Bio: Rajesh Dikshit is an academic researcher from Homi Bhabha National Institute. The author has contributed to research in topic(s): Population & Cancer. The author has an hindex of 32, co-authored 91 publication(s) receiving 26879 citation(s). Previous affiliations of Rajesh Dikshit include Tata Memorial Hospital & International Agency for Research on Cancer.
01 Mar 2015-International Journal of Cancer
Abstract: Estimates of the worldwide incidence and mortality from 27 major cancers and for all cancers combined for 2012 are now available in the GLOBOCAN series of the International Agency for Research on Cancer. We review the sources and methods used in compiling the national cancer incidence and mortality estimates, and briefly describe the key results by cancer site and in 20 large “areas” of the world. Overall, there were 14.1 million new cases and 8.2 million deaths in 2012. The most commonly diagnosed cancers were lung (1.82 million), breast (1.67 million), and colorectal (1.36 million); the most common causes of cancer death were lung cancer (1.6 million deaths), liver cancer (745,000 deaths), and stomach cancer (723,000 deaths).
23 Jun 2012-The Lancet
TL;DR: This work aimed to quantify suicide mortality in India in 2010 by applying the age-specific and sex-specific proportion of suicide deaths in this survey to the 2010 UN estimates of absolute numbers of deaths in India.
Abstract: Summary Background WHO estimates that about 170 000 deaths by suicide occur in India every year, but few epidemiological studies of suicide have been done in the country. We aimed to quantify suicide mortality in India in 2010. Methods The Registrar General of India implemented a nationally representative mortality survey to determine the cause of deaths occurring between 2001 and 2003 in 1·1 million homes in 6671 small areas chosen randomly from all parts of India. As part of this survey, fieldworkers obtained information about cause of death and risk factors for suicide from close associates or relatives of the deceased individual. Two of 140 trained physicians were randomly allocated (stratified only by their ability to read the local language in which each survey was done) to independently and anonymously assign a cause to each death on the basis of electronic field reports. We then applied the age-specific and sex-specific proportion of suicide deaths in this survey to the 2010 UN estimates of absolute numbers of deaths in India to estimate the number of suicide deaths in India in 2010. Findings About 3% of the surveyed deaths (2684 of 95 335) in individuals aged 15 years or older were due to suicide, corresponding to about 187 000 suicide deaths in India in 2010 at these ages (115 000 men and 72 000 women; age-standardised rates per 100 000 people aged 15 years or older of 26·3 for men and 17·5 for women). For suicide deaths at ages 15 years or older, 40% of suicide deaths in men (45 100 of 114 800) and 56% of suicide deaths in women (40 500 of 72 100) occurred at ages 15–29 years. A 15-year-old individual in India had a cumulative risk of about 1·3% of dying before the age of 80 years by suicide; men had a higher risk (1·7%) than did women (1·0%), with especially high risks in south India (3·5% in men and 1·8% in women). About half of suicide deaths were due to poisoning (mainly ingestions of pesticides). Interpretation Suicide death rates in India are among the highest in the world. A large proportion of adult suicide deaths occur between the ages of 15 years and 29 years, especially in women. Public health interventions such as restrictions in access to pesticides might prevent many suicide deaths in India. Funding US National Institutes of Health.
01 Jan 2015-Lancet Oncology
TL;DR: The continuation of current patterns of population weight gain will lead to continuing increases in the future burden of cancer, and the need for a global effort to abate the increasing numbers of people with high BMI is emphasised.
