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.
Level 4 - case-series / case-control
Level 4 by design analogy (cross-sectional and ecological time-series modeling of aggregate observational and vital registration datasets).
PubMed 38582094 · doi:10.1016/S0140-6736(24)00367-2
What was done
The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 estimated mortality and years of life lost (YLLs) for 288 causes of death across 204 countries and territories and 811 subnational locations from 1990 to 2021. The study synthesized 56,604 data sources—including vital registration, verbal autopsy, censuses, surveys, surveillance systems, and cancer registries. Cause-specific death rates were modeled primarily using the Cause of Death Ensemble model (CODEm) to generate 1,000-draw uncertainty intervals (UIs), decomposing life expectancy changes by cause, location, and year while accounting for COVID-19 and pandemic-related excess mortality.
What was found
From 1990 to 2019, the leading global age-standardized causes of death were ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), and lower respiratory infections. In 2021, COVID-19 became the second-leading cause of death globally at 94.0 deaths (95% UI 89.2–100.0) per 100,000 population, shifting stroke to third and COPD to fourth. Age-standardized COVID-19 death rates in 2021 were highest in sub-Saharan Africa (271.0 [250.1–290.7] per 100,000) and Latin America and the Caribbean (195.4 [182.1–211.4] per 100,000), and lowest in high-income regions (48.1 [47.4–48.8] per 100,000) and Southeast Asia, East Asia, and Oceania (23.2 [16.3–37.2] per 100,000). Between 2019 and 2021, global life expectancy dropped by a net 1.6 years due to pandemic mortality, with regional COVID-19 life expectancy declines ranging from 0.4 years in Southeast Asia, East Asia, and Oceania to 3.6 years in Latin America and the Caribbean.
Why it matters
This study provides the benchmark global assessment of cause-specific mortality trajectories, showing how the COVID-19 pandemic reversed decades of steady gains in life expectancy while highlighting extreme geographic disparities in pandemic impact.
Limits
Findings rely heavily on statistical modeling and imputation in low-resource settings that lack complete vital registration systems, depending instead on verbal autopsy and surveillance data with inherent diagnostic uncertainty. Variations in certification practices and pandemic reporting capacity across regions may affect cause-specific attribution.
Cited by
- supports Cardiovascular disease is the leading cause of death in most developed countries.
- supports People in Japan have a 5-year increased life expectancy compared to people in the United States.