BACKGROUND Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, and the gap between male and female life expectancy increased with progression to higher levels of SDI. Some countries with exceptional health performance in 1990 in terms of the difference in observed to expected life expectancy at birth had slower progress on the same measure in 2016. INTERPRETATION Globally, mortality rates have decreased across all age groups over the past five decades, with the largest improvements occurring among children younger than 5 years. However, at the national level, considerable heterogeneity remains in terms of both level and rate of changes in age-specific mortality; increases in mortality for certain age groups occurred in some locations. We found evidence that the absolute gap between countries in age-specific death rates has declined, although the relative gap for some age-sex groups increased. Countries that now lead in terms of having higher observed life expectancy than that expected on the basis of development alone, or locations that have either increased this advantage or rapidly decreased the deficit from expected levels, could provide insight into the means to accelerate progress in nations where progress has stalled. FUNDING Bill & Melinda Gates Foundation, and the National Institute on Aging and the National Institute of Mental Health of the National Institutes of Health.

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1970-2016 年全球、区域和国家 5 岁以下儿童死亡率、成人死亡率、特定年龄死亡率和预期寿命：2016 年全球疾病负担研究的系统分析。

背景 对死亡率模式，特别是特定年龄死亡率的详细评估是使卫生系统能够针对特定人群采取干预措施的关键投入。了解全因死亡率随发展状况的变化可以确定最佳实践的范例。为了实现这一目标，2016 年全球疾病、伤害和风险因素负担研究 (GBD 2016) 估计了 1970 年至 2016 年间 195 个国家和地区以及 5 个国家以下地区的特定年龄和特定性别全因死亡率。 2016 年人口超过 2 亿的国家。 方法 我们使用一套称为成人死亡分布方法的人口学方法，并考虑了 5 岁以下儿童的调查和人口普查数据，评估了民事登记系统捕获死亡的情况。我们通过将每个地点年份登记的死亡人数除以我们总体估算过程中生成的所有年龄死亡人数的估算值，对死亡登记的完整性进行了总体评估。对于 163 个地点，包括拥有完整生命登记 (VR) 系统的人口超过 2 亿的国家的次国家单位，我们的估计主要由观测数据驱动，并对数字的小幅波动和近年来的估计进行了修正。数据报告滞后（滞后因地点而异，一般为 1 年至 6 年）。对于其他地点，我们利用不同的数据源，使用完整的出生史、摘要出生史和经过调整的不完整 VR 来衡量 5 岁以下死亡率 (U5MR)；我们使用调整后的不完全 VR、兄弟姐妹历史和家庭死亡回忆来测量成人死亡率（15-60 岁个体的死亡概率）。我们使用 U5MR 和成人死亡率，以及 GBD 模型生命表系统中的 HIV 粗死亡率来估计每个地点年份的特定年龄和特定性别死亡率。利用各种国际数据库，我们确定了致命的不连续性，我们将其定义为由于冲突和恐怖主义、自然灾害、重大运输或技术事故以及一部分流行性传染病导致的死亡率增加每百万人中有一人以上；这些已添加到相关年份的估计中。在 47 个国家，成人艾滋病毒/艾滋病患病率峰值超过 0·5%，且 VR 系统完成度不到 65%，我们使用估计和预测包 (EPP) 提供了对年龄-性别特定死亡率的估计。 )-适合国家艾滋病毒/艾滋病流行率调查和产前诊所血清监测系统的谱模型。我们使用时空高斯过程回归模型中的调查和 VR 数据估算了死产、早期新生儿、晚期新生儿和儿童死亡率。我们使用特定年龄死亡率估算了所有地点年份的简略生命表。我们根据社会人口指数 (SDI) 将地点分为发展五分位数，并按五分位数分析死亡率趋势。使用样条回归，我们估计了每个年龄-性别组的预期死亡率作为 SDI 的函数。我们通过仅根据发展状况将观察到的预期寿命与预期预期寿命进行比较，确定了预期寿命高于预期的国家。调查结果 死亡登记的完整性从 1970 年的 28% 上升到 2013 年的峰值 45%；由于报告滞后，2013 年之后完整性较低。从 1970 年到 2016 年，5 岁以下儿童的总死亡人数有所下降，5-24 岁年龄段的下降速度较慢。相比之下，25 岁​​以上每个 5 岁年龄段的成人死亡人数均有所增加。2000年至2016年期间，与前几十年相比，年龄别死亡率的年化变化率分布有所不同：年化变化率上升的频率较低，但在某些地方，特别是青少年和青少年死亡率的年化变化率仍然上升。较年轻的成人年龄组。自 1970 年以来，全球死产率和 5 岁以下儿童死亡率均有所下降。全球死亡率趋同的证据好坏参半。尽管SDI水平最低和最高的国家之间年龄标准化死亡率之间的绝对差异有所缩小，但这些死亡率的比率（衡量相对不平等的指标）略有增加。1970 年至 2016 年间，预期寿命发生了巨大转变，尤其是在 SDI 水平较高时。2016 年，在人口超过 100 万的国家中，日本女性出生时预期寿命最高，为 86·9 岁（95% UI 86·7-87·2），新加坡男性出生时预期寿命最高，为 81·3 岁2016年，男性预期寿命为78·8-83·7。1970年至2016年间，男性预期寿命普遍低于女性预期寿命，并且随着SDI水平的提高，男性和女性预期寿命之间的差距扩大。一些国家在 1990 年观察到的出生时预期寿命与预期预期寿命之间的差异方面表现出色，但在 2016 年以同样的标准衡量进展较慢。 解释 在全球范围内，过去 50 年来，所有年龄组的死亡率均有所下降，随着最大的进步发生在 5 岁以下的儿童中。然而，在国家一级，年龄别死亡率的水平和变化率仍然存在相当大的异质性；某些地区某些年龄组的死亡率有所上升。我们发现有证据表明，尽管某些年龄性别群体的相对差距有所扩大，但各国之间的年龄别死亡率绝对差距已经缩小。目前在观察到的预期寿命高于仅根据发展所预期的预期寿命方面处于领先地位的国家，或者增加了这一优势或从预期水平迅速减少赤字的国家，可以提供有关加速国家进步的方法的见解进展停滞的地方。资助比尔及梅琳达·盖茨基金会、美国国立卫生研究院国家老龄化研究所和国家心理健康研究所。