Abstract: Summary Background High body-mass index (BMI; defined as 25 kg/m 2 or greater) is associated with increased risk of cancer. To inform public health policy and future research, we estimated the global burden of cancer attributable to high BMI in 2012. Methods In this population-based study, we derived population attributable fractions (PAFs) using relative risks and BMI estimates in adults by age, sex, and country. Assuming a 10-year lag-period between high BMI and cancer occurrence, we calculated PAFs using BMI estimates from 2002 and used GLOBOCAN2012 data to estimate numbers of new cancer cases attributable to high BMI. We also calculated the proportion of cancers that were potentially avoidable had populations maintained their mean BMIs recorded in 1982. We did secondary analyses to test the model and to estimate the effects of hormone replacement therapy (HRT) use and smoking. Findings Worldwide, we estimate that 481 000 or 3·6% of all new cancer cases in adults (aged 30 years and older after the 10-year lag period) in 2012 were attributable to high BMI. PAFs were greater in women than in men (5·4% vs 1·9%). The burden of attributable cases was higher in countries with very high and high human development indices (HDIs; PAF 5·3% and 4·8%, respectively) than in those with moderate (1·6%) and low HDIs (1·0%). Corpus uteri, postmenopausal breast, and colon cancers accounted for 63·6% of cancers attributable to high BMI. A quarter (about 118 000) of the cancer cases related to high BMI in 2012 could be attributed to the increase in BMI since 1982. Interpretation These findings emphasise the need for a global effort to abate the increasing numbers of people with high BMI. Assuming that the association between high BMI and cancer is causal, the continuation of current patterns of population weight gain will lead to continuing increases in the future burden of cancer. Funding World Cancer Research Fund International, European Commission (Marie Curie Intra-European Fellowship), Australian National Health and Medical Research Council, and US National Institutes of Health.
13 Mar 2008-The New England Journal of Medicine
TL;DR: If these associations are mainly causal, smoking in persons between the ages of 30 and 69 years is responsible for about 1 in 20 deaths of women and 1 in 5 deaths of men.
Abstract: BACKGROUND The nationwide effects of smoking on mortality in India have not been assessed reliably. METHODS In a nationally representative sample of 1.1 million homes, we compared the prevalence of smoking among 33,000 deceased women and 41,000 deceased men (case subjects) with the prevalence of smoking among 35,000 living women and 43,000 living men (unmatched control subjects). Mortality risk ratios comparing smokers with nonsmokers were adjusted for age, educational level, and use of alcohol. RESULTS About 5% of female control subjects and 37% of male control subjects between the ages of 30 and 69 years were smokers. In this age group, smoking was associated with an increased risk of death from any medical cause among both women (risk ratio, 2.0; 99% confidence interval [CI], 1.8 to 2.3) and men (risk ratio, 1.7; 99% CI, 1.6 to 1.8). Daily smoking of even a small amount of tobacco was associated with increased mortality. Excess deaths among smokers, as compared with nonsmokers, were chiefly from tuberculosis among both women (risk ratio, 3.0; 99% CI, 2.4 to 3.9) and men (risk ratio, 2.3; 99% CI, 2.1 to 2.6) and from respiratory, vascular, or neoplastic disease. Smoking was associated with a reduction in median survival of 8 years for women (99% CI, 5 to 11) and 6 years for men (99% CI, 5 to 7). If these associations are mainly causal, smoking in persons between the ages of 30 and 69 years is responsible for about 1 in 20 deaths of women and 1 in 5 deaths of men. In 2010, smoking will cause about 930,000 adult deaths in India; of the dead, about 70% (90,000 women and 580,000 men) will be between the ages of 30 and 69 years. Because of population growth, the absolute number of deaths in this age group is rising by about 3% per year. CONCLUSIONS Smoking causes a large and growing number of premature deaths in India.
International Agency for Research on Cancer1, Cancer Institute2, German Cancer Research Center3, Tianjin Medical University Cancer Institute and Hospital4, National University of Singapore5, Hospital Authority6, New Generation University College7, Inha University8, Chiang Mai University9, Prince of Songkla University10, Khon Kaen University11, Tata Memorial Hospital12, Makerere University13, National Medical College14
01 Feb 2010-Lancet Oncology
TL;DR: Variations in survival correlated with early detection initiatives and level of development of health services, and emphasises the need for urgent investments in improving awareness, population-based cancer registration, early detection programmes, health-services infrastructure, and human resources.
