Causes of Death

Our articles and data visualizations rely on work from many different people and organizations. When citing this entry, please also cite the underlying data sources. This entry can be cited as:

Hannah Ritchie and Max Roser (2018) - "Causes of Death". Published online at OurWorldInData.org. Retrieved from: 'https://ourworldindata.org/causes-of-death' [Online Resource]
This article was first published in February 2018.

As global population increases, life expectancy rises, and living standards improve, causes of death across the world are changing. In this entry we present a global overview of the causes of death. The data visualisations and explainers in the early part of this entry attempt to provide a comparison between causes and risk factors of death across countries and age groups. The sections which then follow explore the empirical data of specific causes in more detail.

Each of the charts which follows is shown at a global level. However, all of the data included in this entry is available to explore at the national level using the "change country" function on the interactive charts. As will become clear in the data which follows, causes of death across the world remain heterogeneous and continue to change.

I. Empirical View

I.1 Causes of death in recent decades

In the chart below we provide a comparison of the number of people which died as a result of specific causes in 2016. This data is given as the total across all ages, and both sexes. Causes of death varies notably between age groups — deaths across individual age groupings can be explored in the sections which follow.

At a global level we see that the majority of deaths are attributed to the category of non-communicable diseases (NCDs); these are chronic, long-term illnesses such as cardiovascular diseases (including stroke), respiratory disease, cancers and diabetes.  Collectively NCDs account for more than 70 percent of global deaths.

Causes of death vary significantly by country and income levels across the world. These deaths are shown in the charts below, which present figures as absolute number of deaths, and as a percentage of total deaths. We also look at the major differences in mortality across the world using country examples in our blog post here. NCDs not only dominate mortality figures at a global level, but also account for the majority of deaths in high-income countries. Deaths from causes such as infectious disease, malnutrition, nutritional deficiencies, neonatal and maternal deaths in high-income countries is typically very low in relative terms.

These causes of death are, however, still prevalent (and some cases dominant) across low-to-middle income nations. In Kenya, for example, the leading cause of death remains diarrheal diseases. In South Africa and Botswana, the leading cause of death remains HIV/AIDS.

Death rates related to disease, illness and other health factors tend to change relatively slowly over time. Whilst death rates may fall or decline from year-to-year as part of a general trend, dramatic changes in such deaths are typically rare. Natural disaster and terrorism-related deaths are an important exception to this rule: mortality from disasters or terrorism/conflict events can be volatile. This can make the annual comparison of deaths and death rates between health-related factors and volatile events more challenging. Understanding the relative risk of these events can require a longer-term overview of high and low-mortality years. We cover discussion and analysis on this topic in a blog post here.

Whilst terrorism-related deaths are typically very low for most countries relative to other mortality causes, in some cases they can be significant. For example, terrorism fatalities were the 6th largest killer in Iraq in 2016. This is well above deaths related to road accidents, respiratory disease and dementia.

I.2 Why are the number of deaths changing?

As we see in the charts above — whilst death rates are falling globally, the total number of deaths is increasing. What explains this increase in absolute number of deaths?

In the visualisation below — based on figures published by the Institute of Health Metrics and Evaluation (IHME)1 — we see the global change in deaths and burden of disease over the past decade (2006 to 2016) disaggregated by contributing factors.

Population growth and ageing play a significant role in the total increase in number of deaths. If all other factors were kept constant, population growth alone over this period would have resulted in a 12.4 percent in deaths; population ageing alone would have resulted in a 14.9 percent increase. The impact of population ageing on non-communicable diseases (NCDs), the results are even more striking; alone, ageing would have resulted in a 19.5 percent increase in global deaths.

The actual net percentage change in deaths over this period has of course been smaller (approximately 3 percent) because population growth and ageing factors have been offset by reductions in risk exposure and residual factors (such as improved underlying health and healthcare). The impact of residual factors such as healthcare alone would have resulted in a 15.3 percent decline in global deaths. This influence has been even greater for communicable, maternal, neonatal and nutritional diseases — alone it would have resulted in a 30 percent decline in deaths.

I.3 Causes of death by age group

In the chart below we see the total annual number of deaths differentiated by broad age category. In 2016, we see there were around 55 million deaths globally; nearly half of these (48%) were in those aged 70 years or older; 27% in the 50-69 year age group; 15% aged 15-49; only 1% aged 5-14; and around 10% in children under the age of 5.

The demographics of deaths has changed significantly since 1990 with a notable shift from young-to-old. In 1990 nearly one-quarter of all deaths were in children under 5 years old. In 2016, this had declined to just under 10 percent. In contrast, the share of deaths in the over-70s age bracket has increased from 33 percent to 48 percent over this period.

The distribution of deaths by age varies significantly by country. In Japan, for example, around 83 percent of deaths occur in those aged 70 or older. Deaths in children and adolescents less than 15 years old account for around 0.25 percent of the total. Contrast this with South Sudan where the majority of deaths (44 percent) occur in children under 5 years old. In South Africa, where the leading cause of death is HIV/AIDS, the leading age bracket is aged 15-49. 

