title: Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010.
abstract: BACKGROUND
  Reliable and timely information on the leading causes of death in populations, and how these are changing, is a crucial input into health policy debates. In the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010), we aimed to estimate annual deaths for the world and 21 regions between 1980 and 2010 for 235 causes, with uncertainty intervals (UIs), separately by age and sex.
  
  
  METHODS
  We attempted to identify all available data on causes of death for 187 countries from 1980 to 2010 from vital registration, verbal autopsy, mortality surveillance, censuses, surveys, hospitals, police records, and mortuaries. We assessed data quality for completeness, diagnostic accuracy, missing data, stochastic variations, and probable causes of death. We applied six different modelling strategies to estimate cause-specific mortality trends depending on the strength of the data. For 133 causes and three special aggregates we used the Cause of Death Ensemble model (CODEm) approach, which uses four families of statistical models testing a large set of different models using different permutations of covariates. Model ensembles were developed from these component models. We assessed model performance with rigorous out-of-sample testing of prediction error and the validity of 95% UIs. For 13 causes with low observed numbers of deaths, we developed negative binomial models with plausible covariates. For 27 causes for which death is rare, we modelled the higher level cause in the cause hierarchy of the GBD 2010 and then allocated deaths across component causes proportionately, estimated from all available data in the database. For selected causes (African trypanosomiasis, congenital syphilis, whooping cough, measles, typhoid and parathyroid, leishmaniasis, acute hepatitis E, and HIV/AIDS), we used natural history models based on information on incidence, prevalence, and case-fatality. We separately estimated cause fractions by aetiology for diarrhoea, lower respiratory infections, and meningitis, as well as disaggregations by subcause for chronic kidney disease, maternal disorders, cirrhosis, and liver cancer. For deaths due to collective violence and natural disasters, we used mortality shock regressions. For every cause, we estimated 95% UIs that captured both parameter estimation uncertainty and uncertainty due to model specification where CODEm was used. We constrained cause-specific fractions within every age-sex group to sum to total mortality based on draws from the uncertainty distributions.
  
  
  RESULTS
  In 2010, there were 52·8 million deaths globally. At the most aggregate level, communicable, maternal, neonatal, and nutritional causes were 24·9% of deaths worldwide in 2010, down from 15·9 million (34·1%) of 46·5 million in 1990. This decrease was largely due to decreases in mortality from diarrhoeal disease (from 2·5 to 1·4 million), lower respiratory infections (from 3·4 to 2·8 million), neonatal disorders (from 3·1 to 2·2 million), measles (from 0·63 to 0·13 million), and tetanus (from 0·27 to 0·06 million). Deaths from HIV/AIDS increased from 0·30 million in 1990 to 1·5 million in 2010, reaching a peak of 1·7 million in 2006. Malaria mortality also rose by an estimated 19·9% since 1990 to 1·17 million deaths in 2010. Tuberculosis killed 1·2 million people in 2010. Deaths from non-communicable diseases rose by just under 8 million between 1990 and 2010, accounting for two of every three deaths (34·5 million) worldwide by 2010. 8 million people died from cancer in 2010, 38% more than two decades ago; of these, 1·5 million (19%) were from trachea, bronchus, and lung cancer. Ischaemic heart disease and stroke collectively killed 12·9 million people in 2010, or one in four deaths worldwide, compared with one in five in 1990; 1·3 million deaths were due to diabetes, twice as many as in 1990. The fraction of global deaths due to injuries (5·1 million deaths) was marginally higher in 2010 (9·6%) compared with two decades earlier (8·8%). This was driven by a 46% rise in deaths worldwide due to road traffic accidents (1·3 million in 2010) and a rise in deaths from falls. Ischaemic heart disease, stroke, chronic obstructive pulmonary disease (COPD), lower respiratory infections, lung cancer, and HIV/AIDS were the leading causes of death in 2010. Ischaemic heart disease, lower respiratory infections, stroke, diarrhoeal disease, malaria, and HIV/AIDS were the leading causes of years of life lost due to premature mortality (YLLs) in 2010, similar to what was estimated for 1990, except for HIV/AIDS and preterm birth complications. YLLs from lower respiratory infections and diarrhoea decreased by 45-54% since 1990; ischaemic heart disease and stroke YLLs increased by 17-28%. Regional variations in leading causes of death were substantial. Communicable, maternal, neonatal, and nutritional causes still accounted for 76% of premature mortality in sub-Saharan Africa in 2010. Age standardised death rates from some key disorders rose (HIV/AIDS, Alzheimer's disease, diabetes mellitus, and chronic kidney disease in particular), but for most diseases, death rates fell in the past two decades; including major vascular diseases, COPD, most forms of cancer, liver cirrhosis, and maternal disorders. For other conditions, notably malaria, prostate cancer, and injuries, little change was noted.
