Pi Is 014067361261719 X

Articles
Age-specic and sex-specic mortality in 187 countries,

19702010: a systematic analysis for the Global Burden of
Disease Study 2010
Haidong Wang*, Laura Dwyer-Lindgren, Katherine T Lofgren, Julie Knoll Rajaratnam, Jacob R Marcus, Alison Levin-Rector, Carly E Levitz, Alan D Lopez, Christopher J L Murray
Summary
Background Estimation of the number and rate of deaths by age and sex is a key rst stage for calculation of the
burden of disease in order to constrain estimates of cause-specic mortality and to measure premature mortality in
populations. We aimed to estimate life tables and annual numbers of deaths for 187 countries from 1970 to 2010.
Methods We estimated trends in under-5 mortality rate (children aged 04 years) and probability of adult death
(1559 years) for each country with all available data. Death registration data were available for more than 100 countries
and we corrected for undercount with improved death distribution methods. We applied rened methods to survey
data on sibling survival that correct for survivor, zero-sibling, and recall bias. We separately estimated mortality from
natural disasters and wars. We generated nal estimates of under-5 mortality and adult mortality from the data with
Gaussian process regression. We used these results as input parameters in a relational model life table system. We
developed a model to extrapolate mortality to 110 years of age. All death rates and numbers have been estimated with
95% uncertainty intervals (95% UIs).
Findings From 1970 to 2010, global male life expectancy at birth increased from 564 years (95% UI 555572) to
675 years (669681) and global female life expectancy at birth increased from 612 years (602620) to 733 years
(728738). Life expectancy at birth rose by 34 years every decade from 1970, apart from during the 1990s (increase
in male life expectancy of 14 years and in female life expectancy of 16 years). Substantial reductions in mortality
occurred in eastern and southern sub-Saharan Africa since 2004, coinciding with increased coverage of antiretroviral
therapy and preventive measures against malaria. Sex-specic changes in life expectancy from 1970 to 2010 ranged
from gains of 2329 years in the Maldives and Bhutan to declines of 17 years in Belarus, Lesotho, Ukraine, and
Zimbabwe. Globally, 528 million (95% UI 516541 million) deaths occurred in 2010, which is about 135% more
than occurred in 1990 (465 million [457474 million]), and 219% more than occurred in 1970 (433 million
[422446 million]). Proportionally more deaths in 2010 occurred at age 70 years and older (428% in 2010 vs 331%
in 1990), and 229% occurred at 80 years or older. Deaths in children younger than 5 years declined by almost 60%
since 1970 (164 million [161167 million] in 1970 vs 68 million [6671 million] in 2010), especially at
ages 159 months (108 million [104111 million] in 1970 vs 40 million [3842 million] in 2010). In all regions,
including those most aected by HIV/AIDS, we noted increases in mean ages at death.
Lancet 2012; 380: 207194

See Comment pages 2053, 2054,
2055, 2058, 2060, 2062,
and 2063
See Special Report page 2067
See Articles pages 2095, 2129,
2144, 2163, 2197, and 2224
*Corresponding author
See Online for appendix
Institute for Health Metrics
and Evaluation, University of
Washington, Seattle, WA, USA
(H Wang PhD,
L Dwyer-Lindgren MPH,
K T Lofgren BA,
J K Rajaratnam PhD,
J R Marcus MPH,
A Levin-Rector MPH,
C E Levitz BA,
Prof C J L Murray MD); and
University of Queensland
School of Population Health,
Brisbane, QLD, Australia
(Prof A D Lopez PhD)
Correspondence to:
Haidong Wang, Institute for
Health Metrics and Evaluation,
University of Washington,
Seattle, WA 98121, USA
haidong@uw.edu
Interpretation Despite global and regional health crises, global life expectancy has increased continuously and
substantially in the past 40 years. Yet substantial heterogeneity exists across age groups, among countries, and over
dierent decades. 179 of 187 countries have had increases in life expectancy after the slowdown in progress in the
1990s. Eorts should be directed to reduce mortality in low-income and middle-income countries. Potential underestimation of achievement of the Millennium Development Goal 4 might result from limitations of demographic data
on child mortality for the most recent time period. Improvement of civil registration system worldwide is crucial for
better tracking of global mortality.
Funding Bill & Melinda Gates Foundation.
Introduction
Accurate estimation of the number of deaths in each age
and sex group in a country, region, or worldwide is a
crucial starting point for assessment of the global burden
of disease. Information about rates of mortality at dierent
ages, especially what might reasonably be regarded as
premature mortality, is an important impetus for public
policy action, especially when the causes of premature
mortality can be reliably established. Years of life lost
(YLLs) due to premature mortality made up nearly
www.thelancet.com Vol 380 December 15/22/29, 2012
two-thirds of the global burden of disease in 2010.1 Levels

of mortality have been changing strikingly in the past
40 years and substantial progress has been made in
reduction of the number of deaths in children younger
than 5 years, postponing deaths to progressively older
ages.2,3 However, the number of young adult deaths has
increased in the past 20 years, especially in eastern Europe
because of epidemics of mortality related to alcohol
overconsumption and in eastern and southern sub-Saharan
Africa because of HIV/AIDS.1,415 A careful assessment of
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See Online for appendix
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the demographic evidence on the levels of age-specic

mortality is an integral component of any Global Burden
of Disease Study: such analyses require the sum of deaths
from specic causes to equal the independently assessed
level of mortality from all causes, for every age and sex
group. Such assessment is not a straightforward addition
of reported causes. Because there are likely to be many
more data reported for levels of all-cause mortality than
there are for individual causes, the independent
assessment of age-specic mortality is crucial to constrain
the often less robust estimates of cause-specic mortality
within each population group dened by age and sex.
Accurate measurement of age-specic mortality,
however, is severely constrained by the fact that most
developing countries have incomplete or no vital registration systems. Estimation of mortality rates requires
application of a suite of demographic estimation
methods that have been developed and rened during
the past 60 years. For the Global Burden of Disease
2000 analysis,16 assessment of age-specic mortality was
improved in two important ways compared with the
Global Burden of Disease 1990 analysis.17 First, estimates
for 2000 of under-5 mortality, measured as the probability of death between 0 years and 5 years of age (5q0),
and mortality as a young adult or middle-aged adult,
measured as the probability of death between 15 years
and 60 years of age (45q15), were developed after review of
available vital registration, sample registration, and
census data and the application of the synthetic extinct
generations and growth balance methods to correct for
under-registration of deaths.1823 When no vital registration, census, or sample registration data were available, adult mortality was predicted on the basis of the
rate of under-5 mortality. Second, a model life table
system was developed by Murray and colleagues to
generate age-specic death rates from estimates of
under-5 mortality and 45q15.24 This analysis yielded life
tables for 191 countries in 2000.25 Age-specic death
rates from HIV/AIDS were separately estimated and
added to the model-based estimates from this second
stage, allowing for competing risks. The Global Burden
of Disease 2000 mortality methods have continued to be
applied by the WHO in their annual updates of mortality
published in successive World Health Reports of 5q0 and
26,27
An increasing body of evidence suggests a
45q15.
substantial divergence in the key determinants of trends
in under-5 mortality and adult mortality;2833 therefore,
the continued reliance on information about child
mortality to predict adult mortality in a large number of
countries is inadvisable.
The United Nations Population Division (UNPD)
has generated demographic estimates since 1951 and
produces biennial assessments of population, mortality,
and fertility for every country from 1950 to 2050.34
Compared with WHO, the UNPD uses a broader array of
data sources such as survey or census data for
orphanhood, widowhood, and sibling survival data in
selected countries. Another advantage of the UNPD

estimates is that they assess a full time series of mortality
and other demographic parameters for every country in
each 2 year cycle of revision, compared with WHO
analyses that look at serial cross-sectional data for
mortality. The UNPD estimation strategy places great
emphasis on the demographic balance equation, in
which population in an age group must equal new
entrants to the age group minus deaths plus net
migration (the addition of immigration, minus emigration) and exits due to ageing out of a given age group.
UNPD mortality estimates are, in eect, a byproduct of
the primary task of estimating population by age and
sex.34 Despite these advantages, the UNPD and WHO
approaches have limitations. For example, neither
approach produces uncertainty intervals (UIs) for their
estimates of age-specic mortality, despite the very
substantial uncertainty in the underlying data used to
produce them and uncertainty from model specication.
Moreover in countries with large HIV epidemics, both
approaches assume that the Joint United Nations
Programme on HIV/AIDS (UNAIDS) estimates of
deaths due to HIV are additive to hypothetical HIV-free
life tables. As a result, demographic sources such as vital
registration, censuses, or surveys are not used to validate
estimates of age-specic death rates in countries with
moderate-to-large HIV epidemics.
As a key rst step in the Global Burden of Diseases,
Injuries, and Risk Factors Study 2010 (hereafter referred
to as Global Burden of Disease Study 2010), we
reassessed levels and trends of age-specic mortality
worldwide. Improved methods for estimation of
completeness of vital registration,35 analysis of sibling
history data,36 and synthesis of data with UIs3,4,37 provide
the basis for robust estimation of age-specic death
rates. We used these advances, and a further extension
of the Brass relational model life tables, to develop a
time series of annual age-specic mortality rates for
187 countries from 1970 to 2010, including uncertainty.
In this report and accompanying appendix, we present
the data, methods, and key ndings of the Global Burden
of Disease Study 2010 on levels, trends, and age patterns
of mortality worldwide.
Methods
Overview
Because vital registration systems in most developing
countries are incomplete, measurement of child and
adult mortality requires use of multiple sources of
data and the application of appropriate methods. Our
approach to mortality estimation can be divided into
three components: estimation of under-5 mortality,
estimation of adult mortality, and estimation of agespecic mortality. Figure 1 provides a high-level summary of the mortality estimation process, including
dierent data sources and analyses that are incorporated
in these three steps and how they interrelate. The rst
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Child mortality
Complete birth
history
Survey
data
Summary birth
history
Raw 5q0
(by country, year)
Vital registration
Sample registration
Data synthesis
Adult mortality
Vital
registration
Sample
registration
Survey data
Spatial-temporal regression
Age and sex model
Gaussian process regression
Shock model
DDM
adjustment
Raw 45q15
(by country, sex, and year)
Sibling
history
Estimates of child and adult mortality

5q0 and 45q15 (non-shock and shock):
by country and sex from 1970 to 2010
New model life table system
Mortality envelope
Deaths by country, year, sex, and age
19702010
Figure 1: Mortality estimation process for the Global Burden of Diseases, Injuries, and Risk Factors 2010 Study
5q0=probability of death from birth to age 5 years. 45q15=probability of death from age 15 years to 60 years. DDM=suite of demographic methods used to assess the
completeness of a vital registration system.
two steps can be subdivided into the identication of data

sources, processing of data to yield estimates of under-5
mortality or adult mortality taking into account various
types of biases in the data, and data synthesis. The third
step uses estimates of 5q0, 45q15, and a model life table
system to generate age-specic mortality rates and
numbers of deaths for 187 countries, for each of 24 age
groups, and two sexes, for every year from 1970 to 2010.
In each of these three steps, we quantify the uncertainty
due to sampling error, known non-sampling error,
missing data, and model parameters.
Estimation of 5q0
We applied the methods previously described by Lozano
and colleagues2 and Rajaratnam and colleagues.3 These
eorts incorporated advances in the analysis of summary
birth histories that reduced the error from this data
source.38 We updated the database with recently released
surveys, censuses, sample registration data, and vital
registration data; appendix p 33 summarises the present
dataset and the changes from that used by Lozano
and colleagues2 for their estimation of child mortality
worldwide. Appendix pp 70257 provide plots of the data

for every country and estimates of 5q0 with 95% UIs. For
the data synthesis step, we have modied how we
estimate the prior mean function used in the Gaussian
process regression (GPR) so that it is exactly analogous
to how it is developed for 45q15 (appendix pp 913).
Improving on the method used by Lozano and
colleagues,2 we selected the GPR parameters scale and
amplitude through out-of-sample predictive validity
testing. We modied this analysis to place more
emphasis on the validity of the 95% UIs. One important
output from GPR is an estimate of both the expected
value of 5q0 and 95% uncertainty in 5q0. The uncertainty
estimate captures both uncertainty in the prior mean
function and the data variance from each observation.
Data variance is a function of both sampling error and
known non-sampling error. Appendix pp 70257 show
how the 95% UIs around the estimates of 5q0 generated
by GPR widen over long intervals with no observations
and tend to narrow when there are more abundant and
more consistent data available. We have also updated the
age and sex model used to estimate sex-specic mortality
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for early neonatal, late neonatal, postneonatal, and

