Global Causes of Death WHO

WHO
methods and data sources for global causes of death 20002011

Department of Health Statistics and Information Systems WHO, Geneva June 2013

GlobalHealthEstimatesTechnicalPaperWHO/HIS/HSI/GHE/2013.3
Acknowledgments
ThisTechnicalReport waswritten byColin Mathers,GretchenStevens andDoris MaFat withinputs and assistancefromWahyuRetnoMahanani,JessicaHoandLiLiu.Estimatesofregionaldeathsbycausefor years 20002011 were primarily prepared by Colin Mathers, Gretchen Stevens, Jessica Ho, Doris Ma Fat and Wahyu Retno Mahanani, of the Mortality and Burden of Disease Unit in the WHO Department of Health Statistics and Information Systems, in the Health Systems and Innovation Cluster of the World Health Organization (WHO), Geneva, drawing heavily on advice and inputs from other WHO Departments, collaborating United Nations (UN) Agencies, and WHO expert advisory groups and academiccollaborators. Many of the inputs to these estimates result from collaborations with Interagency Groups, expert advisory groups and academic groups. The most important of these include the Interagency Group on Child Mortality Estimation (UNIGME), the UN Population Division, the Child Health Epidemiology Reference Group (CHERG), the Maternal Mortality Expert and Interagency Group (MMEIG), the International Agency for Research on Cancer, WHO QUIVER, and the Global Burden of Disease 2010 Study Collaborating Group. While it is not possible to name all those who provided advice, assistance or data, both inside and outside WHO, we would particularly like to note the assistance and inputs provided by Kirill Andreev, Diego Bassani, Bob Black, Ties Boerma, Phillipe Boucher, Freddie Bray, Tony Burton, Harry Campbell, Doris Chou, Richard Cibulskis, Simon Cousens, Jacques Ferlay, Marta Gacic Dobo, Richard Garfield, Alison Gemmill, Patrick Gerland, Peter Ghys, Philippe Glaziou, Danan Gu, Ken Hill,KacemIaych,MieInoue,RobertJakob,DeanJamison,PrabhatJha,HopeJohnson,JoyLawn,NanLi, Li Liu, Rafael Lozano, Chris Murray, Lori Newman, Mikkel Oestergaard, Max Parkin, Margie Peden, Francois Pelletier, Juergen Rehm, Igor Rudan, Lale Say, Emily Simons, Charalampos Sismanidis, Thomas Spoorenberg, Karen Stanecki, Peter Strebel, Emi Suzuki, Tamitza Toroyan, Theo Vos, Tessa Wardlaw, RichardWhite,JohnWilmothandDanzhenYou. Estimatesandanalysisareavailableat: http://www.who.int/gho/mortality_burden_disease/en/index.html Forfurtherinformationabouttheestimatesandmethods,pleasecontacthealthstat@who.int In this series 1. WHO methods and data sources for life tables 19902011 (Global Health Estimates Technical Paper WHO/HIS/HSI/GHE/2013.1) 2.CHERGWHO methodsand datasources forchild causesof death20002011 (GlobalHealth Estimates TechnicalPaperWHO/HIS/HSI/GHE/2013.2) 3. WHO methods and data sources for global causes of death 20002011 (Global Health Estimates TechnicalPaperWHO/HIS/HSI/GHE/2013.3)
Table of Contents
Acknowledgments ..........................................................................................................................................i TableofContents..........................................................................................................................................ii 1 Introduction.1 2 Populationandallcausemortalityestimatesforyears20002011........................................................3 2.1 Allcausemortalityandpopulationestimates................................................................................. 3 2.2 Estimationofneonatal,infantandunder5mortalityrates............................................................3 2.3 Allcausemortalitycomputedfromcivilregistrationdata..............................................................4 2.4 Allcausemortalityprojectedfromcivilregistrationdata...............................................................4 2.5 Countrieswithotherinformationonlevelsofadultmortality.......................................................5 2.6 Mortalityshocksepidemics,conflictsanddisasters..................................................................... 6 3 Countrieswithuseabledeathregistrationdata...................................................................................... 7 3.1 Dataandestimates.......................................................................................................................... 7 3.2 Inclusioncriteriaforcountrieswithhighqualitydeathregistrationdata.......................................7 3.3 Redistributionofunknownsex/ageandgarbagecodesandadjustmentforincompletedeath registration .....................................................................................................................................12 3.4 MappingtoGHEcauselists............................................................................................................ 12 3.5 Interpolationandextrapolationformissingcountryyears...........................................................14 ........................................................................................................ 14 3.6 Adjustmentofspecificcauses 3.7 Othernationallevelinformationoncausesofdeath................................................................... 14 4 Childmortalitybycause........................................................................................................................ 19 4.1 Causesofunder5deathincountrieswithgooddeathregistrationdata.....................................19 .....................................................19 4.2 Causesofneonataldeath(deathsatlessthan28daysofage) 4.3 Causesofchilddeathatages159monthslowmortalitycountries ...........................................20 4.4 Causesofchilddeathatages159monthshighmortalitycountries.........................................20 4.5 CausesofchilddeathforChinaandIndia..................................................................................... 21 4.6 InclusionofWHOCHERGestimatesinGlobalHealthEstimates20002011................................21 5 Methodsforspecificcauseswithadditionalinformation..................................................................... 22 5.1 Tuberculosis...................................................................................................................................22 5.2 HIV/AIDSandsexuallytransmitteddiseases................................................................................. 22 5.3 Malaria...........................................................................................................................................22 5.4 Whoopingcough............................................................................................................................ 23 5.5 Measles..........................................................................................................................................23 5.6 Schistosomiasis.............................................................................................................................. 24 ii
5.7 Maternalcausesofdeath.............................................................................................................. 24 5.8 Cancers...........................................................................................................................................24 5.9 Alcoholuseanddrugusedisorders............................................................................................... 25 5.10 Epilepsy..........................................................................................................................................25 5.11 Roadinjuries..................................................................................................................................25 5.11.1 5.11.2 5.11.3 5.11.4 Countrieswithdeathregistrationdata............................................................................. 26 Countrieswithothersourcesofinformationoncausesofdeath....................................26 Countrieswithpopulationslessthan150000.................................................................26 Countrieswithouteligibledeathregistrationdata..........................................................26
5.12 Conflictandnaturaldisasters........................................................................................................ 28 6 Othercausesofdeathforcountrieswithoutuseabledata................................................................... 30 7 Uncertaintyofestimates....................................................................................................................... 33 References.37 ........................................................................... 43 AnnexTableA GHEcausecategoriesandICD10codes AnnexTableB Firstlevelcategoriesforanalysisofchildcausesofdeath...............................................48 AnnexTableC ReassignmentofICD10codesforcertainneonataldeaths...........................................49 AnnexTableD Countrygroupingsusedforregionaltabulations.............................................................51 D.1 WHORegionsandMemberStates................................................................................................ 51 D.2 CountriesgroupedbyWHORegionandaverageincomepercapita*..........................................52 D.3 WorldBankincomegrouping*...................................................................................................... 53 D.4 WorldBankRegions....................................................................................................................... 54 D.5 MillenniumDevelopmentGoal(MDG)Regions............................................................................ 55 AnnexTableE MappingofIndiaMDScategoriestoGHEcauses.............................................................56 AnnexTableF Methodsusedforestimationofchildandadultmortalitylevels,andcausesofdeath,by country,20002011 ........................................................................................................... 58 AnnexTableG Methodsusedtoestimateroadtrafficdeathsfor182participatingcountries...............64
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Introduction
Global, regional, and country statistics on population and health indicators are important for assessing development and health progress and for guiding resource allocation. The demand is growing for timely datato monitor progress inhealth outcomes such as childmortality, maternal mortality, life expectancy and age and causespecific mortality rates. Much of the current focus is on monitoring progress towardsthetargetsofthe(healthrelated)MillenniumDevelopmentGoals(MDGs),includingtimeseries and countrylevel estimates that are regularly updated. But increasingly, the demand is for comprehensive estimates across the full spectrum, including noncommunicable diseases (NCDs) and injuries. WHO has previously published comprehensive estimates of deaths by region, cause, age and sex for years 2000 and 2002 (1), 2001 (2), 2004 (3) and 2008 (4). Beginning with the 2004 estimates, WHO has also released summary estimates of causes of death for its Member States (5). These successive single year estimates did not form a time series, as each revision involved revisions to data and methods for a range of inputs. To address the increasing demand for time series, for countrylevel estimates, and for comprehensive estimates across NCD and injury causes, as well as the more traditional priorities in infectious and parasitic diseases, updated Global Health Estimates (GHE) are being released, commencingwithregionallevelestimatesofdeathsbycause,ageandsexforyears20002011(6). This technical paper documents the data sources and methods used for preparation of these regional level cause of death estimates for years 20002011. Annex Table A lists the cause of death categories and their definitions in terms of the International Classification of Diseases, Tenth Revision (ICD10) (7). These estimates are available for years 2000 and 2011 for selected regional groupings of countries (6), definedinAnnexTablesD,athttp://www.who.int/healthinfo/global_health_estimates/en/. Comprehensive estimates of mortality, causes of death, DALYs for diseases, injuries and risk factors were released in December 2012 (810) by the Institute of Health Metrics and Evaluation (IHME) as part oftheGlobalBurdenofDisease2010study(GBD2010).WHOwasacollaboratorinthestudyfrom2007 to2011,butdidnotendorsethefinalresults,asitwasunabletoobtainfullaccesstotheresultspriorto publication or to evaluate them. In some areas, the results of the GBD 2010 differ substantially from existinganalysesdonebyWHOandotherUnitedNationsagenciesatglobal,regionalandcountrylevels. In many other areas, the GBD 2010 results are updates that are broadly similar to previous WHO analyses. Further work with IHME and expert groups is needed to examine the reasons for current differences. One of the six core functions of WHO is monitoring of the health situation, trends and determinants in theworld.OvertheyearsithascooperatedcloselywithotherUNpartneragencieslikeUNICEF,UNAIDS, UNFPA and the UN Population Division to collect and compile global health statistics. There are a number of established UN multiagency expert group mechanisms for cross cutting topics such as child mortality (the UNIGME including UNICEF/WHO/ UNPD/World Bank and the UNIGME Technical Advisory Group) and child causes of death (CHERG, WHO/UNICEF), specific diseases such as HIV/AIDS (UNAIDS Reference Group), maternal mortality (MMEIG including WHO/UNICEF/UNFPA/World Bank), tuberculosis (WHO STAG), malaria (Malaria Reference Group and Roll Back Malaria Malaria Monitoring andEvaluationReferenceGroup). These WHO Global Health Estimates provide a comprehensive and comparable set of cause of death estimatesfromyear2000onwards,consistentwithandincorporatingUNagency,interagencyandWHO estimatesforpopulation,births,allcausedeathsandspecificcausesofdeath,including: o mostrecentvitalregistration (VR)dataforall countrieswheretheVR dataqualityisassessed as useable; Page 1
World Health Organization
o o o updated and additional information on levels and trends for child and adult mortality in many countrieswithoutgooddeathregistrationdata improvementsinmethodsusedfortheestimationofcausesofchilddeathsincountrieswithout gooddeathregistrationdata. Updated assessments of levels and trends for specific causes of death by WHO programs and interagencygroups.Theseinclude: o TuberculosisWHO HIVUNAIDSandWHO MalariaWHO VaccinepreventablechildcausesWHO OthermajorchildcausesWHOandCHERG MaternalmortalityMMEIG CancersIARC RoadtrafficaccidentsWHO Conflict and natural disasters WHO and the Collaborating Center for Research on the EpidemiologyofDisasters(CRED)
GBD 2010 study estimates for other causes in countries without useable VR data or other nationallyrepresentativesourcesofinformationoncausesofdeath.
Because these estimates draw on new data and on the result of the GBD 2010 study, and there have beensubstantialrevisionstomethodsformanycauses,theseestimatesfortheyears20002011arenot directly comparable with previous WHO estimates for 2008 and earlier years. These are provisional estimates and will be further revised in the process of extending the series to 2012 for release at country level in late 2013. WHO and collaborators will continue to include new data and improve methods,anditisanticipatedthatsomecauseswillbesubstantiallyupdatedinthenextrevision. TheseGlobalHealthEstimatesrepresentthebestestimatesofWHO,basedontheevidenceavailableto itupuntilMay2013,ratherthantheofficialestimatesofMemberStates,andhavenotnecessarilybeen endorsed by Member States. They have been computed using standard categories, definitions and methods to ensure crossnational comparability and may not be the same as official national estimates producedusingalternate,potentiallyequallyrigorousmethods.Thefollowingsectionsofthisdocument provideexplanatorynotesondatasourcesandmethodsforpreparingmortalityestimatesbycause.
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Population and allcause mortality estimates for years 20002011
2.1 Allcause mortality and population estimates