  
  
  CONCLUSIONS
  Population growth, increased average age of the world's population, and largely decreasing age-specific, sex-specific, and cause-specific death rates combine to drive a broad shift from communicable, maternal, neonatal, and nutritional causes towards non-communicable diseases. Nevertheless, communicable, maternal, neonatal, and nutritional causes remain the dominant causes of YLLs in sub-Saharan Africa. Overlaid on this general pattern of the epidemiological transition, marked regional variation exists in many causes, such as interpersonal violence, suicide, liver cancer, diabetes, cirrhosis, Chagas disease, African trypanosomiasis, melanoma, and others. Regional heterogeneity highlights the importance of sound epidemiological assessments of the causes of death on a regular basis.
  
  
  BACKGROUND
  Bill & Melinda Gates Foundation.
authors.affiliation: Institute for Health Metrics and Evaluation, Seattle, WA, USA.
authors.forename: Rafael
authors.initials: R
authors.lastname: Lozano
authors.forename: Mohsen
authors.initials: M
authors.lastname: Naghavi
authors.forename: Kyle
authors.initials: K
authors.lastname: Foreman
authors.forename: Stephen
authors.initials: S
authors.lastname: Lim
authors.forename: Kenji
authors.initials: K
authors.lastname: Shibuya
authors.forename: Victor
authors.initials: V
authors.lastname: Aboyans
authors.forename: Jerry
authors.initials: J
authors.lastname: Abraham
authors.forename: Timothy
authors.initials: T
authors.lastname: Adair
authors.forename: Rakesh
authors.initials: R
authors.lastname: Aggarwal
authors.forename: Stephanie Y
authors.initials: SY
authors.lastname: Ahn
authors.forename: Miriam
authors.initials: M
authors.lastname: Alvarado
authors.forename: H Ross
authors.initials: HR
authors.lastname: Anderson
authors.forename: Laurie M
authors.initials: LM
authors.lastname: Anderson
authors.forename: Kathryn G
authors.initials: KG
authors.lastname: Andrews
authors.forename: Charles
authors.initials: C
authors.lastname: Atkinson
authors.forename: Larry M
authors.initials: LM
authors.lastname: Baddour
authors.forename: Suzanne
authors.initials: S
authors.lastname: Barker-Collo
authors.forename: David H
authors.initials: DH
authors.lastname: Bartels
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Bell
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
authors.forename: Derrick
authors.initials: D
authors.lastname: Bennett
authors.forename: Kavi
authors.initials: K
authors.lastname: Bhalla
authors.forename: Boris
authors.initials: B
authors.lastname: Bikbov
authors.forename: Aref
authors.initials: A
authors.lastname: Bin Abdulhak
authors.forename: Gretchen
authors.initials: G
authors.lastname: Birbeck
authors.forename: Fiona
authors.initials: F
authors.lastname: Blyth
authors.forename: Ian
authors.initials: I
authors.lastname: Bolliger
authors.forename: Soufiane
authors.initials: S
authors.lastname: Boufous
authors.forename: Chiara
authors.initials: C
authors.lastname: Bucello
authors.forename: Michael
authors.initials: M
authors.lastname: Burch
authors.forename: Peter
authors.initials: P
authors.lastname: Burney
authors.forename: Jonathan
authors.initials: J
authors.lastname: Carapetis
authors.forename: Honglei
authors.initials: H
authors.lastname: Chen
authors.forename: David
authors.initials: D
authors.lastname: Chou
authors.forename: Sumeet S
authors.initials: SS
authors.lastname: Chugh
authors.forename: Luc E
authors.initials: LE
authors.lastname: Coffeng
authors.forename: Steven D
authors.initials: SD
authors.lastname: Colan
authors.forename: Samantha
authors.initials: S
authors.lastname: Colquhoun
authors.forename: K Ellicott
