Summary Background Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. Methods We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography–year datapoints. For GBD 2015, eight causes, including Ebola virus disease, were added to the previous GBD cause list for mortality. We used six modelling approaches to assess cause-specific mortality, with the Cause of Death Ensemble Model (CODEm) generating estimates for most causes. We used a series of novel analyses to systematically quantify the drivers of trends in mortality across geographies. First, we assessed observed and expected levels and trends of cause-specific mortality as they relate to the Socio-demographic Index (SDI), a summary indicator derived from measures of income per capita, educational attainment, and fertility. Second, we examined factors affecting total mortality patterns through a series of counterfactual scenarios, testing the magnitude by which population growth, population age structures, and epidemiological changes contributed to shifts in mortality. Finally, we attributed changes in life expectancy to changes in cause of death. We documented each step of the GBD 2015 estimation processes, as well as data sources, in accordance with Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Findings Globally, life expectancy from birth increased from 61·7 years (95% uncertainty interval 61·4–61·9) in 1980 to 71·8 years (71·5–72·2) in 2015. Several countries in sub-Saharan Africa had very large gains in life expectancy from 2005 to 2015, rebounding from an era of exceedingly high loss of life due to HIV/AIDS. At the same time, many geographies saw life expectancy stagnate or decline, particularly for men and in countries with rising mortality from war or interpersonal violence. From 2005 to 2015, male life expectancy in Syria dropped by 11·3 years (3·7–17·4), to 62·6 years (56·5–70·2). Total deaths increased by 4·1% (2·6–5·6) from 2005 to 2015, rising to 55·8 million (54·9 million to 56·6 million) in 2015, but age-standardised death rates fell by 17·0% (15·8–18·1) during this time, underscoring changes in population growth and shifts in global age structures. The result was similar for non-communicable diseases (NCDs), with total deaths from these causes increasing by 14·1% (12·6–16·0) to 39·8 million (39·2 million to 40·5 million) in 2015, whereas age-standardised rates decreased by 13·1% (11·9–14·3). Globally, this mortality pattern emerged for several NCDs, including several types of cancer, ischaemic heart disease, cirrhosis, and Alzheimer's disease and other dementias. By contrast, both total deaths and age-standardised death rates due to communicable, maternal, neonatal, and nutritional conditions significantly declined from 2005 to 2015, gains largely attributable to decreases in mortality rates due to HIV/AIDS (42·1%, 39·1–44·6), malaria (43·1%, 34·7–51·8), neonatal preterm birth complications (29·8%, 24·8–34·9), and maternal disorders (29·1%, 19·3–37·1). Progress was slower for several causes, such as lower respiratory infections and nutritional deficiencies, whereas deaths increased for others, including dengue and drug use disorders. Age-standardised death rates due to injuries significantly declined from 2005 to 2015, yet interpersonal violence and war claimed increasingly more lives in some regions, particularly in the Middle East. In 2015, rotaviral enteritis (rotavirus) was the leading cause of under-5 deaths due to diarrhoea (146 000 deaths, 118 000–183 000) and pneumococcal pneumonia was the leading cause of under-5 deaths due to lower respiratory infections (393 000 deaths, 228 000–532 000), although pathogen-specific mortality varied by region. Globally, the effects of population growth, ageing, and changes in age-standardised death rates substantially differed by cause. Our analyses on the expected associations between cause-specific mortality and SDI show the regular shifts in cause of death composition and population age structure with rising SDI. Country patterns of premature mortality (measured as years of life lost [YLLs]) and how they differ from the level expected on the basis of SDI alone revealed distinct but highly heterogeneous patterns by region and country or territory. Ischaemic heart disease, stroke, and diabetes were among the leading causes of YLLs in most regions, but in many cases, intraregional results sharply diverged for ratios of observed and expected YLLs based on SDI. Communicable, maternal, neonatal, and nutritional diseases caused the most YLLs throughout sub-Saharan Africa, with observed YLLs far exceeding expected YLLs for countries in which malaria or HIV/AIDS remained the leading causes of early death. Interpretation At the global scale, age-specific mortality has steadily improved over the past 35 years; this pattern of general progress continued in the past decade. Progress has been faster in most countries than expected on the basis of development measured by the SDI. Against this background of progress, some countries have seen falls in life expectancy, and age-standardised death rates for some causes are increasing. Despite progress in reducing age-standardised death rates, population growth and ageing mean that the number of deaths from most non-communicable causes are increasing in most countries, putting increased demands on health systems. Funding Bill & Melinda Gates Foundation.

Introduction 1 Roulson J

Benbow EW

Hasleton PS Discrepancies between clinical and autopsy diagnosis and the value of post mortem histology; a meta-analysis and review. , 2 Murray CJ

Lozano R

Flaxman AD

et al. Using verbal autopsy to measure causes of death: the comparative performance of existing methods. , 3 Serina P

Riley I

Stewart A

et al. A shortened verbal autopsy instrument for use in routine mortality surveillance systems. , 4 Naghavi M

Makela S

Foreman K

O'Brien J

Pourmalek F

Lozano R Algorithms for enhancing public health utility of national causes-of-death data. , 5 Foreman KJ

Lozano R

Lopez AD

Murray CJ Modeling causes of death: an integrated approach using CODEm. , 6 Sonderegger-Iseli K

Burger S

Muntwyler J

Salomon F Diagnostic errors in three medical eras: a necropsy study. Comparable information about deaths and mortality rates broken down by age, sex, cause, year, and geography provides a starting point for informed health policy debate. However, generating meaningful comparisons of mortality involves addressing many data and estimation challenges, which include reconciling marked discrepancies in cause of death classifications over time and across populations; adjusting for vital registration system data with coverage and quality issues; appropriately synthesising mortality data from cause-specific sources, such as cancer registries, and alternative cause of death identification tools, such as verbal autopsies; and developing robust analytical strategies to estimate cause-specific mortality amid sparse data.The annual Global Burden of Disease (GBD) analysis provides a standardised approach to addressing these problems, thereby enhancing the capacity to make meaningful comparisons across age, sex, cause, time, and place. Research in context Evidence before this study In 2012, the Global Burden of Disease 2010 study was published, providing results from the first complete revision of the Global Burden of Disease (GBD) since the first assessment in 1993. The study reported on mortality and causes of death between 1990 and 2010 in 187 countries. In response to demand for up-to-date information on the health of populations to inform health policy debates, annual updates of the GBD study are now prepared, with the first of these, the GBD 2013 study, published in 2015. For the first time, collaborative teams undertook subnational assessments for China, Mexico, and the UK as part of this study. Added value of this study The GBD 2015 assessment of mortality and causes of death provides new and more robust evidence on the health of populations worldwide through the inclusion of subnational data from an expanded group of countries, including Brazil, India, Japan, Kenya, Saudi Arabia, South Africa, Sweden, and the USA, in addition to updates for China, Mexico, and the UK. This study complies with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) recommendations. Estimation of mortality levels, patterns, and distribution for several new causes, including Ebola virus disease, further disaggregations of carcinoma and leukaemia, motor neuron disease, and mortality attributable to environmental heat and cold exposure have been added for the GBD 2015 study. Furthermore, this analysis extends the concept of sociodemographic status first reported in GBD 2013, with important changes to computational methods, resulting in a new Socio-demographic Index (SDI) for a more robust positioning of countries and territories on the development continuum. Implications of all the available evidence This study provides the most comprehensive assessment to date of patterns and levels of mortality worldwide, expanding on previous analyses by further investigating the main determinants of epidemiological patterns and trends across geographies and over time. The GBD 2015 study entails a complete reanalysis of trends for each cause of death from 1990 to 2015; the time series published here supersedes the results of the GBD 2013 study. The expansion of geographic units, from 296 in GBD 2013 to 519 for GBD 2015, is envisaged to continue so as to sustain comparability over time and across all geographies. The comparison of estimates of observed mortality levels with patterns expected based on the SDI provides an in-depth understanding of national health challenges and priority areas for intervention. 7 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. , 8 Wang H

Liddell CA

Coates MM

et al. Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. , 9 Kassebaum NJ

Bertozzi-Villa A

Coggeshall MS

et al. Global, regional, and national levels and causes of maternal mortality during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. , 10 Murray CJL

Lopez AD the Harvard School of Public Health World Health Organization World Bank , 11 Murray CJL

Ortblad KF

Guinovart C

et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. 7 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. Previous iterations of the GBD study showed substantial reductions in under-5 mortality, largely driven by decreasing rates of death from diarrhoeal diseases, lower respiratory infections, malaria, and, in several countries, neonatal conditions and malnutrition.Non-communicable diseases (NCDs) and injuries claimed increasingly more lives throughout the world, although age-standardised death rates fell for many causes and countries.Examination of epidemiological convergence among high-income, middle-income, and low-income countries showed the importance of evaluating both absolute and relative changes in mortality, as solely focusing on absolutes can mask rising relative inequality among certain age groups and causes. The GBD 2015 study expands on these analyses by further evaluating the drivers of epidemiological patterns across countries and over time. Such mortality trends are generally shaped by a combination of factors, including changes in income per capita, educational attainment, fertility, shifts in clinical care and health system responsiveness, emergent health threats such as disease outbreaks or increasing rates of obesity, and geography-specific health contexts. An in-depth understanding of national health gains and priority areas for intervention can be provided by comparing estimates of expected mortality patterns. These results are of particular importance amid debates on financing and policy options for the newly adopted Sustainable Development Goals, which include both ambitious targets for maternal and child health and a much broader health agenda also encompassing NCDs and injuries. 12 Wang H

Dwyer-Lindgren L

Lofgren KT

et al. Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. 7 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. , 13 Newton JN

Briggs ADM

Murray CJL

et al. Changes in health in England, with analysis by English regions and areas of deprivation, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. , 14 Zhou M

Wang H

Zhu J

et al. Cause-specific mortality for 240 causes in China during 1990–2013: a systematic subnational analysis for the Global Burden of Disease Study 2013. , 15 Gómez-Dantés H

Fullman N

Lamadrid-Figueroa H

et al. Dissonant health transition in the states of Mexico, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. 16 The GBD 2010 study presented results for 187 countries, encompassing all those with a population greater than 50 000 in the year 2000.In the GBD 2013 study, collaborative teams produced subnational assessments for the UK, Mexico, and China, expanding the number of geographies included in the GBD analysis to 296.The value of such subnational assessments to local decision makershas driven further geographical disaggregation for GBD 2015 including in Brazil, India, Japan, Kenya, Saudi Arabia, South Africa, Sweden, and the USA, in addition to updates for China, Mexico, and the UK. The expansion of the geographical units in the GBD studies will continue in a way that will sustain the comparability over time for the period 1990 to present and across all geographic entities. 17 Bhalla K

Harrison JE GBD-2010 overestimates deaths from road injuries in OECD countries: new methods perform poorly. , 18 Rudan I

Chan KY Global health metrics needs collaboration and competition. As with all revisions of the GBD, the GBD 2015 study provides an update for the entire time series from 1990 to 2015 based on newly identified data sources released or collected since GBD 2013. In response to published commentaries and unpublished seminars and communications about GBD methods, various methodological refinements have been implemented.Additionally, in the GBD 2015 cycle, a major effort towards data and code transparency has been made. As with each GBD cycle, the full time series published here supersedes previous GBD studies. This detailed assessment of causes of death allows the exploration of key questions including what are the leading causes of deaths in each geography, which causes are increasing or decreasing, what is the expected pattern of change in causes of death with the epidemiological transition and how does this expected pattern over time diverge across geographies.