Abstract: Summary Background Population-based cancer survival data, a key indicator for monitoring progress against cancer, are not widely available from countries in Africa, Asia, and Central America. The aim of this study is to describe and discuss cancer survival in these regions. Methods Survival analysis was done for 341 658 patients diagnosed with various cancers from 1990 to 2001 and followed up to 2003, from 25 population-based cancer registries in 12 countries in sub-Saharan Africa (The Gambia, Uganda), Central America (Costa Rica), and Asia (China, India, Pakistan, Philippines, Saudi Arabia, Singapore, South Korea, Thailand, Turkey). 5-year age-standardised relative survival (ASRS) and observed survival by clinical extent of disease were determined. Findings For cancers in which prognosis depends on stage at diagnosis, survival was highest in China, South Korea, Singapore, and Turkey and lowest in Uganda and The Gambia. 5-year ASRS ranged from 76–82% for breast cancer, 63–79% for cervical cancer, 71–78% for bladder cancer, and 44–60% for large-bowel cancers in China, Singapore, South Korea, and Turkey. Survival did not exceed 22% for any cancer site in The Gambia; in Uganda, survival did not exceed 13% for any cancer site except breast (46%). Variations in survival correlated with early detection initiatives and level of development of health services. Interpretation The wide variation in cancer survival between regions emphasises the need for urgent investments in improving awareness, population-based cancer registration, early detection programmes, health-services infrastructure, and human resources. Funding Association for International Cancer Research (AICR; St Andrews, UK), Association pour la Recherche sur le Cancer (ARC, Villejuif, France), and the Bill & Melinda Gates Foundation (Seattle, USA).
01 Jan 1999-CA: A Cancer Journal for Clinicians
TL;DR: A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination, and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake.
Abstract: The global burden of cancer continues to increase largely because of the aging and growth of the world population alongside an increasing adoption of cancer-causing behaviors, particularly smoking, in economically developing countries. Based on the GLOBOCAN 2008 estimates, about 12.7 million cancer cases and 7.6 million cancer deaths are estimated to have occurred in 2008; of these, 56% of the cases and 64% of the deaths occurred in the economically developing world. Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death among females, accounting for 23% of the total cancer cases and 14% of the cancer deaths. Lung cancer is the leading cancer site in males, comprising 17% of the total new cancer cases and 23% of the total cancer deaths. Breast cancer is now also the leading cause of cancer death among females in economically developing countries, a shift from the previous decade during which the most common cause of cancer death was cervical cancer. Further, the mortality burden for lung cancer among females in developing countries is as high as the burden for cervical cancer, with each accounting for 11% of the total female cancer deaths. Although overall cancer incidence rates in the developing world are half those seen in the developed world in both sexes, the overall cancer mortality rates are generally similar. Cancer survival tends to be poorer in developing countries, most likely because of a combination of a late stage at diagnosis and limited access to timely and standard treatment. A substantial proportion of the worldwide burden of cancer could be prevented through the application of existing cancer control knowledge and by implementing programs for tobacco control, vaccination (for liver and cervical cancers), and early detection and treatment, as well as public health campaigns promoting physical activity and a healthier dietary intake. Clinicians, public health professionals, and policy makers can play an active role in accelerating the application of such interventions globally.
01 Mar 2015-CA: A Cancer Journal for Clinicians
TL;DR: A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests.