Life tables have been developed for all Member States for years 1990 2011 starting with a systematic review of all available evidence from surveys, censuses, sample registration systems, population laboratories and vital registration on levels and trends in underfive and adult mortality rates. Annex table F summarizes the methods used for preparing life tables. Data sources are documented in more detailinTechnicalPaper2013.1(11). In recent years, WHO has liaised more closely with the UN Population Division (on life tables for countries, in order to maximize the consistency of UN and WHO life tables, and to minimize differences in the use and interpretation of available data on mortality levels. For countries where WHO previously predicted levels of adult mortality from estimated levels of child mortality, this update has taken into accountadditionalcountryspecificsourcesofinformationonlevelsofadultmortalityasreflectedinthe lifetablespreparedbytheUNPopulationDivisionforitsWorldPopulationProspects(WPP). TotaldeathsbyageandsexwereestimatedforeachcountrybyapplyingtheWHOlifetabledeathrates to the estimated de facto resident populations prepared by the UN Population Division in its 2010 revision (12). They may thus differ slightly from official national estimates for corresponding years. All cause mortality and deaths by cause will be updated in the next WHO GHE revision to take account of revisionstopopulationestimatesincludedintheWPP2012(releasedmidJune2013)(13).
2.2 Estimation of neonatal, infant and under5 mortality rates

Methods for estimating time series for neonatal, infant and under5 mortality rates have been developed and agreed upon within the Interagency Group for Child Mortality Estimation (UNIGME) whichismadeupofWHO,UNICEF,UNPopulationDivision,WorldBankandacademicgroups.UNIGME annuallyassessesandadjustsallavailablesurveys,censusesandvitalregistrationdata,tothenestimate the countryspecific trends in underfive mortality per 1000 live births (U5MR) over the past few decades in order to predict the rates for the reference years (14). All data sources and estimates are documented on the UNIGME website.1 For countries with complete recording of child deaths in death registrationsystems,theseareusedasthesourceofdatafortheestimationoftrendsinneonatal,infant and child mortality. For countries with incomplete death registration, all other available census and survey data sources, which meet quality criteria, are used. UNIGME methods are documented in a seriesofpaperspublishedinacollectionin2012(15). For data from civil registration, the neonatal mortality per 1000 live births (NMR) is calculated as the number of neonatal death divided by the live births reported from the country when available. For household surveys, child and neonatal mortality rates are calculated from the full birth history (FBH) data, where women are asked for the date of birth of each of their children, whether the child is still alive,andifnottheageatdeathFBHdata,collectedbyallDemographicHealthSurveys(DHS),allowthe calculation of child mortality indicators for specific time periods in the past; DHS publishes child mortalityestimatesforfive5yearperiodsbeforethesurvey,thatis,0to4,5to9,10to14etc. A database consisting of pairs of NMRs and U5MRs was compiled. For a given year, NMR and U5MR were included in the database when data for both of these were available. To ensure consistency with
www.childmortality.org
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U5MR estimates produced by UNIGME, U5MR and NMR data points were rescaled for all years to matchtheUNIGMEestimates. For countries where child mortality is strongly affected by HIV, the NMR was estimated initially using neonatal and child mortality observations for nonAIDS deaths, calculated by subtracting from total death rates the estimated HIV death rates in the neonatal and 159 month periods respectively, and then AIDS neonatal deaths be added back on to the nonHIV neonatal deaths to compute the total estimatedneonataldeathrate. ThefollowingstatisticalmodelwasusedtoestimateNMR:
log(NMR/1000)=0+1*log(U5MR/1000)+2*([log(U5MR/1000)]2)
with additional random effect intercept parameters for both country and region. For countries with good vital registration data covering the period 19902011, random effects parameters for slope or trend parameters were also added. Based on predictive performance evaluation using tenfold cross validation, the statistical model fitted to data point for 1990 onwards were retained and only the most recentdatapointfromeachsurveywasincluded(16).
2.3 Allcause mortality computed from civil registration data

For 133 Member States with vital registration and sample vital registration systems, demographic techniques (such as Brass GrowthBalance method, Generalized GrowthBalance method or Bennett Horiuchi method) were first applied to assess the level of completeness of recorded mortality data in the population above five years of age and then those mortality rates were adjusted accordingly. The proportion of all deaths which are registered in the population covered by the vital registration system (referred to as completeness) has been estimated by WHO and is given for the latest available years in theannextable. Where vital registration data for all the reference years were available, the age specific mortality rates, adjustedforcompletenessifnecessarywereuseddirectlytoconstructthelifetables.Deathregistration datauptoandincludingyear2011wereavailablefor53MemberStates.
2.4 Allcause mortality projected from civil registration data

For another 60 Member States where vital registration data for 2011 was not available, life table parameters were projected from those for available data years from 1985 onwards. Adjusted levels of child mortality (5q0) and adult mortality (45q15), excluding HIV/AIDS deaths where necessary, were used toestimatelevelsoftwolifetableparameters(l5,l60)foreachavailableyear.Thelifetableparameterl60 was projected forward to 2011 using a weighted regression model giving more weight to recent years (using an exponential weighting scheme such that the weight for each year t was 25% less than the weight for year t+1). For Member States with a total population less than 750,000 or where the root mean square error from this regression was greater than or equal to 0.011, a shorterterm trend was estimated by applying a weighting factor with 50% annual exponential decay. These projected values of l60,togetherwithvaluesofl5basedon5q0fromUNIGMEwerethenappliedtoamodifiedlogitlifetable model,usingthemostrecentnationaldataasthestandard,topredictthefulllifetablesinthereference years(17).Wherenecessary,HIV/AIDSdeathrateswerethenaddedtototalmortalityrates. Fortwo small countries withoutavailable death registration data, Andorraand Monaco, life tables were basedonmortalityratesfromneighbouringregionsofSpainandFrance,respectively. World Health Organization Page 4
2.5 Countries with other information on levels of adult mortality