Results Global life expectancy and mortality Table 4 Global life expectancy at birth and at age 50, age-standardised death rates, age-standardised YLL rate, and total deaths, by sex, 1980–2015 Life expectancy at birth (years) Life expectancy at age 50 (years) Age-standardised death rate (per 100 000) Age-standardised YLL rate (per 100) Total deaths (millions) Male Female Male Female Male Female Male Female Male Female Both sexes 1980 59·6 (59·3–60·0) 63·7 (63·3–64·1) 23·1 (22·9–23·2) 26·4 (26·2–26·7) 1536·1 (1513·0–1558·5) 1194·6 (1172·4–1217·9) 49·8 (49·0–50·5) 40·8 (40·1–41·6) 23·5 (23·2–23·9) 21·6 (21·2–22·0) 45·2 (44·6–45·7) 1981 59·9 (59·6–60·2) 64·1 (63·7–64·4) 23·1 (22·9–23·3) 26·5 (26·3–26·8) 1525·0 (1502·7–1547·1) 1177·5 (1155·9–1199·6) 49·1 (48·4–49·8) 40·0 (39·3–40·7) 23·7 (23·4–24·1) 21·7 (21·3–22·1) 45·5 (44·9–46·0) 1982 60·3 (59·9–60·6) 64·5 (64·1–64·9) 23·2 (23·0–23·4) 26·7 (26·5–26·9) 1499·7 (1478·4–1521·2) 1155·8 (1134·3–1177·4) 48·1 (47·4–48·7) 39·1 (38·4–39·7) 23·8 (23·5–24·1) 21·7 (21·3–22·1) 45·5 (45·0–46·1) 1983 60·5 (60·1–60·9) 64·7 (64·3–65·2) 23·3 (23·1–23·5) 26·7 (26·5–26·9) 1486·1 (1463·7–1507·7) 1146·6 (1125·7–1167·7) 47·4 (46·7–48·2) 38·5 (37·8–39·2) 24·0 (23·6–24·4) 22·0 (21·6–22·4) 46·0 (45·5–46·6) 1984 60·8 (60·4–61·2) 65·1 (64·6–65·5) 23·4 (23·2–23·5) 26·8 (26·6–27·0) 1472·0 (1451·3–1493·7) 1132·5 (1112·4–1153·3) 46·7 (46·0–47·5) 37·7 (37·0–38·4) 24·2 (23·9–24·6) 22·1 (21·8–22·5) 46·4 (45·8–47·0) 1985 61·2 (60·9–61·6) 65·5 (65·1–65·9) 23·4 (23·3–23·6) 26·9 (26·7–27·1) 1453·9 (1434·0–1474·9) 1116·4 (1097·3–1135·7) 45·6 (45·0–46·3) 36·8 (36·2–37·4) 24·3 (24·0–24·7) 22·2 (21·9–22·6) 46·6 (46·0–47·1) 1986 61·7 (61·3–62·0) 66·0 (65·6–66·4) 23·6 (23·4–23·8) 27·1 (26·9–27·3) 1428·4 (1409·1–1450·0) 1091·5 (1073·4–1111·2) 44·5 (43·9–45·2) 35·7 (35·2–36·3) 24·3 (24·0–24·7) 22·1 (21·8–22·5) 46·5 (45·9–47·0) 1987 62·0 (61·6–62·3) 66·3 (65·9–66·7) 23·7 (23·5–23·9) 27·2 (27·0–27·4) 1411·7 (1392·5–1432·2) 1077·6 (1059·9–1097·0) 43·8 (43·2–44·4) 35·0 (34·5–35·6) 24·5 (24·1–24·8) 22·3 (21·9–22·6) 46·7 (46·2–47·3) 1988 62·1 (61·7–62·4) 66·5 (66·2–66·9) 23·7 (23·5–23·8) 27·2 (27·0–27·4) 1409·9 (1389·3–1430·2) 1068·2 (1051·0–1087·0) 43·5 (42·8–44·1) 34·5 (34·0–35·0) 24·9 (24·5–25·2) 22·5 (22·1–22·9) 47·3 (46·8–47·9) 1989 62·4 (62·0–62·7) 66·9 (66·5–67·2) 23·6 (23·5–23·8) 27·3 (27·1–27·5) 1401·9 (1380·9–1422·3) 1055·5 (1039·0–1073·2) 42·8 (42·2–43·4) 33·8 (33·3–34·3) 25·1 (24·7–25·4) 22·6 (22·3–23·0) 47·7 (47·2–48·2) 1990 62·5 (62·2–62·8) 67·1 (66·7–67·4) 23·7 (23·5–23·9) 27·4 (27·2–27·6) 1381·1 (1359·0–1401·6) 1035·1 (1019·1–1052·0) 42·4 (41·8–43·0) 33·2 (32·8–33·7) 25·3 (24·9–25·7) 22·6 (22·3–23·0) 47·9 (47·4–48·5) 1991 62·6 (62·3–62·9) 67·3 (66·9–67·6) 23·8 (23·6–24·0) 27·5 (27·3–27·7) 1371·9 (1349·3–1393·1) 1025·1 (1010·2–1041·2) 42·1 (41·4–42·7) 32·8 (32·4–33·3) 25·6 (25·2–26·0) 22·7 (22·4–23·1) 48·3 (47·8–48·8) 1992 62·8 (62·5–63·1) 67·5 (67·2–67·8) 23·8 (23·7–24·0) 27·6 (27·4–27·7) 1363·9 (1342·2–1384·4) 1016·1 (1001·2–1032·0) 41·6 (41·0–42·2) 32·3 (31·9–32·8) 25·8 (25·4–26·2) 22·9 (22·5–23·2) 48·7 (48·2–49·2) 1993 62·8 (62·5–63·1) 67·6 (67·3–67·9) 23·8 (23·6–24·0) 27·5 (27·3–27·7) 1367·1 (1347·1–1386·3) 1016·0 (1001·6–1031·0) 41·5 (40·9–42·1) 32·0 (31·6–32·5) 26·3 (25·9–26·6) 23·2 (22·8–23·5) 49·4 (48·9–49·9) 1994 62·6 (62·2–63·0) 67·7 (67·4–68·0) 23·8 (23·6–24·0) 27·6 (27·4–27·7) 1375·7 (1353·5–1399·0) 1014·1 (999·2–1029·5) 42·0 (41·2–43·0) 31·9 (31·5–32·4) 27·0 (26·5–27·5) 23·5 (23·2–23·8) 50·5 (49·9–51·2) 1995 63·1 (62·8–63·4) 68·0 (67·7–68·3) 23·9 (23·8–24·1) 27·7 (27·5–27·8) 1351·0 (1333·4–1368·4) 1000·7 (987·4–1014·9) 40·9 (40·4–41·4) 31·3 (30·9–31·7) 26·8 (26·5–27·2) 23·5 (23·2–23·9) 50·4 (49·9–50·9) 1996 63·4 (63·1–63·6) 68·3 (68·0–68·5) 24·1 (24·0–24·3) 27·9 (27·7–28·0) 1330·2 (1314·1–1347·0) 986·6 (974·0–999·9) 40·2 (39·7–40·7) 30·8 (30·5–31·2) 26·9 (26·6–27·2) 23·6 (23·3–23·9) 50·4 (50·0–50·9) 1997 63·7 (63·4–63·9) 68·5 (68·3–68·8) 24·3 (24·2–24·4) 28·0 (27·9–28·1) 1312·0 (1296·7–1327·7) 975·1 (962·9–986·9) 39·6 (39·1–40·0) 30·4 (30·0–30·7) 27·0 (26·6–27·3) 23·6 (23·3–23·9) 50·6 (50·1–51·1) 1998 63·9 (63·6–64·1) 68·8 (68·5–69·0) 24·4 (24·3–24·5) 28·1 (28·0–28·2) 1301·7 (1286·8–1316·9) 966·6 (954·7–978·8) 39·1 (38·7–39·5) 29·9 (29·6–30·3) 27·2 (26·8–27·5) 23·8 (23·5–24·1) 50·9 (50·5–51·4) 1999 64·0 (63·7–64·2) 68·9 (68·7–69·1) 24·4 (24·3–24·6) 28·1 (28·0–28·3) 1297·1 (1282·1–1312·1) 963·9 (952·1–976·1) 38·8 (38·4–39·2) 29·6 (29·3–30·0) 27·6 (27·2–27·9) 24·1 (23·8–24·4) 51·6 (51·2–52·1) 2000 64·2 (64·0–64·4) 69·1 (68·9–69·4) 24·5 (24·4–24·6) 28·2 (28·1–28·3) 1284·9 (1270·1–1299·5) 954·8 (943·4–966·3) 38·3 (37·9–38·7) 29·2 (28·8–29·6) 27·9 (27·5–28·2) 24·3 (24·0–24·6) 52·1 (51·7–52·6) 2001 64·4 (64·2–64·7) 69·4 (69·1–69·6) 24·6 (24·5–24·7) 28·3 (28·2–28·4) 1272·5 (1258·1–1286·7) 944·1 (932·9–955·5) 37·7 (37·3–38·1) 28·7 (28·4–29·1) 28·1 (27·8–28·4) 24·5 (24·2–24·8) 52·6 (52·1–53·1) 2002 64·6 (64·4–64·9) 69·6 (69·4–69·8) 24·6 (24·5–24·8) 28·4 (28·2–28·5) 1265·8 (1251·2–1280·3) 933·4 (923·0–944·4) 37·2 (36·8–37·7) 28·2 (27·9–28·6) 28·5 (28·2–28·9) 24·7 (24·4–25·0) 53·2 (52·7–53·7) 2003 65·0 (64·8–65·2) 70·0 (69·7–70·2) 24·8 (24·7–24·9) 28·5 (28·4–28·7) 1240·0 (1225·5–1254·6) 915·4 (905·3–925·9) 36·4 (36·0–36·8) 27·5 (27·2–27·9) 28·6 (28·2–28·9) 24·7 (24·4–25·0) 53·3 (52·9–53·8) 2004 65·3 (65·1–65·5) 70·3 (70·1–70·5) 25·0 (24·8–25·1) 28·7 (28·6–28·9) 1216·5 (1202·2–1231·6) 895·9 (885·5–906·9) 35·8 (35·3–36·2) 26·9 (26·6–27·3) 28·7 (28·4–29·1) 24·7 (24·4–25·0) 53·5 (53·0–54·0) 2005 65·7 (65·5–65·9) 70·7 (70·5–71·0) 25·1 (25·0–25·3) 28·9 (28·8–29·0) 1195·0 (1180·9–1209·1) 878·1 (868·3–888·2) 34·9 (34·5–35·3) 26·1 (25·8–26·4) 28·9 (28·5–29·2) 24·8 (24·5–25·1) 53·6 (53·1–54·1) 2006 66·2 (65·9–66·4) 71·2 (71·0–71·5) 25·4 (25·3–25·5) 29·2 (29·1–29·3) 1163·8 (1150·2–1176·9) 852·4 (842·9–862·3) 33·8 (33·4–34·2) 25·2 (24·9–25·5) 28·7 (28·4–29·1) 24·6 (24·3–24·8) 53·3 (52·8–53·7) 2007 66·6 (66·3–66·8) 71·7 (71·5–72·0) 25·6 (25·4–25·7) 29·4 (29·3–29·5) 1141·3 (1127·7–1154·8) 830·4 (820·5–840·6) 33·0 (32·6–33·4) 24·4 (24·1–24·7) 28·8 (28·4–29·2) 24·5 (24·2–24·8) 53·3 (52·8–53·7) 2008 66·8 (66·6–67·1) 72·1 (71·9–72·4) 25·7 (25·6–25·8) 29·6 (29·5–29·7) 1127·2 (1112·9–1140·8) 814·0 (803·9–823·4) 32·5 (32·0–32·9) 23·7 (23·4–24·1) 29·1 (28·7–29·5) 24·5 (24·2–24·8) 53·6 (53·1–54·1) 2009 67·3 (67·0–67·6) 72·6 (72·4–72·9) 25·9 (25·7–26·0) 29·9 (29·7–30·0) 1103·4 (1090·0–1116·6) 791·7 (782·3–801·5) 31·5 (31·1–31·9) 22·9 (22·6–23·2) 29·1 (28·7–29·5) 24·4 (24·1–24·7) 53·5 (52·9–54·0) 2010 67·5 (67·2–67·8) 72·9 (72·6–73·2) 26·0 (25·8–26·1) 30·0 (29·9–30·2) 1091·6 (1077·2–1105·6) 777·8 (767·4–788·0) 31·0 (30·6–31·5) 22·4 (22·0–22·7) 29·5 (29·1–29·9) 24·5 (24·2–24·8) 54·0 (53·4–54·6) 2011 68·0 (67·7–68·3) 73·4 (73·1–73·8) 26·2 (26·0–26·3) 30·3 (30·1–30·4) 1068·1 (1053·8–1083·1) 756·1 (745·4–767·2) 30·1 (29·7–30·5) 21·5 (21·2–21·9) 29·5 (29·0–29·9) 24·4 (24·0–24·7) 53·8 (53·3–54·4) 2012 68·3 (68·0–68·6) 73·9 (73·5–74·2) 26·3 (26·1–26·5) 30·5 (30·3–30·6) 1051·9 (1037·1–1067·9) 739·9 (728·9–751·9) 29·4 (29·0–29·9) 20·8 (20·5–21·2) 29·7 (29·2–30·2) 24·4 (24·0–24·8) 54·1 (53·5–54·7) 2013 68·6 (68·2–68·9) 74·2 (73·9–74·6) 26·4 (26·2–26·6) 30·6 (30·4–30·8) 1037·9 (1021·4–1055·4) 725·8 (714·1–738·9) 28·8 (28·3–29·3) 20·2 (19·9–20·6) 30·0 (29·5–30·5) 24·5 (24·1–25·0) 54·5 (53·8–55·1) 2014 68·8 (68·4–69·1) 74·5 (74·1–74·9) 26·5 (26·3–26·6) 30·7 (30·5–30·9) 1029·7 (1012·5–1048·3) 715·8 (703·8–729·6) 28·4 (27·9–28·9) 19·8 (19·4–20·2) 30·4 (29·9–31·0) 24·8 (24·3–25·2) 55·2 (54·4–55·9) 2015 69·0 (68·6–69·4) 74·8 (74·4–75·2) 26·6 (26·4–26·8) 30·9 (30·7–31·1) 1018·6 (1000·4–1037·1) 703·4 (691·0–717·8) 27·9 (27·4–28·5) 19·3 (18·9–19·7) 30·9 (30·3–31·5) 24·9 (24·5–25·5) 55·8 (55·0–56·6) Data in parentheses are 95% uncertainty intervals. Age-standardised rates are standardised using the GBD world population standard. YLLs=years of life lost. GBD=Global Burden of Disease. Global life expectancy at birth increased by 10·2 years, rising from 61·7 years (95% uncertainty interval [UI] 61·4–61·9) in 1980 to 71·8 years (71·5–72·2) in 2015 ( table 4 ), equating to an average gain of 0·29 years per year. By 2015, male life expectancy had risen by 9·4 years, increasing from 59·6 years (59·3–60·0) in 1980 to 69·0 years (68·6–69·4), whereas female life expectancy improved by 11·1 years, climbing from 63·7 years (63·3–64·1) to 74·8 years (74·4–75·2). On average, an additional 0·27 and 0·32 years of life were gained per year for males and females, respectively, since 1980. Global gains in life expectancy were generally gradual but steady, although catastrophic events, including the Rwandan genocide and North Korean famines, and escalating mortality due to HIV/AIDS, had worldwide effects on longevity. Slower gains were achieved for life expectancy at 50 years, or the average number of additional years of life 50 year olds can anticipate at a given point in time. On average, 50-year-old females saw an increase of 4·5 additional years of life since 1980, and 50-year-old males experienced an increase of 3·5 years. Annual estimates of life expectancy, by sex and geography are shown in the results appendix (pp 36–47) Global mortality trends showed a 16·4% (95% UI 14·3–18·5) increase in total deaths between 1990 and 2015, whereas age-standardised rates of mortality fell by 28·5% (27·3–29·8) during this time. The trend was similar from 2005 to 2015, with total deaths increasing by 4·1% (2·6–5·6) and age-standardised death rates decreasing by 17·0% (15·8–18·1). In 2015, 55·8 million deaths (55·0 million to 56·6 million) occurred worldwide, an increase of 7·9 million deaths since 1990 and 2·2 million deaths since 2005 ( table 4 ). From 1990 to 2015, total deaths rose by 21·9% (19·1–24·8) for males and 10·3% (7·6–13·1) for females, whereas age-standardised death rates fell by 26·2% (24·5–27·9) for males and 32·1% (30·4–33·8) for females. In 2015, 30·9 million (30·3 million to 31·5 million) males and 24·9 million (24·5 million to 25·5 million) females died, representing an increase of 5·6 million male deaths and 2·3 million female deaths since 1990. Differences in total deaths by sex widened over time, with increasingly more males dying than females; this gap grew from 2·7 million in 1990 to 4·1 million in 2005 and 6·0 million in 2015. Age-standardised rates of YLLs per 100 population, a measure of premature mortality, fell 34·1% (95% UI 32·5–35·6) for males and 42·1% (40·6–43·5) for females between 1990 and 2015. Notably, the pace of decline in YLL rates was faster from 2005 to 2015 (19·9%, 95% UI 18·3–21·5 for males and 26·3%, 24·6–27·9 for females) than from 1990 to 2005 (17·7%, 16·2–19·2 for males and 21·4%, 20·0–22·7 for females). Evolution of global and super-region life expectancy, probabilities of death, and SDI Figure 10 Co-evolution of life expectancy and probabilities of death with SDI globally and for GBD super-regions, 1980 to 2015 Show full caption (A) Life expectancy at birth and SDI; (B) under-5 death rate (5q0) and SDI; (C) probability of death between 15 and 50 years of age (35q15) and SDI; and (D) probability of death between 50 and 70 years of age (20q50) and SDI. Coloured lines show global and super-region values. Each point in a line represents 1 year, starting at 1980 and ending at 2015. In all super-regions, SDI has increased year on year so progress in SDI is associated with later years for a given super-region. Black lines show trajectories expected for each geography on the basis of SDI alone. GBD=Global Burden of Disease. SDI=Socio-demographic Index. 5q0=probability of death from birth to age 5 years. 35q15=probability of death from age 15 years to 50 years. 