14-year-old mortality by adding new data.2
Estimation of 45q15
We applied methods used by Rajaratnam and colleagues4 to assess levels and trends in 45q15 by country.
That study took advantage of improved death-distribution methods to assess the completeness of vital
registration, sample registration, and recall of household deaths in surveys or censuses.35 As a result of
debate in the demographic literature,36,3945 the sibling
history corrections to deal with survivor bias (which
refers to the under-representation of high mortality
sibships in the population), zero-surviving sibship
(which comes from the mortality experience of families
not represented because none of the siblings were alive
and eligible to respond to the survey), and recall bias
(which refers to the downward bias where survey
respondents fail to report the death of certain siblings)
have been improved (appendix pp 45). We rened the
overall assessment of trends in completeness of vital
registration and sample vital registration by use of
multiple period estimates of completeness from the
optimised synthetic extinct generations, generalised
growth balance, and the combined method, to better
account for uncertainty (appendix pp 45). We removed
the formal assumption that child death registration is
always more complete than adult death registration,
although this often remains the case.46,47 Importantly,
mortality shocks due to wars and natural disasters have
been updated to reect recent data from the Armed
Conict Database from the International Institute for
Strategic Studies (19972011), Uppsala Conict Data
Program/PRIO Armed Conict Dataset (19462012),
and the International Disaster Database (Centre
for Research on the Epidemiology of Disasters;
19502012).4850 In the data synthesis step, the covariates
used in the GPR mean function have been modied to
be lagged distributed income (a lagged version of gross
domestic product, on a logarithmic scale), populationweighted average years of education in ages 1559 years
by sex, and estimated crude death rates from HIV/AIDS
by sex for ages 1559 years.51,52 The predicted crude
death rate from HIV/AIDS was provided by UNAIDS
and was based on their 2012 assessment. These
covariates are used in the prediction model that
generates GPR mean functions together with country
random eects. The GPR yields a complete distribution
of 45q15 for every year. We took 1000 samples from this
distribution and computed the 95% UI for 45q15 from
this sampled distribution.
New relational model life table system

Estimates of 5q0 and 45q15, each with 95% UIs, can be used
to generate a full set of age-specic death rates with a
model life table system. We have developed such a model
life table system with exible standards (MLTFS), which
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is an extension of the modied logit life table system

(MLLT) but designed to deal with two of its key
limitations (appendix pp 1424).24 First, the MLLT did not
provide valid estimates of age-specic mortality in
settings with very high 45q15 attributable to HIV. The
MLLT overestimates mortality at older ages and underestimates it at younger ages compared with reported
data. Second, the MLLT, when applied to a time series of
5q0 and 45q15 can generate paradoxical trends in agespecic death rates in some age groups. For example,
when both 5q0 and 45q15 are decreasing, the MLLT can yield
implausible increases in some age-specic death rates.
Out-of-sample predictive validity testing shows that the
performance of MLTFS is better than MLLT in prediction
of age-specic mortality rates even in populations
aected by HIV/AIDS.
In all relational model life table systems, the choice of
the standard age pattern of mortality has an important
inuence on the results. The MLTFS is designed to use
dierent standards, dependent on how much is known
about the age pattern of mortality in a specic country
from reliable sources. 95% UIs in age-specic death
rates from this analysis capture four sources of
uncertainty: uncertainty in estimates of 5q0, uncertainty
in estimates of 45q15, uncertainty in the choice of the
standard, and uncertainty in model coecients as
suggested by King and colleagues (appendix p 22).37
Another advantage of the MLTFS is that it yields
improved estimates of age-specic mortality for the
oldest age groups. As survivorship improves with time,
the proportion of deaths that occurs in the oldest age
groups (ie, individuals aged 80 years) increases. We
have developed a new approach to extrapolate agespecic mortality at ages 7579 years and 8084 years to
every 5 year age group up to age 110 years or older
(appendix p 21). This model has notable advantages over
the most commonly used Gompertz model53 and other
variants of it in terms of out-of-sample predictive
validity.
Estimation of numbers of deaths

To estimate the number of age-specic deaths by sex,
year, and country, we applied two separate processes to
age groups 04 years and 5 years and older. For the
04 year age group, we divided each 1 year birth cohort
into 52 birth week cohorts and follow them through to
age 5 years. For each birth-week cohort, depending on
the start and end time of membership in each age group,
we apply our mortality rate (ie, probability of death) estimates from potentially dierent years. For example, if a
person were born in November of year 1 and survived at
least 2 months, we regarded them as exposed to the
under-1 mortality rate in both year 1 and year 2. Details of
this method are provided elsewhere.2 For age groups
59 years and older, we used estimated age-specic
mortality rates and population estimates to generate
numbers of deaths. We took birth and population
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estimates from the most recent World Population Prospects (WPP) 2010 revision, Human Mortality Database,
and WHO mortality database.34,54,55
We provide estimates for 187 countries that had a
population of more than 50 000 individuals in 2000. To
take into account smaller populations within a region, we
scale regional results by the ratio of the total estimated
regional population divided by the population living in
countries for which we provide estimates.
Country-specic values of 5q0 and 45q15 measurements
are available from the authors on request as are the
model life table standards for each country.
Role of the funding source

The sponsor of the study had no role in study design,
data collection, data analysis, data interpretation, or
writing of the report. The corresponding author had full
access to all the data in the study and had nal
responsibility for the decision to submit for publication.
Results
Table 1 shows how global life expectancy changed in the
past 40 years. From 1970 to 2010, male life expectancy at
birth increased by 111 years and female life expectancy
at birth increased by 121 years. The greater increase in
female life expectancy widened the gap between the
sexes from 48 years in 1970 to 57 years in 2010. Global
life expectancy increased about 34 years per decade for
both sexes in every decade apart from the 1990s, when
smaller improvements were recorded (14 years for male
life expectancy and 16 years for female life expectancy),
largely because of the eect of HIV/AIDS in some
regions and deaths related to alcohol in eastern Europe
and central Asia,515 coupled with a slowdown in survival
gains in childhood.5658 Appendix pp 5556 provide
another way to visualise the change in the global life
table by plotting global survivorship function by age over
time and comparing this change with the survivorship
function for the country with the lowest and highest life
Male life expectancy
Female life expectancy
1970
1980
1970
1980
0 years
564
(555572)
598
628
(592602) (623633)
642
675
(636646) (669681)
612
(602620)
649
681
698
(643654) (676686) (693702)
733
(728738)
1 year
629
(619637)
650
666
(644654) (661671)
672
695
(666676) (688700)
667
(657676)
693
714
(688698) (709718)
724
(719728)
749
(744754)
5 years
610
627
(599619) (621632)
640
644
664
(635645) (638648) (657669)
648
(638657)
671
687
696
(665676) (682692) (691700)
718
(713723)
10 years
566
(555575)
594
597
(589599) (591602)
616
(610622)
604
(593613)
625
(620631)
641
649
670
(636646) (644653) (666675)
15 years
534
546
520
(509528) (528540) (541551)
549
568
(544554) (562574)
557
(547566)
578
(573583)
594
601
622
(589598) (596605) (617627)
20 years
474
489
500
503
522
(464483) (483494) (495505) (499508) (515527)
512
(502520)
532
(527537)
547
(543552)
554
(550558)
575
(571580)
25 years
431
(421439)
468
(459475)
487
502
(482492) (497506)
509
(505513)
529
(525533)
30 years
387
400
411
416
(378394) (394404) (406415) (411419)
433
(427438)
424
(416431)
441
(437446)
456
(451460)
465
484
(461468) (479488)
35 years
343
(335351)
355
(350360)
367
(362371)
372
389
(368376) (383394)
381
(373387)
396
(392401)
410
420
(406414) (416423)
438
(434442)
40 years
301
312
(293308) (307316)
323
(319327)
330
(326333)
345
(340350)
338
(331344)
353
(349357)
366
(362369)
375
(372378)
393
(389396)
45 years
260
(253266)
270
(266275)
280
288
(276284) (285291)
303
(298307)
296
(289301)
309
(305313)
321
(318325)
331
(328334)
347
(344351)
50 years
221
(215227)
231
(227235)
240
(236243)
248
(245251)
261
(257265)
254
(249259)
267
(264271)
278
(275281)
287
(285290)
303
(300306)
55 years
186
(180190)
194
(190197)
202
(199205)
210
(207212)
222
(219226)
216
(211220)
227
(224230)
237
(234240)
246
(243248)
260
(257263)
60 years
153
(148156)
160
(157163)
167
(165170)
174
(172176)
186
(182188)
178
(174182)
188
(185191)
198
(195200)
206
(204208)
219
(216221)
65 years
123
(120126)
130
(127132)
136
(134138)
143
(141144)
152
(149154)
144
(141147)
153
(151156)
162
(160164)
169
(167171)
180
(178182)
70 years
98
(96100)
102
(101104)
108
(106110)
114
(113115)
121
(119123)
113
(111116)
121
(119123)
129
(127130)
136
(134137)
145
(143147)
75 years
76
(7578)
79
(7881)
84
(8385)
89
(8890)
95
(9396)
87
(8689)
93
(9295)
100
(99101)
106
(105107)
113
(112115)
80 years
58
(5759)
60
(5961)
63
(6364)
68
(6768)
72
(7173)
66
(6566)
70
(6971)
75
(7476)
79
(7980)
85
(8486)
582
(575587)
1990
2000
2010
444
455
459
477
(438449) (451460) (455463) (471482)
1990
2000
2010
Table 1: Global life expectancy in years (95% uncertainty interval) by sex, year, and age, 19702010
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expectancies for each sex. Substantial improvement in

survival for children younger than 5 years is evident but
so also is the shift in the survivorship functions, such
that an increasing fraction of a birth cohort is progressively surviving to older than 7080 years. The
continued survival advantage of female individuals
compared with male individuals is also evident. Globally,
50% of boys born in 1970 could expect to survive to
65 years compared with 70 years for girls, whereas 50%
of boys born in 2010 would be expected to survive to
73 years compared with 79 years for girls. Table 1 provides
additional details on life expectancies at dierent ages,
and at birth, conrming that all ages have had important
gains in life expectancy in the past 40 years, including at
the oldest ages.
Another way to understand the extent of progress in
reduction of global mortality is to examine the percentage
decline in death rates by age group from 1970 to
2010 (gure 2). At the youngest ages (09 years) for both
sexes, rates of mortality have declined by more than 60%
since 1970. At 1554 years of age, female death rates
generally declined by 4050%. The slightly lower pace of
decline in mortality at 2534 years was probably due to
the rise of HIV/AIDS in these age groups.13,32,59 The
percentage decline in mortality for women aged
5579 years was also smaller than that at other ages,
ranging from 40% to 43%, whereas for age groups older
than 80 years death rates declined by about 25%. The
slower decline in death rates in the eldest population age
group (>80 years) was aected by the rising mean age of
the population in this open-ended age group. Declines in
mortality in men were uniformly lower than for females
in all age groups, with dierences between the sexes
greatest at 1554 years; indeed, global average mortality
rates in men aged 2039 years declined by 197% in
1970 to 2010. Because the eect of HIV/AIDS has been
roughly similar for women and men at the global level,
this reduced pace of progress for young men compared
80
Male mortality
Female mortality
70
Decline (%)
60
50
40
30
20
10
Age group (years)
Figure 2: Decline in global age-specic mortality rate, 19702010
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0
8
9
30
3
4
35
3
9
40
4
4
45
4
9
50
5
4
55
5
9
60
6
4
65
6
9
70
7
4
75
7
9
4
2
1
9
1
4
2
25
20
15
10
<
1 1
4
5
9
with young women probably reects slow progress in

