| Global burden of 292 causes of death in 204 countries and
territories and 660 subnational locations, 1990–2023:
a systematic analysis for the Global Burden of Disease
Study 2023 |
| Authors: |
GBD 2023 Causes of Death Collaborators |
| Source: |
Lancet, Volume 406, Issue 10513 |
| Topic(s): |
Data models
Mortality
|
| Country: |
More than one region
Multiple Regions
|
| Published: |
OCT 2025 |
| Abstract: |
BACKGROUND: Timely and comprehensive analyses of causes of death stratified by age, sex, and location are essential for
shaping effective health policies aimed at reducing global mortality. The Global Burden of Diseases, Injuries, and
Risk Factors Study (GBD) 2023 provides cause-specific mortality estimates measured in counts, rates, and years of life
lost (YLLs). GBD 2023 aimed to enhance our understanding of the relationship between age and cause of death by
quantifying the probability of dying before age 70 years (70q0) and the mean age at death by cause and sex. This study
enables comparisons of the impact of causes of death over time, offering a deeper understanding of how these causes
affect global populations.
METHODS: GBD 2023 produced estimates for 292 causes of death disaggregated by age-sex-location-year in 204 countries
and territories and 660 subnational locations for each year from 1990 until 2023. We used a modelling tool developed
for GBD, the Cause of Death Ensemble model (CODEm), to estimate cause-specific death rates for most causes. We
computed YLLs as the product of the number of deaths for each cause-age-sex-location-year and the standard life
expectancy at each age. Probability of death was calculated as the chance of dying from a given cause in a specific age
period, for a specific population. Mean age at death was calculated by first assigning the midpoint age of each age
group for every death, followed by computing the mean of all midpoint ages across all deaths attributed to a given
cause. We used GBD death estimates to calculate the observed mean age at death and to model the expected mean age
across causes, sexes, years, and locations. The expected mean age reflects the expected mean age at death for
individuals within a population, based on global mortality rates and the population’s age structure. Comparatively, the
observed mean age represents the actual mean age at death, influenced by all factors unique to a location-specific
population, including its age structure. As part of the modelling process, uncertainty intervals (UIs) were generated
using the 2·5th and 97·5th percentiles from a 250-draw distribution for each metric. Findings are reported as counts
and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2023 include a
correction for the misclassification of deaths due to COVID-19, updates to the method used to estimate COVID-19,
and updates to the CODEm modelling framework. This analysis used 55 761 data sources, including vital registration
and verbal autopsy data as well as data from surveys, censuses, surveillance systems, and cancer registries, among
others. For GBD 2023, there were 312 new country-years of vital registration cause-of-death data, 3 country-years of
surveillance data, 51 country-years of verbal autopsy data, and 144 country-years of other data types that were added to
those used in previous GBD rounds.
FINDINGS: The initial years of the COVID-19 pandemic caused shifts in long-standing rankings of the leading causes of
global deaths: it ranked as the number one age-standardised cause of death at Level 3 of the GBD cause classification
hierarchy in 2021. By 2023, COVID-19 dropped to the 20th place among the leading global causes, returning the
rankings of the leading two causes to those typical across the time series (ie, ischaemic heart disease and stroke).
While ischaemic heart disease and stroke persist as leading causes of death, there has been progress in reducing their
age-standardised mortality rates globally. Four other leading causes have also shown large declines in global agestandardised
mortality rates across the study period: diarrhoeal diseases, tuberculosis, stomach cancer, and measles.
Other causes of death showed disparate patterns between sexes, notably for deaths from conflict and terrorism in
some locations. A large reduction in age-standardised rates of YLLs occurred for neonatal disorders. Despite this,
neonatal disorders remained the leading cause of global YLLs over the period studied, except in 2021, when COVID-19
was temporarily the leading cause. Compared to 1990, there has been a considerable reduction in total YLLs in many
vaccine-preventable diseases, most notably diphtheria, pertussis, tetanus, and measles. In addition, this study
quantified the mean age at death for all-cause mortality and cause-specific mortality and found noticeable variation by
sex and location. The global all-cause mean age at death increased from 46·8 years (95% UI 46·6–47·0) in 1990
to 63·4 years (63·1–63·7) in 2023. For males, mean age increased from 45·4 years (45·1–45·7) to 61·2 years (60·7–61·6),
and for females it increased from 48·5 years (48·1–48·8) to 65·9 years (65·5–66·3), from 1990 to 2023. The highest
all-cause mean age at death in 2023 was found in the high-income super-region, where the mean age for femalesreached 80·9 years (80·9–81·0) and for males 74·8 years (74·8–74·9). By comparison, the lowest all-cause mean age
at death occurred in sub-Saharan Africa, where it was 38·0 years (37·5–38·4) for females and 35·6 years (35·2–35·9)
for males in 2023. Lastly, our study found that all-cause 70q0 decreased across each GBD super-region and region
from 2000 to 2023, although with large variability between them. For females, we found that 70q0 notably increased
from drug use disorders and conflict and terrorism. Leading causes that increased 70q0 for males also included drug
use disorders, as well as diabetes. In sub-Saharan Africa, there was an increase in 70q0 for many non-communicable
diseases (NCDs). Additionally, the mean age at death from NCDs was lower than the expected mean age at death for
this super-region. By comparison, there was an increase in 70q0 for drug use disorders in the high-income superregion,
which also had an observed mean age at death lower than the expected value.
INTERPRETATION: We examined global mortality patterns over the past three decades, highlighting—with enhanced
estimation methods—the impacts of major events such as the COVID-19 pandemic, in addition to broader trends
such as increasing NCDs in low-income regions that reflect ongoing shifts in the global epidemiological transition.
This study also delves into premature mortality patterns, exploring the interplay between age and causes of death and
deepening our understanding of where targeted resources could be applied to further reduce preventable sources of
mortality. We provide essential insights into global and regional health disparities, identifying locations in need of
targeted interventions to address both communicable and non-communicable diseases. There is an ever-present need
for strengthened health-care systems that are resilient to future pandemics and the shifting burden of disease,
particularly among ageing populations in regions with high mortality rates. Robust estimates of causes of death are
increasingly essential to inform health priorities and guide efforts toward achieving global health equity. The need for
global collaboration to reduce preventable mortality is more important than ever, as shifting burdens of disease are
affecting all nations, albeit at different paces and scales.
FUNDING: Gates Foundation. |
| Web: |
https://pubmed.ncbi.nlm.nih.gov/41092928/ |
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