20q50=probability of death from age 50 years to 70 years. The differences between observed life expectancy and mortality rates and those expected on the basis of SDI show the complex interactions between gains in SDI and improved health over time. Figure 10 summarises the trends in observed and expected life expectancy or mortality at the global level and for each GBD super-region from 1980 to 2015. Some regions have higher than expected levels, whereas others have lower levels than expected. By 2015, global life expectancy had increased faster than expected based on changes in SDI for both sexes, equating to an increase of an additional 3·06 years for males and 2·78 years for females ( figure 10A ); however, before 2005, gains in life expectancy were lower than expected, particularly for females. Observed life expectancy consistently exceeded expected levels over time in southeast and east Asia and Oceania; Latin America and the Caribbean; and north Africa and the Middle East. Furthermore, for the latter two super-regions, gains for male life expectancy improved following the 1980s and 1990s, when observed levels of longevity were closer to expected life expectancy based on SDI. By contrast, observed life expectancy was generally lower than expected based on SDI in high-income countries and central Europe, eastern Europe, and central Asia. For high-income countries, however, observed male life expectancy converged with expected levels around 2005, whereas the gap between observed and expected life expectancy based on SDI widened for females in this super-region. In south Asia, where average SDI more than doubled between 1980 and 2015, observed male life expectancy consistently met or slightly exceeded expected levels, whereas female life expectancy gradually moved closer to expected levels based on SDI. Amid its escalating HIV/AIDS epidemic, sub-Saharan Africa recorded widening gaps between observed and expected life expectancies for both sexes between 1988 and 1999. From 2001 to 2015, during which the region's average SDI rose by 31%, observed life expectancy quickly increased, particularly among females, nearing expected levels. Overall, global and regional trends for observed under-5 mortality steadily moved closer to expected levels, based on rising SDI, and in some super-regions, such as Latin America, the Caribbean, and north Africa and the Middle East, observed rates of under-5 mortality became lower than expected ( figure 10B ). Substantial progress occurred in sub-Saharan Africa, with the gap between observed and expected 5q0 decreasing from 0·055 in 1980 to 0·006 in 2015. Observed under-5 mortality was consistently lower than expected, given rising SDI, in southeast Asia, east Asia, and Oceania, whereas the opposite was seen for central and eastern Europe and central Asia, with observed under-5 mortality exceeding expected levels from 1980 to 2015. With the exception of south Asia, super-region under-5 mortality trends did not substantially differ by sex. Observed levels of male under-5 mortality in south Asia gradually neared expected rates of under-5 mortality over time, whereas female under-5 mortality remained above expected levels between 1980 and 2000; by 2015, however, this gap had narrowed considerably. Regional trends for observed and expected 35q15, which represents the probability of dying between the ages of 15 and 50 years, were much more variable than life expectancy at birth or 5q0 ( figure 10C ). The 35q15 age band corresponds to the reproductive period; for the analysis of changes in mortality with SDI, we include results for these age groups because of their very strong association with mortality from HIV/AIDS during the reproductive age period. Except for three super-regions (high income; sub-Saharan Africa; and central Europe, eastern Europe, and central Asia), observed levels of 35q15 remained lower than would be expected based on SDI between 1980 and 2015. However, relative trends, in terms of proximity to expected levels of 35q15 over time and by sex, shifted considerably. Although observed rates of female 35q15 were lower than expected from 1980 to 2015 in three super-regions (Latin America and the Caribbean; north Africa and the Middle East; and southeast and east Asia and Oceania), each super-region registered improvements in 35q15 over time and moved closer to expected levels by 2015. In sub-Saharan Africa, observed 35q15 for both sexes increased to well above expected levels between 1988 and 2000, a trend largely attributable to HIV/AIDS. By 2004, however, gains in SDI quickened in sub-Saharan Africa, and observed 35q15 began to fall closer to expected levels at a similar pace. Central and eastern Europe and central Asia experienced the most divergent patterns for 35q15 by sex. For males in this super-region, observed 35q15 remained far above expected levels of mortality based on SDI from 1980 to 2015, but observed 35q15 climbed between 1986 and 1994. This rapid rise in observed male mortality between the ages of 15 and 50 years, relative to SDI, occurred in tandem with the collapse of the Soviet Union and the widespread economic hardships that followed. The gap between observed and expected male 35q15 began to gradually narrow during the late 1990s, corresponding with rises in SDI; nonetheless, gains stalled by 1999. For females in central and eastern Europe and central Asia, observed 35q15 closely followed expected levels from 1980 to 1990, after which observed mortality jumped and remained higher than expected 35q15, based on SDI, through to 2015. Results were similarly heterogeneous for observed and expected trends for 20q50, or the probability of dying between the ages 50 and 70 years, particularly by sex and rising SDI ( figure 10D ). First, based on gains in SDI alone, expected levels of 20q50 differed substantially by sex. For males, expected reductions for 20q50 were quite gradual relative to improvements in SDI, until the 80th percentile, after which expected 20q50 steeply fell. For females, expected 20q50 followed a fairly linear trend with rising SDI. Two regions—Latin America and the Caribbean and north Africa and the Middle East—experienced observed levels of 20q50 that were lower than expected from 1980 to 2015 for both sexes; however, for females in north Africa and the Middle East, observed 20q50 shifted closer to expected levels of mortality after 1999. After largely following expected rates of 20q50 from 1989 to 1998, southeast and east Asia and Oceania saw observed male 20q50 drop below expected levels. Observed female 20q50 generally remained lower than expected for this super-region, although observed levels approached expected rates from 2000 to 2003 before declining again. Although south Asia recorded large gains in SDI over time, from an average of the 25th percentile in 1980 to the 54th in 2015, observed rates of 20q50 remained higher than expected for both sexes over time. Aside from a jump in observed 20q50 rates between 1995 and 2007, in sub-Saharan Africa, observed 20q50 for both sexes mainly followed the expected rates given rising SDI. Similar to the results for 35q15, observed levels of male and female 20q50 in central and eastern Europe and central Asia followed a dissonant pattern over time. For males, although observed 20q50 surpassed expected rates between 1980 and 2015, observed 20q50 escalated from 1986 to 1994, rapidly increasing the gap between observed and expected rates of mortality for several years. The difference between observed and expected 20q50 widened for females in central and eastern Europe and central Asia during this time, albeit with a much smaller magnitude of change. Notably, observed levels of male 20q50 consistently exceeded expected rates for high-income countries between 1980 and 1997 before converging. Conversely, observed 20q50 for females in high-income countries remained higher than expected from 1980 to 2015. Global causes of death Table 5 Global deaths in 2005 and 2015 for all ages and both sexes combined and age-standardised death rates, with percentage change between 2005 and 2015 for 249 causes All age deaths (thousands) Age-standardised mortality rate (per 100 000) 2005 2015 Percentage change, 2005–15 2005 2015 Percentage change, 2005–15 All causes 53 618·5(53 139·8 to 54 075·8) 55 792·9 (54 984·1 to 56 640·3) 4·1 (2·6 to 5·6) 1024·0 (1015·1 to 1032·6) 850·1 (838·3 to 862·4) −17·0 (−18·1 to −15·8) Communicable, maternal, neonatal, and nutritional diseases (Group 1 causes) 14 023·9 (13 734·8 to 14 335·3) 11 263·6 (10 922·7 to 11 594·5) −19·7 (−21·6 to −17·8) 226·2 (221·3 to 231·6) 159·3 (154·4 to 163·9) −29·6 (−31·3 to −27·9) HIV/AIDS and tuberculosis 3139·5 (2938·6 to 3469·8) 2305·2 (2092·7 to 2578·0) −26·6 (−30·1 to −23·0) 51·6 (48·0 to 57·4) 31·9 (28·8 to 35·9) −38·2 (−41·2 to −35·2) Tuberculosis 1347·6 (1152·9 to 1658·7) 1112·6 (909·8 to 1392·8) −17·4 (−24·4 to −11·3) 24·2 (20·8 to 29·9) 16·0 (13·1 to 20·1) −33·8 (−39·6 to −28·7) HIV/AIDS 1791·9 (1703·8 to 1886·6) 1192·6 (1130·8 to 1270·3) −33·4 (−36·2 to −30·0) 27·4 (26·0 to 28·8) 15·8 (15·0 to 16·9) −42·1 (−44·6 to −39·1) HIV/AIDS—tuberculosis 351·8 (281·7 to 400·4) 211·7 (161·9 to 245·0) −39·8 (−44·3 to −34·4) 5·4 (4·4 to 6·2) 2·8 (2·2 to 3·3) −48·2 (−52·1 to −43·5) HIV/AIDS resulting in other diseases 1440·1 (1349·6 to 1546·7) 980·8 (914·7 to 1063·6) −31·9 (−35·6 to −27·7) 21·9 (20·5 to 23·6) 13·0 (12·1 to 14·1) −40·6 (−43·8 to −36·9) Diarrhoea, lower respiratory, and other common infectious diseases 5773·1 (5548·3 to 6004·8) 4959·8 (4711·6 to 5179·4) −14·1 (−17·1 to −11·0) 99·3 (95·5 to 103·1) 73·2 (69·5 to 76·4) −26·3 (−28·7 to −23·8) Diarrhoeal diseases 1657·2 (1565·0 to 1756·1) 1312·1 (1233·6 to 1391·3) −20·8 (−26·1 to −15·4) 28·1 (26·7 to 29·6) 19·1 (18·0 to 20·2) −32·2 (−36·5 to −27·7) Intestinal infectious diseases 208·6 (118·0 to 344·1) 178·5 (100·9 to 293·7) −14·4 (−20·7 to −8·7) 3·0 (1·7 to 5·0) 2·4 (1·4 to 4·0) −20·3 (−26·1 to −15·0) Typhoid fever 172·9 (94·6 to 293·2) 148·8 (81·9 to 249·7) −14·0 (−20·6 to −8·1) 2·5 (1·4 to 4·3) 2·0 (1·1 to 3·4) −19·8 (−25·7 to −14·0) Paratyphoid fever 33·9 (15·6 to 65·1) 29·2 (13·7 to 56·3) −14·1 (−21·8 to −6·2) 0·5 (0·2 to 0·9) 0·4 (0·2 to 0·8) −20·3 (−27·4 to −13·2) Other intestinal infectious diseases 1·8 (0·6 to 3·3) 0·6 (0·3 to 1·2) −64·0 (−75·5 to −43·9) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) −67·7 (−77·7 to −51·2) Lower respiratory infections 2828·5 (2628·6 to 2965·8) 2736·7 (2500·3 to 2860·8) −3·2 (−6·9 to 0·4) 51·7 (47·9 to 54·1) 41·6 (38·0 to 43·5) −19·5 (−22·3 to −16·9) Upper respiratory infections 3·8 (3·3 to 4·2) 3·1 (2·8 to 3·5) −18·0 (−28·5 to −5·2) 0·1 (0·1 to 0·1) 0·0 (0·0 to 0·1) −32·2 (−40·4 to −22·0) Otitis media 3·9 (3·5 to 4·3) 3·2 (2·9 to 3·7) −17·7 (−27·3 to −4·5) 0·1 (0·1 to 0·1) 0·0 (0·0 to 0·1) −27·8 (−38·5 to −14·5) Meningitis 407·7 (351·1 to 457·1) 379·2 (322·7 to 444·7) −7·0 (−15·4 to 5·2) 6·3 (5·5 to 7·1) 5·2 (4·5 to 6·1) −17·2 (−24·3 to −6·7) Pneumococcal meningitis 112·1 (93·3 to 135·2) 112·9 (93·4 to 141·8) 0·7 (−8·7 to 13·8) 1·7 (1·5 to 2·1) 1·6 (1·3 to 1·9) −10·8 (−18·4 to 0·7) Haemophilus influenzae type b meningitis 110·6 (88·3 to 135·8) 71·5 (56·7 to 91·8) −35·4 (−43·6 to −24·7) 1·7 (1·3 to 2·0) 1·0 (0·8 to 1·3) −41·1 (−48·3 to −31·4) Meningococcal meningitis 74·3 (58·7 to 91·8) 73·3 (58·0 to 93·2) −1·3 (−13·1 to 15·4) 1·1 (0·9 to 1·4) 1·0 (0·8 to 1·3) −11·6 (−21·8 to 3·0) Other meningitis 110·6 (94·9 to 128·6) 121·5 (101·8 to 144·2) 9·8 (1·1 to 22·0) 1·8 (1·5 to 2·1) 1·7 (1·4 to 2·0) −4·6 (−11·8 to 5·9) Encephalitis 147·0 (135·3 to 163·0) 149·5 (137·6 to 167·0) 1·7 (−4·7 to 8·1) 2·4 (2·2 to 2·7) 2·1 (1·9 to 2·4) −11·7 (−17·1 to −6·4) Diphtheria 5·6 (3·0 to 11·0) 2·1 (1·1 to 4·7) −61·3 (−85·0 to −2·0) 0·1 (0·0 to 0·2) 0·0 (0·0 to 0·1) −64·2 (−86·2 to −9·2) Whooping cough 99·6 (36·8 to 226·3) 58·7 (20·3 to 126·6) −41·0 (−77·9 to 65·1) 1·4 (0·5 to 3·3) 0·8 (0·3 to 1·7) −45·1 (−79·4 to 53·8) Tetanus 108·0 (90·9 to 151·1) 56·7 (48·2 to 80·0) −47·5 (−54·6 to −39·0) 1·7 (1·4 to 2·4) 0·8 (0·7 to 1·1) −53·2 (−59·7 to −45·9) Measles 293·7 (110·6 to 611·4) 73·4 (26·1 to 161·4) −75·0 (−84·5 to −58·8) 4·2 (1·6 to 8·8) 1·0 (0·4 to 2·2) −76·7 (−85·5 to −61·6) Varicella and herpes zoster 9·6 (8·5 to 11·0) 6·4 (5·4 to 7·8) −33·5 (−44·4 to −19·2) 0·2 (0·2 to 0·2) 0·1 (0·1 to 0·1) −45·8 (−54·7 to −34·7) Neglected tropical diseases and malaria 1298·5 (1082·7 to 1509·1) 843·1 (669·9 to 1019·7) −35·1 (−43·6 to −26·7) 19·5 (16·3 to 22·6) 11·5 (9·1 to 13·9) −41·3 (−48·9 to −33·8) Malaria 1167·0 (952·1 to 1378·1) 730·5 (555·8 to 904·0) −37·4 (−47·0 to −27·8) 17·4 (14·2 to 20·6) 9·9 (7·5 to 12·3) −43·1 (−51·8 to −34·7) Chagas disease 7·5 (7·2 to 7·8) 8·0 (7·5 to 8·6) 7·7 (0·1 to 15·9) 0·1 (0·1 to 0·2) 0·1 (0·1 to 0·1) −16·5 (−22·4 to −10·3) Leishmaniasis 23·1 (14·8 to 33·2) 24·2 (17·1 to 32·5) 4·9 (−8·5 to 21·5) 0·3 (0·2 to 0·5) 0·3 (0·2 to 0·4) −7·2 (−18·7 to 7·1) Visceral leishmaniasis 23·1 (14·8 to 33·2) 24·2 (17·1 to 32·5) 4·9 (−8·5 to 21·5) 0·3 (0·2 to 0·5) 0·3 (0·2 to 0·4) −7·2 (−18·7 to 7·1) African trypanosomiasis 14·2 (7·6 to 23·1) 3·5 (1·8 to 5·7) −75·3 (−81·4 to −67·9) 0·2 (0·1 to 0·4) 0·0 (0·0 to 0·1) −78·4 (−83·7 to −72·0) Schistosomiasis 7·8 (7·0 to 8·9) 4·4 (3·8 to 4·9) −44·2 (−52·7 to −35·6) 0·1 (0·1 to 0·2) 0·1 (0·1 to 0·1) −55·8 (−62·7 to −48·8) Cysticercosis 0·6 (0·5 to 0·7) 0·4 (0·3 to 0·5) −37·0 (−43·5 to −28·0) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) −47·7 (−53·1 to −40·2) Cystic echinococcosis 1·8 (1·7 to 1·9) 1·2 (1·1 to 1·3) −32·6 (−35·7 to −29·4) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) −44·6 (−47·0 to −42·1) Dengue 12·3 (8·6 to 15·1) 18·4 (11·8 to 22·7) 48·7 (15·1 to 90·9) 0·2 (0·1 to 0·2) 0·3 (0·2 to 0·3) 34·0 (4·4 to 70·9) Yellow fever 6·3 (1·3 to 16·9) 5·1 (1·1 to 14·2) −18·8 (−33·5 to −0·8) 0·1 (0·0 to 0·2) 0·1 (0·0 to 0·2) −25·7 (−39·2 to −9·4) Rabies 32·1 (28·0 to 36·1) 17·4 (14·8 to 20·6) −45·8 (−52·2 to −39·0) 0·5 (0·4 to 0·6) 0·2 (0·2 to 0·3) −52·9 (−58·4 to −47·3) Intestinal nematode infections 3·8 (3·3 to 4·3) 2·7 (2·4 to 3·1) −28·5 (−36·9 to −19·7) 0·1 (0·1 to 0·1) 0·0 (0·0 to 0·0) −34·7 (−42·3 to −26·7) Ascariasis 3·8 (3·3 to 4·3) 2·7 (2·4 to 3·1) −28·5 (−36·9 to −19·7) 0·1 (0·1 to 0·1) 0·0 (0·0 to 0·0) −34·7 (−42·3 to −26·7) Ebola virus disease 0·0 (0·0 to 0·0) 5·5 (4·4 to 6·6) 32 659·1 (32 659·1 to 32 659·1) 0·0 (0·0 to 0·0) 0·1 (0·1 to 0·1) 28 636·1 (28 636·1 to 28 636·1) Other neglected tropical diseases 21·9 (14·0 to 27·7) 21·8 (12·7 to 27·6) −0·6 (−14·5 to 15·9) 0·4 (0·2 to 0·4) 0·3 (0·2 to 0·4) −13·0 (−24·9 to 1·1) Maternal disorders 350·8 (327·9 to 376·6) 275·3 (243·8 to 315·5) −21·5 (−30·3 to −10·7) 5·1 (4·7 to 5·5) 3·6 (3·2 to 4·1) −29·1 (−37·1 to −19·3) Maternal haemorrhage 99·7 (87·6 to 113·0) 83·1 (67·0 to 101·5) −16·6 (−28·8 to −3·2) 1·4 (1·3 to 1·6) 1·1 (0·9 to 1·3) −25·0 (−35·9 to −12·9) Maternal sepsis and other maternal infections 24·7 (20·4 to 29·9) 17·9 (13·4 to 23·9) −27·7 (−41·7 to −10·8) 0·4 (0·3 to 0·4) 0·2 (0·2 to 0·3) −35·0 (−47·6 to −19·8) Maternal hypertensive disorders 63·7 (54·9 to 74·3) 46·9 (37·1 to 59·6) −26·4 (−36·7 to −13·1) 0·9 (0·8 to 1·1) 0·6 (0·5 to 0·8) −32·9 (−42·5 to −20·9) Maternal obstructed labour and uterine rupture 26·9 (22·1 to 32·0) 23·1 (17·2 to 30·0) −13·9 (−27·4 to 1·5) 0·4 (0·3 to 0·5) 0·3 (0·2 to 0·4) −22·5 (−34·5 to −8·5) Maternal abortion, miscarriage, and ectopic pregnancy 41·2 (34·7 to 49·6) 31·7 (24·6 to 39·7) −23·1 (−33·9 to −11·1) 0·6 (0·5 to 0·7) 0·4 (0·3 to 0·5) −30·7 (−40·4 to −19·8) Indirect maternal deaths 38·2 (31·6 to 45·4) 30·8 (23·1 to 40·5) −19·4 (−32·4 to −1·9) 0·6 (0·5 to 0·7) 0·4 (0·3 to 0·5) −27·1 (−38·8 to −11·1) Late maternal deaths 7·9 (5·3 to 11·5) 6·7 (4·3 to 10·0) −15·1 (−26·2 to −1·1) 0·1 (0·1 to 0·2) 0·1 (0·1 to 0·1) −23·3 (−33·3 to −10·6) Maternal deaths aggravated by HIV/AIDS 2·8 (1·8 to 3·8) 2·3 (1·4 to 3·3) −15·8 (−33·1 to 8·0) 0·0 (0·0 to 0·1) 0·0 (0·0 to 0·0) −24·8 (−40·4 to −3·7) Other maternal disorders 45·7 (39·0 to 53·9) 32·7 (26·3 to 40·5) −28·4 (−37·1 to −18·3) 0·7 (0·6 to 0·8) 0·4 (0·3 to 0·5) −35·3 (−43·3 to −26·2) Neonatal disorders 2653·5 (2583·4 to 2728·1) 2163·2 (2095·1 to 2232·5) −18·5 (−20·4 to −16·4) 37·3 (36·4 to 38·4) 28·8 (27·9 to 29·7) −22·8 (−24·6 to −20·9) Neonatal preterm birth complications 1088·0 (1010·9 to 1217·7) 805·8 (736·2 to 898·6) −25·9 (−31·3 to −20·6) 15·3 (14·2 to 17·1) 10·7 (9·8 to 12·0) −29·8 (−34·9 to −24·8) Neonatal encephalopathy (birth asphyxia and trauma) 882·8 (800·7 to 974·3) 740·4 (667·6 to 829·2) −16·1 (−23·8 to −8·0) 12·4 (11·3 to 13·7) 9·9 (8·9 to 11·0) −20·5 (−27·8 to −12·8) Neonatal sepsis and other neonatal infections 352·3 (252·0 to 465·7) 351·7 (249·2 to 459·1) −0·2 (−16·2 to 20·3) 5·0 (3·5 to 6·6) 4·7 (3·3 to 6·1) −5·5 (−20·6 to 13·9) Haemolytic disease and other neonatal jaundice 68·3 (42·9 to 106·1) 45·1 (30·1 to 67·3) −34·0 (−47·9 to −17·1) 1·0 (0·6 to 1·5) 0·6 (0·4 to 0·9) −37·6 (−50·6 to −21·6) Other neonatal disorders 262·0 (190·3 to 343·0) 220·2 (167·6 to 276·8) −16·0 (−34·1 to 5·6) 3·7 (2·7 to 4·8) 2·9 (2·2 to 3·7) −20·5 (−37·7 to −0·1) Nutritional deficiencies 460·8 (380·3 to 541·6) 405·7 (331·7 to 495·6) −11·9 (−22·9 to 0·6) 7·8 (6·5 to 9·0) 5·9 (4·8 to 7·2) −24·3 (−32·9 to −14·3) Protein-energy malnutrition 379·7 (314·3 to 457·1) 323·2 (264·9 to 400·8) −14·9 (−27·3 to −0·2) 6·4 (5·3 to 7·6) 4·7 (3·9 to 5·8) −26·3 (−35·8 to −14·5) Iodine deficiency 2·1 (1·6 to 2·9) 2·0 (1·5 to 2·7) −3·1 (−31·4 to 40·7) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) −18·4 (−41·6 to 15·7) Iron-deficiency anaemia 48·4 (31·9 to 63·1) 54·2 (35·1 to 72·9) 12·1 (−2·1 to 28·0) 0·8 (0·5 to 1·1) 0·8 (0·5 to 1·0) −5·1 (−16·8 to 7·8) Other nutritional deficiencies 30·7 (21·7 to 43·7) 26·3 (20·7 to 33·6) −14·1 (−33·1 to 1·1) 0·6 (0·4 to 0·8) 0·4 (0·3 to 0·5) −30·0 (−45·1 to −18·7) Other communicable, maternal, neonatal, and nutritional diseases 347·7 (291·2 to 419·8) 311·3 (257·9 to 372·7) −10·5 (−15·6 to −4·6) 5·6 (4·7 to 6·6) 4·4 (3·6 to 5·2) −21·5 (−26·0 to −16·6) Sexually transmitted diseases excluding HIV 135·5 (81·2 to 207·2) 108·0 (64·6 to 165·7) −20·3 (−28·3 to −12·4) 2·0 (1·2 to 3·0) 1·5 (0·9 to 2·2) −26·1 (−33·7 to −19·0) Syphilis 134·1 (79·9 to 205·7) 106·8 (63·4 to 164·6) −20·3 (−28·5 to −12·4) 1·9 (1·2 to 3·0) 1·4 (0·9 to 2·2) −26·1 (−33·8 to −18·8) Chlamydial infection 0·2 (0·1 to 0·2) 0·2 (0·1 to 0·2) −5·3 (−17·0 to 10·6) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) −23·5 (−32·9 to −11·3) Gonococcal infection 0·8 (0·7 to 0·9) 0·7 (0·5 to 0·8) −15·7 (−26·7 to −4·7) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) −31·3 (−40·1 to −22·6) Other sexually transmitted diseases 0·4 (0·3 to 0·4) 0·3 (0·2 to 0·4) −16·8 (−27·6 to −6·1) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) −31·7 (−40·3 to −23·0) Hepatitis 123·0 (118·6 to 127·6) 105·8 (100·7 to 110·8) −14·0 (−17·9 to −10·0) 2·1 (2·0 to 2·2) 1·5 (1·4 to 1·6) −28·0 (−31·1 to −24·7) Acute hepatitis A 16·9 (10·9 to 23·1) 11·2 (6·9 to 15·9) −34·0 (−43·5 to −24·2) 0·2 (0·2 to 0·3) 0·2 (0·1 to 0·2) −39·4 (−47·9 to −30·4) Hepatitis B 71·4 (62·0 to 80·1) 65·4 (56·4 to 73·7) −8·4 (−14·1 to −2·2) 1·3 (1·1 to 1·4) 0·9 (0·8 to 1·1) −26·4 (−30·9 to −21·6) Hepatitis C 2·8 (0·6 to 6·4) 2·5 (0·5 to 5·9) −9·8 (−24·4 to 8·6) 0·1 (0·0 to 0·1) 0·0 (0·0 to 0·1) −29·6 (−41·0 to −15·1) Acute hepatitis E 31·9 (23·0 to 42·3) 26·7 (18·5 to 36·6) −16·4 (−26·1 to −6·6) 0·5 (0·4 to 0·7) 0·4 (0·3 to 0·5) −26·3 (−34·3 to −17·9) Other infectious diseases 89·1 (61·3 to 102·3) 97·5 (61·3 to 112·9) 9·4 (−2·3 to 23·2) 1·5 (1·1 to 1·7) 1·4 (0·9 to 1·6) −6·4 (−16·8 to 5·2) Non-communicable diseases 34 835·6 (34 441·3 to 35 277·1) 39 804·2 (39 210·8 to 40 452·2) 14·3 (12·6 to 16·0) 719·1 (711·9 to 727·3) 624·7 (615·8 to 634·5) −13·1 (−14·3 to −11·9) Neoplasms 7492·8 (7378·4 to 7616·5) 8764·6 (8591·1 to 8945·6) 17·0 (14·8 to 19·3) 149·2 (147·1 to 151·7) 134·3 (131·6 to 137·0) −10·0 (−11·6 to −8·3) Lip and oral cavity cancer 110·2 (107·6 to 112·9) 146·0 (141·6 to 150·6) 32·5 (28·5 to 37·0) 2·2 (2·1 to 2·2) 2·2 (2·1 to 2·3) 1·4 (−1·6 to 4·8) Nasopharynx cancer 55·8 (45·9 to 58·8) 63·0 (51·1 to 67·0) 12·8 (5·1 to 19·4) 1·0 (0·8 to 1·1) 0·9 (0·7 to 1·0) −10·9 (−16·8 to −5·7) Other pharynx cancer 51·9 (50·5 to 53·2) 64·4 (61·6 to 67·1) 24·1 (18·4 to 29·7) 1·0 (1·0 to 1·0) 1·0 (0·9 to 1·0) −5·0 (−9·3 to −0·6) Oesophageal cancer 459·3 (445·1 to 474·2) 439·0 (422·6 to 456·9) −4·4 (−9·0 to 0·7) 9·2 (8·9 to 9·5) 6·7 (6·5 to 7·0) −26·8 (−30·3 to −22·9) Stomach cancer 824·5 (806·8 to 843·0) 818·9 (795·5 to 843·7) −0·7 (−3·7 to 2·6) 16·7 (16·3 to 17·0) 12·7 (12·4 to 13·1) −23·8 (−26·0 to −21·4) Colon and rectum cancer 675·5 (664·9 to 688·2) 832·0 (811·7 to 854·5) 23·2 (20·6 to 26·0) 14·0 (13·8 to 14·2) 13·0 (12·7 to 13·4) −6·7 (−8·7 to −4·6) Liver cancer 726·7 (636·0 to 762·2) 810·5 (749·7 to 862·8) 11·5 (5·9 to 20·4) 13·9 (12·3 to 14·6) 12·1 (11·2 to 12·9) −13·1 (−17·4 to −6·7) Liver cancer due to hepatitis B 263·1 (224·4 to 282·5) 265·3 (241·0 to 290·5) 0·8 (−5·6 to 12·5) 4·8 (4·1 to 5·1) 3·8 (3·5 to 4·2) −20·2 (−25·2 to −11·5) Liver cancer due to hepatitis C 137·8 (126·1 to 146·3) 167·1 (153·9 to 177·9) 21·3 (17·3 to 26·2) 2·8 (2·6 to 3·0) 2·6 (2·4 to 2·8) −7·4 (−10·4 to −3·8) Liver cancer due to alcohol use 194·5 (168·8 to 208·3) 245·2 (225·1 to 266·6) 26·1 (18·5 to 37·1) 3·8 (3·3 to 4·1) 3·7 (3·4 to 4·0) −3·1 (−8·6 to 4·8) Liver cancer due to other causes 131·3 (114·1 to 141·6) 132·9 (119·8 to 144·4) 1·2 (−4·2 to 9·7) 2·5 (2·2 to 2·7) 2·0 (1·8 to 2·2) −21·1 (−25·2 to −15·0) Gallbladder and biliary tract cancer 124·5 (120·8 to 127·8) 140·5 (131·4 to 147·2) 12·9 (7·3 to 18·2) 2·6 (2·5 to 2·7) 2·2 (2·1 to 2·3) −14·7 (−19·0 to −10·6) Pancreatic cancer 314·6 (310·1 to 319·0) 411·6 (403·6 to 420·7) 30·8 (28·3 to 33·6) 6·5 (6·4 to 6·6) 6·4 (6·3 to 6·6) −0·9 (−2·8 to 1·2) Larynx cancer 93·1 (90·9 to 95·7) 105·9 (102·7 to 109·5) 13·8 (10·5 to 17·5) 1·8 (1·8 to 1·9) 1·6 (1·6 to 1·7) −12·8 (−15·3 to −10·0) Tracheal, bronchus, and lung cancer 1434·5 (1406·5 to 1463·5) 1722·5 (1673·7 to 1772·7) 20·1 (16·7 to 24·0) 29·0 (28·5 to 29·6) 26·6 (25·9 to 27·4) −8·1 (−10·7 to −5·2) Malignant skin melanoma 47·0 (38·7 to 58·6) 59·8 (47·6 to 72·7) 27·2 (20·0 to 32·6) 0·9 (0·8 to 1·1) 0·9 (0·7 to 1·1) −1·8 (−7·1 to 2·4) Non-melanoma skin cancer 36·3 (35·4 to 37·1) 51·9 (49·9 to 53·8) 42·9 (37·4 to 47·8) 0·8 (0·7 to 0·8) 0·8 (0·8 to 0·9) 7·6 (3·4 to 11·1) Squamous-cell carcinoma 36·3 (35·4 to 37·1) 51·9 (49·9 to 53·8) 42·9 (37·4 to 47·8) 0·8 (0·7 to 0·8) 0·8 (0·8 to 0·9) 7·6 (3·4 to 11·1) Breast cancer 439·8 (418·8 to 461·9) 533·6 (502·2 to 553·1) 21·3 (14·9 to 27·2) 8·5 (8·1 to 8·9) 7·9 (7·5 to 8·2) −6·8 (−11·5 to −2·5) Cervical cancer 225·4 (213·9 to 237·8) 238·6 (225·3 to 252·4) 5·8 (−0·5 to 13·8) 4·2 (4·0 to 4·4) 3·5 (3·3 to 3·7) −17·7 (−22·5 to −11·5) Uterine cancer 81·8 (78·5 to 85·4) 89·9 (86·1 to 94·3) 10·0 (3·8 to 17·4) 1·6 (1·6 to 1·7) 1·4 (1·3 to 1·4) −16·1 (−20·8 to −10·7) Ovarian cancer 133·8 (130·8 to 138·6) 161·1 (156·5 to 166·5) 20·4 (16·5 to 24·4) 2·6 (2·6 to 2·7) 2·4 (2·3 to 2·5) −7·9 (−10·8 to −4·9) Prostate cancer 277·4 (230·8 to 348·9) 365·9 (303·5 to 459·6) 31·9 (28·2 to 35·4) 6·1 (5·1 to 7·7) 6·0 (5·0 to 7·6) −1·7 (−4·5 to 0·8) Testicular cancer 8·6 (8·3 to 9·1) 9·4 (8·8 to 9·9) 8·4 (1·3 to 14·4) 0·1 (0·1 to 0·1) 0·1 (0·1 to 0·1) −8·9 (−14·7 to −3·9) Kidney cancer 104·5 (102·4 to 106·9) 136·9 (133·0 to 141·3) 31·0 (27·0 to 34·6) 2·1 (2·1 to 2·1) 2·1 (2·0 to 2·2) 0·4 (−2·6 to 3·2) Bladder cancer 150·6 (147·9 to 153·2) 188·0 (182·8 to 192·7) 24·8 (21·4 to 28·3) 3·2 (3·2 to 3·3) 3·0 (2·9 to 3·1) −6·4 (−9·0 to −3·8) Brain and nervous system cancer 190·4 (173·3 to 201·2) 228·8 (209·5 to 244·7) 20·1 (12·7 to 27·2) 3·5 (3·2 to 3·6) 3·3 (3·0 to 3·6) −3·6 (−9·3 to 1·8) Thyroid cancer 25·5 (24·4 to 27·6) 31·9 (28·9 to 33·2) 24·8 (14·8 to 31·0) 0·5 (0·5 to 0·6) 0·5 (0·5 to 0·5) −4·8 (−12·2 to 0·0) Mesothelioma 23·2 (22·7 to 23·8) 32·4 (31·2 to 33·4) 39·6 (34·4 to 44·3) 0·5 (0·5 to 0·5) 0·5 (0·5 to 0·5) 7·8 (3·6 to 11·6) Hodgkin lymphoma 25·4 (22·7 to 29·7) 23·9 (21·8 to 29·0) −6·0 (−10·6 to −1·3) 0·5 (0·4 to 0·5) 0·3 (0·3 to 0·4) −23·9 (−27·7 to −20·1) Non-Hodgkin's lymphoma 179·3 (160·6 to 191·6) 231·4 (195·7 to 243·8) 29·0 (18·1 to 35·2) 3·5 (3·1 to 3·7) 3·5 (3·0 to 3·7) 0·0 (−8·0 to 4·4) Multiple myeloma 77·5 (75·6 to 79·7) 101·1 (97·7 to 104·1) 30·5 (26·3 to 34·5) 1·6 (1·6 to 1·6) 1·6 (1·5 to 1·6) −1·3 (−4·4 to 1·7) Leukaemia 303·5 (297·3 to 311·8) 353·5 (344·6 to 363·1) 16·5 (13·5 to 19·6) 5·6 (5·5 to 5·7) 5·3 (5·1 to 5·4) −5·7 (−7·9 to −3·3) Acute lymphoid leukaemia 97·5 (90·4 to 108·0) 110·5 (101·2 to 118·4) 13·3 (7·1 to 19·0) 1·6 (1·5 to 1·8) 1·6 (1·4 to 1·7) −3·0 (−8·1 to 1·7) Chronic lymphoid leukaemia 51·5 (49·3 to 53·9) 60·7 (57·9 to 64·6) 17·9 (12·5 to 23·4) 1·1 (1·0 to 1·1) 1·0 (0·9 to 1·0) −10·1 (−14·0 to −6·1) Acute myeloid leukaemia 119·0 (110·5 to 126·7) 147·1 (137·3 to 157·0) 23·5 (19·3 to 27·8) 2·2 (2·1 to 2·3) 2·2 (2·1 to 2·3) −0·4 (−3·5 to 2·7) Chronic myeloid leukaemia 35·4 (33·4 to 38·2) 35·2 (33·4 to 37·7) −0·7 (−4·8 to 3·8) 0·7 (0·6 to 0·7) 0·5 (0·5 to 0·6) −22·0 (−25·3 to −18·5) Other neoplasms 292·1 (270·9 to 302·6) 372·2 (335·9 to 392·1) 27·4 (21·4 to 32·6) 5·5 (5·1 to 5·7) 5·5 (5·0 to 5·8) 1·2 (−3·6 to 5·3) Cardiovascular diseases 15 933·7 (15 732·1 to 16 161·6) 17 921·0 (17 590·5 to 18 276·8) 12·5 (10·6 to 14·4) 338·1 (333·8 to 342·9) 285·5 (280·2 to 291·2) −15·6 (−16·9 to −14·2) Rheumatic heart disease 333·2 (313·1 to 349·5) 319·4 (297·3 to 337·3) −4·1 (−8·2 to −0·1) 6·4 (6·0 to 6·7) 4·8 (4·5 to 5·1) −24·7 (−27·9 to −21·6) Ischaemic heart disease 7648·4 (7551·5 to 7774·3) 8917·0 (8751·6 to 9108·8) 16·6 (14·6 to 18·6) 163·1 (160·8 to 165·6) 142·1 (139·5 to 145·2) −12·8 (−14·2 to −11·4) Cerebrovascular disease 6020·9 (5920·2 to 6127·1) 6326·1 (6175·2 to 6492·9) 5·1 (2·7 to 7·5) 127·9 (125·8 to 130·1) 101·0 (98·6 to 103·6) −21·0 (−22·8 to −19·2) Ischaemic stroke 2760·8 (2682·7 to 2837·5) 2978·0 (2880·8 to 3068·8) 7·9 (5·2 to 10·6) 61·3 (59·5 to 62·9) 48·9 (47·3 to 50·4) −20·2 (−22·1 to −18·1) Haemorrhagic stroke 3260·1 (3169·2 to 3359·8) 3348·2 (3240·9 to 3500·1) 2·7 (−0·6 to 6·4) 66·7 (64·9 to 68·7) 52·1 (50·4 to 54·5) −21·9 (−24·3 to −19·0) Hypertensive heart disease 760·5 (711·9 to 823·7) 962·4 (873·6 to 1024·5) 26·5 (17·5 to 32·3) 16·2 (15·2 to 17·5) 15·4 (13·9 to 16·4) −4·9 (−11·9 to −0·6) Cardiomyopathy and myocarditis 328·8 (315·8 to 338·8) 353·7 (339·5 to 370·6) 7·6 (3·8 to 11·4) 6·4 (6·2 to 6·6) 5·4 (5·2 to 5·7) −16·1 (−18·9 to −13·2) Atrial fibrillation and flutter 142·8 (117·3 to 172·0) 195·3 (159·5 to 236·2) 36·8 (34·0 to 39·6) 3·4 (2·8 to 4·1) 3·3 (2·7 to 4·0) −3·4 (−4·9 to −1·9) Aortic aneurysm 134·8 (131·7 to 138·3) 168·2 (163·6 to 172·8) 24·8 (19·5 to 28·5) 2·9 (2·8 to 3·0) 2·7 (2·6 to 2·8) −6·6 (−10·4 to −3·8) Peripheral vascular disease 38·1 (36·7 to 39·6) 52·5 (49·7 to 55·7) 37·7 (30·1 to 46·5) 0·9 (0·8 to 0·9) 0·9 (0·8 to 0·9) −0·3 (−5·9 to 6·3) Endocarditis 68·8 (60·4 to 74·7) 84·9 (74·7 to 93·0) 23·4 (18·5 to 28·2) 1·4 (1·2 to 1·5) 1·3 (1·2 to 1·4) −4·6 (−8·1 to −1·1) Other cardiovascular and circulatory diseases 457·4 (446·7 to 470·6) 541·4 (521·7 to 561·2) 18·4 (14·0 to 22·5) 9·6 (9·3 to 9·8) 8·6 (8·3 to 8·9) −10·3 (−13·5 to −7·4) Chronic respiratory diseases 3709·1 (3631·6 to 3796·0) 3795·5 (3683·9 to 3910·4) 2·3 (−0·8 to 5·4) 79·0 (77·3 to 80·9) 61·0 (59·3 to 62·8) −22·8 (−25·1 to −20·4) Chronic obstructive pulmonary disease 3100·5 (2997·7 to 3194·9) 3188·3 (3083·8 to 3292·5) 2·8 (−0·6 to 6·9) 67·0 (64·8 to 69·0) 51·7 (50·0 to 53·4) −22·9 (−25·4 to −20·0) Pneumoconiosis 31·9 (28·4 to 36·3) 36·1 (31·5 to 40·7) 13·2 (6·4 to 22·4) 0·7 (0·6 to 0·8) 0·6 (0·5 to 0·7) −14·4 (−19·5 to −7·7) Silicosis 10·2 (9·4 to 11·4) 10·4 (9·4 to 11·7) 2·0 (−9·0 to 15·4) 0·2 (0·2 to 0·2) 0·2 (0·1 to 0·2) −21·8 (−30·2 to −11·8) Asbestosis 2·8 (2·0 to 3·2) 3·6 (2·5 to 4·2) 28·4 (17·6 to 39·5) 0·1 (0·0 to 0·1) 0·1 (0·0 to 0·1) −2·1 (−10·2 to 6·2) Coal workers pneumoconiosis 2·7 (2·4 to 3·0) 2·5 (2·2 to 2·9) −7·3 (−21·5 to 6·4) 0·1 (0·1 to 0·1) 0·0 (0·0 to 0·0) −29·9 (−40·4 to −19·6) Other pneumoconiosis 16·1 (13·3 to 19·7) 19·5 (15·8 to 23·2) 21·2 (11·0 to 33·5) 0·3 (0·3 to 0·4) 0·3 (0·3 to 0·4) −9·4 (−16·9 to −0·2) Asthma 449·9 (362·1 to 518·0) 397·1 (363·0 to 438·7) −11·7 (−21·2 to 3·4) 8·8 (7·1 to 10·2) 6·1 (5·6 to 6·7) −31·3 (−38·9 to −19·4) Interstitial lung disease and pulmonary sarcoidosis 80·4 (61·2 to 92·8) 121·8 (94·1 to 135·2) 51·5 (37·9 to 60·5) 1·7 (1·3 to 2·0) 2·0 (1·5 to 2·2) 14·1 (4·1 to 20·9) Other chronic respiratory diseases 46·4 (33·9 to 55·6) 52·1 (38·0 to 61·0) 12·2 (1·4 to 23·0) 0·8 (0·6 to 1·0) 0·8 (0·6 to 0·9) −5·9 (−13·8 to 2·5) Cirrhosis and other chronic liver diseases 1171·7 (1131·9 to 1236·7) 1292·1 (1239·9 to 1371·7) 10·3 (7·0 to 13·7) 21·6 (20·9 to 22·8) 18·8 (18·0 to 19·9) −13·1 (−15·6 to −10·5) Cirrhosis and other chronic liver diseases due to hepatitis B 341·4 (316·2 to 374·1) 371·1 (341·6 to 410·0) 8·7 (4·7 to 12·7) 6·3 (5·9 to 6·9) 5·4 (5·0 to 6·0) −14·6 (−17·5 to −11·6) Cirrhosis and other chronic liver diseases due to hepatitis C 287·4 (268·1 to 307·8) 325·6 (301·8 to 349·9) 13·3 (10·4 to 16·5) 5·4 (5·0 to 5·8) 4·8 (4·4 to 5·1) −11·7 (−13·9 to −9·3) Cirrhosis and other chronic liver diseases due to alcohol use 310·1 (289·4 to 333·4) 347·9 (322·7 to 374·6) 12·2 (8·4 to 16·7) 5·6 (5·2 to 6·0) 5·0 (4·6 to 5·3) −11·6 (−14·5 to −8·2) Cirrhosis and other chronic liver diseases due to other causes 232·8 (217·6 to 254·6) 247·5 (230·3 to 272·2) 6·3 (3·4 to 9·8) 4·3 (4·0 to 4·7) 3·6 (3·4 to 4·0) −14·8 (−17·1 to −12·2) Digestive diseases 1113·2 (1081·1 to 1186·7) 1203·0 (1150·5 to 1270·0) 8·1 (3·7 to 12·6) 22·0 (21·4 to 23·4) 18·5 (17·7 to 19·5) −16·1 (−19·3 to −12·7) Peptic ulcer disease 294·3 (278·0 to 322·0) 267·5 (249·4 to 290·0) −9·1 (−15·3 to 0·0) 5·8 (5·5 to 6·3) 4·1 (3·8 to 4·4) −29·3 (−34·1 to −22·1) Gastritis and duodenitis 49·9 (40·2 to 60·9) 49·7 (41·8 to 60·1) −0·5 (−10·9 to 12·4) 1·0 (0·8 to 1·2) 0·8 (0·6 to 0·9) −23·0 (−31·0 to −12·9) Appendicitis 49·9 (42·9 to 56·4) 50·1 (41·2 to 56·0) 0·5 (−9·0 to 10·7) 0·9 (0·8 to 1·0) 0·7 (0·6 to 0·8) −17·0 (−24·5 to −9·0) Paralytic ileus and intestinal obstruction 233·4 (210·7 to 272·0) 264·3 (242·4 to 307·4) 13·2 (7·7 to 19·7) 4·6 (4·1 to 5·3) 4·0 (3·7 to 4·7) −11·4 (−15·5 to −6·6) Inguinal, femoral, and abdominal hernia 56·6 (40·0 to 63·8) 59·8 (41·1 to 69·2) 5·8 (−3·1 to 16·8) 1·1 (0·8 to 1·3) 0·9 (0·6 to 1·1) −18·1 (−25·2 to −9·3) Inflammatory bowel disease 42·6 (38·3 to 47·3) 47·4 (43·5 to 51·7) 11·2 (2·9 to 18·8) 0·9 (0·8 to 0·9) 0·7 (0·7 to 0·8) −14·6 (−20·4 to −9·1) Vascular intestinal disorders 84·3 (79·0 to 91·2) 105·8 (99·0 to 114·3) 25·6 (20·4 to 30·5) 1·8 (1·7 to 2·0) 1·7 (1·6 to 1·8) −6·1 (−10·0 to −2·7) Gallbladder and biliary diseases 96·4 (91·1 to 103·1) 111·7 (105·3 to 120·0) 15·9 (10·2 to 21·3) 2·0 (1·9 to 2·1) 1·8 (1·7 to 1·9) −11·7 (−15·8 to −7·7) Pancreatitis 109·6 (103·0 to 117·2) 132·7 (122·9 to 144·0) 21·1 (14·3 to 28·1) 2·0 (1·9 to 2·2) 1·9 (1·8 to 2·1) −3·9 (−9·2 to 1·5) Other digestive diseases 96·3 (86·5 to 116·2) 114·0 (101·9 to 131·1) 18·3 (8·1 to 28·9) 2·0 (1·8 to 2·4) 1·8 (1·6 to 2·0) −9·5 (−16·6 to −2·1) Neurological disorders 1671·0 (1445·9 to 1889·8) 2258·9 (1937·8 to 2574·4) 35·2 (33·2 to 37·2) 38·7 (33·1 to 44·1) 37·6 (32·2 to 43·0) −2·7 (−3·7 to −1·6) Alzheimer's disease and other dementias 1380·8 (1152·7 to 1599·4) 1908·2 (1586·7 to 2229·1) 38·2 (36·2 to 40·1) 33·2 (27·6 to 38·7) 32·3 (26·9 to 37·8) −2·7 (−3·7 to −1·7) Parkinson's disease 82·4 (80·0 to 85·6) 117·4 (113·9 to 121·3) 42·4 (37·3 to 46·9) 1·9 (1·8 to 2·0) 2·0 (1·9 to 2·0) 4·2 (0·5 to 7·6) Epilepsy 119·0 (111·9 to 127·6) 124·9 (119·3 to 131·0) 5·0 (−2·1 to 12·3) 1·9 (1·8 to 2·0) 1·7 (1·6 to 1·8) −9·2 (−15·1 to −3·3) Multiple sclerosis 16·5 (14·9 to 18·1) 18·9 (17·3 to 20·0) 14·8 (7·2 to 20·7) 0·3 (0·3 to 0·3) 0·3 (0·2 to 0·3) −9·7 (−15·3 to −5·1) Motor neuron disease 27·6 (26·8 to 28·8) 35·2 (33·9 to 36·7) 27·6 (20·6 to 31·1) 0·5 (0·5 to 0·6) 0·5 (0·5 to 0·6) −1·2 (−6·5 to 1·6) Other neurological disorders 44·8 (43·6 to 47·8) 54·3 (53·0 to 57·5) 21·3 (17·5 to 24·5) 0·8 (0·8 to 0·8) 0·8 (0·8 to 0·8) −1·0 (−4·1 to 1·7) Mental and substance use disorders 305·9 (293·5 to 314·9) 324·9 (308·6 to 337·4) 6·2 (1·9 to 10·4) 5·1 (4·9 to 5·3) 4·5 (4·3 to 4·7) −12·6 (−16·0 to −9·2) Schizophrenia 19·1 (17·9 to 20·0) 16·9 (15·9 to 18·0) −11·4 (−18·8 to −2·9) 0·3 (0·3 to 0·4) 0·2 (0·2 to 0·3) −29·2 (−34·9 to −22·9) Alcohol use disorders 157·4 (147·4 to 163·3) 137·5 (131·5 to 144·0) −12·6 (−16·7 to −7·0) 2·7 (2·5 to 2·8) 1·9 (1·8 to 2·0) −29·2 (−32·4 to −24·7) Drug use disorders 128·8 (124·0 to 133·6) 169·9 (152·1 to 179·2) 31·8 (20·4 to 39·4) 2·1 (2·0 to 2·2) 2·3 (2·1 to 2·5) 11·5 (2·0 to 17·7) Opioid use disorders 94·2 (90·5 to 99·7) 122·1 (109·5 to 129·7) 29·6 (18·2 to 37·2) 1·5 (1·5 to 1·6) 1·7 (1·5 to 1·8) 10·0 (0·5 to 16·5) Cocaine use disorders 7·4 (5·0 to 7·9) 11·1 (8·5 to 12·2) 49·7 (33·6 to 75·4) 0·1 (0·1 to 0·1) 0·1 (0·1 to 0·2) 26·4 (12·9 to 48·0) Amphetamine use disorders 7·3 (4·3 to 8·2) 12·2 (8·4 to 14·2) 67·5 (25·6 to 118·9) 0·1 (0·1 to 0·1) 0·2 (0·1 to 0·2) 42·3 (7·2 to 85·6) Other drug use disorders 19·9 (18·6 to 22·8) 24·5 (22·7 to 27·3) 23·0 (12·7 to 32·1) 0·3 (0·3 to 0·4) 0·3 (0·3 to 0·4) 2·6 (−5·6 to 9·5) Eating disorders 0·6 (0·4 to 0·8) 0·7 (0·5 to 0·9) 7·7 (0·8 to 17·3) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) −4·4 (−10·2 to 3·5) Anorexia nervosa 0·6 (0·4 to 0·7) 0·6 (0·4 to 0·8) 5·6 (−1·2 to 14·1) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) −6·0 (−11·8 to 1·1) Bulimia nervosa 0·0 (0·0 to 0·1) 0·1 (0·0 to 0·1) 33·2 (19·1 to 58·1) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) 14·6 (3·3 to 34·2) Diabetes, urogenital, blood, and endocrine diseases 2635·3 (2534·5 to 2716·0) 3409·3 (3287·5 to 3516·5) 29·4 (26·1 to 32·7) 52·9 (51·0 to 54·3) 52·9 (51·0 to 54·5) −0·1 (−2·3 to 2·3) Diabetes mellitus 1150·2 (1120·9 to 1176·8) 1519·0 (1470·3 to 1576·0) 32·1 (27·7 to 36·3) 23·6 (23·0 to 24·2) 23·7 (23·0 to 24·6) 0·4 (−2·7 to 3·6) Acute glomerulonephritis 12·7 (9·9 to 14·4) 11·8 (7·8 to 13·3) −6·9 (−23·8 to 2·0) 0·2 (0·2 to 0·3) 0·2 (0·1 to 0·2) −25·3 (−38·9 to −18·2) Chronic kidney disease 937·7 (866·2 to 970·8) 1234·9 (1131·7 to 1282·4) 31·7 (27·7 to 35·6) 19·0 (17·7 to 19·7) 19·2 (17·7 to 20·0) 1·2 (−1·9 to 4·0) Chronic kidney disease due to diabetes mellitus 299·4 (278·7 to 314·2) 417·8 (388·7 to 441·4) 39·5 (35·4 to 43·5) 6·1 (5·7 to 6·4) 6·5 (6·1 to 6·9) 6·4 (3·3 to 9·3) Chronic kidney disease due to hypertension 408·5 (377·1 to 427·6) 549·5 (501·6 to 575·6) 34·5 (30·0 to 38·7) 8·4 (7·8 to 8·8) 8·7 (7·9 to 9·1) 2·4 (−0·9 to 5·5) Chronic kidney disease due to glomerulonephritis 205·6 (184·9 to 217·9) 237·7 (212·6 to 255·9) 15·6 (10·9 to 20·2) 4·0 (3·6 to 4·2) 3·6 (3·3 to 3·9) −9·0 (−12·6 to −5·4) Chronic kidney disease due to other causes 24·2 (20·2 to 28·6) 30·0 (25·0 to 35·2) 23·9 (17·8 to 30·2) 0·5 (0·4 to 0·6) 0·5 (0·4 to 0·5) −2·2 (−6·9 to 2·5) Urinary diseases and male infertility 201·1 (188·2 to 215·7) 261·7 (243·2 to 277·6) 30·1 (23·7 to 36·6) 4·2 (3·9 to 4·5) 4·1 (3·8 to 4·4) −1·3 (−6·1 to 3·6) Interstitial nephritis and urinary tract infections 149·8 (139·3 to 160·9) 196·4 (181·5 to 211·0) 31·1 (25·3 to 37·3) 3·2 (2·9 to 3·4) 3·1 (2·9 to 3·4) −1·1 (−5·5 to 3·7) Urolithiasis 14·9 (12·5 to 18·1) 16·1 (14·0 to 20·3) 7·8 (0·0 to 21·2) 0·3 (0·3 to 0·4) 0·2 (0·2 to 0·3) −16·5 (−22·6 to −5·8) Other urinary diseases 36·4 (30·8 to 42·7) 49·2 (41·2 to 55·4) 35·1 (20·4 to 49·9) 0·7 (0·6 to 0·9) 0·8 (0·6 to 0·9) 4·2 (−7·1 to 15·3) Gynaecological diseases 7·6 (6·1 to 8·6) 7·9 (5·9 to 9·2) 2·9 (−10·1 to 24·5) 0·1 (0·1 to 0·2) 0·1 (0·1 to 0·1) −17·4 (−28·0 to −1·0) Uterine fibroids 2·1 (1·2 to 2·7) 2·3 (1·2 to 3·0) 9·5 (−12·5 to 34·7) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) −13·3 (−30·5 to 5·8) Polycystic ovarian syndrome 0·7 (0·2 to 1·3) 0·6 (0·2 to 1·0) −17·9 (−37·0 to 10·1) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) −30·9 (−47·0 to −7·9) Endometriosis 0·0 (0·0 to 0·1) 0·1 (0·0 to 0·1) 24·2 (−0·6 to 59·4) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) 5·7 (−15·2 to 35·4) Genital prolapse 1·1 (0·6 to 1·8) 0·9 (0·6 to 1·5) −19·5 (−36·0 to 12·9) 0·0 (0·0 to 0·0) 0·0 (0·0 to 0·0) −39·0 (−51·1 to −15·9) Other gynaecological diseases 3·6 (2·7 to 4·5) 4·0 (3·0 to 4·8) 9·9 (−5·8 to 34·4) 0·1 (0·0 to 0·1) 0·1 (0·0 to 0·1) −10·0 (−23·1 to 9·9) Haemoglobinopathies and haemolytic anaemias 215·5 (173·5 to 274·0) 226·9 (177·2 to 306·2) 5·3 (−9·4 to 24·1) 3·6 (2·9 to 4·5) 3·2 (2·5 to 4·3) −9·8 (−21·2 to 5·1) Thalassaemias 19·7 (16·5 to 23·3) 16·8 (13·9 to 20·2) −14·5 (−27·7 to 2·9) 0·3 (0·3 to 0·4) 0·2 (0·2 to 0·3) −23·6 (−34·1 to −10·3) Sickle cell disorders 108·3 (78·5 to 159·8) 114·8 (78·3 to 183·2) 6·0 (−20·1 to 40·4) 1·6 (1·2 to 2·3) 1·6 (1·1 to 2·5) −2·7 (−26·0 to 28·3) Glucose-6-phosphate dehydrogenase deficiency 27·5 (23·5 to 32·1) 33·0 (28·0 to 38·9) 19·9 (11·6 to 29·2) 0·4 (0·4 to 0·5) 0·5 (0·4 to 0·5) 1·2 (−5·9 to 8·7) Other haemoglobinopathies and haemolytic anaemias 60·0 (53·2 to 66·5) 62·3 (54·7 to 71·1) 3·9 (−3·4 to 10·2) 1·2 (1·1 to 1·3) 1·0 (0·9 to 1·1) −19·6 (−25·6 to −15·0) Endocrine, metabolic, blood, and immune disorders 110·5 (108·1 to 113·5) 147·3 (142·5 to 151·7) 33·2 (28·0 to 37·2) 2·1 (2·1 to 2·2) 2·2 (2·2 to 2·3) 5·6 (1·7 to 8·7) Musculoskeletal disorders 76·2 (69·2 to 80·5) 90·1 (82·5 to 94·6) 18·2 (10·8 to 24·3) 1·5 (1·4 to 1·6) 1·4 (1·3 to 1·5) −8·3 (−13·5 to −3·8) Rheumatoid arthritis 26·5 (23·2 to 29·3) 30·0 (27·0 to 34·6) 13·2 (5·0 to 23·5) 0·6 (0·5 to 0·6) 0·5 (0·4 to 0·5) −14·0 (−20·0 to −6·4) Other musculoskeletal disorders 49·7 (45·5 to 53·1) 60·1 (53·1 to 63·5) 20·9 (11·5 to 27·0) 1·0 (0·9 to 1·0) 0·9 (0·8 to 1·0) −5·0 (−11·5 to −0·5) Other non-communicable diseases 726·6 (626·8 to 869·3) 744·6 (667·8 to 811·6) 2·5 (−10·6 to 11·7) 10·9 (9·4 to 13·0) 10·2 (9·2 to 11·1) −6·5 (−17·7 to 1·5) Congenital anomalies 634·2 (535·9 to 773·4) 627·8 (567·3 to 694·4) −1·0 (−15·4 to 9·0) 9·2 (7·8 to 11·2) 8·4 (7·6 to 9·3) −8·0 (−21·1 to 1·1) Neural tube defects 76·5 (56·7 to 107·0) 64·6 (47·9 to 83·4) −15·5 (−34·9 to 4·4) 1·1 (0·8 to 1·5) 0·9 (0·6 to 1·1) −20·5 (−38·8 to −1·7) Congenital heart anomalies 319·0 (267·4 to 378·1) 303·3 (268·8 to 335·4) −4·9 (−18·9 to 6·5) 4·6 (3·9 to 5·4) 4·1 (3·6 to 4·5) −11·4 (−24·4 to −0·9) Cleft lip and cleft palate 3·3 (2·6 to 3·8) 1·3 (1·1 to 1·7) −59·0 (−66·4 to −50·1) 0·0 (0·0 to 0·1) 0·0 (0·0 to 0·0) −61·3 (−68·3 to −52·9) Down's syndrome 26·6 (17·9 to 42·7) 26·5 (19·1 to 36·9) −0·2 (−25·0 to 30·6) 0·4 (0·3 to 0·6) 0·4 (0·3 to 0·5) −10·1 (−31·7 to 16·9) Other chromosomal abnormalities 20·6 (9·8 to 49·3) 22·7 (12·9 to 40·5) 10·3 (−21·8 to 41·0) 0·3 (0·1 to 0·7) 0·3 (0·2 to 0·5) 3·3 (−26·6 to 31·3) Other congenital anomalies 188·3 (158·7 to 231·9) 209·4 (188·9 to 241·3) 11·2 (−3·7 to 24·5) 2·8 (2·3 to 3·4) 2·8 (2·6 to 3·3) 2·7 (−10·6 to 14·6) Skin and subcutaneous diseases 71·6 (48·1 to 90·4) 97·6 (66·6 to 128·8) 36·2 (29·5 to 46·4) 1·5 (1·0 to 1·8) 1·5 (1·0 to 2·0) 3·7 (−1·6 to 12·5) Cellulitis 12·6 (7·8 to 17·4) 16·9 (10·4 to 23·0) 34·2 (22·2 to 48·2) 0·3 (0·2 to 0·3) 0·3 (0·2 to 0·3) 3·5 (−5·5 to 14·1) Pyoderma 30·9 (21·3 to 43·5) 44·1 (31·1 to 62·8) 42·7 (33·0 to 53·3) 0·6 (0·4 to 0·8) 0·7 (0·5 to 1·0) 12·5 (4·7 to 21·4) Decubitus ulcer 25·1 (14·5 to 30·7) 32·4 (19·3 to 40·0) 29·3 (20·4 to 42·4) 0·6 (0·3 to 0·7) 0·5 (0·3 to 0·7) −5·7 (−12·6 to 4·4) Other skin and subcutaneous diseases 3·1 (2·2 to 4·2) 4·2 (3·0 to 5·8) 35·4 (26·9 to 46·0) 0·1 (0·0 to 0·1) 0·1 (0·0 to 0·1) 5·7 (−1·2 to 14·2) Sudden infant death syndrome 20·8 (16·9 to 33·7) 19·2 (15·9 to 27·5) −7·9 (−23·0 to 8·9) 0·3 (0·2 to 0·5) 0·3 (0·2 to 0·4) −13·5 (−27·7 to 2·3) Injuries 4759·0 (4451·4 to 4893·1) 4725·1 (4398·5 to 4905·2) −0·7 (−4·3 to 3·5) 78·6 (73·5 to 80·8) 66·2 (61·5 to 68·7) −15·8 (−18·7 to −12·4) Transport injuries 1494·1 (1444·8 to 1550·6) 1466·6 (1394·8 to 1536·5) −1·8 (−7·4 to 3·3) 24·2 (23·4 to 25·0) 20·2 (19·3 to 21·2) −16·2 (−20·8 to −11·8) Road injuries 1392·5 (1341·0 to 1446·0) 1361·7 (1294·0 to 1428·1) −2·2 (−7·8 to 2·6) 22·5 (21·7 to 23·3) 18·8 (17·9 to 19·7) −16·4 (−21·1 to −12·3) Pedestrian road injuries 581·4 (546·3 to 631·3) 560·6 (525·8 to 617·1) −3·6 (−10·7 to 2·8) 9·6 (9·1 to 10·5) 7·8 (7·4 to 8·6) −18·6 (−24·6 to −13·2) Cyclist road injuries 63·4 (58·7 to 68·9) 58·7 (54·4 to 64·4) −7·5 (−15·2 to 1·2) 1·0 (1·0 to 1·1) 0·8 (0·8 to 0·9) −21·9 (−28·5 to −14·6) Motorcyclist road injuries 245·7 (215·2 to 263·8) 257·1 (230·6 to 290·9) 4·6 (−4·7 to 16·5) 3·8 (3·4 to 4·1) 3·5 (3·1 to 3·9) −8·9 (−17·0 to 1·6) Motor vehicle road injuries 483·1 (445·9 to 536·6) 464·2 (417·8 to 508·3) −3·9 (−9·3 to 2·1) 7·7 (7·1 to 8·5) 6·4 (5·7 to 7·0) −17·2 (−21·8 to −12·1) Other road injuries 18·9 (13·1 to 22·5) 21·1 (14·0 to 24·8) 11·3 (−5·4 to 34·9) 0·3 (0·2 to 0·4) 0·3 (0·2 to 0·3) −4·5 (−18·7 to 14·7) Other transport injuries 101·5 (93·2 to 114·0) 104·9 (90·5 to 127·2) 3·3 (−6·4 to 14·7) 1·7 (1·5 to 1·9) 1·4 (1·2 to 1·8) −12·6 (−20·7 to −3·2) Unintentional injuries 1887·3 (1701·0 to 1969·6) 1838·7 (1634·6 to 1939·1) −2·6 (−5·7 to 3·2) 32·3 (29·1 to 33·6) 26·5 (23·6 to 28·0) −17·8 (−20·4 to −13·4) Falls 436·1 (402·3 to 451·2) 527·2 (467·8 to 554·5) 20·9 (14·6 to 27·2) 8·6 (7·9 to 8·9) 8·1 (7·2 to 8·5) −5·5 (−10·1 to −0·8) Drowning 403·1 (349·2 to 424·7) 323·8 (285·8 to 347·5) −19·7 (−23·6 to −14·2) 6·3 (5·4 to 6·6) 4·5 (4·0 to 4·8) −28·5 (−31·8 to −23·8) Fire, heat, and hot substances 195·2 (161·4 to 209·0) 176·0 (145·1 to 189·6) −9·9 (−14·8 to −2·5) 3·3 (2·7 to 3·5) 2·5 (2·1 to 2·7) −23·5 (−27·7 to −17·7) Poisonings 100·8 (71·4 to 117·4) 86·4 (58·6 to 101·0) −14·3 (−24·1 to −1·1) 1·6 (1·2 to 1·9) 1·2 (0·8 to 1·4) −26·7 (−34·3 to −16·2) Exposure to mechanical forces 202·6 (175·4 to 214·0) 200·6 (157·6 to 216·7) −1·0 (−11·7 to 7·0) 3·3 (2·8 to 3·5) 2·8 (2·2 to 3·0) −15·1 (−24·1 to −8·9) Unintentional firearm injuries 32·7 (23·8 to 35·6) 32·0 (23·3 to 35·1) −2·1 (−7·1 to 3·3) 0·5 (0·4 to 0·6) 0·5 (0·3 to 0·5) −17·0 (−20·9 to −12·7) Unintentional suffocation 34·9 (27·1 to 39·4) 35·6 (25·6 to 40·3) 2·0 (−11·6 to 15·8) 0·6 (0·4 to 0·6) 0·5 (0·4 to 0·6) −9·2 (−21·2 to 2·5) Other exposure to mechanical forces 135·0 (113·9 to 144·3) 133·0 (101·1 to 145·1) −1·5 (−13·6 to 8·5) 2·2 (1·9 to 2·3) 1·9 (1·4 to 2·0) −16·2 (−26·2 to −8·3) Adverse effects of medical treatment 97·3 (74·1 to 107·8) 99·8 (77·3 to 109·0) 2·5 (−2·6 to 9·3) 1·7 (1·4 to 1·9) 1·5 (1·1 to 1·6) −15·6 (−19·2 to −11·4) Animal contact 104·4 (67·1 to 114·9) 94·0 (55·8 to 132·3) −9·9 (−19·7 to 18·4) 1·7 (1·1 to 1·9) 1·3 (0·8 to 1·8) −22·5 (−31·0 to 1·6) Venomous animal contact 88·2 (54·1 to 98·6) 79·6 (44·2 to 115·9) −9·8 (−21·0 to 20·5) 1·4 (0·9 to 1·6) 1·1 (0·6 to 1·6) −22·3 (−32·1 to 3·7) Non-venomous animal contact 16·2 (13·1 to 18·7) 14·4 (11·4 to 16·4) −10·8 (−19·7 to 10·9) 0·3 (0·2 to 0·3) 0·2 (0·2 to 0·2) −23·5 (−30·6 to −5·8) Foreign body 145·7 (118·7 to 175·9) 151·6 (132·6 to 169·8) 4·1 (−4·7 to 13·6) 2·5 (2·1 to 3·0) 2·2 (1·9 to 2·4) −12·3 (−18·4 to −6·1) Pulmonary aspiration and foreign body in airway 116·6 (93·0 to 148·1) 124·0 (105·5 to 143·2) 6·3 (−4·9 to 15·7) 2·0 (1·7 to 2·5) 1·8 (1·5 to 2·1) −10·8 (−18·5 to −4·6) Foreign body in other body part 29·0 (18·1 to 43·2) 27·6 (20·3 to 34·4) −5·0 (−22·7 to 11·2) 0·5 (0·3 to 0·7) 0·4 (0·3 to 0·5) −18·8 (−34·3 to −6·2) Environmental heat and cold exposure 53·4 (39·9 to 57·2) 45·2 (33·5 to 49·5) −15·4 (−21·1 to −9·1) 0·9 (0·7 to 1·0) 0·7 (0·5 to 0·7) −31·3 (−35·8 to −26·6) Other unintentional injuries 148·8 (141·4 to 157·7) 134·2 (124·8 to 147·8) −9·8 (−16·7 to −1·6) 2·4 (2·3 to 2·5) 1·9 (1·7 to 2·0) −22·3 (−28·2 to −15·4) Self-harm and interpersonal violence 1253·0 (1125·6 to 1288·8) 1236·7 (1130·1 to 1287·9) −1·3 (−5·7 to 3·0) 20·3 (18·2 to 20·9) 17·0 (15·5 to 17·7) −16·3 (−20·1 to −12·6) Self-harm 827·6 (725·4 to 855·5) 828·1 (745·8 to 868·7) 0·1 (−6·2 to 6·1) 13·7 (12·0 to 14·2) 11·5 (10·3 to 12·1) −16·3 (−21·5 to −11·2) Interpersonal violence 425·3 (388·7 to 439·6) 408·6 (370·5 to 431·5) −3·9 (−7·0 to −0·1) 6·5 (6·0 to 6·8) 5·5 (5·0 to 5·8) −16·4 (−19·1 to −13·1) Assault by firearm 162·9 (142·8 to 168·8) 173·1 (149·3 to 183·2) 6·3 (2·4 to 11·0) 2·4 (2·1 to 2·5) 2·3 (2·0 to 2·4) −6·0 (−9·4 to −1·8) Assault by sharp object 104·4 (97·5 to 110·7) 89·5 (83·3 to 97·3) −14·3 (−18·8 to −9·1) 1·6 (1·5 to 1·7) 1·2 (1·1 to 1·3) −25·6 (−29·4 to −21·2) Assault by other means 158·0 (143·1 to 167·5) 145·9 (129·6 to 159·7) −7·6 (−12·6 to −1·5) 2·5 (2·3 to 2·6) 2·0 (1·8 to 2·2) −20·6 (−24·8 to −15·4) Forces of nature, war, and legal intervention 124·7 (82·5 to 166·5) 183·1 (100·0 to 263·8) 46·8 (−14·2 to 120·5) 1·9 (1·3 to 2·6) 2·4 (1·3 to 3·5) 27·4 (−25·5 to 90·7) Exposure to forces of nature 90·8 (53·0 to 128·0) 11·8 (7·2 to 16·4) −87·0 (−87·9 to −86·1) 1·4 (0·8 to 2·0) 0·2 (0·1 to 0·2) −88·5 (−89·3 to −87·6) Collective violence and legal intervention 33·8 (25·5 to 43·0) 171·3 (88·1 to 251·1) 406·0 (236·0 to 524·5) 0·5 (0·4 to 0·7) 2·3 (1·2 to 3·3) 347·5 (192·4 to 455·8) Data in parentheses are 95% uncertainty intervals. Table 5 shows the global estimates of total deaths and age-standardised death rates by cause for 2005 and 2015, as well as the percentage change in mortality from 2005 to 2015. Annual mortality estimates from 1990 to 2015 and more detailed age–sex results can be viewed online Broadly, communicable, maternal, neonatal, and nutritional diseases, known as Group 1 causes for GBD, accounted for 20·2% (95% UI 19·7–20·7) of global deaths in 2015 (11·3 million, 95% UI 10·9 million to 11·6 million), NCDs caused 71·3% (70·9–72·0) of deaths (39·8 million, 39·2 million to 40·5 million), and injuries resulted in 8·5% (7·9–8·5) of deaths (4·7 million, 4·4 million to 4·9 million). Between 2005 and 2015, Group 1 causes saw significant reductions for both total deaths (decrease of 19·7% [17·8–21·6]) and age-standardised rates (decrease of 29·6% [27·9–31·3]). For NCDs, total deaths rose by 14·3% (12·6–16·0), an increase of 5·0 million deaths (4·4 million to 5·6 million) since 2005, but age-standardised rates decreased from 719·1 deaths (711·9–727·3) per 100 000 in 2005 to 624·7 deaths (615·8–634·5) per 100 000 in 2015 (decrease of 13·1%, 11·9–14·3). Injuries caused about 4·7 million deaths in both 2005 and 2015, but the age-standardised rates due to injuries significantly declined during this time, decreasing by 15·8% (12·4–18·7) from 78·6 deaths (73·5–80·8) per 100 000 in 2005 to 66·2 deaths (61·5–68·7) per 100 000 in 2015. Communicable, maternal, neonatal, and nutritional diseases Marked reductions in total deaths and age-standardised death rates were achieved for many of the world's most important communicable diseases. Total HIV/AIDS deaths fell 33·4% (95% UI 30·0–36·2), from 1·8 million (95% UI 1·7 million to 1·9 million) in 2005 to 1·2 million (1·1 million to 1·3 million) in 2015, and age-standardised death rates dropped even more rapidly (reduction of 42·1%, 39·1–44·6). Globally, HIV/AIDS mortality peaked in 2005, underscoring the continued expansion of ART and PMTCT. Malaria deaths decreased by 37·4% (27·8–47·0), falling to 730 500 (555 800–904 000) in 2015. Age-standardised death rates due to malaria fell slightly more rapidly (43·1%, 34·7–51·8) during this time; nonetheless, this rate of decline only partly represents the sustained gains against malaria, given that mortality peaked in 2003, claiming 1·2 million lives (1·0 million to 1·4 million) that year. Age-standardised death rates due to diarrhoeal diseases fell 32·2% (27·7–36·5) from 2005 to 2015, although total deaths fell more slowly (20·8%, 15·4–26·1) to 1·3 million deaths (1·2 million to 1·4 million). Other communicable diseases that had significant reductions in mortality included tetanus (decreased by 47·5% [95% UI 39·0–54·6], to 56 700 deaths [48 200–80 000]), measles (decreased by 75·0% [58·8–84·5], to 73 400 deaths [26 100–161 400]), and African trypanosomiasis (decreased by 75·3% [67·9–81·4], to 3510 deaths [1790–5660]). Amid these gains, less pronounced progress occurred for several communicable diseases, and fatalities climbed rapidly for