Divergent trends in adult and elderly mortality for 21 regions and 187 countries, by sex, from 1970 to 2010: a systematic analysis

• Published in: The Lancet (British edition) 2013-06, Vol.381 (S2), p.S131-S131
• Main Authors: Schumacher, Austin E, BS, Wang, Haidong, PhD, Lopez, Alan D, Prof, Murray, Christopher JL, Prof
• Format: Article
• Language: English
• Subjects: alcohols; burden of disease; death; disease outbreaks; elderly; Epidemics; Global health; Internal Medicine; issues and policy; life tables; men; Mortality; probability; Risk factors; Sexually transmitted diseases; STD; violence; women; World Health Organization; World population
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(13)61385-9

Abstract Background Adult mortality, measured as the probability of death from age 15 to 60 years (45q15), is a major global health concern. Elderly mortality, measured as the probability of death from age 60 to 80 years (20q60), is becoming more important with increasing global life expectancies. Divergent trends in adult and elderly mortality expose critical health inequalities. Many estimation techniques exist; exploring different estimates demonstrates robustness of trends. Furthermore, 45q15 is widely used, directly or indirectly, as an entry parameter into model life table systems for estimating age-specific mortality. Understanding trends of adult and elderly mortality has significant implications for estimating mortality and addressing health inequalities worldwide. Methods Using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010, we compare trends in 45q15 and 20q60 from 1970 to 2010 over 21 regions and 187 countries, by sex. We also compare our 45q15 and 20q60 trends with those of the World Health Report by WHO and the World Population Prospect series by the United Nations Population Division. Findings Globally, 45q15 decreased from 1970 to 2010. Countries in sub-Saharan Africa, Oceania, and eastern Europe showed increases for both sexes, whereas high-income countries showed the sharpest decreases. Latin America showed increases for men only, whereas increases for women were less in eastern Europe and varied by country in sub-Saharan Africa. These trends reflect HIV, alcohol, and violence or injury epidemics. Countries with overall increases, except those in Latin America, tended toward more extreme decreases from 2004 to 2010. From 1970 to 2010, 20q60 showed global, continuous declines, as these epidemics do not affect this age range, with key diverging trends by sex among countries. Interpretation Interesting inequalities in adult and elderly mortality exist between regions, countries, and sexes, which must be further studied to be resolved. Precisely estimating divergent adult and elderly mortality trends has important health inequality policy implications and warrants additional analysis. Funding Bill & Melinda Gates Foundation.