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 age-standardised 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 females reached 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 super-region, 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.

Zobrazit více v PubMed

IHME COVID-19 Forecasting Team Modeling COVID-19 scenarios for the United States. Nat Med. 2021;27:94–105. PubMed PMC

Azad A. CNN; March 30, 2020. Model cited by White House says 82,000 people could die from coronavirus by August, even with social distancing.https://www.cnn.com/2020/03/30/health/coronavirus-us-ihme-model-us/index.html

COVID-19 Excess Mortality Collaborators Estimating excess mortality due to the COVID-19 pandemic: a systematic analysis of COVID-19-related mortality, 2020–21. Lancet. 2022;399:1513–1536. PubMed PMC

Murray CJL. The Global Burden of Disease Study at 30 years. Nat Med. 2022;28:2019–2026. PubMed

Jamison DT, Summers LH, Chang AY, et al. Global health 2050: the path to halving premature death by mid-century. Lancet. 2024;404:1561–1614. PubMed PMC

WHO The global health observatory. Noncommunicable diseases: mortality. https://www.who.int/data/gho/data/themes/topics/topic-details/GHO/ncd-mortality

GBD 2023 Demographics Collaborators 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. Lancet. 2025 doi: 10.1016/S0140-6736(25)01330-3. published online Oct 12. PubMed DOI

Sauerberg M, Luy M. Standardized mean age at death (MADstd): exploring its potentials as a measure of human longevity. Demogr Res. 2024;50:871–898.

Garmany A, Yamada S, Terzic A. Longevity leap: mind the healthspan gap. NPJ Regen Med. 2021;6:57. PubMed PMC

GBD 2023 Disease and Injury and Risk Factor Collaborators Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990–2023: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025 doi: 10.1016/S0140-6736(25)01637-X. published online Oct 12. PubMed DOI

WHO WHO Director-General's opening remarks at the media briefing on COVID-19—11 March 2020. https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020

Polizzi A, Zhang L, Timonin S, et al. Indirect effects of the COVID-19 pandemic: a cause-of-death analysis of life expectancy changes in 24 countries, 2015 to 2022. PNAS Nexus. 2024;4 PubMed PMC

Institute for Health Metrics and Evaluation Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) Protocol. June 4, 2024. https://www.healthdata.org/sites/default/files/2024-06/GBD%20Protocol%20060424.pdf

GBD 2021 Causes of Death Collaborators Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403:2100–2132. PubMed PMC

Lozano R, Naghavi M, Foreman K, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2095–2128. PubMed PMC

GBD 2013 Mortality and Causes of Death Collaborators Global, regional, and national age–sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117–171. PubMed PMC

GBD 2015 Mortality and Causes of Death Collaborators Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388:1459–1544. PubMed PMC

GBD 2016 Causes of Death Collaborators Global, regional, and national age-sex specific mortality for 264 causes of death, 1980–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1151–1210. PubMed PMC

GBD 2017 Causes of Death Collaborators Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392:1736–1788. PubMed PMC

Johnson SC, Cunningham M, Dippenaar IN, et al. Public health utility of cause of death data: applying empirical algorithms to improve data quality. BMC Med Inform Decis Mak. 2021;21:175. PubMed PMC

PAHO/WHO . Pan American Health Organization; 2021. Monitoring the premature mortality from the four major noncommunicable diseases (cardiovascular diseases, cancer, diabetes mellitus, and chronic respiratory diseases) in the Region of the Americas, 2000–2019.https://www.paho.org/en/enlace/risk-dying-prematurely-ncds

National Cancer Institute. National Institutes of Health NCI Dictionary of Cancer Terms: premature death. Feb 2, 2011. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/premature-death

García MC, Rossen LM, Matthews K, et al. Preventable premature deaths from the five leading causes of death in nonmetropolitan and metropolitan counties, United States, 2010–2022. MMWR Surveill Summ. 2024;73:1–11. PubMed PMC

França EB, Ishitani LH, de Abreu DMX, et al. Measuring misclassification of COVID-19 as garbage codes: results of investigating 1365 deaths and implications for vital statistics in Brazil. PLOS Glob Public Health. 2022;2 PubMed PMC

US Centers for Disease Control and Prevention Excess deaths associated with COVID-19. Sept 28, 2023. https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm

Birnbaum JK, Murray CJ, Lozano R. Exposing misclassified HIV/AIDS deaths in South Africa. Bull World Health Organ. 2011;89:278–285. PubMed PMC

COVID-19 Forecasting Team Forecasting the trajectory of the COVID-19 pandemic into 2023 under plausible variant and intervention scenarios: a global modelling study. medRxiv. 2023 doi: 10.1101/2023.03.07.23286952. published online March 8. (preprint). DOI

GBD 2019 Healthcare Access and Quality Collaborators Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990–2019: a systematic analysis from the Global Burden of Disease Study 2019. Lancet Glob Health. 2022;10:e1715–e1743. PubMed PMC

GBD 2021 Diseases and Injuries Collaborators Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet. 2024;403:2133–2161. PubMed PMC

Institute for Health Metrics and Evaluation GBD Results. https://vizhub.healthdata.org/gbd-results

Stevens GA, Alkema L, Black RE, et al. Guidelines for Accurate and Transparent Health Estimates Reporting: the GATHER statement. Lancet. 2016;388:e19–e23. PubMed

Lewis S, Ewald L, Duber HC, Mokdad AH, Gakidou E. Determinants of unmet healthcare needs during the final stage of the COVID-19 pandemic: insights from a 21-country online survey. Int J Public Health. 2024;69 PubMed PMC

Gates Bill. Penguin Books; 2023. How to prevent the next pandemic.