others, such as Ebola virus disease. Tuberculosis, which killed fewer people than HIV/AIDS in 2005 (1·3 million, 95% UI 1·2 million to 1·7 million), essentially matched HIV/AIDS's toll by 2015, causing 1·1 million deaths (0·91 million to 1·4 million). Deaths due to tuberculosis decreased by 17·4% (11·3–24·4) between 2005 and 2015; however, age-standardised tuberculosis death rates dropped by 33·8% (28·7–39·6). Total mortality due to lower respiratory infections remained fairly constant from 2005 to 2015 (between 2·8 million and 2·7 million deaths), although age-standardised death rates fell by 19·5% (16·9–22·3); a similar trend was observed for meningitis. Deaths due to hepatitis and age-standardised death rates decreased (deaths fell by 14·0% [10·0–17·9], to 106 000 [101 000–111 000], and death rates fell by 28·0% [24·7–31·1]), which was mainly driven by significant reductions in deaths due to acute hepatitis A (decrease of 34·0% [24·2–43·5], to 11 000 [7000–16 000]) since 2005. Mortality due to other types of hepatitis improved less rapidly. Dengue deaths increased by 48·7% (15·1–90·9), resulting in 18 400 deaths (11 800–22 700) in 2015, and Chagas disease, which largely affects populations in Latin America, claimed 8000 lives (7500–8600) that year. Deaths due to leishmaniasis increased, albeit not significantly, between 2005 and 2015, causing 24 200 deaths (17 100–32 500) in 2015. The peak of the west African Ebola virus disease outbreak occurred in 2014, causing 12 800 deaths (10 300–15 300) that year. In 2015, 5500 people (4400–6600) died from Ebola virus disease, mainly in Guinea, Liberia, and Sierra Leone. Among the leading causes of global maternal mortality, most showed significant reductions in both total deaths and age-standardised death rates between 2005 and 2015. Deaths due to maternal haemorrhage decreased by 16·6% (95% UI 3·2–28·8), claiming 16 600 (3300–29 800) fewer lives in 2015, and deaths due to abortion, miscarriage, and ectopic pregnancies dropped by 23·1% (11·1–33·9), to 32 000 (25 000–40 000); age-standardised death rates fell by 25·0% (12·9–35·9) for maternal haemorrhage and by 30·7% (19·8–40·4) for abortion, miscarriage, and ectopic pregnancies. For neonatal disorders, total deaths fell by 18·5% (16·4–20·4) and age-standardised death rates fell by 22·8% (−24·6 to −20·9) from 2005 to 2015, to 2·2 million (2·1 million to 2·2 million). Preterm birth complications caused 282 200 (215 000–353 500) fewer deaths in 2015 than in 2005 (reduction of 25·9%, 20·6–31·3) and age-standardised rates dropped by 29·8% (24·8–34·9). Total deaths and age-standardised death rates due to neonatal encephalopathy also decreased significantly during this time, albeit at a more moderate pace. Overall, these trends probably reflect a combination of decreasing fertility rates, improved maternal care, and safer delivery practices in many settings. Notably less progress occurred for nutritional deficiencies, which caused 405 700 deaths (95% UI 331 700–495 600) in 2015. In 2015, iron-deficiency anaemia led to 54 200 deaths (35 100–72 900) and protein-energy malnutrition caused 323 200 deaths (264 900–400 800); in combination, nutritional deficiencies accounted for 3·6% (2·7–4·1) of lives lost to Group 1 disorders. Age-standardised death rates significantly decreased for nutritional deficiencies (decreased by 24·3%, 14·3–32·9). Non-communicable diseases In 2015, the leading causes of NCD deaths were cardiovascular disease (17·9 million, 95% UI 17·6 million to 18·3 million), cancers (8·8 million, 8·6 million to 8·9 million), and chronic respiratory diseases (3·8 million, 3·7 million to 3·9 million). The global death toll due to cancers increased by 17·0% (95% UI 14·8–19·3) between 2005 and 2015, although age-standardised rates of death fell by 10·0% (8·3–11·6). Tracheal, bronchus, and lung cancer (total deaths 1·7 million, 1·7 million to 1·8 million) were the leading causes of cancer deaths, and also had the highest age-standardised death rate (26·6 deaths [25·9–27·4] per 100 000) among cancers in 2015. For several cancers, total deaths increased by 20% or more between 2005 and 2015, including tracheal, bronchus, and lung cancer (20·1% [16·7–24·0], to 1·7 million deaths [1·7 million to 1·8 million); colon and rectum cancer (23·2% [20·6–26·0], to 832 000 deaths [811 700–854 500]); malignant skin melanoma (27·2% [20·0–32·6], to 59 800 deaths [47 600–72 700]); pancreatic cancer (30·8% [28·3–33·6], to 411 600 deaths [403 600–420 700]); and prostate cancer (31·9% [28·2–35·4], to 365 900 deaths [303 500–459 600]). Breast and ovarian cancers, which largely, if not exclusively, affect females, caused significantly more deaths in 2015 than in 2005 (breast cancer increased by 21·3% [14·9–27·2], to 534 000 deaths [502 000–553 000]; ovarian cancer increased by 20·4% [16·5–24·4], to 161 000 deaths [157 000–167 000]); however, age-standardised death rates for both cancers significantly declined during this time (breast cancer decreased by 6·8% [2·5–11·5] and ovarian cancer decreased by 7·9% [4·9–10·8]). The largest reductions in death rates from 2005 to 2015 were recorded for oesophageal cancer, which fell by 26·8% (22·9–30·3) and Hodgkin's lymphoma, which fell by 23·9% (20·1–27·7). At the same time, significant increases occurred in age-standardised death rates due to non-melanoma skin cancer (increased by 7·6%, 3·4–11·1) and mesothelioma (increased by 7·8%, 3·6–11·6). Global cardiovascular disease deaths rose by 12·5% (95% UI 10·6–14·4) between 2005 and 2015, whereas age-standardised rates of death due to cardiovascular disease fell 15·6% (14·2–16·9). These reductions were largely driven by declining mortality rates due to cerebrovascular disease (ie, stroke; decreased by 21·0%, 19·2–22·8) since 2005. Globally, deaths due to ischaemic heart disease increased by 16·6% (14·6–18·6) from 2005 to 2015 to 8·9 million deaths (8·8 million to 9·1 million), whereas age-standardised mortality rates for ischaemic heart disease decreased at a more moderate pace (fell by 12·8%, 11·4–14·2). Ischaemic heart disease and stroke accounted for 15·2 million deaths (15·0 million to 15·6 million) in 2015, equating to 85·1% (84·7–85·5) of all deaths due to cardiovascular disease that year. Among respiratory conditions, age-standardised death rates fell by 22·9% (20·0–25·4) for chronic obstructive pulmonary disease (COPD) and by 31·3% (19·4–38·9) for asthma; total deaths due to these causes did not significantly differ from 2005 to 2015. By contrast, for interstitial lung disease and pulmonary sarcoidosis, significant increases occurred in total deaths, which rose by 51·5% (37·9–60·5) to 121 800 deaths (94 100–135 200), and age-standardised rates, which rose by 14·1% (4·1–20·9) from 2005 to 2015. Mortality patterns were similar for other leading NCD causes of death. Age-standardised mortality rates decreased for all subtypes of cirrhosis, yet total deaths increased to 1·3 million in 2015 (95% UI 1·2 million to 1·4 million). Total mortality also increased from 2005 to 2015 for diabetes, which rose by 32·1% (95% UI 27·7–36·3), to 1·5 million deaths (1·5 million to 1·6 million), and chronic kidney disease, which rose by 31·7% (27·7–35·6), to 1·2 million deaths (1·1 million to 1·3 million); by contrast, changes in age-standardised death rates due to diabetes and chronic kidney disease were not statistically significant. Chronic kidney disease due to diabetes mellitus caused significantly more deaths in 2015 than in 2005 (an increase of 39·5% [35·4–43·5], to 418 000 deaths [389 000–441 000]), and age-standardised death rates also rose 6·4% (3·3–9·3). Global deaths due to Alzheimer's disease and other dementias increased by 38·2% (36·2–40·1), to 1·9 million deaths (1·6 million to 2·2 million), which was largely driven by population ageing, given that age-standardised mortality decreased by 2·7% (1·7–3·7). Notably, both total deaths and age-standardised death rates due to alcohol use disorders significantly dropped from 2005 to 2015, falling by 12·6% (7·0–16·7), to 138 000 deaths (131 000–144 000), and 29·2% (24·7–32·4), respectively. However, drug use disorders claimed increasingly more lives, resulting in a rise of 31·8% (20·4–39·4; rising to 170 000 deaths, 152 000–179 000) since 2005. Deaths due to opioid use disorders accounted for 71·9% (69·5–73·3) of these drug-related deaths in 2015, increasing by 29·6% (18·2–37·2) to a total of 122 100 deaths (109 500–129 700) that year. Injuries In 2015, transport injuries caused 1·5 million deaths (95% UI 1·4 million to 1·5 million), unintentional injuries resulted in 1·8 million (1·6 million to 1·9 million), and intentional injuries, including self-harm and interpersonal violence, led to 1·2 million (1·1 million to 1·3 million). Although total deaths did not significantly change between 2005 and 2015, age-standardised death rates fell by 16·2% (11·8–20·8) for transport injuries, 17·8% (13·4–20·4) for unintentional injuries, and 16·3% (12·6–20·1) for intentional injuries. Age-standardised death rates for road injuries and most types of road injuries, including pedestrian, cyclist, and motor vehicle injuries, significantly decreased from 2005 to 2015. Notably, deaths due to falls increased by 20·9% (14·6–27·2) between 2005 and 2015 (to 527 000 deaths, 468 000–555 000), which probably reflects global shifts in ageing rather than a rise in injury risk given that age-standardised death rates fell by 5·5% (0·8–10·1). For drowning, there were significant reductions in both total deaths (decreased by 19·7% [14·2–23·6], to 324 000 deaths [286 000–347 000]) and age-standardised death rates (decreased by 28·5%, 23·8–31·8). Total deaths due to self-harm and interpersonal violence remained relatively unchanged since 2005, but age-standardised deaths fell by 16·3% (11·2–21·5) and 16·4% (13·1–19·1), respectively. Assault by firearms, which accounted for 42·4% (40·4–43·9) of all interpersonal violence deaths, claimed 173 100 lives (149 300–183 200) in 2015, and in contrast with all other causes of interpersonal violence, total deaths significantly increased since 2005 (rose by 6·3%, 2·4–11·0). Figure 11 Global deaths due to fatal discontinuities by cause group for each year, 1980–2015 Show full caption Numbers shown are total deaths. Fatal discontinuities are events that lead to abrupt changes in deaths in a geography. The causes for these fatal discontinuities include wars, natural disasters, industrial accidents, large transport accidents, epidemics, famines, or other injuries. Mortality trends due to natural disasters and war were highly irregular ( figure 11 ). By decade, the numbers of war deaths were higher in the 1970s and 1980s, then fell in the 1990s and in the first decade of the 21st century. Conversely, between 2010 and 2015, mortality due to war (collective violence and legal intervention) increased, rising to 171 300 (88 100–251 100) in 2015. More than 40·6% (34·8–45·1) of these deaths occurred in Syria and Yemen (70 000 deaths, 33 000–107 000). These numbers of war fatalities remain much lower than those recorded in 1993 and 1994, when more than 626 000 lives were lost to the Rwandan genocide, the Iraq civil war, ongoing armed conflict in Bosnia and Herzegovina, and other occurrences of collective violence; nonetheless, the rising number of casualties in the Middle East represents the largest increase in war deaths since 1995. Because of deaths in Afghanistan, Iraq, Syria, and Yemen, war deaths have increased during 2014–15. Between 2004 and 2010, natural disasters claimed thousands of lives, including 226 000 from the Indonesian earthquake and tsunami in 2004; 74 700 from earthquakes in India and Pakistan, as well as 1870 from Hurricane Katrina in the USA in 2005; 87 900 from an earthquake in China and 138 000 from a cyclone in Myanmar in 2008; and 223 000 from the earthquake in Haiti in 2010. In 2015, natural disasters caused 11 800 deaths (7160–16 