;Mustafa, Ghulam;Muthu, Sathish;Muthupandian, Saravanan;Myung, Woojae;Nabhan, Ashraf F;Nafukho, Fredrick Muyia;Nagarajan, Ahamarshan Jayaraman;Naghavi, Mohsen;Naghavi, Pirouz;Naik, Ganesh R;Naik, Gurudatta;Naimzada, Mukhammad David;Nair, Sanjeev;Nair, Tapas Sadasivan;Najmuldeen, Hastyar Hama Rashid;Naldi, Luigi;Nangia, Vinay;Nargus, Shumaila;Nascimento, Bruno Ramos;Nascimento, Gustavo G;Naser, Abdallah Y;Nasiri, Mohammad Javad;Natto, Zuhair S;Nauman, Javaid;Naveed, Muhammad;Nayak, Biswa Prakash;Nayak, Vinod C;Nayyar, Ashish Kumar;Nazri-Panjaki, Athare;Negash, Hadush;Negero, Amayu Kumesa;Negoi, Ionut;Negoi, Ruxandra Irina;Negru, Serban Mircea;Nejadghaderi, Seyed Aria;Nejjari, Chakib;Nematollahi, Mohammad Hadi;Nena, Evangelia;Nepal, Samata;Nesbit, Olivia D;Newton, Charles Richard James;Ngunjiri, Josephine W;Nguyen, Dang H;Nguyen, Phat Tuan;Nguyen, Phuong The;Nguyen, Tuan Thanh;Nguyen, Van Thanh;Nigatu, Yeshambel T;Nikolouzakis, Taxiarchis Konstantinos;Nikoobar, Ali;Nikpoor, Amin Reza;Nizam, Muhammad A;Nomura, Shuhei;Noreen, Mamoona;Noroozi, Nafise;Norouzian Baghani, Abbas;Norrving, Bo;Noubiap, Jean Jacques;Novotney, Amanda;Nri-Ezedi, Chisom Adaobi;Ntaios, George;Ntsekhe, Mpiko;Nuñez-Samudio, Virginia;Nurrika, Dieta;Oancea, Bogdan;Obamiro, Kehinde O;Odetokun, Ismail A;Ofakunrin, Akinyemi O D;Ogunsakin, Ropo Ebenezer;Oguta, James Odhiambo;Oh, In-Hwan;Okati-Aliabad, Hassan;Okeke, Sylvester Reuben;Okekunle, Akinkunmi Paul;Okidi, Lawrence;Okonji, Osaretin Christabel;Okwute, Patrick Godwin;Olagunju, Andrew T;Olaiya, Muideen Tunbosun;Olanipekun, Titilope O;Olatubi, Matthew Idowu;Olivas-Martinez, Antonio;Oliveira, Gláucia Maria Moraes;Oliver, Susan;Olorukooba, Abdulhakeem Abayomi;Olufadewa, Isaac Iyinoluwa;Olusanya, Bolajoko Olubukunola;Olusanya, Jacob Olusegun;Oluwafemi, Yinka Doris;Oluwatunase, Gideon Olamilekan;Omar, Hany A;Omer, Goran Latif;Ong, Sokking;Onwujekwe, Obinna E;Onyedibe, Kenneth Ikenna;Opio, John Nelson;Ordak, Michal;Orellana, E Roberto;Orisakwe, Orish Ebere;Orish, Verner N;Orru, Hans;Ortega-Altamirano, Doris V;Ortiz, Alberto;Ortiz-Brizuela, Edgar;Ortiz-Prado, Esteban;Osuagwu, Uchechukwu Levi;Otoiu, Adrian;Otstavnov, Nikita;Ouyahia, Amel;Ouyang, Guoqing;Owolabi, Mayowa O;Oyeyemi, Ifeoluwa Temitayo;Oyeyemi, Oyetunde T;Ozten, Yaz;P A, Mahesh Padukudru;Padubidri, Jagadish Rao;Pahlavikhah Varnosfaderani, Mahsa;Pal, Pramod Kumar;Palicz, Tamás;Palladino, Claudia;Palladino, Raffaele;Palma-Alvarez, Raul Felipe;Pana, Adrian;Panahi, Parsa;Pandey, Ashok;Pandi-Perumal, Seithikurippu R;Pando-Robles, Victoria;Pangaribuan, Helena Ullyartha;Panos, Georgios D;Pantazopoulos, 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Ganesh Kumar;Sayadi, Yaser;Sayeed, Abu;Sayeed, Md Abu;Saylan, Mete;Scarmeas, Nikolaos;Schaarschmidt, Benedikt Michael;Schlee, Winfried;Schmidt, Maria Inês;Schuermans, Art;Schwebel, David C;Schwendicke, Falk;Šekerija, Mario;Selvaraj, Siddharthan;Semreen, Mohammad H;Senapati, Sabyasachi;Sengupta, Pallav;Senthilkumaran, Subramanian;Sepanlou, Sadaf