Otto SP, MacPherson A, Colijn C. Endemic does not mean constant as SARS-CoV-2 continues to evolve. Evolution. 2024;78:1092–1108. PubMed

Johnson NPAS, Mueller J. Updating the accounts: global mortality of the 1918–1920 ‘Spanish’ influenza pandemic. Bull Hist Med. 2002;76:105–115. PubMed

Murray CJ, Lopez AD, Chin B, Feehan D, Hill KH. Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918–20 pandemic: a quantitative analysis. Lancet. 2006;368:2211–2218. PubMed

UN Office on Drugs and Crime World drug report. 2024. https://www.unodc.org/unodc/en/data-and-analysis/world-drug-report-2024.html

Montesanti SR. The role of structural and interpersonal violence in the lives of women: a conceptual shift in prevention of gender-based violence. BMC Womens Health. 2015;15:93. PubMed PMC

Pirkis J, Dandona R, Silverman M, Khan M, Hawton K. Preventing suicide: a public health approach to a global problem. Lancet Public Health. 2024;9:e787–e795. PubMed

UN Office for the Coordination of Humanitarian Affairs Reported impact snapshot: Gaza Strip. 8 January 2025. https://www.ochaopt.org/content/reported-impact-snapshot-gaza-strip-8-january-2025

Guillot M, Draidi M, Cetorelli V, Silva JHCMD, Lubbad I. Life expectancy losses in the Gaza Strip during the period October, 2023, to September, 2024. Lancet. 2025;405:478–485. PubMed

GBD 2021 Suicide Collaborators Global, regional, and national burden of suicide, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Public Health. 2025;10:e189–e202. PubMed PMC

Yan Y, Jiang Y, Liu R, et al. Impact of pesticide regulations on mortality from suicide by pesticide in China: an interrupted time series analysis. Front Psychiatry. 2023;14 PubMed PMC

Cai Z, Chen M, Ye P, Yip PSF. Socio-economic determinants of suicide rates in transforming China: a spatial-temporal analysis from 1990 to 2015. Lancet Reg Health West Pac. 2022;19 PubMed PMC

WHO Comprehensive mental health action plan 2013–2030. Sept 21, 2021. https://www.who.int/publications/i/item/9789240031029

Razeghian-Jahromi I, Ghasemi Mianrood Y, Dara M, Azami P. Premature death, underlying reasons, and preventive experiences in Iran: a narrative review. Arch Iran Med. 2023;26:403–410. PubMed PMC

GBD 2021 Tuberculosis Collaborators Global, regional, and national age-specific progress towards the 2020 milestones of the WHO End TB Strategy: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Infect Dis. 2024;24:698–725. PubMed PMC

Troeger CE, Khalil IA, Blacker BF, et al. GBD 2017 Lower Respiratory Infections Collaborators Quantifying risks and interventions that have affected the burden of lower respiratory infections among children younger than 5 years: an analysis for the Global Burden of Disease Study 2017. Lancet Infect Dis. 2020;20:60–79. PubMed PMC

Niessen L. Comparative impact assessment of child pneumonia interventions. Bull World Health Organ. 2009;87:472–480. PubMed PMC

GBD 2021 Diarrhoeal Diseases Collaborators Global, regional, and national age-sex-specific burden of diarrhoeal diseases, their risk factors, and aetiologies, 1990–2021, for 204 countries and territories: a systematic analysis for the Global Burden of Disease Study 2021. Lancet Infect Dis. 2024;25:519–536. PubMed PMC

GBD 2023 Vaccine Collaborators Global, regional, and national trends in routine childhood vaccination coverage from 1980 to 2023 with forecasts to 2030: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025;406:235–260. PubMed PMC

WHO The End TB Strategy. 2022. https://www.who.int/teams/global-tuberculosis-programme/the-end-tb-strategy

WHO Child health. https://www.who.int/health-topics/child-health

UN Department of Economic and Social Affairs Sustainable Development: the 17 Goals. https://sdgs.un.org/goals

NCD Countdown 2030 Collaborators NCD Countdown 2030: pathways to achieving Sustainable Development Goal target 3.4. Lancet. 2020;396:918–934. PubMed PMC

NCD Countdown 2030 Collaborators NCD Countdown 2030: efficient pathways and strategic investments to accelerate progress towards the Sustainable Development Goal target 3.4 in low-income and middle-income countries. Lancet. 2022;399:1266–1278. PubMed PMC

Ngowi JE, Munishi C, Ndumwa HP, et al. Efforts to address the burden of non-communicable diseases need local evidence and shared lessons from high-burden countries. Ann Glob Health. 2023;89:78. PubMed PMC

Boutayeb A. In: Handbook of disease burdens and quality of life measures. Preedy VR, Watson RR, editors. Springer; 2010. The burden of communicable and non-communicable diseases in developing countries; pp. 531–546.

Quantifying the fatal and non-fatal burden of disease associated with child growth failure, 2000-2023: a systematic analysis from the Global Burden of Disease Study 2023

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

Burden of 375 diseases and injuries, risk-attributable burden of 88 risk factors, and healthy life expectancy in 204 countries and territories, including 660 subnational locations, 1990-2023: a systematic analysis for the Global Burden of Disease Study 2023

The global, regional, and national burden of cancer, 1990-2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023