Causes of death in under-5s

The chart below shows the number of deaths in children under 5 years old by cause. Through the combination of neonatal (newborn infants less than 28 days old) disorders, infections and congenital (from birth) defects, we see that the largest share of deaths in under-5s arises from complications at birth or in the first few weeks of life. Under-5s are also highly susceptible to lower respiratory infections, infectious diseases, diarrheal infections, malnutrition and nutritional deficiencies.

Death rates in under-5s are typically much lower in high-income countries, and the nature of these deaths is different from lower incomes. In the United Kingdom, for example, child deaths tend to be highly dominated by neonatal complications; deaths from infectious and diarrheal diseases and malnutrition is very low. In contrast, the leading cause of death in under-5s in Mali is malaria. In South Sudan, malnutrition and nutritional deficiencies are very high. 

Causes of death aged 5-14

Globally, deaths in the 5-14 year old age bracket account for a small percentage of the total (1-2 percent). There are six dominant causes of deaths in this age category. The leading cause globally in 5-14 year olds is malaria (although its dominance, of course, varies regionally with malaria distribution). Lower respiratory infections, road accidents, HIV/AIDS, cancers, diarrheal diseases, and drowning are all dominant causes typically in the range of 50,000-60,000 deaths in 2016.

Again, this distribution varies by country. In the United States, for example, cancers are the leading cause of death. In India, it's diarrheal diseases; in Bangladesh and China it's drowning; and in South Africa road accidents.

Causes of death aged 15-49

By the 15-49 years old category, we see that non-communicable diseases (NCDs) begin to become dominant. Globally the leading cause of death in this age group is cardiovascular disease, followed cancers which both account for more than one million deaths. Road accidents, HIV/AIDS and suicide are all significant within this group.

For some countries, such as South Africa, by far the dominant cause of death (across all age groups) is HIV/AIDS in the 15-49 years old age bracket. In a number of countries (in particular across Latin America, including Brazil and Mexico), homicide is the dominant cause for 15-49 years old.

Causes of death aged 50-69

By aged 50-69 years old, non-communicable diseases (NCDs) are strongly dominant — here cardiovascular disease, cancers, respiratory disease and diabetes are the top causes. With the exception of HIV/AIDS and tuberculosis which for some countries climb into the top causes, the global variability in death causes for 50-69 year olds is much lower than that of younger age categories.

Causes of death aged 70+

For the oldest age category (70 years and older), non-communicable diseases (NCDs) still dominate, however other death causes including Alzheimer's/dementias, and diarrheal diseases also become dominant. Diarrheal diseases remain within the few leading causes of deaths in 70+ year olds for many low-income countries, despite being relatively low at higher incomes.

I.4 Comparisons of risk factors of death

Whilst the Global Burden of Disease (GBD) assessment assigns each death to one specific cause, we know that the risk of disease burden and health outcomes are closely linked to a number of risk factors. It includes risk factors across four broad categories: behavioural, environmental, occupational, and metabolic risks.

We describe further information on how the GBD attributes risk factors to mortality in our Data Quality & Definitions section. Note that this process of estimation is not additive; in other words, these risk-specific relationships do not account for the compounding effects of multiple risk factors. High BMI, for example, may likely be present with other lifestyle factors such as low physical activity levels, high blood pressure, low fruit and vegetable intake. All of these estimates are developed independently. We cannot therefore sum all 'attributed deaths' and conclude that this is the actual number of deaths. The attributed number of deaths by risk factor in many cases exceeds that of those by cause of death.

In the chart below we see the number of deaths attributed to specific risk factors in 2016. This data is measured across all age groups and both sexes — figures for specific age groups are detailed below. Here we see that there are several dominant risk factors for death: notably, those related to dietary and activity lifestyle factors (including blood pressure, physical activity, body-mass index, blood sugar, and dietary intake); smoking; air pollution (both outdoor and indoor); environmental factors including clean water and sanitation; and safe sex (for the prevention of HIV/AIDS).

The contribution of specific risk factors varies significantly by country. For most high-income countries, the dominant risk factors are those related to healthy diets, smoking and alcohol intake. Other risk factors such as clean water, sanitation, and child wasting or stunting are very low. In low-income countries the inverse is true: in Sierra Leone for example, the top risk factors include child wasting, household air pollution, unsafe water source, poor sanitation, and no access to handwashing facilities. For countries where HIV/AIDS is a major health burden, such as South Africa and Kenya, unsafe sex is the top risk factor.

I.5 Risk factors of death by age group

In the charts below we see how these risk factors differ between age groups, ranging from children under-5, to those 70+ years old. In the youngest age group we see dominant risk factors related to childhood development, including child wasting, stunting and low-birth weight. In older children and adolescents, environmental factors including water sources, sanitation, handwashing and air pollution become more dominant. By the 15-49 year old category, unsafe sex becomes the largest risk factor (in relation to the contraction of HIV/AIDS), with alcohol, smoking and some dietary factors also becoming important.

