Alan Lopez Professor of Global Health Head, School of Population Health The University of Queensland

1. Mortality
Alan Lopez
Professor of Global Health
Head, School of Population Health
The University of Queensland

2. Outline
GBD 2010
Age- and Sex-specific Mortality for 187 Countries

3. What is the Global Burden of Disease 2010?
1) A systematic scientific effort to quantify the
comparative magnitude of health loss due to
major diseases, injuries and risk factors by
age, sex, country for 1990 and 2010.
2) By the numbers: 291 diseases and
injuries, 1,160 sequelae of these diseases and
injuries, and 67 risk factors or clusters of risk
factors.
3) GBD 2010 provides uncertainty intervals for all
quantities of interest.

4. GBD 2010 Team
1. 486 authors from 302 institutions in 50 countries.

6. Some GBD Terminology
1) Years of life lost due to premature mortality due to a
death at age x is the standard life expectancy at age x.
2) Years lived with disability for a cause in an age-sex
group equals the prevalence of the condition times the
disability weight for that condition.
3) DALYs = Years of life lost due to premature mortality
(YLLs) and years lived with disability (YLDs).
4) In the GBD, disability refers to any short-term or long-
term health loss.
5) In the GBD 2010, DALYs are not discounted or age-
weighted

7. Why Mortality matters
• Numbers of male and female deaths at
various ages provide important constraint
on cause of death estimates/claims
• Typically more, and more reliable
information on numbers rather than causes
of death
• Age-distribution of deaths and age-specific
risks of death important source of health
intelligence for health policy and planning

9. Progress in Reducing Age and Sex-Specific Mortality
157 of 187 countries had increases in life expectancy at birth from
1990 to 2010 for males and 166 of 187 for females.
9

10. Change in Male Life Expectancy at Birth,
1970 to 2010

11. Change in Female Life Expectancy at Birth,
1970 to 2010

14. Quantifying Uncertainty in Mortality
Estimation
1) Murray et al 2007 study on child mortality was
the first effort to quantify uncertainty in country
estimates of under-five mortality.
2) This study is the first attempt to quantify 95%
uncertainty intervals in age-specific mortality by
country across all ages.
3) Uncertainty for many countries is large
reflecting the need for better data particularly on
adult mortality.

15. Underestimating Progress in Under-
Five Mortality

16. Use of Sibling Histories to Measure Adult
Mortality
1) Important aspect of this study is using results from
sibling histories in household surveys in the estimation
of adult mortality.
2) UN Population Division tends not to use sibling
histories. For many countries in sub-Saharan
Africa, adult mortality is predicted from child mortality by
UNPD.
3) Methods used to analyze sibling histories are on
average unbiased but there may be important cultural
variation in responses to sibling histories.

17. Improving Vital Registration
• Complete death registration ( with reliable cause of
death certification) optimal source of routine mortality
statistics
• 50-60% of countries worldwide have functioning VR
systems, but only half of those are complete and reliable
• Substantial global momentum to rapidly improve VR
systems, with good progress, but requires leadership
and commitment
• Meanwhile, wider application of new mortality
measurement methods that have emerged from the
GBD2010 will reduce uncertainty about mortality levels
and trends