Abstract: Cancer constitutes an enormous burden on society in more and less economically developed countries alike. The occurrence of cancer is increasing because of the growth and aging of the population, as well as an increasing prevalence of established risk factors such as smoking, overweight, physical inactivity, and changing reproductive patterns associated with urbanization and economic development. Based on GLOBOCAN estimates, about 14.1 million new cancer cases and 8.2 million deaths occurred in 2012 worldwide. Over the years, the burden has shifted to less developed countries, which currently account for about 57% of cases and 65% of cancer deaths worldwide. Lung cancer is the leading cause of cancer death among males in both more and less developed countries, and has surpassed breast cancer as the leading cause of cancer death among females in more developed countries; breast cancer remains the leading cause of cancer death among females in less developed countries. Other leading causes of cancer death in more developed countries include colorectal cancer among males and females and prostate cancer among males. In less developed countries, liver and stomach cancer among males and cervical cancer among females are also leading causes of cancer death. Although incidence rates for all cancers combined are nearly twice as high in more developed than in less developed countries in both males and females, mortality rates are only 8% to 15% higher in more developed countries. This disparity reflects regional differences in the mix of cancers, which is affected by risk factors and detection practices, and/or the availability of treatment. Risk factors associated with the leading causes of cancer death include tobacco use (lung, colorectal, stomach, and liver cancer), overweight/obesity and physical inactivity (breast and colorectal cancer), and infection (liver, stomach, and cervical cancer). A substantial portion of cancer cases and deaths could be prevented by broadly applying effective prevention measures, such as tobacco control, vaccination, and the use of early detection tests.
15 Dec 2010-International Journal of Cancer
TL;DR: The results for 20 world regions are presented, summarizing the global patterns for the eight most common cancers, and striking differences in the patterns of cancer from region to region are observed.
Abstract: Estimates of the worldwide incidence and mortality from 27 cancers in 2008 have been prepared for 182 countries as part of the GLOBOCAN series published by the International Agency for Research on Cancer. In this article, we present the results for 20 world regions, summarizing the global patterns for the eight most common cancers. Overall, an estimated 12.7 million new cancer cases and 7.6 million cancer deaths occur in 2008, with 56% of new cancer cases and 63% of the cancer deaths occurring in the less developed regions of the world. The most commonly diagnosed cancers worldwide are lung (1.61 million, 12.7% of the total), breast (1.38 million, 10.9%) and colorectal cancers (1.23 million, 9.7%). The most common causes of cancer death are lung cancer (1.38 million, 18.2% of the total), stomach cancer (738,000 deaths, 9.7%) and liver cancer (696,000 deaths, 9.2%). Cancer is neither rare anywhere in the world, nor mainly confined to high-resource countries. Striking differences in the patterns of cancer from region to region are observed.
Memorial Sloan Kettering Cancer Center1, Institut Gustave Roussy2, Harvard University3, Roswell Park Cancer Institute4, Johns Hopkins University5, Stanford University6, University of Washington7, Vanderbilt University8, Fox Chase Cancer Center9, Macquarie University10, Aarhus University11, University of Helsinki12, The Royal Marsden NHS Foundation Trust13, University of Duisburg-Essen14, Niigata University15, Swansea University16, University of British Columbia17, Bristol-Myers Squibb18, University of Texas MD Anderson Cancer Center19
04 Nov 2015-The New England Journal of Medicine
TL;DR: Overall survival was longer and fewer grade 3 or 4 adverse events occurred with nivolumab than with everolimus among patients with previously treated advanced renal-cell carcinoma.
Abstract: BackgroundNivolumab, a programmed death 1 (PD-1) checkpoint inhibitor, was associated with encouraging overall survival in uncontrolled studies involving previously treated patients with advanced renal-cell carcinoma. This randomized, open-label, phase 3 study compared nivolumab with everolimus in patients with renal-cell carcinoma who had received previous treatment. MethodsA total of 821 patients with advanced clear-cell renal-cell carcinoma for which they had received previous treatment with one or two regimens of antiangiogenic therapy were randomly assigned (in a 1:1 ratio) to receive 3 mg of nivolumab per kilogram of body weight intravenously every 2 weeks or a 10-mg everolimus tablet orally once daily. The primary end point was overall survival. The secondary end points included the objective response rate and safety. ResultsThe median overall survival was 25.0 months (95% confidence interval [CI], 21.8 to not estimable) with nivolumab and 19.6 months (95% CI, 17.6 to 23.1) with everolimus. The haz...