For81MemberStateswithoutuseabledeathregistrationdata,assessmentsofmortalityratesforages5 and over were based on life table analyses of the UN Population Division (12). The sources of available datausedin theWPP arelistedelsewhere (18).Annual agesexspecificdeathrates foryears 19902011 were interpolated from the WPP life tables, where necessary first subtracting out conflict and disaster deaths occurring in each specific 5year time period. Annual estimates for conflict and disaster deaths werethenaddedbackasdescribedbelow. For 39 of these Member States, with high levels of HIV mortality, the UN Population Division explicitly estimated HIV deaths in preparing life table time series. For these Member States, HIVfree mortality rateswerecomputedforinterpolationofannualdeathrates(makinguseofunpublishedsupplementary tabulations provided by the UN Population Division for estimated HIV deaths by age and sex in these countries). The latest estimates of annual HIV death rates prepared by UNAIDS (19) were then added backtotheannualmortalityratestocomputetotalallcausedeathratesbyyear.ThehighHIVcountries forwhichthismethodwasusedareidentifiedintheAnnexTableF. For six countries, additional data inputs for the most recent period were also taken into account based on provisional analyses for the WPP 2012 provided by the UN Population Division (20). Data sources for these countries are listed in the Annex Table F, and the following notes provide an overview of the analysesused. Afghanistan The 2012 revision of child mortality estimates for Afghanistan by UNIGME took into account data from the2010AfghanistanMortalitySurvey(21)andthe2011UNICEFMICS4survey(22). Adjustedestimatesofadultmortality(45q15)derivedfrom recenthouseholddeathsdatafromthe2010AfghanistanMortalitySurvey(AMS); parentalorphanhoodfromthe2010AMS(excludingtheSouthernregion); siblings deaths from the 2010 AMS (excluding the Southern region) adjusted for age misreportingandrecallbiases
were also considered, but the implied low level of adult mortality could not be reconciled with intercensal survival between the 1979 Afghan census and 200305 Afghan household listing, or with population estimates from 200305 Household listing and more recent surveys in 20072008 and 2011, or with intercensal estimates of the trends in fertility, and international migration based on UNHCR statistics on the number of Afghan refugees. Additionally, they would imply that Afghan adult mortality levelsweresubstantiallylowerthanthoseinneighboringcountries. As a result, the life tables for Afghanistan are based on provisional analyses by UN Population Division using the West model of the CoaleDemeny Model Life Tables with three parameters: (1) estimates of infant mortality, (2) estimates of child mortality, and (3) adjusted estimates of adult mortality (45q15) derived from (a) recent household deaths data from the 1979 census; (b) implied relationship between child mortality and adult mortality based on the UN South Asian and West model of the CoaleDemeny Model Life Tables, and (c) levels of adult mortality based on sample registration data from neighboring countriesforrecentyears.
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China Life tables for years since 2000 have been revised to take into account a faster rate of decline for adult mortality than previously projected in the World Population Prospects 2010 revision. Unpublished analyses of the China 2010 census data on adult mortality by UN Population Division have adjusted for underreporting of deaths resulting in estimates of adult mortality rates for 2010 quite similar to those reportedbytheChinaDiseaseSurveillancePointsSystem(23). Egypt Life tables have been based on official estimates of life expectancy available through 2012, and in turn derived from death registration data for Egypt. The age pattern of mortality is based on official life tables for various years from 1960 to 2010 adjusted for infant and child mortality as estimated by UN IGME,andadultmortality. SaudiArabia The World Population Prospects 2010 revision based estimates of adult mortality for Saudi Arabia using model life tables with estimates of child mortality as input. Estimates of adult mortality have been provisionally updated using adjusted death rates by age and sex from the 1999 Demographic Survey, 2004 Census and 2007 Demographic Survey adjusted for infant and child mortality, and oldage mortality.Lifetablesbasedonannualdeathsfromthe2000DemographicSurvey,aswellason2005and 2009registereddeathswerealsoconsidered. SouthSudanandSudan The former Sudan became two countries, South Sudan and Sudan, on 9 July 2011. Previously published WHO and UN life tables refer to the former Sudan. Life tables for the two Member States of South Sudan and Sudan are based on provisional analyses of population and mortality rates for the territories correspondingtothecurrentSouthSudanandSudanovertheperiod1990to2011. Infant and child mortality for South Sudan and Sudan are derived from UNIGME estimates published in 2012 (14). Life tables are based on provisional unpublished analyses of the UN Population Division, deriving adult mortality rates from estimates of infant and child mortality by assuming that the age pattern of mortality conforms to the North model of the CoaleDemeny Model Life Tables. The demographicimpactsofAIDSandconflicthavealsobeenfactoredintothemortalityestimates.
2.6 Mortality shocks epidemics, conflicts and disasters

Countryspecific estimates of deaths for organized conflicts and major natural disasters were prepared foryears19902011usingdataandmethodsdocumentedinSection5.12.Forcountryyearswheretotal death rates from these conflicts and disasters exceeded 1 per 10,000 population, these deaths were addedtothelifetabledeathratesfortherelevantyear. The revised WHO estimates for conflict deaths were taken into account in preparing final life tables for Member States for years 19902011 as follows. For countryyears where death rates from conflict or disasters exceeded 1 per 10,000 population, the estimated annual agesexspecific conflict deaths were addedtothelifetabledeathratesfortherelevantyear.Incasesofextendedconflictswheredeathrates fluctuated above and below 1 per 10,000, only the death rate in excess of 1 per 10,000 was added to relevantyears. MeaslesoutbreaksandepidemicswereidentifiedasdescribedinSection5.5belowandsimilarlyadded toallcauseenvelopesforrelevantcountryyears. World Health Organization Page 6
Countries with useable death registration data
3.1 Data and estimates

Causeofdeath statistics are reported to WHO on an annual basis by country, year, cause, age and sex. Most of these statistics can be accessed in the WHO Mortality Database (24). The number of countries reporting data using ICD10 has continued to increase. For these estimates, a total of 114 countries had datacovering80%ormoreofdeathsinthecountry,ofwhich93countrieswerereportingdatacodedto thethirdorfourthcharacterofICD10and59countrieshaddataforyears2010or2011. For countries with a highquality vital registration system including information on cause of death, we used the vital registration data recorded in the WHO Mortality Database. We analyzed the data using thefollowingsteps: 1) applicationofinclusioncriteriatoselectcountrieswithhighqualityvitalregistrationdata; 2) extractionofdeathsbycausegroup,withashortoradetailedcauselistuseddependingon theICDrevisionusedineachcountryyear; 3) redistributionofdeathsofunknownsex/ageanddeathsassignedtogarbagecodesand adjustmentforincompleteregistrationofdeathsinsomecountries; 4) interpolation/extrapolationofnumberofdeathsformissingcountryyears; 5) adjustmentsforcertainspecificcausesusingadditionalinformationtoadjustforoveror underreporting 6) scalingoftotaldeathsbyageandsextopreviouslyestimatedWHOallcauseenvelopesfor years20002011 Detailsareprovidedbelow.
3.2 Inclusion criteria for countries with high quality death registration data
WeappliedthefollowinginclusioncriteriatodataintheWHOmortalitydatabase: Atleastfiveyearsofdataareavailableduring1998present; Thedataareavailablefor5yearagegroupstoages85andover; Thedataareforacountrywhosepopulationin2008wasgreaterthan500,000; ThedataareforacountrythatiscurrentlyaWHOMemberState; Thedatafulfillqualitycriteriapertainingtogarbagecodesandcompleteness,asdescribed below.
For 131 Member States with vital registration systems who have provided summary data to WHO, demographic techniques (such as Brass GrowthBalance method, Generalized GrowthBalance method or Bennett Horiuchi method) were first applied to assess the level of completeness of recorded mortality data in the population above five years of age. We then calculated the proportion of deaths withunderlyingcausecodedtoashortlistofsocalledgarbagecodes: symptoms,signsandilldefinedconditions(ICD10codesR00R99), injuriesundeterminedwhetherintentionalorunintentional(ICD10Y10Y34,Y87.2), illdefinedcancers(C76,C80,andC97),and illdefinedcardiovasculardiseases(I47.2,I49.0,I46,I50,I51.4,I51.5,I51.6,I51.9andI70.9).
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Table3.1.Characteristicsofuseablecountryvitalregistrationdata (Only countries fulfilling the first four inclusion criteria listed above are included in this table. ICD10 codesincludedinthegarbagecategoryaregiveninthetextabove).
Country Firstyear Lastyear Average 1998+ available usability available 2000+ 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 2004 1998 1998 1998 2000 1998 1998 1998 2004 2010 2011 2011 2011 2007 2009 2009 2010 2011 2009 2009 2009 2011 2011 2010 2011 2011 2011 2010 2011 2009 2011 2011 55% 79% 66% 95% 90% 84% 88% 88% 76% 79% 94% 94% 89% 87% 87% 90% 73% 88% 87% 59% 61% 58% 94% 97% Rangeof completeness 67% 100% 66% 100% 100% 81% 99% 100% 87% 100% 100% 100% 93% 90% 98% 96% 90% 99% 100% 72% 99% 75% 100% 100% 71% 100% 81% 100% 100% 96% 100% 100% 91% 100% 100% 100% 96% 95% 100% 98% 91% 100% 100% 73% 100% 75% 100% 100% Rangeof garbage fraction 18% 20% 3% 5% 1% 2% 10% 12% 12% 16% 6% 6% 6% 4% 8% 1% 16% 10% 12% 16% 32% 18% 5% 2% Notes
Albania Argentina Armenia Australia Austria Azerbaijan Belarus Belgium Brazil Bulgaria Canada Chile Colombia CostaRica Croatia Cuba Cyprus CzechRepublic Denmark Ecuador Egypt ElSalvador Estonia Finland
20% Excludedduetolow usability 22% Excludedduetohigh proportiongarbage 6% Excludedduetolow usability 6% 14% 34% Excludedduetohigh proportiongarbage 13% Summarizedcauselist used 15% 21% 28% Excludedduetohigh proportiongarbage 8% 11% 8% 7% 17% 9% 24% 15% 14% 23% Excludedduetolow usability 41% Excludedduetolow usability 25% Excludedduetolow usability 8% 3%
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Country Firstyear Lastyear Average 1998+ available usability available 2000+ 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 2000 1998 1998 1998 1998 1998 1999 1998 2004 2009 2010 2011 2010 2009 2011 2009 2010 2010 2010 2011 2010 2011 2010 2010 2010 2011 2010 2009 2011 2009 2011 2009 2008 2011 2011 2009 85% 53% 87% 75% 73% 94% 94% 94% 90% 90% 89% 83% 87% 90% 92% 94% 90% 95% 70% 86% 97% 89% 80% 83% 74% 82% 74% Rangeof completeness 100% 78% 100% 100% 89% 99% 100% 100% 100% 100% 100% 84% 98% 91% 99% 99% 100% 100% 93% 100% 100% 100% 84% 91% 100% 100% 100% 100% 83% 100% 100% 90% 100% 100% 100% 100% 100% 100% 89% 98% 95% 100% 100% 100% 100% 93% 100% 100% 100% 91% 93% 100% 100% 100% Rangeof garbage fraction 14% 7% 11% 24% 12% 4% 5% 5% 8% 8% 9% 3% 9% 3% 5% 2% 8% 5% 23% 13% 3% 11% 8% 10% 25% 17% 22% Notes
France Georgia Germany Greece Guatemala Hungary Iceland Ireland Israel Italy Japan Kazakhstan Kuwait Kyrgyzstan Latvia Lithuania Mauritius Mexico Montenegro Netherlands NewZealand Norway Panama Philippines Poland Portugal Qatar
16% 69% Excludedduetolow usability 14% 27% Excludedduetohigh proportiongarbage 22% Excludedduetohigh proportiongarbage 7% 6% 8% 14% 12% 13% 11% Summarizedcauselist used 14% 8% 11% 6% 15% 6% 28% Excludedduetolow usability 15% 4% 12% 14% 13% 28% Excludedduetohigh proportiongarbage 22% 32% Excludedduetohigh proportiongarbage
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Country Firstyear Lastyear Average 1998+ available usability available 2000+ 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 1998 2011 2011 2011 2010 2011 2011 2010 2010 2009 2011 2006 2010 2010 2010 2006 2008 2011 2010 2008 2009 2005 2009 85% 88% 92% 95% 72% 74% 94% 89% 68% 89% 55% 89% 89% 84% 48% 95% 96% 93% 93% 83% 83% 86% Rangeof completeness 90% 89% 99% 100% 84% 74% 100% 99% 81% 100% 74% 100% 100% 96% 78% 100% 100% 100% 100% 100% 85% 93% 100% 91% 100% 100% 89% 84% 100% 100% 88% 100% 74% 100% 100% 98% 88% 100% 100% 100% 100% 100% 87% 95% Rangeof garbage fraction 13% 2% 0% 4% 12% 2% 4% 9% 19% 9% 23% 10% 10% 9% 39% 2% 3% 6% 7% 16% 2% 7% Notes
Republicof Korea Republicof Moldova Romania Russian Federation Serbia Singapore Slovakia Slovenia SouthAfrica Spain SriLanka Sweden Switzerland TFYR Macedonia Thailand Trinidadand Tobago Ukraine United Kingdom UnitedStates ofAmerica Uruguay Uzbekistan Venezuela (Bolivarian Republicof)
21% 7% 8% 6% Summarizedcauselist used 18% 4% 11% 12% 32% Excludedduetolow usability 13% 32% Excludedduetolow usability 12% 13% 15% 54% Excludedduetolow usability 5% 6% Summarizedcauselist used 8% 10% 17% 6% Summarizedcauselist usedforsomeyears 9%
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Asummaryusabilityscorewascalculatedasfollows: (PercentUsable)=Completeness(%)*(1ProportionGarbage) All countries with a mean percent usable below 70% during the period 2000 to latest available year wereexcluded(seeTable3.1). Thequalityofcauseofdeathcodingwasfurtherinvestigatedintheremainingcountries.Theproportion of deaths assigned to an expanded list of illdefined causes (Table 3.2) was calculated for each year in the period 20002011. For the period 20052011 countries had reported an average of 5 years of data. Data from a country were excluded if the average proportion of illdefined causes was above 25% for 20052011 (if available) or 20002004 (if more recent data were not available). Based on this analysis, data from Argentina, Azerbaijan, Bulgaria, Greece, Guatemala, Poland, and Qatar were excluded (Table 3.1). Table3.2.Expandedlistofgarbagecodes
ICD10code(s) Description A40A41 D65 E86 I10 I269 I46 I472 I490 I50 I514 I515 I516 I519 I709 I99 J81 J96 K72 N17 N18 N19 P285 Streptococcalandothersepticaemia Disseminatedintravascularcoagulation[defibrinationsyndrome] Volumedepletion Essential(primary)hypertension Pulmonaryembolismwithoutmentionofacutecorpulmonale Cardiacarrest Ventriculartachycardia Ventricularfibrillationandflutter Heartfailure Myocarditis,unspecified Myocardialdegeneration Cardiovasculardisease,unspecified Heartdisease,unspecified Generalizedandunspecifiedatherosclerosis Otherandunspecifieddisordersofcirculatorysystem Pulmonaryoedema Respiratoryfailure,notelsewhereclassified Hepaticfailure,notelsewhereclassified Acuterenalfailure Chronicrenalfailure Unspecifiedrenalfailure Respiratoryfailureofnewborn C76,C80,C97 Illdefinedcancersites
Y10Y34,Y872 Externalcauseofdeathnotspecifiedasaccidentallyorpurposelyinflicted
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3.3 Redistribution of unknown sex/age and garbage codes and adjustment for incomplete death registration
First, deaths of unknown sex prorata within causeage groups of known sexes were redistributed, and then deaths of unknown age prorata within causesex groups of known ages. Deaths coded to garbage codes were reassigned using previously published methods (25). We redistributed deaths coded to symptoms, signs and illdefined conditions prorata to all noninjury causes of death, and injuries with undetermined intent prorata to all injury causes of death. Cancers with unspecified site were redistributed prorata to all sites excluding liver, pancreas, ovary, and lung. Additionally, we redistributed cancer of uterus, part unspecified (C55) prorata to cervix uteri (C53) and corpus uteri (C54). Illdefined cardiovascular causes were redistributed to ischaemic heart disease and other cardiovascular causes of death. Finally, the total number of deaths was adjusted for incomplete recordingofdeathsusingthecompletenessestimatesdescribedinSection3.2.
3.4 Mapping to GHE cause lists

