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Publication date: 
April 30, 2010

Abstract

The most comprehensive assessment to date of global adult mortality shows how health disparities among countries and between men and women are widening around the world. The study, Worldwide mortality in men and women aged 15-59 years from 1970 to 2010: a systematic analysis, was conducted by researchers at IHME, Harvard Medical School, and the School of Population Health at the University of Queensland. It shows that across countries, inequality in adult mortality has grown to the point where adult women in Zambia – the country with the highest adult mortality rate – now have a probability of premature death that is 16 times the adult mortality rate of the country with the lowest rate, Cyprus.

Research findings

The new adult mortality trends reveal a significant rise in global inequalities. Key findings include:
  • The adult mortality gap between countries is growing, a trend that runs contrary to the lessening of disparities in child mortality and in maternal mortality. The rates of adult mortality in Southern Africa are now higher than mortality rates were in Sweden in 1751.
  • The United States has fallen significantly behind other countries in reducing deaths. In 1990, the US ranked 34th in the world in female mortality and 41st in male mortality, but by 2010, it had dropped in the rankings to 49th for women and 45th for men. This puts it behind all of Western Europe and lower-income countries such as Chile, Tunisia, and Albania.
  • Women overall have seen their health improve more than men. In the 40 years between 1970 and 2010, adult mortality fell by 34% in women and 19% in men globally. The gap between adult male and female mortality widened by 27% in that period.
  • The lowest risk of death in adults was recorded in Iceland (men) and Cyprus (women).
  • Mortality rates for men and women in 37 countries are higher in 2010 than they were in 1990.
  • Eastern Europe has seen one of the largest public health reversals of modern times. Russia has fallen from a rank of 43rd place for female mortality in 1970 to 121st.
  • Since 2005, sub-Saharan Africa has seen strong mortality declines, a possible result of efforts to prevent new HIV infections and to treat AIDS patients with antiretroviral drugs.
  • South Asia, and India in particular, had among the highest female mortality in the world in 1970. Both the region and the country have seen major declines. In 2010, it was better to be a woman in India than it was to be a man in the US in 1997.
  • The list of countries with the lowest adult mortality has changed greatly. Only three – Sweden, the Netherlands, and Norway – remained in the top 10 for male mortality between 1970 and 2010.

Analytical approach

Until this study, adult mortality research has focused on a subset of the global population and has often relied on estimates derived from child mortality numbers. IHME developed new methods that allowed researchers to make estimates for nearly every country and to base those estimates on adult death statistics. Researchers used vital registration data, censuses, surveys on household deaths, and sibling survival histories. They generated estimates for 187 countries of the probability that an individual who has just turned 15 will die a premature death before reaching age 60 (termed 45q15).

Research objective

To understand how societies are tackling the world’s greatest health challenges, IHME regularly updates mortality estimates across countries and across time. Child mortality estimates have had a substantial impact on guiding health policy by showing both country governments and donors where the most children are dying prematurely, but young adult mortality has received less attention. By improving the methods used to measure adult mortality and providing estimates that are as current as the data allow, IHME intends to raise the level of dialogue around priority setting for adult health.

Recommendations for future work

The trends in adult mortality indicate that the determinants of mortality in adults are substantially different from those in children, underscoring the importance of tracking adult mortality separately. Equally important is the need for more discussion of the drivers of the trends and the reasons behind the strong differences between countries. Finally, further work is required to measure the effect of war and other shocks on adult mortality. Policymakers have long assumed that by making efforts to reduce under-5 mortality, benefits would accrue naturally to adults as well. This study shows that those assumptions are no longer valid and that mortality shocks can cause gender disparities and disparities between countries.
Citation: 

Rajaratnam JK, Marcus JR, Levin-Rector A, Chalupka AN, Wang H, Dwyer L, Costa M, Lopez AD, Murray CJL. Worldwide mortality in men and women aged 15–59 years from 1970 to 2010: a systematic analysis. The Lancet. 2010 Apr 30; 375:1704–1720.