authors.initials: KE
authors.lastname: Colson
authors.forename: John
authors.initials: J
authors.lastname: Condon
authors.forename: Myles D
authors.initials: MD
authors.lastname: Connor
authors.forename: Leslie T
authors.initials: LT
authors.lastname: Cooper
authors.forename: Matthew
authors.initials: M
authors.lastname: Corriere
authors.forename: Monica
authors.initials: M
authors.lastname: Cortinovis
authors.forename: Karen Courville
authors.initials: KC
authors.lastname: de Vaccaro
authors.forename: William
authors.initials: W
authors.lastname: Couser
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Cowie
authors.forename: Michael H
authors.initials: MH
authors.lastname: Criqui
authors.forename: Marita
authors.initials: M
authors.lastname: Cross
authors.forename: Kaustubh C
authors.initials: KC
authors.lastname: Dabhadkar
authors.forename: Nabila
authors.initials: N
authors.lastname: Dahodwala
authors.forename: Diego
authors.initials: D
authors.lastname: De Leo
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.forename: Allyne
authors.initials: A
authors.lastname: Delossantos
authors.forename: Julie
authors.initials: J
authors.lastname: Denenberg
authors.forename: Don C
authors.initials: DC
authors.lastname: Des Jarlais
authors.forename: Samath D
authors.initials: SD
authors.lastname: Dharmaratne
authors.forename: E Ray
authors.initials: ER
authors.lastname: Dorsey
authors.forename: Tim
authors.initials: T
authors.lastname: Driscoll
authors.forename: Herbert
authors.initials: H
authors.lastname: Duber
authors.forename: Beth
authors.initials: B
authors.lastname: Ebel
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.forename: Patricia
authors.initials: P
authors.lastname: Espindola
authors.forename: Majid
authors.initials: M
authors.lastname: Ezzati
authors.forename: Valery
authors.initials: V
authors.lastname: Feigin
authors.forename: Abraham D
authors.initials: AD
authors.lastname: Flaxman
authors.forename: Mohammad H
authors.initials: MH
authors.lastname: Forouzanfar
authors.forename: Francis Gerry R
authors.initials: FG
authors.lastname: Fowkes
authors.forename: Richard
authors.initials: R
authors.lastname: Franklin
authors.forename: Marlene
authors.initials: M
authors.lastname: Fransen
authors.forename: Michael K
authors.initials: MK
authors.lastname: Freeman
authors.forename: Sherine E
authors.initials: SE
authors.lastname: Gabriel
authors.forename: Emmanuela
authors.initials: E
authors.lastname: Gakidou
authors.forename: Flavio
authors.initials: F
authors.lastname: Gaspari
authors.forename: Richard F
authors.initials: RF
authors.lastname: Gillum
authors.forename: Diego
authors.initials: D
authors.lastname: Gonzalez-Medina
authors.forename: Yara A
authors.initials: YA
authors.lastname: Halasa
authors.forename: Diana
authors.initials: D
authors.lastname: Haring
authors.forename: James E
authors.initials: JE
authors.lastname: Harrison
authors.forename: Rasmus
authors.initials: R
authors.lastname: Havmoeller
authors.forename: Roderick J
authors.initials: RJ
authors.lastname: Hay
authors.forename: Bruno
authors.initials: B
authors.lastname: Hoen
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Hotez
authors.forename: Damian
authors.initials: D
authors.lastname: Hoy
authors.forename: Kathryn H
authors.initials: KH
authors.lastname: Jacobsen
authors.forename: Spencer L
authors.initials: SL
authors.lastname: James
authors.forename: Rashmi
authors.initials: R
authors.lastname: Jasrasaria
authors.forename: Sudha
authors.initials: S
authors.lastname: Jayaraman
authors.forename: Nicole
authors.initials: N
authors.lastname: Johns
authors.forename: Ganesan
authors.initials: G