Included vital registration data were coded according to ICD9, ICD10, or one of several abbreviated cause lists derived from ICD9 or ICD10. Total deaths by cause, age and sex were mapped to the GHE cause list (Annex Table A). We used the complete cause list in Annex Table A if the data were coded using 3 or 4digit ICD10 codes. In other cases, we extracted the number of deaths by cause, age and sex, using only the broad cause categories listed in Table 3.3. This shortlist in Table 3.3 was used for all datafromthePhilippines. For Russia, Belarus and Ukraine, HIV deaths recorded in the death registration data were substantially miscoded to tuberculosis (GHE3), lower respiratory infections (GHE39), other infectious diseases (GHE37), lymphomas and multiple myeloma (GHE76), other malignant neoplasms (GHE78), and endocrine, blood and immune disorders (GHE81). Deaths in these categories falling in the characteristic HIV age pattern were recoded to HIV (GHE10), according to the agesexspecific HIV mortality estimates fromUNAIDS(referSection5.2). For countries with deaths data grouped by the shortlist in Table 3.3, shortlist categories were expanded to the full cause list using the causefraction distribution within each shortlist category by year, age, sex andGBD2010regionfromtheGBD2010studyresults(26). Codingofnaturalcausesofdeathforneonatesvariesagreatdealacrosscountries.Somecountriescode these deaths to the P chapter (conditions originating in the perinatal period) while others use a combination of P codes and other codes as well. In some instances the age of death is not always taken intoaccount.Someconditions,suchassepticaemiaandpneumonia,havespecificcodeswithinP00P96 which should be used for neonates (027days). For countries with vital registration data, we have recoded all the deaths aged 027days from natural causes that were initially coded outside the P chapter to codes in the P chapter whenever possible. In a number of countries, neonatal septicaemia (P36) is frequently assigned to A40 and A41 (septicaemia). In this case we have recoded them back to P36,thusidentifyingmoredeathsduetocausesoriginatingintheperinatalperiod.
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Table 3.3. Short cause list used for vital registration data coded using ICD9 or ICD10 abbreviated cause lists
GHE code 1 3 9 20 38 39 42 49 60 61 62 63 64 65 66 68 70 71 72 80 110 117 121 126 140 151 152 153 160 161 162 163 Shortlistcausecategory I. Communicable,maternal,perinatalandnutritionalconditions A1.Tuberculosis A3.HIV/AIDS
A.Infectiousandparasiticdiseases B.Respiratoryinfections B1.Lowerrespiratoryinfections C.Maternalconditions D.Neonatalconditions II.Noncommunicablediseases A.Malignantneoplasms A1.Mouthandoropharynxcancers A2.Oesophaguscancer A3.Stomachcancer A4.Colonandrectumcancers A5.Livercancer A7.Trachea,bronchusandlungcancers A9.Breastcancer A10.Cervixutericancer A13. Prostatecancer
C.Diabetesmellitus H.Cardiovasculardiseases I.Respiratorydiseases J.Digestivedisorders K.Genitourinarydiseases N.Congenitalanomalies III.Injuries A.Unintentionalinjuries A1.Roadinjury B1.Selfharm B2.Interpersonalviolence B3.Collectiveviolenceandlegalintervention B.Intentionalinjuries
82+94 E/F.Mentalandneurologicaldisorders
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3.5 Interpolation and extrapolation for missing countryyears

For many countries, data were missing for some years. In order to create a continuous timeseries of data, we interpolated mortality rates for each country and cause, and then extrapolated up to three years of data at the beginning and end of the data series. To interpolate, a logistic regression was fitted for each missing countrysexcause group, using death rates six years prior and six years after the missing data year as the dependent variable and year as the independent variable. In some cases, few deaths were recorded for a specific countrysexcause group and the logistic regression did not converge. In that case, the death rate was estimated as the average rate in the three years prior and three years following the missing data year. To extrapolate for up to three years, a logistic regression was fitted to the first or the final six years of data (including interpolated estimates) for each country sexcause.Again,ifthelogisticregressiondidnotconvergeduetothesmallnumberofdeathsrecorded, thedeathratewasestimatedastheaverageofthefirstorlastthreeyearsdeathrates.
3.6 Adjustment of specific causes

Estimates for HIV deaths were compared with UNAIDS/WHO estimates for 46 countries where fewer HIV deaths were recorded in the death registration data than estimated by UNAIDS/WHO (19). UNAIDS/WHO estimates were used except in the cases of Australia, Chile, Costa Rica, France, Trinidad andTobago,UruguayandUSA. Estimates for malaria deaths were compared with WHO estimates (see Section 5.3) and replaced by WHO estimates for 63 country years where the WHO estimates were larger than those from the death registration data. This affected malaria deaths for Brazil (12 years), Columbia (10), Venezuela (9), Philippines(8)andPanama(3). WHO estimates for maternal deaths include an upwards adjustment for underrecording of maternal deaths in death registration data (27). Maternal deaths were adjusted using these countryspecific factors,andallothercausesadjustedprorata. Deaths due to alcohol and drug use disorders include alcohol and drug poisoning deaths coded to the injury chapter of ICD (see Annex Table A). Further adjustments for underreporting in some countries willbeundertakeninthenextrevisionoftheseestimates. Where necessary, road injury deaths were adjusted upwards to take account of additional surveillance dataprovidedbycountries(seeSection5.11). Estimates of deaths due to conflicts (see Section 5.12) were compared with estimates from the death registration data year by year and added outsidetheenvelope for countryyears where they are not includedindeathregistrationdata.
3.7 Other nationallevel information on causes of death