By the 50-69 year old and 70+ year old age category, lifestyle factors such as dietary intake, smoking, alcohol, and low physical intake become dominant — ultimately increasing the risk of non-communicable diseases (NCDs) such as cardiovascular diseases, cancers, stroke, respiratory disease and diabetes.

Risk factors of death in under-5s

Risk factors of death aged 5-14

Risk factors of death aged 15-49

Risk factors of death aged 50-69

Risk factors of death aged 70+

I.6 Causes of death over the long-run

Causes of death over the long-run are harder to assess due to inconsistencies and poor coverage of data reporting. Extensive data is available for few countries. In the charts below we see causes of deaths across the 20th century in the United States, as reported by the Center for Diseases Control (CDC). Even in this case, data coverage is patchy and only available for the top ten causes of death per year. Data omissions may therefore result when particular causes of death fall in and out of this top ten listing.

Overall, over the 20th century we see a notable transition in deaths from communicable and infectious diseases such as tuberculosis, pneumonia and influenza towards non-communicable diseases (NCDs) such as heart disease, cancers, diabetes and respiratory disease. This is a similar transition to what we see across many developing countries today.

I.7 Cancers

Cancers are defined by the National Cancer Institute (NCI) as a collection of diseases in which abnormal cells can divide and spread to nearby tissue. As this definition suggests, cancers can arise in many parts of the body (leading to a range of cancer types, as shown below) and in some cases spread to other parts of the body through blood and lymph systems.

Cancer deaths by type

In the chart below we see annual deaths attributed to cancers, differentiated by type. Globally, around 8.9 million deaths were attributed to cancers in 2016 — an increase from around 5.7 million in 1990. You can also view cancer deaths in specific countries using the "change country" function.

As shown, there are a broad range of cancer types with varying magnitudes of total death. At a global level, tracheal and lung cancer is the largest killer with over 1.7 million in 2016, followed by stomach, colon and rectum, and liver cancer. On relative terms, testicular, thyroid and non-melenoma skin have the lowest death toll of cancers at the global level. 

Cancer deaths by age

In the chart below we see total cancer deaths broken down by age grouping. As we see, the majority of deaths arise in those over 50 years old, with 44 percent over 70 years old and 43 percent between 50-69 years old. Cancer deaths in children are much smaller in comparison (less than one percent of the total are in children under 14 years old) and typically arise as leukemia cases.

Cancer death rates

In the chart below we see cancer death rates, expressed as the number of cancer deaths per year per 100,000 individuals. Note that these rates have been age-standardized which aims to correct for differences in the age structure of a population (which are different between countries and change over time). This therefore allows us to compare the likelihood that any given individual will die from cancer across countries and through time.

Cancer death rates vary across the world, but for most death rates are below 150 per 100,000 individuals. Greenland had the highest cancer death rate in 2016, at 348 deaths per 100,000; Mongolia, Hungary and Zimbabwe also have notably higher cancer death rates relative to other countries.

If we use the timeline below to look at how cancer rates have changed with time we see that for many countries, this rate has declined since 1990. For example, rates in the United States have fallen from 180 to 145 per 100,000; in China from 206 to 157 per 100,000; in the United Kingdom from 198 to 159 per 100,000.

Cancer death rates by type

In the visualisation below we see these age-standardized death rates (measured per 100,000 people) for individual cancer types. Declines in cancer rates vary by type: for many, such as prostrate and kidney, progress has been relatively slow. For some, such as stomach cancer there has been notable progress — declining from 23 to 13 deaths per 100,000.

Cancer death rates by age

In the visualisation below we see how cancer death rates vary by age group. As we see, death rates are highest for those aged over 70 years old with nearly 1,000 deaths per 100,000 people. Rates in the 50-69 years old category are more than three times lower at just under 300 per 100,000 individuals. For children aged below 14 years old, rates at a global level are less than 5 per 100,000.

I.8 Cardiovascular disease

Cardiovascular disease (CVD) is a term used to refer to the range of diseases which affect the heart and blood vessels. These include hypertension (high blood pressure); coronary heart disease (heart attack); cerebrovascular disease (stroke); heart failure; and other heart diseases. Cardiovascular disease data includes figures related to strokes, however we also cover this separately in the section below. Cardiovascular disease is the top cause of death globally.

Cardiovascular disease deaths by age

In the visualisation  below we see the breakdown of deaths from CVD by age category. Globally we see that approximately 17.7 million people died from CVD. The majority (63 percent) of deaths occurred in the age bracket of 70 years and above. Just below 30 percent  were aged 50-69, and the remaining 7-8 percent aged 15-49 (CVD deaths in those aged 14 years and under are small). 

Cardiovascular disease death rates

In the visualisation below we see cardiovascular disease death rates, expressed as the number of CVD deaths per year per 100,000 individuals. Note that these rates have been age-standardized which aims to correct for differences in the age structure of a population (which are different between countries and change over time). This therefore allows us to compare the likelihood that any given individual will die from cardiovascular disease across countries and through time.