reduction of mortality from injuries that are predominate
in these age-groups. Appendix pp 3435 show, by sex, the
global age-specic mortality rates by decade. Detailed
information about the oldest age group (80 years) is also
included in these two appendix tables.
The progress of nations is often measured in terms
of reduction in mortality rates, summarised by life
expectancy at birth. Table 2 summarises 40 years of
mortality transition in countries, showing life expectancy at birth at the beginning of each decade with
95% UIs for 187 countries and 21 Global Burden of
Disease regions. In 1970, the highest life expectancies
for men (7072 years) were noted in Andorra, Greece,
and northern Europe populations with either very
favourable diets or where smoking had only recently
become widespread. In countries where men had
already been smoking for decades (Australia, New
Zealand, UK, and USA), life expectancy was about
4 years shorter than it was in the regions with longest
estimated life expectancy. Life expectancy values ranged
down to about 3738 years in parts of sub-Saharan Africa
(Angola, Mali, and Sierra Leone). In 1970, male life
expectancy in Japan ranked 11th worldwide at 696 years
(694697). By 1990, male life expectancy in Japan was
the third-highest in the world after Andorra and Kuwait
(table 2), whereas improvements in life expectancy in
Australia, Denmark, New Zealand, UK, and USA were
much smaller, due in a large part to the eect of tobacco.60
More recently, Switzerland and Iceland overtook Japan
in world life expectancy rankings for men, and along
with Sweden, Australia, and Israel, have life expectancies
in excess of 79 years. In 2010, in women, northern
European countries led the global rankings with life
expectancy about 5 years higher than men in the same
region. Life expectancy in Japanese women in 1970 was
just lower than 75 years (table 2). By 1990, Japanese
women had the highest life expectancy of any major
population, which continued to 2010 (table 2). Women in
Andorra, France, Iceland, Spain, and Switzerland also
had life expectancies in excess of 84 years, compared
with 436514 years in Central African Republic, Haiti,
Lesotho, and Swaziland.
Figure 3 shows the change in life expectancy at birth
between 1970 and 2010, by sex. The largest overall gains
since 1970 occurred in the Maldives at 273 years for men
and 294 years for women, or an average of about
07 years per calendar year. Substantial improvements in
life expectancy at birth, in excess of 20 years, were also
recorded in Bangladesh, Bhutan, Iran, and Peru for both
sexes, Guatemala and Oman for female life expectancy,
and Yemen, Bolivia, Cambodia, and Angola for male life
expectancy. Conversely, life expectancy has declined by
17 years in populations severely aected by HIV/AIDS
(eg, for men and women in Zimbabwe and Lesotho) and
the alcohol crisis in eastern Europe (eg, for men in
Ukraine and Belarus).9 Even in high-income countries,
Articles
1970
1980
1990
2000
2010
1970
World
564
(555572)
598
(592602)
628
(623633)
642
(636646)
675
(669681)
High-income Asia Pacic
677
(667686)
715
(713717)
743
(741745)
765
(765766)
Brunei
669
(659679)
706
(695718)
731
(724738)
Japan
696
(694697)
736
(735736)
Singapore
655
(652657)
South Korea
1990
2000
2010
612
649
(602620) (643654)
681
(676686)
698
(693702)
733
(728738)
787
(787788)
732
(724739)
774
(772776)
808
(807810)
833
(832833)
853
(852853)
742
(735748)
755
(743766)
690
(680701)
728
(717739)
760
(753767)
781
(773788)
791
(780803)
760
(760761)
776
(775776)
793
(793794)
749
(747750)
789
(788790)
820
(819820)
841
(840841)
859
(858859)
686
(684688)
728
(726730)
762
(760763)
788
(786790)
720
(717723)
744
(741746)
779
(777781)
804
(802806)
833
(830835)
612
(572653)
641
(633647)
681
725
(675686) (724727)
765
(763767)
672
(635706)
718
(712724)
762
(757765)
797
(796799)
827
(826829)
Central Asia
560
(536584)
599
(590607)
621
(617625)
619
(614624)
646
(634658)
639
(621658)
683
(678690)
703
(699707)
704
(700708)
733
(722742)
Armenia
606
(563652)
653
(636668)
662
(652671)
674
(665683)
689
(672705)
682
(642720)
728
(716741)
742
(734751)
756
(749765)
785
(774796)
Azerbaijan
516
(451576)
594
(573616)
623
(614633)
650
(641660)
689
(676702)
602
(546651)
680
(663700)
710
(701719)
727
(718735)
762
(749774)
Georgia
599
(546647)
642
(626657)
654
683
(644664) (673691)
674
(660687)
689
(645726)
733
(722748)
745
(737753)
773
(765780)
779
(769789)
Kazakhstan
570
(513621)
591
(571609)
611
(601622)
571
(559583)
613
(591633)
663
(623708)
693
(679707)
710
(702718)
688
(677698)
722
(706737)
Kyrgyzstan
539
(489587)
580
(564599)
613
(603622)
615
(605626)
622
(606639)
623
670
(586660) (656683)
695
(687703)
705
(695713)
719
(704732)
Mongolia
531
(507556)
565
(546583)
576
590
(566584) (577602)
603
(586622)
563
(541583)
612
(594631)
636
(622645)
647
(636659)
693
(678708)
Tajikistan
539
(493584)
585
(567602)
609
639
(598620) (629649)
652
(627675)
592
640
(543638) (622655)
666
(655676)
688
(678698)
715
(694736)
Turkmenistan
491
(422555)
559
(535582)
591
(578604)
606
(582630)
654
(607695)
566
638
(508620) (615660)
664
(651676)
687
(666707)
734
(695772)
Uzbekistan
588
(538634)
616
(599633)
640
638
(631649) (628648)
656
(619688)
651
686
(610692) (672698)
705
(696713)
702
(693710)
723
(695753)
East Asia
604
(579628)
648
(629666)
673
684
(659687) (666696)
729
(718740)
635
679
(610662) (659697)
716
(704728)
741
(729750)
789
(780799)
China
604
(579629)
647
(627666)
673
696
(658687) (687705)
729
(718740)
635
678
(609663) (657697)
715
(702727)
749
(741757)
790
(780800)
North Korea
537
(370637)
624
(527684)
664
(605704)
319
(185463)
680
(649707)
578
(427663)
664
(584718)
709
(659743)
446
(291568)
733
(706755)
Taiwan
665
(663667)
691
(690692)
713
(712714)
732
(731733)
759
(758760)
717
(715719)
741
(740743)
766
(765767)
791
(790792)
819
(818820)
South Asia
481
(456506)
534
(520549)
576
(559592)
604
(588619)
634
(614654)
490
550
(460518) (532565)
597
(581614)
633
(617649)
677
(659696)
Afghanistan
402
(369434)
433
(392467)
522
(488555)
519
(485555)
582
(542628)
416
(376455)
451
(414488)
517
(475557)
508
(453553)
573
(522617)
Bangladesh
426
(358472)
529
(509548)
581
643
(562600) (625662)
672
(656688)
475
(426517)
541
(520563)
598
(577621)
677
(658693)
710
(694728)
Bhutan
446
(374509)
491
(420549)
575
(507637)
627
(565681)
676
(609733)
470
(392544)
516
(436589)
604
(530667)
668
(604720)
717
(657771)
India
486
(455518)
535
(517553)
573
(552593)
600
(580618)
632
(606657)
491
(457526)
549
(527570)
595
(574615)
629
(610650)
675
(655699)
Nepal
490
(460517)
512
(486539)
576
(556599)
639
(620660)
677
(655701)
522
542
(488554) (512568)
600
(579622)
669
(650689)
706
(686728)
Pakistan
524
(489558)
574
(550600)
615
626
(596634) (603647)
639
(607671)
511
590
(466555) (561617)
632
(613653)
645
(618669)
678
(648709)
553
(533569)
604
(588615)
637
(621647)
656
(641666)
680
(665692)
599
(578616)
649
(632660)
686
(672695)
711
(699719)
739
(728749)
477
(399551)
523
(443599)
544
568
(458619) (487650)
607
(514698)
512
(427591)
561
(470638)
587
(509659)
625
(551687)
676
(601736)
Southeast Asia
Burma
1980
(Continues on next page)
2077
Articles
1970
1980
1990
2000
2010
1970
1980
1990
2000
2010
Cambodia
442
(371488)
498
(472519)
569
(558580)
573
(563583)
646
(633660)
521
(467559)
556
(534576)
612
(601623)
627
(617637)
701
(688715)
Indonesia
547
(526568)
602
(591612)
635
(627643)
663
(656672)
677
(660692)
576
(555597)
629
(616641)
665
(657672)
695
(687703)
718
(703733)
Laos
453
(356546)
492
(415565)
540
585
(459608) (497655)
624
(544697)
503
(411585)
539
(461606)
585
(517649)
629
(560691)
671
(602735)
Malaysia
635
(630639)
671
(663678)
695
706
(694697) (704707)
713
(710716)
675
723
(670679) (716730)
737
(736739)
754
(753755)
765
(762768)
Maldives
502
(473531)
575
(556594)
653
718
(644660) (711725)
775
(767783)
510
(476545)
565
(543588)
648
(640656)
738
(732745)
804
(797812)
Philippines
610
(600619)
608
(601615)
640
650
(635644) (645654)
666
(655678)
688
683
(678695) (676690)
720
(715724)
727
(723731)
738
(728748)
Sri Lanka
638
(634641)
680
(677682)
688
685
(678697) (684686)
716
(703728)
676
723
(672680) (720726)
763
(755770)
769
(768770)
798
(787807)
Thailand
610
(602619)
641
(634646)
692
(681701)
678
(666690)
709
(691725)
664
(656671)
707
(702713)
757
(749765)
754
(745763)
775
(763788)
Timor-Leste
516
(488543)
543
(520566)
600
(585616)
623
(611633)
678
(663692)
535
(504567)
559
(533585)
610
(592628)
643
(631655)
697
(681712)
Vietnam
540
(481579)
630
(605652)
655
(641670)
686
(671700)
716
(693740)
620
(573655)
692
(671715)
723
(711734)
761
(751772)
796
(780811)
Australasia
679
(678680)
709
(708710)
736
(735736)
768
(767769)
791
(790792)
746
(745748)
778
(777779)
797
(796798)
821
(820822)
836
(835837)
Australia
678
(676679)
710
(709711)
738
(737739)
770
(769771)
792
(791793)
746
(744748)
782
(780783)
800
(799801)
823
(822824)
838
(837839)
New Zealand
685
(683688)
702
(700704)
724
(722726)
758
(757760)
786
(784788)
747
(745749)
763
(760765)
782
(780784)
808
(806810)
827
(825830)
622
(613630)
634
(627640)
658
678
(654662) (674683)
569
(437631)
654
672
(640663) (662680)
697
(692703)
718
(713724)
662
(578699)
Antigua and Barbuda
658
(647670)
672
(655687)
707
(695718)
735
(723748)
741
(722759)
676
713
(665686) (697729)
757
(746767)
776
(765788)
790
(773805)
Barbados
656
(649662)
687
(681693)
690
728
(683697) (719736)
743
(727760)
698
(691704)
733
(727740)
744
(738751)
766
(758774)
770
(756783)
Belize
653
(640666)
674
(663684)
699
652
(690709) (649656)
689
(673703)
688
(674701)
708
(698718)
743
(734752)
709
(705712)
736
(723750)
Cuba
703
(700705)
724
(722726)
730
(728731)
743
(742744)
761
(759762)
739
(736741)
767
(765769)
768
(767770)
779
(777780)
798
(796799)
Dominica
611
(597623)
705
(694715)
685
(674697)
705
(695717)
701
(686715)
638
(624651)
726
(715737)
721
(710731)
759
(748770)
779
(764793)
Dominican Republic
635
(626643)
668
(662676)
689
705
(682696) (696713)
713
(700728)
663
(654671)
699
(692706)
728
(721736)
760
(752768)
763
(751776)
Grenada
628
(604652)
647
(599694)
668
(657678)
676
(667685)
686
(674698)
657
(635677)
687
(639728)
708
(698719)
737
(726747)
735
(722747)
Guyana
603
(594612)
597
(579614)
611
(601622)
619
(608632)
631
(605659)
649
657
(641658) (641670)
674
(665683)
682
(671694)
691
(669712)
Haiti
473
(446498)
490
(469510)
533
(520545)
577
(563591)
325
(198431)
493
(458520)
509
(484531)
550
(534567)
588
(572604)
436
(311517)
Jamaica
658
(642673)
703
(694712)
728
(719737)
721
(701743)
733
(699773)
694
727
(678709) (719735)
743
(735751)
749
(737762)
773
(743803)
Saint Lucia
609
(592628)
643
(635650)
670
691
(661679) (683700)
709
(686734)
647
672
(630664) (667677)
709
(701718)
754
(745764)
765
(745788)
Saint Vincent and the Grenadines 603