Cause of death estimates for a number of countries drew on nonnational death registration data or otherdatasourceswithcauseofdeathinformationasfollows. China Causespecific mortality data for China were available from two sources the sample vital registration systemdataforyears1987to2010(28)andsummarydeathstabulationsfromtheDiseasesSurveillance Points (DSP) system for years 19951998 and 20042010 (29, 30). Table 3.4 summarizes the deaths and World Health Organization Page 14
population covered by these two systems. The sample vital registration system data for years 1987 to 2010 was provided in separate tabulations for urban and rural sampled populations, with more urban than rural sampling. The urban and rural crude deaths rates by age, sex and cause were weighted for each year using the UN Population Divisions estimated urban and rural population fractions, and the resulting death rates reapplied to the UN total estimated population by age and sex. The DSP sample sites are considered to be nationally representative and the resulting total deaths by age, sex and cause were not reweighted. For both sets of data, annual data were rescaled so total deaths by age and sex matchedtheestimatedallcauseenvelopesforChina(seeSection2.5). Table 3.4. Total deaths and population covered by the Chinese vital registration system (VR) and the DiseaseSurveillancePointssystem(DSP)
Vitalregistration system Year 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
datanotavailable.
DiseaseSurveillance Points 430,994 437,490 347,057 401,008 424,683 437,550 453,211
Vitalregistration system 117,183,678 102,889,945 55,288,841 57,272,144 72,240,261 79,101,646 90,158,748
DiseaseSurveillance Points 71,173,205 71,487,277 66,012,299 71,476,477 73,928,499 75,020,489 78,766,626
Numberofdeaths 711,946 626,392 295,906 310,826 379,057 475,289 471,219 505,021 558,915
Population
Both sets of data were assessed and compared for suitability in estimating 20002011 causespecific mortalityfor Chinaat thenational level.As seenin Figure3.1, bothsets ofdata gavequite similar cause distributions at major cause group level by age, across the period 20002010. Additionally, comparison for more detailed major causes of death did not give any clear indication that one data set was of systematicallyhigherqualitythantheother.Wethereforebasedtheupdateofcauseofdeathestimates forChinaonanaverageoftheestimatesfromthetwosystems. For all except the leading causes of death, there are considerable fluctuations across 5year age groups and year in numbers of deaths, due to stochastic variation and perhaps also variations in recording causeofdeathfromyeartoyearorsamplesitetosamplesite.Inordertosmooththesefluctuationsand to estimate underlying trends, cubic spline smoothing was used as follows. For the VR data, cubic spline curveswerefittedtoagesexcausespecificdeathsforyears19872010usinganegativebinomialmodel with population as offset and with knot points at years 1992, 1997, 2003, and 2007. For the DSP data, cubic spline curves were fitted to agesexcause specific deaths for years 19952010 using a negative binomial model with population as offset and with knot points at years 2004, 2007 and 2010. Final estimates for China were calculated as the average of the fitted spline estimates from VR and DSP for years20002011. World Health Organization Page 15
Figure 3.1. Sample vital registration data (VR) and Disease Surveillance Points data (DSP), China: comparisonofcausefractionsforthreemajorcausegroupsbyage,late1990s,2005and2010
The resulting causespecific estimates were further adjusted with information from WHO technical programmes and UNAIDS on specific causes (see Section 5) and from the GBD 2010 for certain specific subcause categories where deaths were either not recorded or recorded to only selected categories in the DSP and/or VR datasets. GBD 2010 analyses were used for GHE causes 59 (STDs), 20 (hepatitis C), 26 (leishmaniasis), 3436 (intestinal nematode infections), 115 (inflammatory heart diseases), and 119 (asthma). Additionally, DSP broad cause group totals were redistributed to detailed subcauses using GBD 2010 cause fractional distributions for the following categories: 82+94 (mental and behavioural disordersandneurologicalconditions),134(musculoskeletaldisorders)and147(oralconditions).Rabies deaths were revised using data on reported human rabies deaths from the Chinese Center for Disease ControlandPrevention(31). For estimates of causes of death under age 5, a separate analysis was undertaken based on an analysis of 206 Chinese communitybased longitudinal studies that reported multiple causes of child death (see Section 4.5 below. The CHERG conducted a systematic search of publically available Chinese databases in collaboration with researchers from Peking University. Information was obtained from the Chinese Ministry of Health and Bureau of Statistics websites, Chinese National Knowledge Infrastructure (CNKI) database and Chinese Health Statistics Yearbooks published between 19902008. A model was developed to assign the total number of child deaths to provinces, age groups and main causes of child death.
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India Analysis of causes of death for India was based on data over a period of 3years (20012003) recorded bytheMillionDeathStudy(32,33),acomprehensivestudybasedonverbalautopsythatassignedcauses to all deaths in areas of India covered by the Sample Registration System. The Sample Registration System monitors a representative sample population of 6.3 million people in over 1 million homes in India. The 1991 census was used to randomly select 6671 areas from approximately 1 million having about1000inhabitantsineach. In 2001 the Indian Registrar General Surveyor introduced an enhanced form of verbal autopsy for assessing the cause of death. Verbal autopsy is a method of ascertaining the cause of death by interviewing a family member or caretaker of the deceased to obtain information on the clinical signs, symptoms and general circumstances that preceded the death. Details of methods and validation have been reported elsewhere (33). Verbal autopsy reports were independently coded to ICD10 categories byatleast twoofa totalof130 physicianstrainedin ICD10coding.In caseofdisagreement onthe ICD 10 codes at the chapter level, reconciliation between reports was conducted, followed by a third senior physiciansadjudication. A total of 136,000 deaths were enumerated between January 2001 and December 2003. Verbal autopsies could not be conducted for 12% of the deaths for reasons such as family migration or change of residence. An additional 9% of the reports could not be coded because of data quality problems, resultingafinaldatasetof122,848codedrecords. Thecausespecificproportionofdeathsineachfiveyearagecategoryfrom0to79yearsandforpeople aged 80 years and over was weighted by the inverse probability of a household being selected within rural and urban subdivisions of each state to account for the sampling design. National estimates for deathsandmortalityrateswerebasedonUnitedNations2005estimatesforIndia,byage,sexandarea. Figure 3.2. Percentage of deaths by cause and age for India: comparison of final GHE estimates for year2002withnationallevelresultsfromtheMillionDeathStudy,20012003
GlobalHealthEstimates:India,2002
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 Age(years) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 Age(years)
MillionDeathStudy:India,20012003
Suicide,homicideandconflict Otherunintentionalinjuries Roadinjury Othernoncommunicable Chronicrespiratorydiseases Cancers Cardiovasculardiseases Maternal,neonatal,nutritional Otherinfectiousdiseases Lowerrespiratoryinfections Diarrhoealdiseases HIV,TBandmalaria
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TheGHEanalysisisbasedontheresultingnationallevelcausespecificmortalityproportionsderivedfor GHE cause categories from the Million Death Study. The mapping of the MDS cause categories to GHE cause categories, and the use of GBD 2010 analyses to redistribute deaths to detailed subcause categories is summarized in Annex Table E. GHE cause categories 26 (leishmaniasis) and 124 (appendicitis)werealsoestimatedusingGBD2010results. The resulting causespecific estimates were further adjusted with information from WHO technical programmes and UNAIDS on specific causes (see Section 5) and adjusted to match WHO estimates of agesex specific allcause mortality for India in 2002. Causespecific trends for India estimated in the GBD2010study(26)wereusedtoprojectcausefractionsforwardsto2011andbackwardsto2000. Figure 3.2 provides a comparison of the final proportional distributional estimates of deaths by cause and age for India in the year 2002 with the original distributions in the Million Death Study for 2001 2003.
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Child mortality by cause
Causespecific estimates of deaths for children under age 5 were estimated for 17 cause categories using methods described elsewhere by Liu et al. (34) and on the WHO website (35). These previously published estimates for years 20002010 were updated to take account of revisions in child mortality levels (14), as well as causespecific estimates for HIV, tuberculosis, measles and malaria deaths (as described in Section 5). Inputs to the multivariate cause composition models were also updated as describedbelow.
4.1 Causes of under 5 death in countries with good death registration data
Death registration data were used directly for estimating causes of neonatal and under 5 child deaths for countries with good quality vital registration (VR) data with population coverage of >80%. VR data were considered as of good quality if the following criteria were met: (a) reasonable distribution of deaths by cause were reported without excessive use of implausible codes or certain codes, and (b) sufficient details of the coding was provided so that deaths could be grouped into appropriate categories used in the analysis. For countries with adequate death registration, data on causes of child deaths were extracted from the WHO mortality database, adjusted for coverage incompleteness where needed, and grouped according to the standard International Classification of Diseases, 10th revision (ICD10). For earlier years when ICD9 codes were used, a mapping system was applied to convert them into ICD10 codes (34,webappendix). Certain neonatal codes were reassigned from illdefined codes to more plausible codes (see Annex Table C). Annual data for years 2000 to the latest available year were included with data closest to the estimating year used where possible. Where the latest year available was earlier than 2011, the cause distribution for the latest available year was assumed to apply for subsequentyear(s),whichwasthenappliedtotheagespecifictotalnumberofchilddeaths.
4.2 Causes of neonatal death (deaths at less than 28 days of age)