Overall we see a strong East-West divide in CVD death rates. Rates across North America and Western/Northern Europe tend to be significantly lower than those across Eastern Europe, Asia and Africa. Across most of Latin America, these rates are moderate. In France, for example, the age-standardized rate was around 110 per 100,000 in 2016; across Eastern Europe this rate was around 5 times higher at 500-600 per 100,000. At the highest end of the scale, Afghanistan had a rate of 830 per 100,000.

Cardiovascular disease death rates by age

In the chart below we see the CVD death rate per 100,000 differentiated by age categories. As established in the breakdown of CVD deaths by age, the majority of deaths occur in the 70+ years old age category. Death rates are therefore significantly higher in the oldest age group at 2750 per 100,000 in 2016.

I.9 Stroke

The World Health Organization (WHO) defines a stroke as the "interruption of the blood supply to the brain, usually because a blood vessel bursts or is blocked by a clot. This cuts off the supply of oxygen and nutrients, causing damage to the brain tissue." Strokes are included as a sub-category within cardiovascular diseases.

Stroke deaths by age

In the chart below we see the breakdown of total deaths attributed to strokes by age group. Globally it's estimated that 5.5 million people died from a stroke in 2016. The majority (61 percent) of deaths from stroke arise in those aged 70 years or older. Those aged 50-69 years old account for approximately one-third of deaths, with those aged 49 and under collectively account for around 7 percent.

Stroke death rates

In the visualisation below we see stroke death rates, expressed as the number of stroke deaths per year per 100,000 individuals. Note that these rates have been age-standardized which aims to correct for differences in the age structure of a population (which are different between countries and change over time). This therefore allows us to compare the likelihood that any given individual will die from stroke across countries and through time.

Stroke death rates vary significantly across the world. Death rates are lowest in Italy, Austria Qatar, Peru and Costa Rica where less than 25 per 100,000 die from stroke. At the other end of the spectrum, with rates ten times higher than the lowest countries are Afghanistan, Central African Republic, Mongolia, North Korea and Papua New Guinea (with rates between 200-250 per 100,000).

Stroke death rates by age

As we see in the breakdown of stroke deaths by age, we see that those over the age of 70 have the highest risk of death at 838 deaths per 100,000 in 2016. This is shown, relative to other age categories in the chart below.

I.10 Respiratory disease

Chronic respiratory diseases (CRDs) are diseases which affect the airways and overall structure of the lungs. Common CRDs include chronic obstructive pulmonary disease (COPD), asthma, occupational lung diseases and pulmonary hypertension.

Respiratory disease deaths by age

The chart below shows the breakdown of deaths related to chronic respiratory diseases (CRDs) by age group. Globally in 2016, around 3.5 million died from CRDs. Around two-thirds (66 percent) of respiratory disease deaths were from those aged 70 years and older, with a further 20 percent in the 50-69 year group; and the remaining 4-5 percent aged 14 years and younger.

Respiratory disease death rates

In the visualisation below we see respiratory disease death rates, expressed as the number of CRDs deaths per year per 100,000 individuals. Note that these rates have been age-standardized which aims to correct for differences in the age structure of a population (which are different between countries and change over time). This therefore allows us to compare the likelihood that any given individual will die from CRDs across countries and through time.

In most countries across the world, the age-standardized death rate from CRDs are below 40 per 100,000 people. Rates across Sub-Saharan Africa and Latin America are typically slightly higher (between 40 and 60 per 100,000), and are typically highest across South Asia (around 140 per 100,000 in India and Nepal). At a country-level the highest rate is in Papua New Guinea at 343 per 100,000.

Respiratory disease death rates have fallen dramatically in some countries over the past few decades. Since 1990, death rates in China have fallen around 70 percent from 247 to 75 per 100,000. In India, rates have fallen by around 40 percent since 1990.

Respiratory disease death rates by age

In the visualisation below we see the breakdown of respiratory disease death rates by age group. Here we see that death rates in the oldest age category (70+ years old) are far above those of other age groups.

I.11 Dementia

Dementia comprises several forms — the most common being Alzheimer's disease — is an illness which results in a deterioration of cognitive capacity and function beyond what is expect from the normal ageing process. It can occur either in a chronic or progressive form. It affects several cognitive functions including memory, comprehension, judgement, language and learning capacity.

Dementia deaths by age

The chart below shows the breakdown of dementia-related deaths by age group. Dementia typically occurs in older persons: of the 2.4 million who died from dementia in 2016, 94 percent were 70 years or older.

Dementia death rates

The visualisation below shows dementia death rates, expressed as the number of dementia deaths per year per 100,000 individuals. Note that these rates have been age-standardized which aims to correct for differences in the age structure of a population (which are different between countries and change over time). This therefore allows us to compare the likelihood that any given individual will die from dementia across countries and through time.

Across most countries, the death rate from dementia-related illness is below 55 per 100,000 individuals. Dementia rates in some countries have changed slightly since 1990, but significantly less so than other disease burdens.