(589618)
621
(607634)
665
(654677)
676
(666685)
697
(685710)
648
670
(632663) (658683)
709
(697721)
719
(710729)
745
(731758)
Suriname
627
(608645)
620
(611627)
663
(653673)
687
(675699)
701
(682722)
655
(635678)
677
(666687)
709
(699719)
722
(713732)
752
(737768)
The Bahamas
595
(584604)
614
(603623)
639
686
(628650) (674700)
714
(685745)
652
678
(640662) (668687)
710
(700720)
794
(767841)
804
(769855)
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Caribbean
2078
Articles
1970
1980
1990
633
(628638)
657
(652662)
658
(654661)
Albania
2000
2010
1970
660
648
(654664) (643653)
662
(650674)
667
(664669)
671
(670672)
694
(693694)
670
(634705)
684
(648715)
Bosnia and Herzegovina
607
(560645)
Bulgaria
1980
1990
2000
2010
681
707
(676685) (702712)
724
(719729)
721
(716727)
753
(741764)
719
(719720)
717
(713720)
736
(734739)
748
(747749)
768
(767768)
792
(791793)
704
704
(699708) (699710)
720
(692749)
711
(679745)
739
(712764)
760
(755765)
768
(763773)
781
(759802)
652
(624674)
689
716
(687691) (710720)
741
(739744)
664
714
(626694) (694731)
748
(746750)
767
(763772)
788
(785790)
687
(685689)
686
(685688)
682
684
(681684) (682686)
701
(699703)
730
(728732)
740
(738741)
748
(746750)
752
(750754)
770
(768772)
Croatia
638
(602671)
662
(643681)
679
(677681)
709
(708711)
734
(732736)
709
(676736)
740
(723755)
759
(756761)
781
(779783)
799
(797801)
Czech Republic
662
(660663)
670
(669672)
678
(677679)
717
(716718)
743
(742745)
733
(731735)
742
(741744)
755
(753756)
784
(782785)
807
(805808)
Hungary
665
(663667)
656
(655658)
651
(650652)
675
(674676)
704
(703706)
722
(720725)
729
(727731)
739
(737740)
761
(760763)
784
(782785)
Macedonia
641
(592680)
670
(657684)
687
708
(683690) (705710)
728
(725730)
684
(636721)
712
(699725)
733
(729737)
757
(754759)
772
(770775)
Montenegro
661
(604698)
690
(656719)
711
707
(694728) (703710)
730
(722736)
705
(659737)
746
(721772)
776
(762790)
764
(760768)
782
(775789)
Poland
663
(661665)
663
(662665)
665
695
(664666) (695696)
721
(720722)
732
(729734)
747
(746749)
755
(754756)
780
(779781)
805
(804806)
Romania
655
(652658)
667
(665669)
667
676
(665668) (674677)
701
(700702)
701
722
(698704) (720724)
732
(730734)
747
(745748)
776
(774777)
Serbia
661
(623697)
691
(658724)
706
(690722)
740
(737742)
714
(678744)
751
(725776)
767
(753781)
771
(770773)
795
(792798)
Slovakia
668
(666670)
669
(667670)
667
692
(665669) (690693)
716
(714717)
732
(730735)
744
(742746)
755
(753756)
774
(773776)
791
(789793)
Slovenia
640
(604672)
664
(654675)
689
719
(687692) (717721)
759
(756762)
716
744
(690740) (735753)
771
(768773)
796
(793798)
825
(822829)
634
(631637)
621
(617624)
638
600
(636641) (598602)
637
(634639)
730
(727733)
729
(726732)
741
(738743)
725
(723727)
749
(747751)
Belarus
672
(665678)
654
(647660)
655
623
(649660) (618629)
641
(634649)
753
(747758)
751
(746755)
750
(746755)
740
(735744)
760
(755765)
Estonia
652
(648656)
639
(636642)
647
647
(644651) (644650)
706
(703710)
744
(740748)
741
(738744)
747
(743750)
760
(757763)
806
(802810)
Latvia
657
(655659)
637
(634639)
645
645
(643647) (643647)
689
(686692)
745
(743748)
741
(738743)
747
(745750)
757
(755759)
785
(782787)
Lithuania
670
(668673)
656
(654658)
662
663
(660664) (661665)
687
(685689)
752
(749754)
755
(753757)
761
(759763)
772
(770774)
793
(791796)
Moldova
603
(569634)
620
(611627)
644
655
(640648) (652658)
655
(650658)
674
692
(649700) (684699)
716
(712720)
730
(727733)
746
(742749)
Russia
623
(619627)
610
(605614)
632
(628635)
589
(586591)
631
(628633)
727
(723731)
725
(721729)
739
(735742)
720
(717722)
747
(744749)
Ukraine
655
(648660)
641
(636646)
651
(647655)
620
(615626)
645
(635653)
736
(730740)
736
(732739)
745
(742747)
732
(729736)
749
(742754)
685
(685686)
706
(706706)
729
(728729)
754
(753754)
779
(778780)
747
(746747)
773
(772773)
794
(794794)
814
(814814)
832
(831832)
Andorra
737
(697773)
760
(724791)
772
(754789)
787
(774800)
798
(788810)
824
824
(800848) (798848)
831
(816847)
843
(831855)
852
(842862)
Austria
667
(665669)
689
(687691)
722
(720723)
750
(749751)
777
(775779)
735
(733737)
761
(760763)
789
(787790)
812
(811814)
833
(832835)
Belgium
678
(676680)
699
(698701)
726
(724727)
746
(745747)
767
(764771)
742
(740744)
768
(766769)
792
(790793)
810
(809811)
823
(819826)
Cyprus
702
(682721)
733
(729737)
755
(751760)
763
(759767)
776
(771781)
752
(738766)
774
(770778)
805
(801810)
815
(810819)
829
(824834)