TheCHERGneonatalworkinggroupundertookanextensiveexercisetoderivemortalityestimatesforsix causes of neonatal death, including preterm birth, asphyxia, severe infection, diarrhoea, congenital malformationandothercauses(36).ThesecausecategoriesaredefinedinAnnexTableB. Death registration data were used directly for 61 countries considered to have reliable information. For another 51 low mortality countries, the cause distribution was estimated using a multinomial model applied to death registration data. For 80 high mortality countries the cause distribution was estimated using a multinomial model applied to (largely) verbal autopsy (VA) data from research studies (34). A total of 90 studies in 34 countries in high mortality populations met the inclusion criteria. The multinomialmodel for high mortalitycountries was generally usedfor countries with average U5MR>35 fortheperiod20002010. A separate cause category for neonatal pneumonia is included in the model, and the neonatal sepsis category includes a number of neonatal infections, such as meningitis and tetanus, not separately identified. The number of tetanus deaths was also modeled separately in a single cause model using usingalogisticregressionmodelwithpercentofwomenwhowereliterate,percentofbirthswithskilled attendant, and percent protected at birth by tetanus toxoid vaccine as covariates. The resulting cause specific inputs were adjusted countrybycountry to fit the estimated neonatal death envelopes for correspondingyears. Pending further revisions of the neonatal tetanus model to estimate longerterm trends in neonatal tetanus deaths, estimates for 2011 and 2000 were based on projection and backprojection of the 2008 estimatesusingestimatesoftrendsintetanusdeathsfromtheGBD2010study(26). World Health Organization Page 19
4.3 Causes of child death at ages 159 months low mortality countries
For 51 low mortality countries without VR data or with VR data not meeting quality criteria (see Section 4.1),the cause distribution was estimated using a multinomial model applied to death registration data. Thismultinomialmodelappliedtodeathregistrationdatawasgenerallyusedforcountrieswithaverage U5MR<35fortheperiod20002010. Fortheestimatesforyears20002011,thepreviousvitalregistrationbasedmulticausemodel(VRMCM) model was revised to include additional death registration data and to update time series for covariates and extend them to 2011. The choice of covariates included in the model was not revisited for this regionallevel update. The multinomial logistic regression model was estimated using death registration data from countries with >80% complete cause of death (CoD) certification for years 19902011 to estimatetheproportionofdeathsduetopneumonia,diarrhea,meningitis,injuries,perinatal,congenital anomalies,otherNCDsandothercauses. The current version of the model used death registration data for the years 1990 to 2011, including 1,123 data points, representing 63 countries. The model included the following covariates that were determinedapriori:U5MRs,GNIpercapita(PPP,$international),WHOEuropeanandAmericanregions. Adjustments for the scalingup of Hib vaccine occurred within the model. The proportional distribution ofcausesofdeathwasthenappliedtotheHIVfreeandmeaslesfreeenvelopeforchildren159months ofage.JackknifeandMonteCarlosimulationmethodswereusedtoestimateuncertainty.
4.4 Causes of child death at ages 159 months high mortality countries
For79highmortalitycountries(averageU5MR>35fortheperiod20002010),thecausedistributionwas estimatedusingamultinomialmodelappliedto(largely)verbalautopsy(VA)datafromresearchstudies (34,36,37).Themulticausemodelfordeathsatages159monthswasusedtoderivemortalityestimates for seven causes of postneonatal death, including pneumonia, diarrhea, malaria, meningitis, injuries, congenital malformations, causes arising in the perinatal period (prematurity, birth asphyxia and trauma, sepsis and other conditions of the newborn), and other causes, based on 113 data points from 74 studies of postneonatal deaths from 33 countries that met inclusion criteria2. Studies were predominantly from lower income high mortality countries. Malnutrition deaths were included in the other cause of death category. Deaths due to unknown causes were excluded from the analysis. Deaths duetomeaslesandHIV/AIDSwereestimatedseparately. The resulting causespecific inputs were adjusted countrybycountry to fit the estimated 159 month death envelopes (excluding HIV and measles deaths) for corresponding years and then estimates were furtheradjusted for intervention coverage(pneumonia and meningitis estimatesadjusted for use of Hib vaccine; malaria estimates adjusted for insecticide treated mosquito nets (ITNs)). This method was used for countries without useable death registration data and with U5MR>26 and gross national income per capitalessthan$7,510.
Studies conducted in year 1980 or later, a multiple of 12 months in study duration, cause of death available for more than a single cause, with at least 25 deaths in children <5 years of age, each death represented once, and less than 25% of deaths due to unknown causes were included. Studies conducted in sub-groups of the study population (e.g. intervention groups in clinical trials) and verbal autopsy studies conducted without use of a standardized questionnaire or the methods could not be confirmed were excluded from the analysis.
2
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4.5 Causes of child death for China and India

In order to estimate trends in under 5 causes of death for India, the previously developed subnational analyses were further refined and used to develop national estimates for years 20002011 (38). For neonates, a verbal autopsy multicause model (VAMCM) based on 37 subnational Indian community basedVAstudieswasusedtopredictthecausedistributionofdeathsatstatelevel.Theresultingcause specific proportions were applied to the estimated total number of neonatal deaths to obtain the estimatednumberofdeathsbycauseatstatelevelpriortosummingtoobtainnationalestimates. For children who died in the ages of 159 months in India, the previously developed multicause model wasrerunforyears20002011usingatotalof23subnationalcommunitybasedVAstudiesplus22sets of observations for the Indian states derived from the Million Death Study (39). Nine cause categories were specified, including measles plus the eight specified in the postneonatal VAMCM for other countries. Statelevel measles deaths were then normalized to fit the national measles estimates produced by the WHO IVB. Statelevel AIDS and malaria estimates were provided by UNAIDS and WHO malariaprogram,respectively.Allcausefractionswereadjustedtosumtoone.Thestatelevelestimates werecollapsedtoobtainnationalestimatesattheend. For China, updated IGME U5MR estimates in 20002011 were applied to the VAbased national cause specific models developed by Rudan and colleagues (40) to derive causefractions annually in this period. Together with causespecific inputs from WHO technical programmes and UNAIDS for measles, meningitis, malaria and AIDS, the resulting causespecific inputs for China were adjusted to fit the estimatedtotaldeathsatages01monthand159months,respectively.
4.6 Inclusion of WHOCHERG estimates in Global Health Estimates 2000 2011

The seventeen cause categories used for the WHOCHERG estimates of under 5 deaths for years 2000 2011(seeAnnexTableB)includeallthemajorcausesofneonatal,postneonataland14yeardeathsand two residual categories containing all remaining causes of death. These residual categories (Other Group 1 and Other Group 2) and cause groups such as Congenital malformations and Injuries were expanded to the full GHE cause list (Annex Table A) for neonatal and under 5 deaths using cause distributions derived from VR data for countries with useable VR data (see Annex Table F) and from the GBD2010estimatesforothercountries(26).
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Methods for specific causes with additional information
5.1 Tuberculosis
Forcountrieswithdeathregistrationdata,tuberculosismortalityestimatesweregenerallybasedonthe most recently available vital registration data. For other countries, total tuberculosis deaths were derived from latest published WHO estimates (41), together with more detailed unpublished age distributionsbasedontheVRdataandnotificationsdata.
5.2 HIV/AIDS and sexually transmitted diseases

For countries with death registration data, HIV/AIDS mortality estimates were generally based on the most recently available vital registration data except where there was evidence of misclassification of HIV/AIDS deaths. In such cases, a time series analysis of causes where there was likely misclassified HIV/AIDS deaths was carried out to identify and reassign such deaths. For other countries, estimates were based on UNAIDS estimated HIV/AIDS mortality (19). It was assumed based on advice from UNAIDSthat1%ofHIVdeathsunderage5occurredintheneonatalperiod.
5.3 Malaria
CountriesoutsidetheWHOAfricanRegionandlowtransmissioncountriesinAfrica3. Estimates of the number of cases were made by adjusting the number of reported malaria cases for completeness of reporting, the likelihood that cases are parasitepositive and the extent of health service use. The procedure, which is described in the World Malaria Report 2012 (42), combines data reported by National Malaria Control Programs (reported cases, reporting completeness, likelihood that cases are parasite positive) with those obtained from nationally representative household surveys on health service use. If data from more than one household survey was available for a country, estimates of health service use for intervening years were imputed by linear regression. If only one household survey was available then health service use was assumed to remain constant over time; analysis summarized in the World Malaria Report 2008 (43) indicated that the percentage of fever cases seeking treatment in public sector facilities varies little over time in countries with multiple surveys. Such a procedureresultsinanestimatewithwideuncertaintyintervalsaroundthepointestimate. The number of deaths was estimated by multiplying the estimated number of P. falciparum malaria cases by a fixed case fatality rate for each country as described in the World Malaria Report 2012 (42). This method is used for all countries outside the African Region and for countries within the African Region where estimates of case incidence were derived from routine reporting systems and where malaria causes less than 5% of all deaths in children under 5. A case fatality rate of 045% is applied to the estimated number of P. falciparum cases for countries in the African Region and a case fatality rate of 03% for P. falciparum cases in other Regions. In situations where the fraction of all deaths due to malaria is small, the use of a case fatality rate in conjunction with estimates of case incidence was considered to provide a better guide to the levels of malaria mortality than attempts to estimate the fractionofdeathsduetomalaria. Somalia,SudanandhightransmissioncountriesintheWHOAfricanRegion. Child malaria deaths were estimated using the VAMCM described in Section 4.4. The VAMCM derives mortality estimates for malaria, as well as 7 other causes (pneumonia, diarrhea, congenital
3
Botswana, Cape Verde, Eritrea, Madagascar, Namibia, Swaziland, South Africa, and Zimbabwe
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malformation, causes arising in the perinatal period, injury, meningitis, and other causes) using multinomial logistic regression methods to ensure that all 8 causes are estimated simultaneously with the total cause fraction summing to 1. Malaria deaths were retrospectively adjusted for coverage of insecticidetreated nets (ITNs) and use of Haemophilus influenzae type b vaccine (34). The bootstrap method was employed to estimate uncertainty intervals by resampling from the studylevel data to estimatethe distribution of thepredicted percent of deathsdue to each cause. The estimated malaria mortality rate in children under 5 years for a country was used to determine malaria transmission intensityandthecorrespondingmalariaspecificmortalityratesinolderagegroups(43).
5.4 Whooping cough