I.12 Diarrheal diseases

Diarrheal disease remains one of the largest causes of death in children, and in some countries (e.g. Kenya), it is the top mortality cause. Diarrheal diseases are typically a symptom of infections within the intestinal tract and is contracted through poor hygiene, sanitation, unsafe water sources, or contaminated food. Most deaths result from dehydration and the loss of essential nutrients and salts. Diarrheal disease is both preventable and treatable.

Diarrheal disease deaths by age

The chart below shows the breakdown of diarrheal disease deaths by age group. Overall we see there has been a significant reduction in global deaths since 1990: falling from 2.8 million to 1.6 million in 2016. Diarrheal deaths disproportionately affect the young and the old: 42 percent of global deaths were from those aged 70 years or older, with 27 percent under 5 years old.

Since 1990 there has been an even more dramatic reduction in deaths in children under 5 years old: in 1990 they accounted for 55 percent of deaths, which have fallen as a share by more than half to 27 percent. In absolute terms, this is a reduction from 1.5 million to under 500,000 (a reduction of more than two-thirds). 

Diarrheal death rates

In the chart below we see diarrheal disease death rates, expressed as the number of deaths per year per 100,000 individuals. Note that these rates have been age-standardized which aims to correct for differences in the age structure of a population (which are different between countries and change over time). This therefore allows us to compare the likelihood that any given individual will die from diarrheal disease across countries and through time.

Overall, we see that the highest death rates lie across Sub-Saharan Africa and South Asia, where rates can reach over 250 per 100,000 (as in the case of Kenya). Rates across these regions typically range from 100 to 150 per 100,000. Across most of the rest of the world, rates are below 25 per 100,000 and in many cases below 1 per 100,000.

Diarrheal death rates by age group

In the chart below we see how diarrheal disease death rates vary by age category. As with the total number of deaths by age, we see the highest death rate in 70+ year olds. At a global level, death rates of under-5s are more than 50 percent lower, and the remaining age categories far below these rates.

I.13 Malnutrition

Malnutrition arises in various forms, with the broad definition capturing undernourishment, micronutrient deficiencies and obesity. In this case, we refer to 'protein-energy malnutrition' (PEM) which refers to energy or protein deficiency caused by insufficient food intake. Protein-energy deficiency can also be exacerbated by infection or disease, which can have the effect of increasing nutritional needs, and/or reducing the body's ability to retain energy or nutrients. You can find more information on hunger and undernourishment in our entry.

Malnutrition deaths by age

In the chart below we see the annual number of deaths attributed to protein-energy malnutrition (PEM), differentiated by age group. Globally there were approximately 308,000 deaths related to PEM. Children under 5 years old are disproportionately affected by PEM (accounting for 54 percent of global deaths) — child wasting (too little weight for one's height) and stunting (too short for one's age) is a common symptom of malnutrition.

Global protein-energy malnutrition deaths have declined since 1990. However, we see the dramatic impact of the North Korean famine through the 1990s.2

Malnutrition death rates

In the chart below we see death rates from protein-energy malnutrition, expressed as the number of deaths per year per 100,000 individuals. Note that these rates have been age-standardized which aims to correct for differences in the age structure of a population (which are different between countries and change over time). This therefore allows us to compare the likelihood that any given individual will die from PEM across countries and through time.

The highest rates are seen across across Sub-Saharan Africa, which are typically in the range of 10-100 per 100,000 individuals. For most countries, this rate is below 5 per 100,000. In North Korea during its famine period, rates reached over 400 per 100,000.

Malnutrition death rates by age

In the visualisation below we see the breakdown of death rates by age category. As with the total number of deaths by age, rates in children under 5 years old are highest; at a global level, these have more than halved from 57 to 26 per 100,000 since 1990. Rates for those over 70 years old are also relatively high, at 21 per 100,000 (although this decline over time has been less significant).

I.14 Tuberculosis

Tuberculosis (TB) is an illness caused by the ingestion of bacteria (Mycobacterium tuberculosis) which affects the lungs. The World Health Organization (WHO) estimate that up to one-quarter of the global population has latent TB, meaning they have been infected with the disease but are not ill with the disease (although this does not inhibit it from becoming active in the future).

People with compromised immune systems, such as those suffering from malnutrition, diabetes, or are smokers are more likely to become ill with TB. There is a strong link between HIV/AIDS and TB: those infected with HIV are 20-30 times more likely to develop active tuberculosis.

Tuberculosis deaths by age

In the chart below we see the breakdown of deaths from tuberculosis by age category. At a global level there has been a one-third drop in TB deaths, falling from 1.8 million in 1990 to 1.2 million in 2016.

TB deaths are relatively equally distributed across age categories over 15 years old: around 35% occur in those aged 15-49 as well as in those aged 50-69 years old; and 27 percent in those aged 70+ years old.