Trinidad and Tobago
Central Europe
Eastern Europe
Western Europe
719
(718721)
2079
Articles
1970
1980
1990
2000
2010
1970
1980
1990
2000
2010
Denmark
710
(708712)
713
(711715)
724
(722725)
745
(743746)
768
(766770)
760
(758762)
773
(772775)
779
(778781)
791
(789793)
810
(808813)
Finland
660
(659662)
693
(692695)
710
(708711)
742
(740743)
768
(766770)
743
(741745)
779
(777780)
790
(789792)
812
(810813)
833
(831836)
France
689
(688690)
705
(704706)
730
(729731)
752
(751752)
775
(772778)
763
(761764)
787
(786788)
811
(810812)
827
(827828)
843
(840845)
Germany
677
(676678)
697
(696698)
719
(718720)
748
(748749)
775
(773777)
737
(735738)
763
(762764)
784
(784785)
809
(808809)
828
(826831)
Greece
715
(713717)
732
(731734)
745
(743746)
754
(753755)
771
(768774)
753
(750755)
778
(776780)
794
(792795)
805
(804806)
821
(819824)
Iceland
714
(709719)
737
(732742)
756
(751760)
781
(777786)
800
(794806)
766
(760771)
792
(786798)
797
(792802)
819
(814824)
844
(837850)
Ireland
690
(688692)
697
(695699)
721
(720723)
739
(737740)
776
(774779)
738
(735741)
756
(754758)
776
(774778)
792
(790794)
822
(819824)
Israel
694
(692696)
719
(717721)
746
(744748)
762
(761762)
792
(790794)
730
(727732)
754
(752756)
781
(779783)
804
(803806)
829
(827831)
Italy
687
(685689)
709
(708710)
736
(735737)
764
(764765)
789
(787791)
746
(744748)
776
(775777)
802
(801803)
824
(823825)
839
(837841)
Luxembourg
665
(661669)
691
(687695)
716
(712720)
746
(742750)
780
(775786)
735
(730740)
760
(755764)
789
(785793)
809
(805813)
822
(817828)
Malta
681
(677686)
699
(695703)
746
(742750)
757
(754761)
771
(766776)
742
(736747)
759
(754764)
797
(792801)
812
(807817)
830
(824836)
Netherlands
708
(707710)
725
(723726)
738
(737739)
754
(753755)
785
(784786)
766
(764767)
791
(789792)
801
(800802)
806
(805807)
826
(824827)
Norway
711
(708713)
724
(722725)
736
(734738)
759
(757760)
785
(783787)
771
(769773)
789
(787791)
800
(798801)
814
(812816)
831
(829834)
Portugal
639
(635642)
681
(680683)
707
(705708)
730
(729732)
763
(762765)
706
(702710)
753
(750755)
778
(777780)
800
(799802)
823
(822825)
Spain
690
(688691)
722
(721723)
733
(732734)
756
(755756)
784
(782787)
746
(744748)
784
(783785)
805
(804806)
826
(825827)
842
(840844)
Sweden
722
(720723)
728
(727729)
748
(747750)
774
(773775)
792
(790794)
771
(770773)
789
(787790)
805
(803806)
820
(819821)
835
(834837)
Switzerland
700
(699702)
724
(722725)
740
(739742)
770
(768771)
797
(795798)
762
(760763)
789
(788791)
810
(808811)
828
(826829)
845
(843847)
UK
687
(685688)
704
(703705)
729
(728729)
754
(754755)
778
(778779)
750
(748751)
765
(764766)
783
(782784)
801
(801802)
819
(818820)
505
(449531)
624
(618630)
665
(660671)
710
(705716)
739
(729748)
565
(532581)
659
(651665)
702
(696709)
744
(737750)
770
(761780)
Bolivia
478
(458502)
552
(537568)
610
662
(596626) (648675)
697
(673725)
526
588
(504548) (571605)
635
(620650)
684
(671698)
717
(695741)
Ecuador
609
(602618)
654
(649659)
693
712
(689698) (707718)
744
(733754)
647
704
(638655) (698709)
748
(744751)
767
(762771)
798
(789806)
Peru
477
(396517)
635
(626645)
672
727
(664680) (717736)
752
(738767)
547
(493572)
664
(654672)
706
(698715)
754
(745763)
776
(761790)
606
(602609)
636
(633639)
678
706
(676681) (703708)
717
(714721)
658
709
(654661) (706712)
745
(742747)
768
(766769)
782
(779784)
Colombia
642
(635648)
668
(659678)
671
683
(664676) (676687)
717
(702730)
689
722
(683696) (714729)
752
(746756)
764
(758768)
783
(773794)
Costa Rica
684
(680688)
735
(731739)
746
(744749)
755
(753757)
771
(769773)
718
(714723)
779
(775782)
788
(785790)
803
(801805)
819
(816821)
El Salvador
565
(555574)
508
(504513)
650
684
(647654) (681687)
699
(693705)
632
689
(622640) (683694)
742
(739745)
768
(765771)
782
(777786)
Guatemala
493
(484504)
558
(552565)
620
(617625)
652
(649655)
669
(663675)
534
(524543)
636
(628642)
671
(666676)
718
(715722)
740
(735745)
Honduras
547
(536557)
642
(634649)
670
680
(658682) (639724)
705
(663746)
586
(576598)
685
(678693)
709
(700718)
712
(683739)
732
(698765)
Andean Latin America
Central Latin America
2080
Articles
1970
1980
1990
Mexico
601
(596607)
630
(625634)
Nicaragua
548
(534562)
Panama
Venezuela
2000
2010
1970
683
720
(678687) (717723)
725
(723728)
626
(608642)
677
701
(669686) (693709)
669
(665673)
713
(706720)
721
(713730)
654
(650658)
1980
1990
2000
2010
657
708
(650663) (703713)
749
(744753)
774
(771777)
784
(782786)
715
(706722)
614
684
(602626) (672695)
729
(722736)
757
(750764)
775
(767782)
744
(734753)
736
(723749)
695
757
(691699) (751764)
772
(763779)
800
(792809)
802
(789815)
673
(670675)
698
709
(696700) (708711)
703
(689715)
701
730
(696705) (728733)
754
(752756)
778
(776779)
792
(784800)
623
(620626)
667
(666669)
691
713
(690692) (712714)
733
(731734)
695
738
(692698) (736740)
763
(762764)
786
(785787)
799
(798801)
Argentina
627
(624631)
668
(666670)
690
705
(689692) (704706)
725
(724726)
700
740
(696704) (738742)
761
(759763)
781
(780783)
793
(792794)
Chile
606
(602610)
664
(662666)
694
740
(692695) (739741)
755
(752759)
673
730
(668678) (727733)
764
(762765)
798
(797799)
815
(812818)
Uruguay
651
(648655)
670
(667672)
693
707
(691695) (705709)
726
(721731)
724
(720728)
741
(738744)
769
(766771)
785
(783788)
804
(799809)
580
(567596)
623
(619628)
656
(652659)
684
(682687)
705
(703708)
649
692
(636662) (686697)
731
(728734)
756
(754759)
777
(774779)
Brazil
578
(565594)
622
(617627)
654
(651658)
683
(681686)
705
(702708)
648
(635661)
731
(727734)
757
(754759)
777
(775779)
Paraguay
672
(665679)
692
(686699)
722
(715728)
716
(710722)
710
(697724)
693
714
(686700) (708721)
743
(737749)
749
(743754)
756
(747764)
527
(515538)
591
(581598)
655
688
(647662) (681693)
710
(702718)
587
(576596)
648
(640654)
702
(695708)
733
(727739)
756
(749762)
Algeria
545
(510575)
555
(545563)
693
(669715)
706
(691720)
743
(732754)
583
(552618)
597
(587606)
724
(704743)
742
(726758)
765
(755775)
Bahrain
638
(599676)
696
(677715)
708
(695721)
731
(719743)
764
(748782)
671
738
(636706) (722754)
723
(711735)
755
(744767)
791
(775807)
Egypt
484
(471497)
551
(538565)
624
(614635)
668
(659676)
680
(670690)
558
(542572)
612
(600625)
670
(660679)
717
(710724)
734
(725742)
Iran
506
(476537)
580
(542600)
646
(617667)
686
(673700)
716
(685746)
562
(534591)
652
(625668)
710
(689728)
746
(734757)
778
(753802)
Iraq
599
(578618)
655
(631679)
694
(667721)
708
(682734)
706
(672737)
650
693
(631668) (672713)
704
(677725)
712
(693731)
714
(683744)
Jordan
591
(577605)
635
(616652)
703
(677727)
734
(716750)
757
(739775)
641
(627655)
686
(673700)
728
(712743)
736
(719753)
751
(732770)
Kuwait
660
(655666)
706
(702710)
768
(765771)
763
(761766)
761
(758764)
712
(705718)
745
(741750)
792
(789796)
794
(791797)
796
(792799)
Lebanon
672
(649696)
693
(673716)
691
(665711)
744
(728761)
762
(741779)
701
(676725)
725
(705744)
733
(716747)
767
(755779)
789
(775804)
Libya
608
(585628)
699
(681716)
714
(685742)
733
(716748)
729
(707750)
639
728
(619661) (712745)
742
(715767)
757
(743772)
765
(746785)
Morocco
550
(525574)
596
(576616)
657
(637675)
690
(670709)
709
(683733)
593
(573612)
637
(624651)
692
(682703)
722
(709736)
744
(722761)
Oman
539
(504570)
619
(585652)
694
(658728)
723
(698747)
738
(722754)
582
(545617)
660
(625690)
735
(703762)
769
(748790)
789
(775801)
Palestine
589
(519647)
656
(615693)
687
(655718)
709
(693727)
703
(679727)
622
(559679)
690
(653727)
725
(694756)
756
(741772)
764
(743783)
Qatar
657
(620697)
684
(660706)
759
(749769)
765
(754773)
789
(777800)
706
(673741)
749
(729768)
766
(756777)
778
(768787)
821
(811832)
Saudi Arabia
586
(540638)
685
(652716)
725
(694752)
738
(726751)
750
(736764)
629
(585667)
723
(691752)
763
(736787)
779
(768791)
799
(788810)
Syria
631
(605655)
675
(657694)
695
(664722)
727
(700750)
751
(735766)
689
728
(667708) (712746)
735
(709760)
764
(743784)
802
(789814)
Tunisia
558
(541575)
647
(633656)
699
(685713)
722
(700742)
741
(707776)
593
(576610)
745
(733757)
771
(752788)
789
(757819)
Southern Latin America
Tropical Latin America
North Africa and Middle East
691
(686696)
688
(675699)
2081
Articles
1970
1980
1990
2000
2010
1970
Turkey
527
(487565)
590
(573607)
637
(622653)
679
(666693)
712
(695730)
United Arab Emirates
661
(627693)
697
(666732)
720
(694745)
734
(723745)
Yemen
406
(339465)
505
(432564)
584
(514641)
672
(671673)
701
(700702)
Canada
694
(692695)
USA
Oceania
1980
1990
2000
2010
603
666
(569633) (651681)
709
(697722)
748
(737759)
777
(759793)
753
(730776)
679
(642713)
718
(682750)
740
(717763)
754
(743765)
786
(765807)
618
(549674)
655
(592714)
464
(393523)
547
(474610)
603
(526668)
629
(551690)
663
(593724)
720
(719720)
744
(744745)
761
(760762)
747
(746748)
775
(774776)
787
(787788)
797
(796797)
808
(807808)
716
(714717)
740
(739741)
765
(764766)
785
(782787)
762
(761764)
786
(785787)
803
(802805)
817
(816818)
827
(825830)
670
(668671)
699
(699700)
717
(717718)
742
(741743)
759
(758759)
746
(744747)
774
(773775)
786
(785787)
795
(794795)
805
(805806)
548
(486603)
545
(471600)
546
560
(464610) (480632)
588
(509657)
590
593
(528645) (528648)
582
(510644)
596
(518666)
620
(550687)
Federated States of Micronesia
543
(451631)
555
(463637)
590
(503667)
623
(536696)
634
(546717)
592
611
(498673) (534676)
636
(551707)
666
(587736)
683
(608747)
Fiji
615
(597632)
606
(594614)
628
634
(596658) (619647)
656
(639673)
668
662
(652683) (653671)
683
(653710)
680
(666693)
688
(671704)
Kiribati
504
(442568)
538
(466607)
543
(505582)
557
(528588)
578
(513640)
540
(472603)
579
(515638)
581
(545618)
625
(600649)
650
(598697)
Marshall Islands
551
(481620)
601
(553649)
617
(595638)
615
(582646)
619
(575660)
605
(541667)
667
(624703)
670
(650688)
649
(621676)
660
(619700)
Papua New Guinea
531
(454608)
526
(437606)
524
(432610)
544
(446639)
575
(481665)
571
571
(493648) (490647)
556
(468638)
575
(482663)
603
(519690)
Samoa
622
(604641)
621
(591649)
641
665
(597684) (631696)
684
(654709)
683
(665702)
702
(676724)
711
(673746)
719
(691746)
734
(709758)
Solomon Islands
563
(478649)
572
(479664)
580
595
(483662) (515669)
605
(522681)
604
(518677)
622
(538703)
614
(522699)
625
(526704)
640
(554714)
Tonga
654
(617688)
664
(627704)
686
(658715)
685
(670696)
673
(647699)
677
(640711)
691
(646730)
715
(684743)
716
(702729)
738
(714761)
Vanuatu
560
(474639)
569
(491640)
598
(501679)
610
(523686)
622
(541695)
606
(530676)
622
(542690)
640
(549712)
652
(571719)
669
(598725)
439
(398475)
474
(448500)
488
(461513)
497
(471517)
532
(503560)
504
(472539)
534
(510555)
543
(519562)
548
(528566)
585
(559609)
Angola
377
(261485)
408
(340480)
439
(363519)
492
(404582)
579
(495665)
476
(363582)
501
(431565)
517
(430590)
555
(470640)
639
(560720)
Central African Republic
442
(409472)
463
(441485)
451
(430475)
418
(382456)
436
(384493)
526
(497555)
544
(525564)
520
(502538)
475
(440505)
493
(440546)
DR Congo
461
(425495)
496
(467526)
509
(485533)
508
(490530)
528
(496559)
509
(472544)
539
(510566)
550
(530571)
552
(536569)
577
(547605)
Equatorial Guinea
400
(291519)
453
(363540)
457
(359541)
494
(412566)
547
(435662)
483
542
(368584) (461614)
533
(435604)
568
(495631)
618
(529738)
Gabon
501
(446555)
550
(522576)
562
(542583)
535
(506564)
550
(500600)
577
(526623)
627
(607647)
643
(629657)
618
(598640)
633
(595674)
Congo
507
(467545)
529
(495561)
519
(490550)
497
(473522)
563
(523603)
551
(515588)
576
(545606)
577
(555601)
547
(524568)
616
(579651)
481
(468494)
502
(491511)
509
(500517)
521
(512530)
594
(583603)
516
(501529)
539
(528549)
549
(541556)
553
(544561)
626
(617635)
Burundi
450
(367521)
479
(398543)
467
(378558)
450
(347569)
530
(427630)
463
(368551)
503
(415576)
503
(417585)
480
(369595)
552
(452646)
Comoros
507
(474539)
523
(487560)
563
(526602)
595
(545641)
616
(565658)
536
(499572)
550
(512588)
588
(545625)
617
(569659)
639
(591682)
Djibouti
580
(505656)
603
(532666)
590
(522652)
592
(509672)
622
(546696)
607
(531686)
630
(558690)
622
(551681)
617
(528702)
644
(551737)
Eritrea
430
(396465)
465
(442489)
505
(485524)
379
(282440)
590
(547629)
484
(452516)
515
(494534)
543
(526561)
472
(381521)
620
(582655)
High-income North America
Central sub-Saharan Africa
Eastern sub-Saharan Africa
2082
Articles
1970
1980
1990
2000
2010
1970
1980
1990
2000
2010
Ethiopia
422
(390456)
419
(394443)
445
(425462)
514
(498529)
595
(575613)
467
(431506)
465
(438488)
490
(474508)
544
(531558)
623
(605641)
Kenya
561
(534585)
609
(591628)
616
560
(604629) (537585)
627
(599657)
586
(562610)
631
(614648)
643
(632653)
586
(567604)
669
(646690)
Madagascar
503
(483522)
521
(496544)
544
(528559)
594
(576611)
622
(589656)
512
551
(489535) (528575)
579
(565593)
622
(609637)
651
(618681)
Malawi
400
(380421)
475
(459490)
467
(451481)
437
(417457)
509
(485536)
440
(417462)
514
(497529)
508
(494521)
467
(452484)
549
(527575)
Mauritius
586
(581589)
614
(611617)
651
678
(649653) (676681)
697
(693700)
647
(642651)
698
(693701)
731
(728734)
748
(744750)
769
(765773)
Mozambique
453
(428481)
493
(475513)
472
(457487)
475
(458493)
500
(469534)
485
(459516)
522
(502542)
528
(512542)
537
(521554)
549
(518583)
Rwanda
447
(415479)
466
(438491)
482
(459503)
475
(457493)
620
(601639)
482
499
(446516) (471525)
513
(495527)
521
(504536)
671
(655690)
Seychelles
606
(594617)
641
(631650)
620
(611628)
626
(618634)
613
(602624)
667
(655679)
717
(706728)
724
(716733)
734
(726743)
718
(707729)
Somalia
494
(392592)
508
(431580)
499
(427570)
522
(433606)
546
(454626)
527
(433616)
540
(455621)
530
(442605)
545
(452625)
572
(477656)
Sudan
556
(534577)
576
(561591)
607
(592619)
627
(607645)
669
(642690)
581
(560601)
601
(587615)
636
(623649)
663
(647681)
707
(688729)
Tanzania
506
(482529)
550
(532566)
550
(536564)
542
(520565)
609
(581637)
550
(527573)
592
(574609)
583
(570596)
552
(534569)
626
(602652)
Uganda
529
(505555)
498
(475519)
481
488
(459506) (465510)
583
(553614)
558
(532583)
542
(523560)
529
(515545)
531
(513550)
625
(598651)
Zambia
531
(507553)
549
(530567)
485
(467504)
426
(403456)
543
(511577)
570
(545594)
586
(570602)
528
(513541)
447
(425468)
573
(542603)
544
(510579)
572
(555586)
606
(592619)
535
(522549)
557
(539574)
615
647
(582640) (633659)
677
(668687)
587
(575600)
606
(588624)
Botswana
565
(530601)
632
(597666)
639
525
(602679) (464574)
681
(636736)
611
(575645)
679
(648709)
693
(660730)
555
(490605)
740
(692806)
Lesotho
487
(457521)
540
(513569)
563
(545583)
470
(446494)
441
(409481)
571
(545597)
627
(608649)
654
(642667)
541
(524562)
507
(472548)
Namibia
559
(533585)
570
(552587)
591
523
(580604) (501544)
584
(552616)
611
(590633)
629
(617640)
658
(648669)
575
(559593)
649
(619676)
South Africa
548
(502594)
574
(552592)
607
(589625)
553
(537568)
574
(548596)
626
654
(582663) (636671)
687
(676699)
613
(598629)
623
(599647)
Swaziland
476
(443504)
547
(521572)
593
(573613)
465
(439491)
474
(435513)
532
(501561)
602
(578626)
652
(637666)
521
(502543)
514
(480551)
Zimbabwe
546
(501587)
571
(546595)
610
(593628)
488
(454540)
511
(466556)
591
(543631)
622
(604642)
649
(636664)
513
(486550)
551
(513593)
470
(455483)
517
(506528)
530
(521540)
534
(526543)
579
(567591)
508
(492524)
550
(536563)
565
(554574)
566
(557575)
609
(596621)
Benin
471
(446495)
519
(499538)
530
(515546)
554
(537570)
607
(576635)
517
(491541)
560
(542577)
586
(571599)
611
(597624)
659
(632685)
Burkina Faso
440
(415466)
479
(459499)
496
(480512)
507
(490526)
528
(466581)
499
(471527)
535
(513554)
545
(531561)
551
(533568)
576
(527621)
Cameroon
508
(480534)
535
(514553)
565
(553580)
526
(506548)
571
(535609)
530
(502557)
558
(537577)
601
(588614)
567
(551586)
611
(578643)
Cape Verde
606
(569638)
654
(638670)
654
681
(638669) (638723)
709
(663755)
650
(617683)
699
(685713)
740
(726753)
768
(735802)
791
(753825)
Chad
486
(451521)
480
(460502)
500
(484515)
494
(474513)
533
(472582)
544
(512577)
537
(518556)
550
(534566)
541
(522558)
578
(530623)
Cte dIvoire
487
(466507)
557
(542572)
527
(512544)
499
(476524)
528
(482571)
533
(507555)
592
(576607)
594
(581607)
578
(557599)
602
(562639)
Ghana
561
(533586)
570
(545593)
593
(574612)
594
(576613)
632
(607657)
587
(557618)
599
(574623)
619
(601637)
622
(607637)
667
(645689)
Southern sub-Saharan Africa
Western sub-Saharan Africa
2083
Articles
1970
1980
1990
Guinea
457
(419495)
479
(457498)
Guinea-Bissau
387
(287474)
Liberia
2000
2010
1970
1980
1990
2000
2010
512
532
(498528) (514549)
584
(537623)
483
(448521)
500
(478522)
530
(516546)
555
(539573)
605
(563640)
463
(397522)
486
506
(429546) (438574)
548
(461634)
456
(354540)
512
(440575)
531
(454594)
550
(481615)
586
(508666)
494
(468519)
519
(499545)
474
527
(444497) (510546)
565
(541589)
533
(506562)
554
(530576)
520
(499540)
544
(527561)
579
(552605)
Mali
373
(350398)
428
(411449)
475
500
(461490) (484517)
569
(529607)
413
(385442)
464
(443484)
499
(484515)
513
(498528)
577
(538612)
Mauritania
525
(499555)
552
(530574)
592
(576610)
602
(581622)
633
(591672)
555
(521581)
578
(557600)
613
(598626)
626
(606645)
657
(618688)
Niger
406
(382433)
419
(398441)
443
(424461)
510
(493527)
569
(517615)
452
463
(426479) (442485)
482
(464502)
533
(516552)
587
(541626)
Nigeria
476
(447504)
534
(512557)
538
(521559)
543
(526563)
588
(565614)
509
560
(480539) (534587)
564
(544584)
562
(545580)
604
(582629)
So Tom and Prncipe
551
(535566)
606
(589622)
622
648
(598641) (630667)
682
(644718)
611
655
(594625) (639671)
648
(629666)
679
(662697)
721
(690752)
Senegal
442
(419465)
507
(489525)
568
(554581)
576
(560592)
635
(611661)
500
(476523)
554
(537570)
609
(597621)
616
(602630)
671
(652693)
Sierra Leone
378
(348412)
412
(386440)
458
(434479)
478
(460495)
565
(536593)
453
485
(417486) (454511)
525
(504547)
534
(516551)
609
(583631)
The Gambia
439
(374496)
516
(447573)
557
583
(495616) (515643)
608
(534690)
495
(423556)
555
(476622)
590
(519655)
615
(542681)
640
(559724)
Togo
498
(472524)
544
(524564)
565
(550583)
583
(547618)
541
(515569)
581
(560602)
601
(585615)
614
(593637)
621
(584656)
578
(554601)
Table 2: Life expectancy in years (95% uncertainty intervals) at birth, by sex and decade for 187 countries and 21 Global Burden of Disease regions
gains in life expectancy of 1112 years have been recorded.