G;Serban, Dragos;Sertsu, Addisu;Sethi, Yashendra;SeyedAlinaghi, SeyedAhmad;Seyedi, Seyed Arsalan;Shafaat, Amir;Shafaat, Omid;Shafie, Mahan;Shafiee, Arman;Shah, Nilay S;Shah, Pritik A;Shahabi, Saeed;Shahbandi, Ataollah;Shahid, Izza;Shahid, Samiah;Shahid, Wajeehah;Shahwan, Moyad Jamal;Shaikh, Masood Ali;Shakeri, Alireza;Shakil, Husain;Sham, Sunder;Shamim, Muhammad Aaqib;Shams-Beyranvand, Mehran;Shamshad, Hina;Shamshirgaran, Mohammad Ali;Shamsi, Mohammad Anas;Shanawaz, Mohd;Shankar, Abhishek;Sharfaei, Sadaf;Sharifan, Amin;Shariff, Mariam;Sharifi-Rad, Javad;Sharma, Manoj;Sharma, Rajesh;Sharma, Saurab;Sharma, Vishal;Shastry, Rajesh P;Shavandi, Amin;Shaw, David H;Shayan, Amir Mehdi;Shehabeldine, Amr Mohamed Elsayed;Sheikh, Aziz;Sheikhi, Rahim Ali;Shen, Jiabin;Shenoy, Manjunath Mala;Shetty, B Suresh Kumar;Shetty, Ranjitha S;Shey, Robert Adamu;Shiani, Amir;Shibuya, Kenji;Shiferaw, Desalegn;Shigematsu, Mika;Shin, Jae Il;Shin, Min-Jeong;Shiri, Rahman;Shirkoohi, Reza;Shittu, Aminu;Shiue, Ivy;Shivakumar, K M;Shivarov, Velizar;Shool, Sina;Shrestha, Sunil;Shuja, Kanwar Hamza;Shuval, Kerem;Si, Yafei;Sibhat, Migbar Mekonnen;Siddig, Emmanuel Edwar;Sigfusdottir, Inga Dora;Silva, João Pedro;Silva, Luís Manuel Lopes Rodrigues;Silva, Soraia;Simões, Jorge Piano;Simpson, Colin R;Singal, Anjali;Singh, Abhinav;Singh, Aditya;Singh, Ambrish;Singh, Balbir Bagicha;Singh, Baljinder;Singh, Mahendra;Singh, Mayank;Singh, Narinder Pal;Singh, Paramdeep;Singh, Surjit;Siraj, Md Shahjahan;Sitas, Freddy;Sivakumar, Shravan;Skryabin, Valentin Yurievich;Skryabina, Anna Aleksandrovna;Sleet, David A;Slepak, Erica Leigh N;Sohrabi, Hanye;Soleimani, Hamidreza;Soliman, Sameh S M;Solmi, Marco;Solomon, Yonatan;Song, Yimeng;Sorensen, Reed J D;Soriano, Joan B;Soyiri, Ireneous N;Spartalis, Michael;Sreeramareddy, Chandrashekhar T;Starnes, Joseph R;Starodubov, Vladimir I;Starodubova, Antonina V;Stefan, Simona Cătălina;Stein, Dan J;Steinbeis, Fridolin;Steiropoulos, Paschalis;Stockfelt, Leo;Stokes, Mark A;Stortecky, Stefan;Stranges, Saverio;Stroumpoulis, Konstantinos;Suleman, Muhammad;Suliankatchi Abdulkader, Rizwan;Sultana, Abida;Sun, Jing;Sunkersing, David;Susanty, Sri;Swain, Chandan Kumar;Sykes, Bryan L;Szarpak, Lukasz;Szeto, Mindy D;Szócska, Miklós;Tabaee Damavandi, Payam;Tabatabaei Malazy, Ozra;Tabatabaeizadeh, Seyed-Amir;Tabatabai, Shima;Tabb, Karen M;Tabish, Mohammad;Taborda-Barata, Luis M;Tabuchi, Takahiro;Tadesse, Birkneh Tilahun;Taheri, Amirmasoud;Taheri Abkenar, Yasaman;Taheri Soodejani, Moslem;Taherkhani, Amir;Taiba, Jabeen;Tajbakhsh, Ardeshir;Talaat, Iman M;Talukder, Ashis;Tamuzi, Jacques Lukenze;Tan, Ker-Kan;Tang, Haosu;Tang, 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2024-01-01
Abstract
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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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11697/229899
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