Tuberculosis death rates

In the chart below we see death rates from tuberculosis, expressed as the number of deaths per year per 100,000 individuals. Note that these rates have been age-standardized which aims to correct for differences in the age structure of a population (which are different between countries and change over time). This therefore allows us to compare the likelihood that any given individual will die from tuberculosis across countries and through time.

Across most countries, the death rate from TB is below 5 per 100,000. Rates in 2016 across Eastern Europe were slightly higher, between 5-10 per 100,000. Across South Asia, these reach 25-50 per 100,000, with highest rates across Sub-Saharan Africa ranging from 50 all the way up to 500 per 100,000. Rates are highest in the Central African Republic which were over 480 per 100,000 in 2016.

Tuberculosis death rates by age

In the visualisation below we see the breakdown of death rates from TB by age category. Here we see that death rates from TB are highest in the 70+ years old age category, followed by 50-69 year olds.

I.15 HIV/AIDS

We cover the topic of HIV/AIDS deaths, breakdown by age, death rates, and additional relevant metrics in our full entry on HIV/AIDS.

I.16 Malaria

We cover the topic of malaria deaths, breakdown by age, death rates, and additional relevant metrics in our full entry on Malaria.

I.17 Drowning

The World Health Organization (WHO) emphasises that drowning is one of the most overlooked, preventable causes of death across the world.3 For every country in the world, drowning is among the top 10 killers for children. In some countries, such as Bangladesh, it is the top mortality cause for children under 15 years old.

Drowning deaths by age group

In the chart below we see the breakdown of annual drowning deaths by age group. At a global level we see drowning deaths have declined around 40 percent from 500,000 in 1990 to 300,000 in 2016. The most dramatic decline is seen in under-5s, where deaths have fallen from 182,000 to just over 50,000 over this period.

Drowning death rates

In the chart below we see death rates from drowning, expressed as the number of deaths per year per 100,000 individuals. Note that these rates have been age-standardized which aims to correct for differences in the age structure of a population (which are different between countries and change over time). This therefore allows us to compare the likelihood that any given individual will die from drowning across countries and through time.

In 2016, death rates were highest in Papua New Guinea and the Central African Republic, between 10 to 15 deaths per 100,000. Rates were also high in countries such as Bangladesh, Vietnam, Afghanistan, Haiti, and Cote d'Ivoire.

If we look at death rates we see a significant decline since 1990 — especially in low to middle-income countries. In Bangladesh and China, for example, rates have fallen by more than two-thirds over this period.

Drowning death rates by age

In the visualisation below we see the relative death rates from drowning across age groups. Here we see that both the young (under 5s) and old (70+ years old) are at highest risk of death from drowning. Most striking is the dramatic decline in death rates for under-5s. This has fallen by more than two-thirds since 1990, decreasing from 30 to 8 per 100,000.

I.18 Fire

Fire deaths by age

The chart below shows the annual deaths from fire or burning incidents broken down by age group. In 2016, there were around 132,000 global deaths from fire which represents a slight decline from the mid-1990s when deaths reached 160,000.

Fire death rates

In the chart below we see death rates from fire, expressed as the number of deaths per year per 100,000 individuals. Note that these rates have been age-standardized which aims to correct for differences in the age structure of a population (which are different between countries and change over time). This therefore allows us to compare the likelihood that any given individual will die from fire across countries and through time.

Most countries across the Americas, Western Europe, East Asia and Oceania average death rates below 2 per 100,000. Rates across Eastern Europe and South Asia are typically higher at 2-6 per 100,000, and those in Sub-Saharan Africa are highest with up to 10 per 100,000. When viewed through time we see a notable decline in fire death rates, particularly across Sub-Saharan Africa and Eastern Europe. 

Fire deaths rates by age

In the visualisation below we see the relative death rates between age categories. At the global level, those 70 years and above are typically at the highest risk with 8 per 100,000. Next is those under 5 years old, but with a significant drop in death rate to 2-3 per 100,000.

I.19 Road incidents

Motor vehicle, motorcyclist, cyclist & pedestrian deaths

Road incident deaths include those from motor vehicles (including drivers and passengers within the car), pedestrians, motorcyclists and cyclists. In the chart below we see the breakdown of these deaths by category. The total number of road deaths increased during the 1990s and early 2000s before roughly plateauing since then (with a small decline in recent years).

The largest share of deaths at the global level are pedestrians (with 38 percent of the share), closely followed by those in motor vehicles (36 percent); motorcyclists (19 percent); and cyclists (6 percent). This share has remained fairly consistent with time.

This breakdown varies significantly across the world, however. In India and Brazil, for example, a much larger share (31 and 33 percent respectively) are motorcyclists. In the United States 70 percent are motor vehicle passengers or drivers. In China, 58 percent are pedestrians.

Road deaths over the long-term

In the chart below we see long-term trends in the number of deaths from road incidents. Note that these estimates may differ from IHME estimates above; most national estimates are based solely on police reports; IHME attempt to correct for varying factors in poor or under-reporting of road deaths. We discuss this with comparisons in our section on Data Quality and Definitions.