Since 1990, the largest gains in life expectancy occurred
in sub-Saharan African countries, especially Angola,
Ethiopia, Niger, and Rwanda, where life expectancy since
1990 has increased by 1215 years for men and women,
as strategies for HIV control and reduction of childhood
diseases have become widespread and eective. Appendix pp 5766 show detailed maps of life expectancy at
birth by sex and decade.
Summary presentation of four decades of changes in
mortality can obscure important secular trends that have
occurred in some regions. Appendix pp 6768 show
the age-standardised mortality rate by region for the
1549 year age group in 1970 (and 2004) and the percentage change in mortality during 19702010 (and 200410).
Appendix p 68 shows the substantial declines in agespecic mortality that have taken place in eastern and
southern sub-Saharan Africa since 2004. These declines
occur in those countries that have scaled up two major
global public health programmes: antiretroviral drugs
for advanced HIV disease and malaria interventions,
including insecticide-treated bednets and artemisinincombination therapies.29,6166 The changes we document in
adult mortality (for individuals aged 1549 years) were
determined from an analysis of demographic sources of
data. Such trends in population health are important to
document and are not widely appreciated, despite their
signicance for provision of supportive evidence on the
2084
eect of key public health programmes. Appendix p 68

also shows that, since 2004, eastern Europe has had a
major decline in adult mortality of nearly 23%. This
decline followed a substantial increase in adult mortality
in the previous two decades and represents a notable
change in mortality trend in that region. The remaining
regions span from almost no change in central and
southern Latin America to about a 30% decline in
southern sub-Saharan Africa. All four sub-Saharan
African regions have had at least a 10% decline in adult
mortality from 2004 to 2010. Asian regions, including
high-income Asia Pacic, have had rapid improvement in
the same period. The decline in east Asia, south Asia, and
southeast Asia was more than 9% from 2004 to 2010.
Comparative survival assessments focus on levels and
changes in age-specic mortality rates or on summary
measures of mortality rates such as life expectancy
at dierent ages. Improvements to understanding of
priorities for health action and the provision of health
services will require information about population
numbers by age and sex and age-specic and sex-specic
death rates to know the distribution of deaths at dierent
ages. For example, metrics such as YLLs or disabilityadjusted life years (DALYs) are measures of absolute
health loss. When these metrics are disaggregated by
disease, injury, or risk factors, they focus attention on
causes that lead to the greatest loss of health to individuals. Although global life expectancy at birth has been
Articles
Change in years
15 to <0
0 to <3
3 to <6
6 to <9
9 to <12
12 to <15
15 to <18
18 to <21
21 to <24
24 to <27
27 to 30
ATG
VCT
Barbados
Comoros
West Africa
Dominica
Caribbean
Grenada
Maldives
Mauritius
LCA
TTO
TLS
Seychelles
ATG
VCT
Barbados
Comoros
Marshall Isl
Kiribati
Solomon Isl
FSM
Vanuatu
Samoa
Fiji
Tonga
Marshall Isl
Kiribati
Solomon Isl
FSM
Vanuatu
Samoa
Fiji
Tonga
Eastern
Mediterranean
Malta
Persian Gulf
Singapore
West Africa
Eastern
Mediterranean
Balkan Peninsula
Dominica
Caribbean
LCA
Grenada
TTO
Maldives
TLS
Mauritius
Seychelles
Malta
Persian Gulf
Singapore
Balkan Peninsula
Figure 3: Change in life expectancy at birth, 19702010

(A) Male life expectancy and (B) female life expectancy. ATG=Antigua and Barbuda. VCT=Saint Vincent and the Grenadines. Isl=islands. FSM=Federated States of Micronesia. LCA=Saint Lucia.
TTO=Trinidad and Tobago. TLS=Timor-Leste.
2085
Articles
increasing, so too has the number of deaths worldwide,

from an estimated 433 million (422446 million) in
1970 to 528 million (516541 million) in 2010 (table 3).
Even at the global level, substantial uncertainty exists
about the number of deaths, which shows the uncertainty
in each step of the estimation process and dierent
demographic estimation methods and their interpretation.
For comparison, gure 4 shows estimates of the global
number of deaths from various WHO and UNPD
estimation exercises.26,27,34,6785 Successive revisions by the
UNPD in the WPP have in general led to downward
1970
revisions in their estimates for the same time period as

new data become available. WHO estimates have been
much higher than our estimates and those of the UNPD.
For 2004, the WHO estimated 5868 million deaths
worldwide, 381 million more than the UNPD estimate
from the WPP 2010 revision and 701 million (136%)
higher than our estimates. The rapid rise in our estimated
number of global deaths in 199495 was due to a series of
mortality shocks. The 1994 genocide in Rwanda killed an
estimated 454 200 people (95% UI 339 500695 700) and
the famine in North Korea throughout the 1990s led to
1990
2010
Male deaths
(thousands)
Female deaths
(thousands)
Overall
(thousands)
Male deaths
(thousands)
Female deaths
(thousands)
Overall
(thousands)
Male deaths
(thousands)
Female deaths
(thousands)
Overall
(thousands)
Early neonatal
2157
(20422280)
1519
(13941678)
3676
(34313959)
1841
(17571926)
1286
(11941401)
3127
(29503326)
1264
(12071319)
900
(841972)
2164
(20472284)
Late neonatal
1109
(10801137)
830
(770896)
1939
(18572021)
715
(700729)
548
(512590)
1263
(12201308)
375
(356394)
302
(283325)
677
(645711)
Postneonatal
2859
(27252992)
2350
(21882518)
5209
(49405481)
1935
(18482022)
1636
(15431743)
3570
(34093733)
1091
(10331157)
940
(8791009)
2031
(19242152)
14 years
2949
(26483261)
2616
(24832723)
5565
(51375972)
1927
(17732086)
1673
(16161725)
3600
(33883814)
1075
(9761178)
894
(843946)
1970
(18252119)
59 years
481
(466496)
392
(378408)
873
(860888)
382
(372392)
329
(318341)
711
(703719)
250
(240261)
203
(194212)
453
(437468)
1014 years
276
(259315)
235
(213267)
511
(481568)
233
(225242)
206
(193220)
438
(425455)
200
(188229)
164
(153177)
364
(346394)
1519 years
371
(340415)
316
(280360)
687
(636757)
399
(382419)
315
(294340)
714
(687746)
414
(392447)
297
(273323)
711
(678750)
2024 years
409
(377456)
346
(309393)
756
(705824)
545
(523571)
390
(366420)
936
(902976)
634
(603673)
424
(397453)
1058
(10181103)
2529 years
375
(346418)
340
(305384)
715
(669781)
545
(524569)
387
(364413)
931
(900970)
720
(685760)
472
(446500)
1192
(11501238)
3034 years
436
(401480)
377
(339423)
812
(762881)
576
(553605)
392
(370417)
968
(9351007)
769
(730816)
477
(450504)
1246
(12001298)
3539 years
521
(472580)
448
(394512)
968
(8951057)
667
(632709)
460
(427497)
1127
(10771187)
895
(837961)
530
(490569)
1425
(13571505)
4044 years
654
(595729)
468
(426518)
1122
(10471219)
711
(675755)
463
(437493)
1174
(11301228)
1040
(9721118)
586
(550621)
1626
(15501720)
4549 years
785
(714876)
550
(508604)
1335
(12491443)
845
(802899)
527
(501555)
1372
(13211429)
1268
(11881359)
711
(674748)
1979
(18942084)
5054 years
958
(8711067)
674
(624741)
1632
(15271758)
1187
(11281253)
733
(698771)
1920
(18521995)
1603
(15061715)
877
(834921)
2480
(23762609)
5559 years
1242
(11491355)
857
(800929)
2099
(19862232)
1497
(14281572)
929
(887974)
2426
(23442512)
1989
(18792118)
1160
(11041219)
3149
(30273299)
6064 years
1531
(14351654)
1159
(10831253)
2690
(25582851)
1929
(18532015)
1281
(12271341)
3210
(31153310)
2205
(20962327)
1390
(13241457)
3595
(34733741)
6569 years
1632
(15511730)
1362
(12831462)
2994
(28683138)
2052
(19822132)
1562
(15021626)
3614
(35203712)
2398
(22942516)
1666
(15971739)
4064
(39444206)
7074 years
1563
(14981640)
1546
(14701640)
3110
(30033234)
2045
(19772120)
1773
(17101845)
3818
(37273917)
2852
(27492964)
2234
(21462328)
5086
(49555231)
7579 years
1263
(12221305)
1485
(14291554)
2748
(26792829)
2054
(20032107)
2132
(20752198)
4186
(41124265)
2856
(27752954)
2533
(24532616)
5389
(52765514)
80 years
1505
(14811532)
2332
(22912380)
3837
(37863890)
2883
(28382928)
4525
(44464602)
7408
(73177492)
5045
(49595139)
7065
(69607174)
12 110
(11 97012 253)
Total
23 077
20 202
43 279
(22 25624 085) (19 43721 081) (42 15244 634)
24 968
21 546
46 514
(24 31325 675) (21 03422 136) (45 68347 437)
28 944
23 826
52 770
(27 92630 121) (23 11724 560) (51 58254 128)
Early neonatal is 06 days; late neonatal is 727 days; and postneonatal is 28364 days.
Table 3: Global deaths (95% uncertainty intervals) by sex and age group in 1970, 1990, and 2010
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between 264 400 and 117 million deaths in 1995.