authors.lastname: Karthikeyan
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kassebaum
authors.forename: Andre
authors.initials: A
authors.lastname: Keren
authors.forename: Jon-Paul
authors.initials: JP
authors.lastname: Khoo
authors.forename: Lisa Marie
authors.initials: LM
authors.lastname: Knowlton
authors.forename: Olive
authors.initials: O
authors.lastname: Kobusingye
authors.forename: Adofo
authors.initials: A
authors.lastname: Koranteng
authors.forename: Rita
authors.initials: R
authors.lastname: Krishnamurthi
authors.forename: Michael
authors.initials: M
authors.lastname: Lipnick
authors.forename: Steven E
authors.initials: SE
authors.lastname: Lipshultz
authors.forename: Summer Lockett
authors.initials: SL
authors.lastname: Ohno
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Mabweijano
authors.forename: Michael F
authors.initials: MF
authors.lastname: MacIntyre
authors.forename: Leslie
authors.initials: L
authors.lastname: Mallinger
authors.forename: Lyn
authors.initials: L
authors.lastname: March
authors.forename: Guy B
authors.initials: GB
authors.lastname: Marks
authors.forename: Robin
authors.initials: R
authors.lastname: Marks
authors.forename: Akira
authors.initials: A
authors.lastname: Matsumori
authors.forename: Richard
authors.initials: R
authors.lastname: Matzopoulos
authors.forename: Bongani M
authors.initials: BM
authors.lastname: Mayosi
authors.forename: John H
authors.initials: JH
authors.lastname: McAnulty
authors.forename: Mary M
authors.initials: MM
authors.lastname: McDermott
authors.forename: John
authors.initials: J
authors.lastname: McGrath
authors.forename: George A
authors.initials: GA
authors.lastname: Mensah
authors.forename: Tony R
authors.initials: TR
authors.lastname: Merriman
authors.forename: Catherine
authors.initials: C
authors.lastname: Michaud
authors.forename: Matthew
authors.initials: M
authors.lastname: Miller
authors.forename: Ted R
authors.initials: TR
authors.lastname: Miller
authors.forename: Charles
authors.initials: C
authors.lastname: Mock
authors.forename: Ana Olga
authors.initials: AO
authors.lastname: Mocumbi
authors.forename: Ali A
authors.initials: AA
authors.lastname: Mokdad
authors.forename: Andrew
authors.initials: A
authors.lastname: Moran
authors.forename: Kim
authors.initials: K
authors.lastname: Mulholland
authors.forename: M Nathan
authors.initials: MN
authors.lastname: Nair
authors.forename: Luigi
authors.initials: L
authors.lastname: Naldi
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
authors.forename: Kiumarss
authors.initials: K
authors.lastname: Nasseri
authors.forename: Paul
authors.initials: P
authors.lastname: Norman
authors.forename: Martin
authors.initials: M
authors.lastname: O'Donnell
authors.forename: Saad B
authors.initials: SB
authors.lastname: Omer
authors.forename: Katrina
authors.initials: K
authors.lastname: Ortblad
authors.forename: Richard
authors.initials: R
authors.lastname: Osborne
authors.forename: Doruk
authors.initials: D
authors.lastname: Ozgediz
authors.forename: Bishnu
authors.initials: B
authors.lastname: Pahari
authors.forename: Jeyaraj Durai
authors.initials: JD
authors.lastname: Pandian
authors.forename: Andrea Panozo
authors.initials: AP
authors.lastname: Rivero
authors.forename: Rogelio Perez
authors.initials: RP
authors.lastname: Padilla
authors.forename: Fernando
authors.initials: F
authors.lastname: Perez-Ruiz
authors.forename: Norberto
authors.initials: N
authors.lastname: Perico
authors.forename: David
authors.initials: D
authors.lastname: Phillips
authors.forename: Kelsey
authors.initials: K
authors.lastname: Pierce
authors.forename: C Arden
authors.initials: CA
authors.lastname: Pope