University of Washington1, Aga Khan University2, University of Toronto3, University of Queensland4, Erasmus University Rotterdam5, University of Canberra6, Chinese Center for Disease Control and Prevention7, National Institutes of Health8, Jimma University9, Sapienza University of Rome10, Virginia Tech11, Cairo University12, Universidade Federal de Minas Gerais13, Cornell University14, Mekelle University15, University of Ibadan16, University of Basel17, University of Melbourne18, University of Extremadura19, Karolinska Institutet20, Council of Scientific and Industrial Research21, Kerman Medical University22, Lund University23, University of Pittsburgh24, University of Rhode Island25, Newcastle University26, University of Alabama at Birmingham27, University of Sheffield28, King Saud University29, University College London30, University of the Republic31, Debre markos University32, University of Oxford33, University of Lorraine34, Harvard University35, Humboldt University of Berlin36, University of Cartagena37, Bahir Dar University38, University of Cape Coast39, Kurdistan University of Medical Sciences40, Swiss Tropical and Public Health Institute41, Oregon Health & Science University42, Aalborg University43, University of the Philippines Manila44, Dalarna University45, Uppsala University Hospital46, University of Belgrade47, University of Manitoba48, University of Qom49, Taipei Medical University50, Sri Ramachandra University51, University of Auckland52, University of Cape Town53, Heidelberg University54, University of Gothenburg55, Pontifical Xavierian University56, University of Canterbury57, Stanford University58, Jhpiego59, University of California, Los Angeles60, Kermanshah University of Medical Sciences61, Charles R. Drew University of Medicine and Science62, Mario Negri Institute for Pharmacological Research63, Addis Ababa University64, University of North Carolina at Chapel Hill65, Yale University66, University of Alberta67, University of São Paulo68, University of London69, Haramaya University70, University of Birmingham71, University of Otago72, Post Graduate Institute of Medical Education and Research73, University of Iowa74, University of South Florida75, University of Oslo76, World Bank77, Anglia Ruskin University78, Danube University Krems79, University of Cambridge80, University of Trnava81, Ohio State University82, German Cancer Research Center83, Mayo Clinic84, University of Leicester85, University of California, San Francisco86, Australian National University87, University of New South Wales88, Telethon Institute for Child Health Research89, Universidad Autónoma Metropolitana90, State University of New York System91, National University of Colombia92, University of Costa Rica93, Ottawa Hospital Research Institute94, University of Valencia95, Albany Medical College96, Peking Union Medical College97, University of Occupational and Environmental Health Japan98, University of Zambia99, University of the Witwatersrand100, University of Copenhagen101, Christian Medical College & Hospital102, University of Adelaide103, University of Salerno104, Walden University105, Guy's and St Thomas' NHS Foundation Trust106, University of Porto107, Wellcome Trust108, Carol Davila University of Medicine and Pharmacy109, Griffith University110, University of Colorado System111, University of Brighton112, University of Peradeniya113, Universidade do Estado de Santa Catarina114, University of Sydney115, Norwegian Institute of Public Health116, Arba Minch University117, Russian Academy of Sciences118, Arak University119, Tehran University of Medical Sciences120, University of Louisville121, Universidade Aberta122, Universidade Federal de Sergipe123, VA Boston Healthcare System124, Queen Mary University of London125, Bielefeld University126, Academy of Medical Sciences, United Kingdom127, University of Edinburgh128, James Cook University129, Imperial College London130, University of Tasmania131, Ludwig Maximilian University of Munich132, Wageningen University and Research Centre133, Howard University134, University of Tokyo135, Brandeis University136, University of Massachusetts System137, University of British Columbia138, West Virginia University139, University of Delhi140, University of Bergen141, Arabian Gulf University142, Hamdan bin Mohammed e-University143, University of New Mexico144, University of Western Australia145, Sun Yat-sen University146, Sree Chitra Thirunal Institute for Medical Sciences and Technology147, University of Barcelona148, Columbia University149, Simon Fraser University150, Yokohama City University151, Albert Einstein College of Medicine152, Baylor College