Karlsson Omar, Chang Angela Y, Norheim Ole F, Mao Wenhui, Bolongaita Sarah, Jamison Dean T
Centre for Economic Demography, School of Economics and Management, Lund University, Lund, Sweden.
Department of Economic History, School of Economics and Management, Lund University, Lund, Sweden.
JAMA Netw Open. 2025 May 1;8(5):e2512198. doi: 10.1001/jamanetworkopen.2025.12198.
Life expectancy is a composite health measure reflecting acute and life-course exposures. Identifying conditions behind disparities in life expectancy can guide policy, planning, and financing to battle the most urgent health problems.
To examine the contribution of 33 causes of death to life expectancy disparities, highlighting 2 sets of priority conditions-8 infectious and maternal and child health conditions (I-8) and 7 noncommunicable diseases and injuries (NCD-7).
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined life expectancy disparities in 7 global regions and 165 countries from 2000 to 2021. Western Europe and Canada (hereafter referred to as the North Atlantic) in 2019 were used as a benchmark for life expectancy achievable with advanced health care and living standards. Life expectancy gaps in locations with life expectancy lower than the benchmark were decomposed by cause of death using the Pollard decomposition on the Global Health Estimates from the World Health Organization. Data were analyzed from February to March 2025.
Geographic location (countries and regions).
Life expectancy at birth.
In the median country in 2019, the I-8 and NCD-7 together accounted for 80% (IQR, 71%-88%) of the life expectancy gap compared with the North Atlantic. Outside sub-Saharan Africa, the NCD-7 accounted for the largest share of the gap; for example, more than the total life expectancy gap in China, or 5.5 (95% uncertainty bounds [UB], 5.0-6.0) years of a 4.3-year life expectancy gap; and 6.4 (95% UB, 5.9-6.8) years of a 11.5-year gap in India. However, reduced mortality from the I-8 contributed to enormous improvements in sub-Saharan Africa, accounting for 21.4 (95% UB, 20.6-22.2) years of a 31-year gap in 2000 and 11.4 (95% UB, 10.9-11.8) years of a 22-year gap in 2019. India transitioned from having most of the gap accounted for by the I-8 in 2000, or 11.9 (95% UB, 11.0-13.0) years of a 19.6-year life expectancy gap, to having a larger share accounted for by the NCD-7 in 2019.
This cross-sectional study suggests that a limited number of causes account for most life expectancy disparities. Together with current information on risk factors, interventions, and morbidity not yet reflected in life expectancy, the varying contributions of these causes to gaps in life expectancy can help focus health policy and guide interventions to reduce risk factors and treat conditions.
预期寿命是一项综合健康指标，反映了急性暴露和生命历程中的暴露情况。确定预期寿命差距背后的状况可为应对最紧迫的健康问题的政策制定、规划和筹资提供指导。
研究33种死因对预期寿命差距的影响，重点关注两组优先状况——8种传染病及孕产妇和儿童健康状况（I-8）以及7种非传染性疾病和伤害（NCD-7）。
设计、设置和参与者：这项横断面研究考察了2000年至2021年期间7个全球区域和165个国家的预期寿命差距。2019年的西欧和加拿大（以下简称北大西洋地区）被用作先进医疗保健和生活水平下可实现的预期寿命基准。使用世界卫生组织全球健康估计数据的波拉德分解法，按死因对预期寿命低于基准的地区的预期寿命差距进行分解。数据于2025年2月至3月进行分析。
地理位置（国家和地区）。
出生时预期寿命。
在2019年的中位数国家，与北大西洋地区相比，I-8和NCD-7共同占预期寿命差距的80%（四分位距，71%-88%）。在撒哈拉以南非洲以外地区，NCD-7在差距中所占份额最大；例如，在中国，其占总预期寿命差距的比例超过了全部差距，即4.3年预期寿命差距中的5.5年（95%不确定区间[UB]，5.0 - 6.0）；在印度，11.5年差距中的6.4年（95% UB，5.9 - 6.8）。然而，I-8死亡率的降低对撒哈拉以南非洲地区的预期寿命有巨大提升作用，在2000年31年的差距中占21.4年（95% UB，20.6 - 22.2），在2019年22年的差距中占11.4年（95% UB，10.9 - 11.8）。印度从2000年大部分差距由I-8导致，即19.6年预期寿命差距中的11.9年（95% UB，11.0 - 13.0），转变为2019年NCD-7在差距中占更大份额。
这项横断面研究表明，少数几种死因导致了大部分预期寿命差距。结合目前尚未在预期寿命中体现的关于风险因素、干预措施和发病率的信息，这些死因对预期寿命差距的不同影响有助于聚焦卫生政策，并指导采取干预措施以降低风险因素和治疗疾病。
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