Appendix p 69 extends the global comparison of Global
Burden of Disease 2010 and UNPD to six age groups. The
latest UNPD estimates are contained within the Global
Burden of Disease UIs for individuals aged 2539 years,
although earlier estimates were much higher than were
our estimates for this age group. For other age groups
(4059 years, 6079 years, and 80 years), the UNPD and
Global Burden of Disease 2010 estimates are consistent.
Estimates of the number of deaths in children younger
than 5 years from the UNPD are substantially higher
than are our estimations; for 200510, their estimates are
8 million deaths higher (16 million per year). The largest
relative dierence, however, is for the age group of
514 years, in which UNPD gures are 18 times our
60
GBD 2010 with

95% UI
WPP 1980
WPP 1982
WPP 1984
WPP 1988
WPP 1990
WPP 1992
WPP 1994
Deaths (millions)
55
estimates for 200510. More detailed examination (data

not shown) suggests that this dierence largely arises at
age 514 years, when death rates are lowest. In absolute
terms, therefore, the dierences are less important.
Table 3 shows the estimated number of deaths worldwide for 20 age groups and two sexes with 95% UIs for
1970, 1990, and 2010. Figure 5A shows the estimated
distribution of deaths by age group for 2010. At the global
level, 428% of deaths occur after individuals reach
70 years of age, and almost a quarter (229%) occur in
individuals older than 80 years. At the other end of the
age spectrum, deaths in children younger than 5 years
accounted for 130% of all deaths in 2010, down from
249% in 1990. Figure 5B shows the distribution of
deaths in 2010 across the 21 regions in the Global Burden
WPP 1996
WPP 1998
WPP 2000
WPP 2002
WPP 2004
WPP 2006
WPP 2008
WPP 2010
WHO estimates
50
45
40
0
1970
1980
1990
Year
2000
2010
Figure 4: Global deaths and 95% UIs from 1970 to 2010 with various UN Population Division and WHO global estimates
GBD 2010 UI shown between dotted lines. UI=uncertainty interval. GBD=Global Burden of Disease Study 2010. WPP=World Population Prospects by the United Nations
Population Division.
Late neonatal
Early neonatal
Postneonatal
14 years
59 years
1014 years
1519 years
2024 years
2529 years
3034 years
East Asia
80 years
Southeast Asia
High-income
Asia Pacic
Central Asia
Oceania

Southern
Latin America
Caribbean
7579 years
3539 years
4044 years
4549 years
5054 years
7074 years
5559 years
6064 years
South Asia
6569 years
Western subSaharan Africa
Australasia
Central Europe
High-income
North America
Eastern Europe Western
Europe
Eastern sub-Saharan
Africa
North Africa and
Middle East
Central sub-Saharan Africa
Figure 5: Global deaths in 2010

(A) By age and (B) by region.
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Change (%)
100 to <75
75 to <50
50 to <40
40 to <30
30 to <20
20 to <10
10 to <0
0 to <25
25 to <50
50 to <75
75 to <100
100 to <200
200 to <500
500 to <3000
ATG
VCT
Barbados
Comoros
West Africa
Dominica
Caribbean
Grenada
Maldives
Mauritius
LCA
TTO
TLS
Seychelles
ATG
VCT
Barbados
Comoros
Marshall Isl
Kiribati
Solomon Isl
FSM
Vanuatu
Samoa
Fiji
Tonga
Marshall Isl
Kiribati
Solomon Isl
FSM
Vanuatu
Samoa
Fiji
Tonga
Eastern
Mediterranean
Malta
Persian Gulf
Singapore
West Africa
Eastern
Mediterranean
Balkan Peninsula
Dominica
Caribbean
LCA
Grenada
TTO
Maldives
TLS
Mauritius
Seychelles
Malta
Persian Gulf
Singapore
Balkan Peninsula
Figure 6: Percentage change in number of deaths by country, 1970 to 2010

(A) Children younger than 5 years and (B) reproductive age-groups (aged 1549 years). ATG=Antigua and Barbuda. VCT=St Vincent and the Grenadines. Isl=islands. FSM=Federated States of Micronesia.
LCA=Saint Lucia. TTO=Trinidad and Tobago. TLS=Timor-Leste.
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UNICEF, 2009
UNICEF, 2010
UNICEF, 2011
UNICEF, 2012
Rajaratnam and colleagues 20103
Lozano and colleagues 20112
Global Burden of Disease, 2010 (this study)
13 000
12 000
11 000
Deaths (thousands)
of Disease Study 2010. South Asia accounted for almost a

quarter (238%) of global mortality, with another sixth
(165%) occurring in east Asia. Appendix pp 3650
contain more detailed regional tables of deaths by age
and sex for 1970, 1990, and 2010 with 95% UIs.
Global public health policy for several decades has
focused on improvements in child survival; but now
calls have been made to focus development assistance
eorts on those countries that contribute the most to
the number of deaths in children younger than 5 years.86
Child death numbers are a function of both the rate of
under-5 mortality and the number of newborns.
Figure 6A shows the percentage change in 19702010 in
the number of deaths in children younger than 5 years
by country. Global under-5 mortality has been decreasing steadily since 1970, even though the global annual
number of livebirths increased by 12%, from 121 million
to about 135 million.34 The trend of decreasing numbers
of deaths in children younger than 5 years worldwide
has been presented in various studies (gure 7). In
addition, this global trend towards decreasing numbers
of deaths in children younger than 5 years is evident for
most developing regions, apart from sub-Saharan
Africa. Indeed, deaths in children younger than 5 years
in central sub-Saharan Africa have increased by about
45% in the past four decades. However, the increase in
the number of deaths in children younger than 5 years
in this region is primarily driven by an increase in the
numbers of newborns, increasing by more than 179%
from 14 million in 1970. The largest increases in
under-5 mortality in the past 40 years occurred in the
band of countries that extend from Niger and Chad to
Zambia; conversely, deaths in children younger
than 5 years have declined in 25 countries in Africa
including countries in west, east, and southern subSaharan Africa.
Because more children now survive to adulthood,
calls have been made for global health policy to pay
greater attention to the prevention of young adult
deaths.87 The percentage changes in the number of
deaths at young adult ages are heterogeneous
(gure 6B). In most developed countries and in some
developing countries such as China and Argentina,
deaths at age 1549 years have decreased, despite
substantial growth in population at these ages. For highincome regions, countries such as Albania, Andorra,
Belarus, Brunei, Greece, Israel, Lithuania, Montenegro,
Russia, and Ukraine stand out because of increases in
the number of deaths in this age group. Other countries
have had large increases in deaths, especially in subSaharan Africa. The number of young adult deaths
(aged 1549 years) in Botswana, South Africa, Zambia,
and Zimbabwe increased by more than 500% since
1970. Only a small amount of this extraordinary
demographic change can be attributed to increasing
population size; most of the change was due to rapid
increases in mortality from HIV/AIDS since the 1980s,
10 000
9000
8000
7000
0
1990
1995
2000
Year
2005
2010
Figure 7: Trend in the global number of under-5 deaths estimated by dierent studies
and particularly in the 1990s. Outside of sub-Saharan

Africa, deaths increased by more than 100% in countries
such as Honduras, Paraguay, Qatar, United Arab
Emirates, and Venezuela. These estimates underlie the
need for urgent policy responses in such countries,
predicated on knowledge of trends in leading causes of
adult mortality.
Levels and trends in the burden of disease in populations reect age-specic and sex-specic mortality
rates, population numbers, and the age structure of
the population. A simple summary measure of these
demographic and epidemiological factors is the mean
age at death. Population ageing and changes in agespecic death rates have led to profound changes in the
mean age at death in dierent regions. Figure 8
compares the mean age at death in 1970 with that in
2010. All regions, including those in sub-Saharan Africa
most aected by HIV/AIDS, have had increases in the
mean age at death. In some regions, especially east Asia,
but also south Asia, southeast Asia, and Latin America,
the mean age at death increased by at least an average of
1 year for every 2 calendar years since 1970. Three out of
four Latin American regions (central, tropical, and
Andean), east Asia, and north Africa and the Middle East
had increases in mean ages at death of more than
29 years. Figure 8 summarises the comparative speed of
epidemiological transition worldwide across dierent
regions: older mean ages at death were associated with
the increasing relative importance of non-communicable
diseases in populations as infectious diseases of childhood and conditions aecting newborn survival were
brought under control.1,88 Appendix pp 5153 provide
estimates of how the mean age at death by country
has changed in the past 40 years. Even within regions
there was substantial variation in this metric of the
health transition.
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85
80
75
70
High-income
North America
Mean age at death in 1970 (years)
Western Europe
Australasia
65
Central Europe
60
Eastern Europe
High-income Asia Pacific
55
Southern Latin America
50
45
Central Asia
40
Caribbean
35
East Asia
South Asia
25
Central subSaharan Africa
Southeast Asia
Oceania
30

Eastern sub-Saharan Africa
20
North Africa and Middle East

Western sub-Saharan Africa
15
15
20
25
30
35
40
45
50
55
Mean age at death in 2010 (years)
60
65
70
75
80
85
Figure 8: Mean age of death in Global Burden of Disease regions in 1970 compared with 2010
Discussion
Global life expectancy has increased substantially in
the past 40 years for men and women, despite major
global and regional health crises. This increase has been
driven by large declines (60%) in child mortality,
declines of 40% or more in adult female mortality, and
declines of 1535% for adult male mortality, dependent
on age group. Global population growth from 37 billion
in 1970 to 69 billion in 2010,34 combined with a rise in
the average age of the population, has led to an
increase in the number of deaths to 528 million
(516541 million) in 2010 from 433 million
(422446 million) in 1970. In this period, the global
crude death rate declined from 117 per 1000 individuals
to 77 per 1000 individuals, because of the large (867%)
relative increase in world population.34 These trends in
global demography mask striking heterogeneity in
trends by age and sex and across countries and regions.
Under-5 deaths decreased by more than half from
164 million (161167 million) in 1970, to 116 million (115117 million) in 1990, to 68 million
(6671 million) in 2010. Substantial progress in the
past 40 years in postponing mortality in populations in all
regions has resulted in large increases in numbers of
deaths in the oldest age groups. Deaths at ages older than
80 years increased from 38 (3839) million in 1970 to
121 (120123) million in 2010 (an increase of 2156%).
The percentage increase in deaths at age 7074 years was
2090
636% and at age 7579 years was 961%, arming this