of Medicine153, Tunis University154, Central South University155, George Washington University156, Birzeit University157, Ghent University158, International Agency for Research on Cancer159, Aarhus University160, United States Agency for International Development161, George Mason University162, Shahid Beheshti University163, University of Kragujevac164, Virginia Commonwealth University165, University College Cork166, Fudan University167, Case Western Reserve University168, Pompeu Fabra University169, All India Institute of Medical Sciences170, Oklahoma State University–Stillwater171, Swansea University172, South African Medical Research Council173, Jordan University of Science and Technology174, New Generation University College175, New York Medical College176, Universidade Federal do Rio Grande do Sul177, Northeastern University178, Southern University College179, University of Cincinnati180, Brown University181, Université de Montréal182, Hacettepe University183, Arkansas State University184, Boston University185, Johns Hopkins University186, Boston Children's Hospital187, Wayne State University188, San Francisco VA Medical Center189, Emory University190, University of Bari191, University of Liverpool192, Aintree University Hospitals NHS Foundation Trust193, National University of Singapore194, Royal Children's Hospital195, Mansoura University196, University of Pennsylvania197, CEU Cardinal Herrera University198, University of York199, Children's Hospital of Philadelphia200, University of Gondar201, Florida Atlantic University202, Alfaisal University203, United Nations204, Helsinki University Central Hospital205, University of Helsinki206, Tufts University207, Pacific Institute208, Curtin University209, Ahmadu Bello University210, Indian Council of Medical Research211, Queensland University of Technology212, Universiti Sains Malaysia213, Stellenbosch University214, University of Ulm215, University of KwaZulu-Natal216, City University of New York217, SIDI218, University of Tampere219, Duy Tan University220, Makerere University221, University of Western Sydney222, Teikyo University223, Autonomous University of Chile224, University of Arizona225, Autonomous University of Madrid226, Karabük University227, University of the West of England228, Kosin University229, Sungkyunkwan University230, University of Calgary231, Flinders University232, Shanghai Jiao Tong University233, Durban University of Technology234, University of Virginia235, Brigham Young University236, Centre for Addiction and Mental Health237, Hamad Medical Corporation238, BRAC239, University of Missouri240, Yonsei University241, Suez Canal University242, Golestan University243, Muhimbili University of Health and Allied Sciences244, National University of Malaysia245, Marshall University246, Universidade Federal de Santa Catarina247, North-West University248, University of Bath249, An-Najah National University250, Indian Institutes of Technology251, Nationwide Children's Hospital252, Korea University253, Northumbria University254, Reykjavík University255, University of Brasília256, Northwestern University257, Banaras Hindu University258, Dartmouth College259, University of Stavanger260, University of Western Ontario261, International Medical University262, National and Kapodistrian University of Athens263, University of California, San Diego264, University of California, Irvine265, University of Illinois at Urbana–Champaign266, Tampere University of Technology267, Colgate University268, Auckland University of Technology269, Outcomes Research Consortium270, WorldFish271, Monash University272, New York University273, Wrocław Medical University274, Jagiellonian University275, Aristotle University of Thessaloniki276, Hanoi Medical University277, Cleveland Clinic278, University of Warwick279, Dalhousie University280, University of Bologna281, National Research University – Higher School of Economics282, Georgetown University283, McGill University284, Seoul National University285, Nanjing University286, Duke University287, University of Zurich288, University of Hong Kong289, Kyoto University290, Jackson State University291, French Institute of Health and Medical Research292, Leibniz Association293
08 Oct 2016-The Lancet
TL;DR: The Global Burden of Disease 2015 Study provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015, finding several countries in sub-Saharan Africa had very large gains in life expectancy, rebounding from an era of exceedingly high loss of life due to HIV/AIDS.
Abstract: 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.
Author's H-index: 32
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