| Global age-sex-specific all-cause mortality and life
expectancy estimates for 204 countries and territories and
660 subnational locations, 1950–2023: a demographic
analysis for the Global Burden of Disease Study 2023 |
| Authors: |
GBD 2023 Demographics Collaborators |
| Source: |
Lancet, Volume 406, Issue 10513 |
| Topic(s): |
Adult mortality
Childhood mortality
Data models
Mortality
|
| Country: |
More than one region
Multiple Regions
|
| Published: |
OCT 2025 |
| Abstract: |
BACKGROUND: Comprehensive, comparable, and timely estimates of demographic metrics—including life expectancy
and age-specific mortality—are essential for evaluating, understanding, and addressing trends in population health.
The COVID-19 pandemic highlighted the importance of timely and all-cause mortality estimates for being able to
respond to changing trends in health outcomes, showing a strong need for demographic analysis tools that can
produce all-cause mortality estimates more rapidly with more readily available all-age vital registration (VR) data. The
Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) is an ongoing research effort that quantifies
human health by estimating a range of epidemiological quantities of interest across time, age, sex, location, cause,
and risk. This study—part of the latest GBD release, GBD 2023—aims to provide new and updated estimates of allcause
mortality and life expectancy for 1950 to 2023 using a novel statistical model that accounts for complex
correlation structures in demographic data across age and time.
METHODS: We used 24 025 data sources from VR, sample registration, surveys, censuses, and other sources to estimate
all-cause mortality for males, females, and all sexes combined across 25 age groups in 204 countries and territories as
well as 660 subnational units in 20 countries and territories, for the years 1950–2023. For the first time, we used
complete birth history data for ages 5–14 years, age-specific sibling history data for ages 15–49 years, and age-specific
mortality data from Health and Demographic Surveillance Systems. We developed a single statistical model that
incorporates both parametric and non-parametric methods, referred to as OneMod, to produce estimates of all-cause
mortality for each age-sex-location group. OneMod includes two main steps: a detailed regression analysis with a
generalised linear modelling tool that accounts for age-specific covariate effects such as the Socio-demographic
Index (SDI) and a population attributable fraction (PAF) for all risk factors combined; and a non-parametric analysis
of residuals using a multivariate kernel regression model that smooths across age and time to adaptably follow trends
in the data without overfitting. We calibrated asymptotic uncertainty estimates using Pearson residuals to produce
95% uncertainty intervals (UIs) and corresponding 1000 draws. Life expectancy was calculated from age-specific
mortality rates with standard demographic methods. For each measure, 95% UIs were calculated with the
25th and 975th ordered values from a 1000-draw posterior distribution.
FINDINGS: In 2023, 60·1 million (95% UI 59·0–61·1) deaths occurred globally, of which 4·67 million (4·59–4·75) were
in children younger than 5 years. Due to considerable population growth and ageing since 1950, the number of
annual deaths globally increased by 35·2% (32·2–38·4) over the 1950–2023 study period, during which the global
age-standardised all-cause mortality rate declined by 66·6% (65·8–67·3). Trends in age-specific mortality rates
between 2011 and 2023 varied by age group and location, with the largest decline in under-5 mortality occurring in
east Asia (67·7% decrease); the largest increases in mortality for those aged 5–14 years, 25–29 years, and 30–39 years
occurring in high-income North America (11·5%, 31·7%, and 49·9%, respectively); and the largest increases in
mortality for those aged 15–19 years and 20–24 years occurring in Eastern Europe (53·9% and 40·1%, respectively).
We also identified higher than previously estimated mortality rates in sub-Saharan Africa for all sexes combined aged
5–14 years (87·3% higher in GBD 2023 than GBD 2021 on average across countries and territories over the 1950–2021
period) and for females aged 15–29 years (61·2% higher), as well as lower than previously estimated mortality rates in
sub-Saharan Africa for all sexes combined aged 50 years and older (13·2% lower), reflecting advances in our modelling
approach. Global life expectancy followed three distinct trends over the study period. First, between 1950 and 2019,
there were considerable improvements, from 51·2 (50·6–51·7) years for females and 47·9 (47·4–48·4) years for
males in 1950 to 76·3 (76·2–76·4) years for females and 71·4 (71·3–71·5) years for males in 2019. Second, this period
was followed by a decrease in life expectancy during the COVID-19 pandemic, to 74·7 (74·6–74·8) years for females
and 69·3 (69·2–69·4) years for males in 2021. Finally, the world experienced a period of post-pandemic recovery in
2022 and 2023, wherein life expectancy generally returned to pre-pandemic (2019) levels in 2023 (76·3 [76·0–76·6] years
for females and 71·5 [71·2–71·8] years for males). 194 (95·1%) of 204 countries and territories experienced at least
partial post-pandemic recovery in age-standardised mortality rates by 2023, with 61·8% (126 of 204) recovering to or falling below pre-pandemic levels. There were several mortality trajectories during and following the pandemic across
countries and territories. Long-term mortality trends also varied considerably between age groups and locations,
demonstrating the diverse landscape of health outcomes globally.
INTERPRETATION: This analysis identified several key differences in mortality trends from previous estimates, including
higher rates of adolescent mortality, higher rates of young adult mortality in females, and lower rates of mortality in
older age groups in much of sub-Saharan Africa. The findings also highlight stark differences across countries and
territories in the timing and scale of changes in all-cause mortality trends during and following the COVID-19
pandemic (2020–23). Our estimates of evolving trends in mortality and life expectancy across locations, ages, sexes,
and SDI levels in recent years as well as over the entire 1950–2023 study period provide crucial information for
governments, policy makers, and the public to ensure that health-care systems, economies, and societies are prepared
to address the world’s health needs, particularly in populations with higher rates of mortality than previously known.
The estimates from this study provide a robust framework for GBD and a valuable foundation for policy development,
implementation, and evaluation around the world.
FUNDING: Gates Foundation. |
| Web: |
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)01330-3/fulltext |
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