notable mortality transition worldwide.
The period since 1970 has been characterised by
substantial heterogeneity in mortality transitions. Life
expectancy in Japanese women in 2010 was 859 years,
and is probably higher in 2012. However, the gain in the
past 40 years was only 11 years, compared with total
improvements of two to three times more in other parts of
Asia (eg, the Maldives), the Middle East (especially Oman),
and Latin America (eg, Bolivia, Peru, and Guatemala).
Disease-control programmes in these countries, and
strong health policies and delivery strategies for health
services, probably have played an important part in these
gains. Developing countries can equally learn from the
failure to control tobacco use, particularly in men, which
was an important contributor to the stagnation of life
expectancy in the 1960s and early 1970s in countries such
as Australia, Denmark, UK, and USA.89 Major success in
control of HIV and childhood infectious diseases has led
to important and exemplary gains in life expectancy since
1990 in several African countries, but at a global level, the
gap in life expectancy between the highest and lowest
countries has remained at 3247 years, excluding the years
with notable mortality shocks such as in 1994 in Rwanda.
Most developing countries do not have reliable vital
registration of deaths, and in these countries, periodic
measurement of adult mortality in surveys is infrequent.
Despite the advent of new methods to improve extraction
Articles
of information on true levels and age patterns of

mortality, our knowledge of death rates in several
countries is very uncertain. This uncertainty needs to be
appropriately quantied and communicated to improve
interpretation of global assessments. To our knowledge,
the Global Burden of Disease Study 2010 is the rst
analysis in which global mortality and death numbers
have been quantied with 95% UIs. Beginning with the
work of Murray and colleagues in 2007,90 attempts have
been made to quantify UIs in under-5 mortality rates and
numbers, but such an approach has not been universal,
despite the substantial and rising global interest in levels
of child mortality as the Millennium Development Goal
(MDG) period comes to an end in 2015. UNICEF only
started reporting 90% UIs for country-specic and global
estimates in its 2012 report.91 Rajaratnam and colleagues4
reported uncertainty for their estimates of 45q15 in 2010,
but no attempts before this study were made to report
uncertainty in death rates and numbers for all age-sex
groups. The absence of UIs as a routine part of
demographic estimation will be surprising to nondemographers. The underemphasis on quantication of
uncertainty in the demographic literature might be
related to the mathematical origins of widely used
indirect estimation techniques in formal demography
rather than from a statistical tradition. As a consequence,
global, regional, and national gures for population,
mortality, and fertility are routinely reported by the UN,
the World Bank, and other agencies with what we
consider to be misleading precision. In view of advances
in measurement science, quantication of uncertainty is
feasible and desirable in all estimates of demography,
thereby enhancing the value of this metric as a support
for policy debates. In this analysis, we attempted to
propagate uncertainty from sampling, corrections for
non-sampling variance in various measurement
approaches, data synthesis, and the use of model life
tables. Our 95% UIs are appropriately wide for most
quantities of interest even at the global level, showing the
present state of our understanding of mortality. Even so,
further research will undoubtedly identify and quantify
additional sources of uncertainty that we omitted.
This study has several important limitations, in addition
to those imposed by sparse data. First, our analysis
depended substantially on the validity of the UNAIDS
estimates of mortality related to HIV by country. These
estimates were used as an input to the prior mean function
in the GPR step of synthesising under-5 mortality and
adult mortality. In settings with sparse data, this prior
mean function can have an important inuence on the
results. We empirically derived the average relation
between UNAIDS estimates of HIV-related mortality and
all-cause mortality; nevertheless, in countries where
UNAIDS estimates are incorrect our mortality estimates
could be biased. Second, our analysis used sibling history
data for 57 countries. For 25 of these countries, sibling
history data are the only source of information about adult
mortality. Levels and trends in adult mortality, as measured

by 45q15 in countries with large HIV epidemics, are driven
in large part by sibling history data (South Africa is an
important exception because we had data from the vital
registration system). Some demographers13,92,93 have used
sibling history data extensively, whereas others argue that
it is too biased to be useful.41,94 We used improved strategies
to deal with survivor bias, zero-surviving sibship bias, and
recall bias in this analysis; simulation studies suggested
that our approach should provide unbiased estimates of
adult mortality when adult mortality in a sibship (ie,
children born to the same parents) is not correlated with
sibship size. Sibling history data from countries with large
HIV epidemics also show plausible large increases in
mortality consistent with the known temporal history of
the HIV epidemic in those countries, including Kenya,
Malawi, Tanzania, and Zambia (appendix pp 258632).
Moreover, in these countries, serial sibling history surveys
yield consistent results on the timing and magnitude of
the increases in adult mortality. In addition, our sibling
history analytical strategy suggests similar levels and
trends in mortality to corrected vital registration data in
countries where both methods overlap, providing
additional empirical support for our analytical strategy of
methods development to appropriately exploit all available
data. Prudent use of empirical data from surveys of deaths
in siblings of the respondent is, we believe, preferable to
methods that predict adult mortality from the survival of
children. Further research will undoubtedly improve our
ability to reduce residual biases with sibling history data
such as cultural variations in the notion of siblings, but
these recent methodological advances have allowed us to
more condently interrogate the data for demographic
analyses such as those reported here.
With every revision (gure 7), estimates of the number
of deaths in children younger than 5 years produced by
UNICEF, Institute for Health Metrics and Evaluation,
and the Global Burden of Disease for the same year have
decreased substantially. For example, UNICEF estimates
for 2007 changed by about 11 million deaths in 3 years of
updates. Institute for Health Metrics and Evaluation
estimates also decreased by 748 000 between estimate
series from 2010 and estimate series from 2012. In the
newly released UNICEF 2012 estimates, the global
under-5 deaths estimate for 2010 was 466 000 lower than
it was for the same year in the 2011 report. These declines
in the estimated number of deaths in children younger
than 5 years globally for the same year originate from
new data for trends in child mortality and from the eect
of advances in estimation methods. New data for child
mortality and fertility have tended to show greater
declines than estimated by models. The models, particularly the Loess model for the most recent time period,
tend to be conservative about recent time trends. The
implication of this nding is that when estimates of the
achievement of MDG 4 (reduce child mortality) are made
in 2015, we are likely to underestimate progress because
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of this historical trend. The problem of underestimation

of true progress on MDG 4 is likely to be even greater at
the country level than at the global level, where some
countries have had much sharper declines than expected
on the basis of income, educational attainment, or other
factors. This key methodological observation is not
widely appreciated by those responsible for monitoring
progress toward MDG 4 and could have serious implications for renewed optimism and global programme
goals to reduce child mortality after 2015.
Great interest exists in the development community
about summary measures of global mortality and
population growth, with an understandable desire that
these estimates are comparable. At the global level, our
estimates of deaths are consistently lower than the UNPD
2010 revision of the WPP for global deaths for three 5 year
periods: 19952000, 200005, and 200510. Assuming the
5 year periods used by the UNPD are dened by the midyear of the rst and last years, they estimate 2811 million
deaths for the period of 20052010, which is 204 million
(78%) more than is reported here. Excess numbers of
deaths are greater for women (114%) than for men
(49%), with the biggest dierences reported for
Afghanistan, Angola, China, Indonesia, Kenya, Nigeria,
Republic of the Congo, South Africa, Sudan, and Uganda
(absolute dierences range from 13 million deaths per
year in China to 107 000 deaths per year in Angola).
Collectively, these countries account for 794% of the total
dierence between the two sets of estimates. Appendix
pp 2529 provide a more detailed explanation of the
factors contributing to the dierence between our assessment and that of the UNPD. The most important factors
identied include lags in the incorporation of child
mortality updates into the UNPD estimation process, use
of the Loess estimator for trends in child mortality,
alternative methods for estimating number of deaths in
children younger than 5 years from the under-5 mortality
rate, and unusual age-patterns of mortality at older ages,
especially in China. These dierences are more than a
matter of statistical interest. Recent analyses95 have drawn
attention to premature death rates in adolescents, which
for some age groups might, based on our ndings, be
exaggerated by at least 50%. In terms of age groups, the
greatest relative dierences occurred in 59 year and
1014 year age groups. Although death rates are low in
these age groups, the UNPD model life tables seem to
generate much higher levels than we identied on the
basis of the empirical standards used in our life table
system. Much greater prudence ought to be exercised
when UNPD estimates are used for policy purposes.
Analysis of global mortality with a standardised set
of statistical techniques that yield meaningful 95% UIs is
much more challenging because of the weak civil
registration systems in many countries. If all countries
had complete civil registration systems and high-quality
decennial censuses, tracking of global deaths with time
would entail substantially less uncertainty than was
2092
encountered in our study. Importantly, countries with

complete civil registration systems with medical certication of causes of death or a standardised verbal autopsy
approach to determine causes of death would have the
essential health intelligence to monitor progress with
development goals and inform priority setting in health.
Timely reporting of mortality data is crucial if the data are
to be useful for policy; for example, the year with the
largest number of countries reporting vital registration or
sample registration data for this analysis was 2003, for
which 216 million deaths were recorded42% of an
estimated 514 million globallywith an even smaller
fraction (104 million) reported from countries with
complete adult and child vital registration systems. In
other words, for an estimated 410 million deaths in 2003
(798% of the global total), statistical methods are required
to extract the levels, patterns, and trends in mortality from
incomplete civil registration or from periodic survey data.
Although the wider use of sibling history data with
respondents of both sexes will be helpful to understand
mortality rates, even in countries with partial or nearly
complete vital registration systems, our knowledge about
global, regional, and national mortality change will only
be reliably informed if much greater and urgent attention
is paid to the strengthening of civil registration systems
in countries. The recent global focus on civil registration
and vital statistics is a very welcome initial response to
this critical development priority9698 but needs to be
sustained and expanded if we are to more condently
track global health progress.
Contributors
CJLM, ADL, and HW conceived of the study and provided overall
guidance. HW, LD-L, KTL, JKR, JRM, AL-R, and CEL analysed child and
adult mortality data sources. CJLM, ADL, HW, LD-L, and KTL reviewed
each cycle of estimation in detail. HW led the development of the model
life table system. HW, LD-L, KTL, CEL, ADL, and CJLM prepared the
rst draft. HW, ADL, CJLM, LD-L, KTL, and CEL nalised the draft
based on comments from other authors and reviewer feedback.
Conicts of interest
We declare that we have no conicts of interest.
Acknowledgments
We would like to thank all individuals who have contributed to the Global
Burden of Disease Study 2010 over the past 5 years. We would also like to
express our gratitude to the United Nations Population Division for
providing data and a forum to discuss our ndings, thereby improving the
study. Finally, we would like to acknowledge the extensive support from all
sta members at the Institute for Health Metrics and Evaluation and
specically thank: James Bullard, Andrew Ernst, and Serkan Yalcin for their
tireless support of the computational infrastructure required to produce the
results; Tasha Murphy for her assistance coordinating the writing process
and for editing the manuscript; Linda A Ettinger for her expert
administrative support and facilitating communication and coordination
amongst the authors; Edgar Sioson for his eorts to design the data
visualizations that were instrumental to the process of assessing results of
the analyses; and, Peter Speyer, Abigail McLain, Katherine Leach-Kemon,
and Eden Stork for their persistent and invaluable work to gain access to
and catalogue as much data as possible to inform the estimates.
References
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Articles

Age-specic and sex-specic mortality in 187 countries,

Lancet 2012; 380: 207194

two-thirds of the global burden of disease in 2010.1 Levels

See Online for appendix

the demographic evidence on the levels of age-specic

selected countries. Another advantage of the UNPD

Age and sex model

Gaussian process regression

Estimates of child and adult mortality

New model life table system

two steps can be subdivided into the identication of data

worldwide. Appendix pp 70257 provide plots of the data

for early neonatal, late neonatal, postneonatal, and

New relational model life table system

is an extension of the modied logit life table system

Estimation of numbers of deaths

Role of the funding source

Male life expectancy

Female life expectancy

www.thelancet.com Vol 380 December 15/22/29, 2012

expectancies for each sex. Substantial improvement in

Age group (years)

Figure 2: Decline in global age-specic mortality rate, 19702010

with young women probably reects slow progress in

Male life expectancy

Female life expectancy

High-income Asia Pacic

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Male life expectancy

Female life expectancy

Antigua and Barbuda

Saint Vincent and the Grenadines 603

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Male life expectancy

Female life expectancy

Bosnia and Herzegovina

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Male life expectancy

Female life expectancy

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Andean Latin America

Central Latin America

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Male life expectancy

Female life expectancy

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Southern Latin America

Tropical Latin America

North Africa and Middle East

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Male life expectancy

Female life expectancy

United Arab Emirates

Federated States of Micronesia

Papua New Guinea