As we see from the two charts below: road deaths have been on the decline over the long-term. However, this is not attributed to a reduction in road accidents; in fact, in Germany the number of reported incidents has increased substantially over this period. Whilst some of this may be attributed to improved and better reporting, it is also true that the numbers injured in road accidents has not declined. Overall, we may therefore conclude that safety standards of and within cars, or in the severity of road incidents due to interventions such as speed limits have dramatically decreased the mortality risk of a given accident.

Road incident deaths by age

In the chart below we see the breakdown of road incident deaths by age category. The largest share of deaths at a global level are within the 15-49 year old category with 57 percent of the total.

Road incident death rates

In the chart below we see death rates from road incidents, expressed as the number of deaths per year per 100,000 individuals. Note that these rates have been age-standardized which aims to correct for differences in the age structure of a population (which are different between countries and change over time). This therefore allows us to compare the likelihood that any given individual will die from road incidents across countries and through time.

Death rates are typically lowest across Western Europe and Japan, with less than 5 deaths per 100,000 individuals. Across the Americas, rates are typically slightly higher at 5-15; most countries in the Asia region lie between 20 and 25; and rates are typically highest across Sub-Saharan Africa with over 25 per 100,000.

Road incident death rates by age

In the chart below we see the breakdown of death rates from road incidents by age category.

I.20 Natural disasters

We cover the topic of natural disasters, number of deaths, death rates, and additional relevant metrics by disaster type in our full entry on Natural Catastrophes.

I.21 Executions

Amnesty International attempt to quantify the number of executions (carried out by the state) across the world. These figures are shown in the chart below from 2007 onwards. Note that these represent the number of executions carried out, and not the number sentenced to death or on death row (which are much higher).

In 2016, at least 1,032 people were executed across 23 countries. This figure is given as a minimum because data collection in some countries is challenging to assess. In 2009 Amnesty International stopped attempts to accurately quantify Chinese figures. They do however maintain that China has the highest annual figures, and reports a minimum of 1000 deaths per year.

I.22 Suicide

We cover the topic of suicide deaths, breakdown by age, death rates, and additional relevant metrics in our full entry on Suicide.

I.23 Smoking & secondhand smoke

We cover the topic of smoking prevalence, deaths, death rates, secondhand smoke deaths, and additional relevant metrics in our full entry on Smoking.

I.24 Homicide

We cover the topic of homicide deaths, breakdown by age, death rates, historical prevalence of violence and additional relevant metrics in our full entry on Homicides.

We cover the topic of terrorism, including the prevalence of incidents, deaths, injuries and additional relevant metrics in our full entry on Terrorism.

II. Correlates, Determinants & Consequences

II.1 Deaths by animal

Estimated number of global human deaths by animal, either from direct contact/attack or transmission of disease.4

II.2 Cardiovascular disease deaths decline with prosperity

II.3 Drowning deaths are higher at low-to-middle incomes

II.4 Malnutrition deaths typically occur at low incomes

II.5 Sanitation crucial to reducing diarrheal disease deaths

II.6 Road deaths vs. income

III. Data Definitions & Quality

III.1 Estimating causes of death

The IHME's Global Burden of Disease (GBD) has developed a highly standardised approach to the attribution of deaths to specific causes based on data limitations, including incompleteness of vital registration (VR) data, the use of verbal autopsy (VA) studies in locations with incomplete VR records, the allocation of disease burden to categories which can be directly attributed to mortality causes, and general data insufficiency in some countries.5

The GBD assessment is strongly tied to mortality cause categories as defined within the International Classification of Diseases (ICD) codes, as used by the World Health Organization (WHO). The GBD methodology states that "each death is attributed to a single underlying cause — the cause that initiated the series of events leading to death—in accordance with ICD principles". The GBD has developed a comprehensive and in-depth database with regards to mortality and attributed causes, utilising data from various  sources. These sources include vital registration (VR); verbal autopsy (VA); surveillance, census and survey data; cancer registries; and police records. GBD then develops a data standardisation and processing methodology within which they define data quality and completeness scores, and where necessary adjust completeness to 100% using cause fractions for a given location-age-sex-year and estimated all-cause mortality for that location-age-sex-year.

An important step in the GBD methodology standardisation is in reallocating deaths attributed within ICD classifications without an underlying cause of death (for example, senility) which can be intermediate but not final cause of death. These categories are termed as 'garbage codes'. GBD redistribute these garbage codes using a methodology explained in detail in Naghavi et al. (2010).6 Note that this redistributing of 'garbage codes' in some cases explains the difference in estimates between IHME and WHO, such as for road accident deaths (compared below).

Death and death rates analyses are then carried out by GBD across locations, age, sex and year based on its Cause of Death Ensemble model (CODEm). Full description of GBD methodology can be found here.

III.2 Estimating deaths attributed to risk factors

Estimating and attributing relative risk factors to number of deaths is a complex task — particularly when risk factors can compound and collectively influence the likelihood of disease burden. The IHME's Global Burden of Disease (GBD) studies provide one of, if not the, most in-depth analysis and synthesis of relative risk factors.7 IHME differentiate risk factors into four broad categories: behavioural, environmental, occupational, and metabolic risks.