Anupdated model of whooping cough (pertussis) mortalityis being developed by the WHO Department ofImmunization,VaccinesandBiologicals(IVB).Thismodelhasnotbeenfinalizedintimefortherelease of these regionallevel estimates but will be used to update the GHE estimates at country level later in 2013.Intheinterim,whoopingcoughmortalityestimatesfromtheGBD2010(26)havebeenusedasan inputtotheWHOCHERGanalysisofchildcausesofdeathunderagefive(seeSection4).
5.5 Measles
To estimate deaths attributable to measles, a new model of measles mortality developed by WHO Department of Immunization, Vaccines and Biologicals (IVB) was used to first estimate countryand yearspecific cases using surveillance data (44). The improved statistical model firstly estimates measles cases by country and year using surveillance data and making explicit projections about dynamic transitionsovertimeaswellasoverallpatternsinincidence. The age distribution of measles cases are then estimated using a logistic regression function fitted to 172,191 measles cases with data on age at infection from 102 countries over 20052009 extracted from WHO's monthly measles casebased reporting system. Two explanatory variables were included in the regression:1)the5yearrollingaverageofestimatedMCV1coverage,categorizedin<60%,6084%,and 85100%;and2)geographicregionclassifiedinto7groups. Countryspecific measles casefatality ratios (CFRs) for children 14 years of age were taken from a comprehensive review of communitybased studies (45). This review included 102 field studies conducted in 29 countries during the period 19742007. The set of CFRs were revised for two countries (India and Nepal) where additional studies have been published subsequent to the review (46, 47). The sameCFRswereusedforinfantsandforchildrenaged14years.Fortheperiod20002011,weassumed thatagespecificCFRsarenotdecliningovertime. Agespecific deaths are aggregated to derive measles deaths for all children below five and for ages five and over. The new method takes into account herd immunity and produces results that are fairly consistent with previous ones (48). Uncertainty is estimated by bootstrap sampling from the distribution of incidence and age distribution estimates. Updated estimates of measles deaths by age and country for years 20002011 were prepared using the above methods at the end of 2012 and summary results published in the Weekly Epidemiological Record (49).These were used for this update ofGHEcausesofdeathforyears20002011. Forcountriesexperiencingmeaslesoutbreaks,themeaslesdeathsweresplitintooutbreakandendemic deaths, the latter of which were smoothed using local regression (50). For the ages of 159 months, the endemicmeaslesdeathsandAIDSdeathswereaddedtothemeaslesandAIDSfreeallcausedeathsfor whichtheVAMCMderivedcausefractionswereapplied.Themeaslesoutbreakdeathswereaddedback attheend.Inplaceswheretheoutbreakdeathsresultedinanincreaseintheallcausedeathsby10%or World Health Organization Page 23
more, the original survey data were screened to examine whether a real increase in child mortality was indicated for the outbreak year. If there were survey data available for the years around the outbreak but no evidence of an increased mortality, the measles outbreak deaths were truncated at 10% of the allcause deaths. This was only necessary in few countries, almost all of which are in Africa and all occurredintheearly2000swhenmoremeaslesdeathswereestimated.
5.6 Schistosomiasis
ForthelastWHOupdateofburdenofdiseaseforyear2004(3),theincidenceandprevalenceofcasesof schistosomiasis infection were separately estimated by country for S.mansoni, S.haematobium and S.japonicumplus S.mekongi. The GBD 2004 estimated that schistosomiasis was responsible for around 41000deathsglobally(excludingattributablecancerdeaths)and36000insubSaharanAfrica,although others have argued that the figure should be much higher (51). Van der Werf et al (52), using limited data from Africa, estimated that schistosomiasis caused 210000 deaths annually. For the GBD 2004 update (3), very limited available data was used to conservatively estimate annual case fatality rates for prevalent cases at 0.01% for S.mansoni, 0.02% for S.haematobium, and 0.03% for S.japonicum and S.mekongi.Therewereestimatedtobe261millionprevalentcasesofschistosomiasisinfectionin2004. The GBD 2010 study estimated that there 11,650 deaths due to schistosomias in 2010, of which 1,813 were in the Middle East and North Africa, and only 61 in subSaharan Africa in 2010. Divided by the numbers of prevalent cases estimated by the GBD 2010, the implied case fatality rates for the Middle East and North Africa, and for Latin America are 0.01% and 0.02% respectively. In comparison, the implied African case fatality rate is almost 400 times smaller. Implied case fatality rates for nonAfrican regionsintheGBD2010weregenerallyconsistentwiththosepreviouslyestimatedbyWHOfortheyear 2004.Revised case fatality ratesof 0.0075% for S.mansoni, 0.015%for S.haematobium were applied to the prevalence rates estimated by GBD 2010 (53) to revise the estimates of schistosomiasis deaths for GHE. This resulted in an estimate of 17,600 deaths in subSaharan Africa and 23,300 deaths globally in 2011.
5.7 Maternal causes of death

Countryspecific estimates for maternal mortality were based on the recent Interagency estimates for years 20002011 (27,54). For 62 Member States with relatively complete data from national death registration systems, these data were used directly for estimating and projecting maternal mortality ratios. For other Member States, a multilevel regression model was developed using available national level data from surveys, censuses, surveillance systems and death registration. This regression model included national income per capita, the general fertility rate and the presence of a skilled attendant at birth(asaproportionoftotalbirths)ascovariatestopredicttrendsinmaternalmortality. Notethatnumbersofmaternaldeathswereadjustedupwardsbyacountryspecificfraction,orby50%, for countries with useable death registration data but without countryspecific data on misclassification of maternal deaths, to allow for underidentification of maternal deaths. Note also that the maternal mortality estimates include those HIV deaths occurring in pregnant women or within 42 days of end of pregnancy which were considered to be indirect maternal deaths rather than incidental. These HIV maternaldeathsweresubtractedfromtotalHIVdeathsasestimatedbyUNAIDS.
5.8 Cancers
Causespecific estimates for cancer deaths were derived from Globocan 2008 (55) for countries without useable death registration data. Sitespecific deaths were projected back to year 2000 and forwards to year2011usingtrendestimatesfromtheGBD2010(26). World Health Organization Page 24
Karposi sarcoma was excluded from the Globocan estimates as this is almost entirely a manifestation of HIV/AIDS, already included in the estimates for HIV/AIDS deaths. Deaths due to nonmelanoma skin cancerswereincludedintheseestimatesalongwithmelanoma,unlikeinGlobocan2008.
5.9 Alcohol use and drug use disorders

The injury codes for accidental poisoning by alcohol and by opioids are now used to code acute intoxication deaths from alcohol and acute overdose deaths by opioids. These deaths have been remapped to alcohol use disorders and drug use disorders respectively (see Annex Table A). WHO estimates of direct deaths associated with alcohol use disorders and total deaths attributable to alcohol consumption are under revision for a forthcoming report. The interim estimates included here for alcoholusedisorderswillberevisedinthenextrevisiontotaketheseupdatesintoaccount. GBD 2010 estimates of deaths due to drug use disorders were revised to correct an extremely low implied case fatality rate for opioid dependent drug users in South Asia and for consistency with estimatesof prevalence and mortality associateduse of illicit opiate drugsreported by the UN Office on Drugs and Crime (UNODC) (56). UNODC estimated that there were around 17 million opiate users globallyin2010,withhigherthanaverageprevalenceofopioidusersinNorthAmerica,Oceania,Eastern Europe and South East Europe. These estimates were quite similar to those of the IHMEGBD 2010, which estimated a global prevalence of 17.3 million for opioid dependence in 2010 (53). The IHMEGBD 2010estimated atotal of77,615 deathsfor druguse disordersin 2010,of which43,000 werefor opioid use disorders. The implied case fatality rate of opioid use was 0.25% globally, 0.23% in the Middle East and North Africa, and just under 0.1% in East and South East Asia. In contrast, the implied case fatality rateof0.025%inSouthAsiawasonly1/10thoftheglobalaverage.Estimatedopioiddependencedeaths wereconservativelyrevisedupwardsforSouthAsiatogiveanimpliedcasefatalityratesimilartothatof theotherAsianregions.TheresultingGHEestimateof91,900deathsforalldrugusedisordersin2011is similar to the UNODC estimate of around 100,000 total direct drug use deaths in 2010 (with an additional 100,000 deaths from other causes, such as infectious diseases, also attributable to drug use disorders).
5.10 Epilepsy
The Million Death Study for India (32,33) recorded relatively high proportions of epilepsy deaths, resulting in an initial GHE estimate of 73,600 epilepsy deaths in India in 2010 compared to an estimated 21,650bytheGBD2010.GBD2010estimatesofuntreatedidiopathicepilepsyprevalencewereusedto calculate implied regional case fatality rates (CFR) and the implied Indian CFR of 0.34 was substantially higher than those for South East Asia (0.09) or the Middle East and North Africa (0.05). Indian epilepsy deaths were adjusted downwards to give an implied case fatality rate of 0.17 (close to the global average),resultinginanestimated35,480epilepsydeathsforIndiain2010.
5.11 Road injuries

For the second WHO Global status report on road safety (57), updated estimates of road injury deaths were prepared for 182 Member States for the year 2010. These estimates drew on death registration data, on reported road traffic deaths from official road traffic surveillance systems (collected in a WHO survey of Member States for the report), and on a revised regression model for countries without useabledeathregistrationdata.Thesamemethodswereusedtodeveloptimeseriesestimatesof road injurydeathsforyears20002011forallMemberStates. The methods used for four groups of countries are summarized below and the method used for each countryisdocumentedinAnnexTableG. World Health Organization Page 25
5.11.1 Countries with death registration data This group includes 87 countries with death registration data meeting one of the following completeness criteria, viz. completeness for the year estimated at 80% or more, or average completenessforthedecadeincludingthecountryyearwas80%ormore. Thesecountriesfellintothreecategories: 1. Forcountrieswithdeathregistrationdatafortheyear2010whichexceededthenumberofroad traffic deaths reported in the survey death registration data was used. There were 33 countriesinthiscategory. 2. ForcountrieswherethelatestdeathregistrationdatasubmittedtoWHOwasearlierthan 2010, but not earlier than 2005 deaths for 2010 were estimated based on a projection of the most recent death registration data using the trends obtained through the survey. There were 40 countriesinthiscategory. 3. For countries where the reported road traffic deaths for 2010 obtained through the survey exceeded the estimate based on death registration data: The reported road traffic deaths (adjusted to the 1 year definition) were used. There were 12 countries in this category. There wereanadditional2countrieswherereporteddataforearlieryearswereprojectedto2010and usedbecausetheyexceededthedeathregistrationnumbers. 5.11.2 Countries with other sources of information on causes of death For India, Iran, Thailand and Viet Nam, data on total deaths by cause were available for a single year or an earlier recent single year or group of years (33,5860). For these countries, the regression method described below was used to project forward from the most recent year for which an estimate of total roadtrafficdeathswereavailable. 5.11.3 Countries with populations less than 150 000 For 13 small countries with populations of less than 150 000 people the deaths reported in the survey wereuseddirectlywithoutadjustment. 5.11.4 Countries without eligible death registration data For 78 countries which did not fall into any of the above groups, a regression model was used to estimate total road traffic deaths. The regression model produced estimates of total road traffic deaths accordingtotheacceptedInternationalClassificationofDiseasedefinition,whichcountsalldeathsthat follow from a road traffic death, regardless of the time period in which they occur (unlike many official road traffic surveillance data sources, where road traffic death data is based on a 30day definition following a road traffic crash). Where total deaths reported by Member States surveillance systems weregreaterthanthedeathsestimatedfromtheregression,thesewereused. Threeclassesofmodelsweretestedandanegativebinomialcountsmodelwaschosen:
ln N C 1 X 1 2 X 2 .... n X n ln Pop
(1)
where N is the total road traffic deaths (for a countryyear), C is a constant term, Xi are a set of explanatory covariates, Pop is the population for the countryyear, included as an offset, and is the negative binomial error term. This model was estimated using death registration data for the period 19502010 that were 80% or more complete for a given year or where the average completeness for
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thelastdecadewasgreaterorequalto80%.Italsoincludednationallyrepresentativeverbalautopsyor sampledeathregistrationdataforIndia,ChinaandVietnam. Threemodels(A,BandC)werechosenthathadgoodinsampleandoutofsamplefit,andforwhichall the covariates (see Table 5.1) were statistically significant at the 95% level. The final estimates were basedontheaveragepredictionsofthesethreebestmodels. Age distributions for road injury deaths were based on regional age distributions estimated in the GBD 2010study(26). Table5.1.Covariatesusedinthemodelforroadinjurydeaths
Independent variables ln(GDP) Description WHOestimatesofGrossDomesticProduct (GDP)percapita(internationaldollarsor purchasingpowerparitydollars,2005base) Totalvehiclesper1000persons Totalroads(km)per1000hectares Themaximumnationalspeedlimitsonrural roads(km/h)fromWHOquestionnaire Themaximumnationalspeedlimitsonurban roads(km/h)fromWHOquestionnaire Healthsystemaccessvariable(principal componentscorebasedonasetofcoverage indicatorsforeachcountry) Litersofalcohol(recordedplusunrecorded) peradultaged15+ Proportionofpopulationaged1516years Percentoftotalvehiclesthataremotorbikes Controlofcorruptionindex(unitsrangefrom about2.5to+2.5withhighervalues correspondingtobettercontrolofcorruption Existenceofnationalpoliciesthatencourage walkingand/orcycling Totalpopulation(usedasoffsetinnegative binomialregression Sourceofinformation WHOdatabase Included inmodels A,B,C
ln(vehiclesper capita) Roaddensity Nationalspeedlimits onruralroads Nationalspeedlimits onurbanroads Healthsystemaccess
GSRRSsurveysandWHOdatabase InternationalFuturesdatabase(63) GSRRSsurvey(57) GSRRSsurvey(57) InstituteforHealthMetricsand Evaluationdataset(61) WHOdatabase WorldPopulationProspects2010 revision(UNDESA) GSRRSsurvey(57) WorldBank(62),International Futuresdatabase(63) GSRRSsurvey(57) WorldPopulationProspects2010 revision(12)
A,B,C A,B,C A,B,C A,B,C A,B,C
Alcoholapparent consumption Populationworking Percentage motorbikes Corruptionindex
A,B,C A,B,C B B
Nationalpoliciesfor walking/cycling Population
C A,B,C
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5.12 Conflict and natural disasters