authors.forename: Esteban
authors.initials: E
authors.lastname: Porrini
authors.forename: Farshad
authors.initials: F
authors.lastname: Pourmalek
authors.forename: Murugesan
authors.initials: M
authors.lastname: Raju
authors.forename: Dharani
authors.initials: D
authors.lastname: Ranganathan
authors.forename: Jürgen T
authors.initials: JT
authors.lastname: Rehm
authors.forename: David B
authors.initials: DB
authors.lastname: Rein
authors.forename: Guiseppe
authors.initials: G
authors.lastname: Remuzzi
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
authors.forename: Thomas
authors.initials: T
authors.lastname: Roberts
authors.forename: Felipe Rodriguez
authors.initials: FR
authors.lastname: De León
authors.forename: Lisa C
authors.initials: LC
authors.lastname: Rosenfeld
authors.forename: Lesley
authors.initials: L
authors.lastname: Rushton
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Salomon
authors.forename: Uchechukwu
authors.initials: U
authors.lastname: Sampson
authors.forename: Ella
authors.initials: E
authors.lastname: Sanman
authors.forename: David C
authors.initials: DC
authors.lastname: Schwebel
authors.forename: Maria
authors.initials: M
authors.lastname: Segui-Gomez
authors.forename: Donald S
authors.initials: DS
authors.lastname: Shepard
authors.forename: David
authors.initials: D
authors.lastname: Singh
authors.forename: Jessica
authors.initials: J
authors.lastname: Singleton
authors.forename: Karen
authors.initials: K
authors.lastname: Sliwa
authors.forename: Emma
authors.initials: E
authors.lastname: Smith
authors.forename: Andrew
authors.initials: A
authors.lastname: Steer
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Taylor
authors.forename: Bernadette
authors.initials: B
authors.lastname: Thomas
authors.forename: Imad M
authors.initials: IM
authors.lastname: Tleyjeh
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Towbin
authors.forename: Thomas
authors.initials: T
authors.lastname: Truelsen
authors.forename: Eduardo A
authors.initials: EA
authors.lastname: Undurraga
authors.forename: N
authors.initials: N
authors.lastname: Venketasubramanian
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Vijayakumar
authors.forename: Theo
authors.initials: T
authors.lastname: Vos
authors.forename: Gregory R
authors.initials: GR
authors.lastname: Wagner
authors.forename: Mengru
authors.initials: M
authors.lastname: Wang
authors.forename: Wenzhi
authors.initials: W
authors.lastname: Wang
authors.forename: Kerrianne
authors.initials: K
authors.lastname: Watt
authors.forename: Martin A
authors.initials: MA
authors.lastname: Weinstock
authors.forename: Robert
authors.initials: R
authors.lastname: Weintraub
authors.forename: James D
authors.initials: JD
authors.lastname: Wilkinson
authors.forename: Anthony D
authors.initials: AD
authors.lastname: Woolf
authors.forename: Sarah
authors.initials: S
authors.lastname: Wulf
authors.forename: Pon-Hsiu
authors.initials: PH
authors.lastname: Yeh
authors.forename: Paul
authors.initials: P
authors.lastname: Yip
authors.forename: Azadeh
authors.initials: A
authors.lastname: Zabetian
authors.forename: Zhi-Jie
authors.initials: ZJ
authors.lastname: Zheng
authors.forename: Alan D
authors.initials: AD
authors.lastname: Lopez
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Murray
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: AlMazroa
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Memish
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends*; D002648:Child; D002675:Child, Preschool; D005260:Female; D014943:Global Health / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D012737:Sex Factors; D055815:Young Adult