IHME have developed a Comparative Risk Assessment (CRA) conceptual framework8 by which they have built a web of risk factors or causes which affect health outcomes. For example, there is evidence of links between body mass index (BMI) and the risk of multiple non-communicable diseases (NCDs) including cardiovascular disease, ischemic stroke and some cancers.9, 10, 11

Such risk-outcome pairs (e.g. high BMI and ischemic stroke) are formed based on evidence links using methods such as cohort studies, randomised trials, and case-control studies. Once a risk-outcome pair has been formed, how does IHME begin to quantify the disease burden or number of deaths attributed to each risk? The CRA can be used for two different types of assessment: attributable burden and avoidable burden. 'Attributable burden' represents the reduction in current disease burden (or that of a given year) if population exposure had shifted to another counterfactual/hypothetical exposure level; 'avoidable burden' represents the potential future avoided burden if population exposure was to shift to a counterfactual level of exposure. Since the number of deaths is based on current or historical data, the data presented here is that of attributable burden.

Attributable burden effectively asks the question: "what would the number of deaths from ischemic stroke be if everyone's body-mass index (BMI) was reduced to a healthy/optimal level (within range)?" This healthy/optimal level is defined as the 'theoretical minimum risk exposure level (TMREL)'. Cohort, case studies and trials of established risk-exposure relationships between BMI and ischemic stroke allow for the calculation of the reduction in deaths which would have occurred if BMI was reduced to a healthy level across the population distribution. This relationship can be established by specific demographic groups, such as by sex or age. The difference between the number of deaths from ischemic stroke which would have occurred at the TMREL and at the actual BMI distribution is given as the number of deaths attributed to high BMI from ischemic stroke.

By completing this process for all risk-outcome pairs, IHME can sum to estimate the total number of deaths attributed to high BMI, and replicated for all risk factors using their individual risk-outcome exposure curves. Note that this process of estimation is not additive; in other words, these risk-specific relationships do not account for the compounding effects of multiple risk factors. High BMI, for example, may likely be present with other lifestyle factors such as low physical activity levels, high blood pressure, low fruit and vegetable intake. All of these estimates are developed independently. We cannot therefore sum all 'attributed deaths' and conclude that this is the actual number of deaths. The attributed number of deaths by risk factor in many cases exceeds that of those by cause of death.

Full methodological explanation of the IHME's approach to risk factor attribution can be found here.

III.3 Road deaths: IHME vs WHO statistics

The data presented on road mortality in this entry were based on figures published by the Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease (GBD) programme. It has been widely recognised that IHME data on road accidents tends to be higher than that of official police reports and that reported by the World Health Organization — this tends to be the case for OECD countries.12 In the chart below we compare road mortality figures by the IHME (y-axis) and World Health Organization (WHO)13 (x-axis). Also shown is the line of parity, along which IHME and WHO estimates are the same.

As we see, there are in some cases notable differences between these estimates, and in particular higher figures for OECD countries for IHME figures. Why does this discrepancy occur? In its own assessment report, IHME highlights this difference, noting that its estimates for OECD countries are on average 58 percent higher than official statistics.14 IHME note that official statistics " typically relies on police reporting, while GBD relies primarily on death registration data in these countries. Furthermore, IRTAD only includes those deaths that occur within the first 30 days of a crash and excludes motor vehicle-related deaths that do not occur in traffic. In contrast, our estimates provide a more comprehensive estimate of the impact of motor vehicles on population health."

A notable difference between these sources is the period within which deaths are reported. Official statistics only record that which occurs within 30 days of a crash. GBD data attempts to account for intermediate injuries of health burden which may result in death following a 30 day period. This relates strongly to discussion in our section on 'estimating causes of death' where so-called 'garbage codes' (which are ICD classifications which can be intermediate but not final cause of death) are assigned to road injuries. In this example, it may be extreme back pain. GBD attempts to redistribute these 'garbage codes' to take a more comprehensive estimate of health burden and death which results over a period longer than 30 days.

IV. Data Sources

Institute of Health Metrics and Evaluation (IHME), Global Burden of Disease (GBD)
  • Data: Death rates, absolute number of premature deaths and DALYS across all risk factors and causes
  • Geographical coverage:Global, across all regions and countries
  • Time span:Most metrics available from 1990 onwards
  • Available at: Online here

World Health Organization (WHO) Global Health Observatory (GHO)
  • Data: Causes-specific mortality by age and sex
  • Geographical coverage:Global, by region and by country
  • Time span:Most metrics available from 2000 to 2015 in 5-year incrememnts
  • Available at: Online here

Global Terrorism Database (GTD)
  • Data: Terrorist attacks with 45-120 variables for each, including number of fatalities, injuries, weapons used, and perpetrators
  • Geographical coverage: Global by country
  • Time span: 1970-2016
  • Available at: http://www.start.umd.edu/gtd/

Amnesty International