400), mainly due to the Nepal earthquake and floods in India. Figure 12 Global age-standardised death rates for males versus females, by GBD cause Level 3, 1990 and 2015 Show full caption The y-axis and x-axis are shown on a log scale to enable comparisons between males and females spanning a wide range of values. Black lines show where death rates are identical for males and females. Causes that only affect one sex, including maternal disorders, chlamydia, cervical, uterine, ovarian, prostate, testicular cancers, and gynaecological diseases are not shown. GBD=Global Burden of Disease. COPD=chronic obstructive pulmonary disease. C=cancer. In general, age-standardised death rates for males and females by cause are highly correlated at the global level ( figure 12 ). For most causes, male age-standardised death rates are higher than for females. Death rates are notably higher in males for many cancers including tracheal, bronchus, and lung, liver, oesophageal, bladder, and larynx cancer, and mesothelioma. Male age-standardised death rates are also higher for many injuries including road injuries, self-harm, falls, and interpersonal violence. For a small number of causes, female age-standardised rates are higher than for males, including breast cancer, rheumatic heart disease, gallbladder and biliary cancer, whooping cough, rheumatoid arthritis, thyroid cancer, and multiple sclerosis, and other musculoskeletal disorders. Decomposition analysis of changes in global mortality Figure 13 Global decomposition of changes in leading 30 causes of death, 2005 to 2015 Show full caption Changes due to population growth, population ageing, and changes in age-specific mortality rates are shown. Causes are reported in descending order by total number of deaths for all ages and both sexes combined in 2015. The black circle shows the overall median percentage change in global deaths from 2005 to 2015. Causes with increases in overall death rates have a circle to the right of the zero, whereas a circle to the left of the zero denotes causes with decreases in overall death rates. The contributions of population growth, ageing, and change in age-specific death rates sum to the total change in numbers of deaths. Drivers of global changes in mortality—population growth, ageing, and changes to age-standardised rates of cause-specific mortality—varied substantially by cause from 2005 to 2015 ( figure 13 ). Among the leading 30 causes of death worldwide, changes in total death tolls ranged from a reduction of 37·4% (95% UI 27·8–47·0) for malaria to an increase of 38·2% (36·2–40·1) for Alzheimer's disease and other dementias. Population growth accounted for increases in numbers of deaths across all 30 causes, but its contribution ranged from less than 9% for several types of cancer, including lung cancer and liver cancer, to 22·9% for malaria. In fact, for malaria, as well as a subset of other Group 1 causes (ie, preterm birth complications, neonatal encephalopathy, and meningitis), population growth was the only factor that hindered further reductions in mortality. Population ageing led to increasing mortality for most causes, but its relative contribution ranged from less than 4% for interpersonal violence and diarrhoeal diseases to 29·6% for Alzheimer's disease and other dementias. Shifts in population age structures also accounted for more than 23% of increased mortality due to cardiovascular disease (ischaemic heart disease and stroke), 24·2% for COPD, and at least 20% for several types of cancer (eg, pancreatic cancer and oesophageal cancer). Conversely, for some causes, namely neonatal conditions and causes that largely affect children, such as malaria, population ageing contributed to decreasing levels of mortality. Except for pancreatic cancer, changes in age-specific and cause-specific rates of death drove reductions in deaths due to the 28 other leading causes. Declines attributable to changes in age-specific and cause-specific mortality rates markedly differed, with several causes experiencing reductions of more than 40% (eg, malaria [58·2%], HIV/AIDS [54·8%], tuberculosis [41·9%], and diarrhoeal diseases [41·0%]) and others showing much smaller decreases (eg, chronic kidney disease [2·4%] and diabetes [3·1%]). Notably, patterns were less distinct for most injuries because population growth and shifts in age-specific and cause-specific mortality rates had relatively similar contributions to changes in deaths due to road injuries, self-harm, and interpersonal violence. Falls were the exception, with a combination of population growth and ageing mainly driving its rising death toll. Global YLLs Figure 14 Leading 30 Level 3 causes of global YLLs for both sexes combined for 1990, 2005, and 2015, with percent change in number of YLLs, and all-age and age-standardised rates Show full caption Causes are connected by lines between time periods. For the time periods 1990 to 2005 and 2005 to 2015, three measures of change are shown: percent change in the number of YLLs, percent change in the all-age YLL rate, and percent change in the age-standardised YLL rate. Statistically significant changes are shown in bold. YLLs=years of life lost. COPD=chronic obstructive pulmonary disease. STDs=sexually transmitted diseases excluding HIV. An interactive version of this figure is available online at http://vizhub.healthdata.org/gbd-compare From 2005 to 2015, changes in the relative ranks of YLLs, emphasised the increasing complexity of global mortality patterns ( figure 14 ). The top three causes of YLLs—ischaemic heart disease, stroke (which includes both ischaemic and haemorrhagic stroke), and lower respiratory infections—all saw reductions in age-standardised rates between 2005 and 2015, but changed minimally in rankings. In 2005, the causes ranked fourth to eighth were all communicable diseases (HIV/AIDS [fourth], diarrhoeal diseases [sixth], and malaria [seventh]) or neonatal disorders (preterm birth complications [fifth] and neonatal encephalopathy [eighth]). By 2015, both total and age-standardised rates of YLLs had significantly decreased for all of these causes, but their relative rankings did not substantially change; the exceptions were HIV/AIDS, which fell to seventh, and malaria, which dropped to ninth. Road injuries, COPD, and congenital anomalies, ranked as ninth, tenth, and 11th leading causes of YLLs in 2005, remained largely the same in terms of ranks in 2015, with only road injuries moving up by one spot to rank eighth. YLLs due to road injuries fell significantly between 2005 and 2015, both in terms of total YLLs, which decreased by 8·1% (95% UI 3·3–13·3), and age-standardised rates, which decreased by 18·5% (14·3–23·1). Among the top ten leading causes, premature mortality due to malaria decreased the most, with total YLLs falling by 40·1% (29·4–50·2) and age-standardised rates dropping 44·7% (34·9–54·1). More pronounced shifts in YLL ranks and percentage changes between 2005 and 2015 occurred beyond the leading 11 causes, particularly for several NCDs. Total YLLs due to diabetes rose 25·4% (95% UI 20·4–30·0) and diabetes advanced from being ranked 18th to 15th. Similar increases occurred for chronic kidney disease (18·4% [13·8–23·1] for total YLLs and rising from 21st to 17th) and Alzheimer's disease and other dementias (30·5% [28·6–32·4] for total YLLs and increasing from 30th to 25th). Several types of cancer, including colon and rectum cancer, breast cancer, pancreatic cancer, and brain cancer, showed significant increases in total YLLs and relative ranks by 2015; however, none of these cancers had significant increases in age-standardised rates of YLLs. Among NCDs, only asthma (ranked 32nd in 2005 and 37th in 2015) and rheumatic heart disease (ranked 41st in 2005 and 43rd in 2015) had significant reductions for both total YLLs and age-standardised rates. By contrast, larger declines for total YLLs and age-standardised rates occurred for several leading Group 1 causes, including tuberculosis (20·5% [14·9–26·0] and 33·7% [29·1–38·3], respectively); protein-energy malnutrition (22·9% [4·8–38·1] and 29·4% [13·0–43·0], respectively); and most notably, measles (75·0% [58·9–84·4] and 76·7% [61·8–85·5], respectively). In general, changes in total YLLs and age-standardised rates due to injuries suggested reduced levels of premature mortality; the main exception was early deaths due to war, which climbed from the 92nd leading cause of YLLs in 2005 to 38th in 2015, and increased more than 350% for total YLLs and age-standardised rates of early death. Additional comparisons for changes in YLLs across different years between 1990 and 2015 can be explored online Causes of child death Table 6 Selected causes of global child deaths for both sexes combined in 2005 and 2015, with percentage change between 2005 and 2015 Neonates age <1 month Children age 1–59 months Under-5 totals 2015 (thousands) Percentage change, 2005–15 2015 (thousands) Percentage change, 2005–15 2015 (thousands) Percentage change, 2005–15 All causes 2621·5 (2562·0–2680·8) −20·3 (−21·8 to −18·7) 3199·4 (3093·9–3309·8) −32·1 (−34·2 to −29·7) 5820·9 (5673·0–5965·2) −27·2 (−29·0 to −25·2) Communicable, maternal, neonatal, and nutritional diseases 2331·6 (2272·8–2394·0) −21·6 (−23·2 to −19·9) 2371·7 (2267·7–2473·5) −37·1 (−39·9 to −34·4) 4703·4 (4569·9–4845·5) −30·3 (−32·4 to −28·1) HIV/AIDS .. .. 88·9 (84·3–93·7) −51·9 (−54·2 to −49·6) 88·9 (84·3–93·7) −51·9 (−54·2 to −49·6) Diarrhoeal diseases 44·0 (38·6–50·6) −38·5 (−46·3 to −29·1) 454·9 (404·4–510·2) −33·9 (−42·4 to −23·4) 498·9 (447·5–557·6) −34·3 (−42·3 to −24·9) Intestinal infectious diseases .. .. 42·2 (22·5–73·2) −20·0 (−29·8 to −8·9) 42·2 (22·5–73·2) −20·0 (−29·8 to −8·9) Lower respiratory infections 152·9 (140·4–166·6) −35·9 (−40·8 to −30·7) 551·0 (502·2–600·5) −37·1 (−43·0 to −30·9) 703·9 (651·4–763·0) −36·9 (−42·0 to −31·6) Meningitis 25·8 (18·3–35·9) −15·6 (−31·9 to 9·3) 147·3 (117·1–196·0) −17·9 (−32·0 to 4·9) 173·1 (137·1–228·9) −17·6 (−31·0 to 4·0) Whooping cough .. .. 54·5 (18·8–117·0) −41·0 (−77·8 to 63·5) 54·5 (18·8–117·0) −41·0 (−77·8 to 63·5) Tetanus 19·9 (17·0–23·5) −57·7 (−64·2 to −50·0) 5·6 (4·1–7·8) −55·2 (−66·4 to −39·3) 25·5 (21·8–30·9) −57·2 (−63·8 to −49·1) Measles .. .. 62·6 (22·4–135·8) −75·1 (−84·5 to −59·6) 62·6 (22·4–135·8) −75·1 (−84·5 to −59·6) Malaria 13·9 (8·9–19·8) −55·9 (−67·8 to −41·1) 460·2 (324·1–604·9) −42·3 (−54·1 to −29·0) 474·1 (333·3–623·7) −42·8 (−54·6 to −29·4) Neonatal preterm birth complications 765·9 (700·0–854·3) −25·9 (−31·5 to −20·5) 39·9 (32·7–48·3) −25·9 (−39·3 to −8·4) 805·8 (736·2–898·6) −25·9 (−31·3 to −20·6) Neonatal encephalopathy (birth asphyxia and trauma) 707·8 (638·4–789·7) −16·3 (−23·8 to −8·0) 32·6 (24·8–43·0) −11·9 (−34·0 to 16·4) 740·4 (667·6–829·2) −16·1 (−23·8 to −8·0) Neonatal sepsis and other neonatal infections 336·3 (237·4–441·5) −0·5 (−16·9 to 20·7) 15·4 (10·0–20·6) 7·8 (−18·0 to 40·6) 351·7 (249·2–459·1) −0·2 (−16·2 to 20·3) Other neonatal disorders 180·0 (133·9–229·4) −16·4 (−35·1 to 6·2) 40·3 (29·2–52·3) −14·1 (−39·2 to 19·9) 220·2 (167·6–276·8) −16·0 (−34·1 to 5·6) Nutritional deficiencies .. .. 192·8 (147·2–248·1) −24·3 (−40·4 to −4·1) 192·8 (147·2–248·1) −24·3 (−40·4 to −4·1) Syphilis 31·5 (17·5–49·2) −28·4 (−34·5 to −21·5) 59·0 (32·9–95·7) −16·5 (−28·7 to −5·4) 90·5 (50·6–144·5) −21·1 (−30·4 to −12·5) Other communicable diseases 53·6 (39·3–75·5) −30·9 (−44·1 to −16·4) 124·7 (108·2–141·5) −21·7 (−30·2 to −10·3) 178·3 (151·7–211·3) −24·7 (−32·3 to −16·2) Non-communicable diseases 267·4 (234·3–290·8) −7·1 (−18·4 to 0·8) 537·2 (488·1–592·6) −8·0 (−18·0 to 2·9) 804·5 (733·8–868·9) −7·7 (−17·3 to 1·0) Congenital anomalies 242·6 (213·6–263·6) −6·0 (−18·4 to 2·5) 254·0 (223·6–297·4) −0·4 (−17·2 to 13·7) 496·6 (444·4–554·6) −3·2 (−17·8 to 7·6) Sudden infant death syndrome 1·9 (1·6–2·6) −9·7 (−25·5 to 4·9) 17·3 (14·2–24·9) −7·7 (−23·1 to 9·7) 19·2 (15·9–27·5) −7·9 (−23·0 to 8