Estimated deaths for major natural disasters were obtained from the CRED International Disaster Database (64). For countryyears where disaster death rates exceeded 1 per 10,000 population, these deaths were added to the life table death rates for the relevant year. Agesex distributions were based onanumberofstudiesofearthquakedeaths(65,66)andtsunamideaths(67,68). Countryspecific estimates of war and conflict deaths were updated for the entire period 19902011 using revised methods together with information on conflict intensity, time trends, and mortality obtainedfromanumberofwarmortalitydatabases(describedbelow).Theseestimatesrelatetodeaths forwhichtheunderlyingcause(followingICDconventions)wasaninjuryduetowar,civilinsurrectionor organized conflict, whether or not that injury occurred during the time of war or after cessation of hostilities. The estimates include injury deaths resulting from all organized conflicts, including organized terrorist groups, whether or not a national government was involved. They do not include deaths from other causes (such as starvation, infectious disease epidemics, lack of medical intervention for chronic diseases),whichmaybecounterfactuallyattributabletowarorcivilconflict. Methods used previously by WHO for estimation of direct conflict deaths were developed in the early 2000s and applied adjustment factors for underreporting to estimates of battlefield or conflict deaths from a variety of published and unpublished conflict mortality databases (6972). Murray et al. (73) summarized the issues with estimation of war deaths, and emphasized the very considerable uncertainty in the original Global Burden of Disease estimates (74) and subsequent WHO estimates for conflict deaths. WHO published estimates for the years 2000 through 2008 used adjustment factors based on conflict intensity developed from an analysis of likely levels of underreporting (14). These adjustmentfactorsrangedfromaround3tohigherthan4insubSaharanAfrica. Obermeyer, Murray and Gakidou (75) more recently analyzed data on deaths due to conflict from post conflict sibling histories collected in the 2002 to 2003 WHO World Health Survey (WHS) program. They used data from 13 countries with more than 5 reported sibling deaths from war injuries in at least one 10year period to estimate total war deaths for these countries for the period 19552002. The authors thencomparedtheirestimatesofwardeathstothenumberofwardeathsestimatedintheUCDPBattle Deathsdatabase(76)toderiveanaverageadjustmentfactorof2.96.GarfieldandBlore(77)notedthat a very small number of war deaths for Georgia resulted in an outlier ratio of 12.0 which heavily influenced the overall ratio of 2.96. They reanalyzed the WHSderived war deaths dataset excluding Georgia,toobtainanoverallrevisedadjustmentfactorof2.21. The revised WHO countryspecific estimates of war and conflict deaths for the period 19902011 make use of estimates of direct deaths from three datasets: BattleRelated Deaths (version 5), NonState Conflict Dataset (UCDP version 2.4), and Onesided Violence Dataset (UCDP version 1.4) from 1989 to 2011 (7880). Using these three datasets, instead of focusing solely on battlerelated deaths, reduces the likelihood that overall direct conflict deaths are underestimated. However, it likely that a degree of undercounting still occurs in the countbased datasets, and the adjusted ratio obtained by Garfield and Blore (77) of 2.21 is applied to the annual battle death main estimates for statestate conflicts (78). No adjustments were applied to estimated conflict deaths (main estimates) for nonstate conflict deaths (79),andonesidedviolence(80). Additional information from epidemiological studies and surveys was also used for Iraq (81,82). Deaths due to landmines and unexploded ordinance were estimated separately by country (83). Agesex distributions for conflict deaths were revised based on available distributions of conflict deaths by age andsexforspecificconflicts(73,75,8186). Thefollowingtablessummarizesandcomparesvarioustimeseriesofconflictdeathsestimates. World Health Organization Page 28
Table 5.2. Estimated total global injury deaths (thousands) due to conflict: comparison of various time seriesandWHOestimates
Year GBD1990(a) WHO20002008 UCDCPRIO WHO2013(i) (h) 95 85 30 18 34 28 138 122 95 69 84 57 IHMEGBD2010(j)
1990 2000 2000 2000 2004 2005 2008 2010
502 656 834
310(b) 230(c) 187(d) 182(e) 238(f) 182(g)
63 53 26 18
(a)EstimatesandprojectionsbyMurrayandLopez(74) (b)WorldHealthReport2001(87)andWorldreportonviolenceandhealth(88). (c)WorldHealthReport2002(1) (d)RevisionforDiseaseControlPrioritiesStudy(2) (e)Globalburdenofdisease:2004update(3) (f)WorldHealthStatistics2007(89) (g)WHOestimatesofcausesofdeathforyear2008(4) (h)Sumofmainestimatesofconflictdeathsforstatestate,statenonstateandonesidedconflicts(7880) (i)RevisedWHOestimatesforyears19902011asdocumentedhere. (j)IHMEGlobalBurdenofDiseaseStudy2010(26).
The revised WHO estimates for total conflict deaths (in the column WHO 2013) are considerably lower than the previous WHO estimates for years 20002008 which used the earlier higher adjustment factor for underreporting, which in turn are lower than the previous estimates and projections in the original GBD study (74). The recently estimates for conflict deaths published by IHME in the GBD 2010 study, shown in the rightmost column, are considerable lower than the revised WHO estimates. For the year 2010, the IHME estimates are also lower than the main estimate from the UCDCPRIO databases for the same year. The IHME methods were based on a regression analysis of available allcause mortality data for countryyears in which battle deaths were reported in various databases. Lozano et al (26) cite (90) formoredetaileddocumentationoftheirmethods. The revised WHO estimates for conflict deaths were taken into account in preparing final allcause mortality envelopes for Member States for years 19902011 as follows. For countryyears where death ratesfromconflictordisastersexceeded1per10,000population,theestimatedannualagesexspecific conflict deaths were added to the life table death rates for the relevant year. In cases of extended conflicts where death rates fluctuated above and below 1 per 10,000, only the death rate in excess of 1 per10,000wasaddedtorelevantyears.
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Other causes of death for countries without useable data
Previous WHO comprehensive estimates of causes of death have relied on causeofdeath modelling and available data on cause of death distributions within each analysis subregion to estimate causes of death for countries without useable data and where WHO causespecific analyses were not available (2, 3). The IHME developed covariate based estimation models for a large number of single causes as inputstoitsoverallestimationofnumbersofdeathsbycountry,cause,ageandsexforyears19902010 in the GBD 2010 study (810). Results from these models are used as inputs to WHO Global Health Estimates for causes of death not addressed by WHO and UN Interagency estimation processes and wherecountriesdidnothaveuseabledeathregistrationdata,asdescribedbelow. SixdifferentmodellingstrategieswereusedbyIHMEforcausesofdeathdependingontheavailabilityof data (26,webappendix). For all major causes of death except HIV/AIDS and measles, IHME used ensemble modelling to create a weighted average of many individual covariatebased models (ranging from hundreds to thousands in some cases) for each specific cause (26,91). IHME cause of death estimation methods are thus complex and highly computerintensive. The overall outofsample predictive validity of the ensemble is usually not much different to that of the topranked model, but uncertaintyrangesaregenerallymuchwiderandmoreplausiblethanforsinglemodels. IHME results for priority causes such as HIV, TB, malaria, cancers, maternal mortality, child mortality differtovaryingdegreesfromthoseofWHOandUNagencypartners.Inpart,thisreflectsdifferencesin modelling strategies, but also the inclusion by IHME of data from verbal autopsy (VA) studies which has been mapped to ICD categories using IHMEdeveloped computer algorithms. WHO aims to work with IHME and expert groups to further improve data and methods, which requires that all input data and detailed analysis methods and results are made available. Figure 6.1 provides a comparison of major cause group death rates for the GBD 2010 and WHO GHE results for year 2010 for seven broad regional groupings. To ensure that the results of all the singlecause models summed to the allcause mortality estimate for each agesexcountryyear group, IHME applied a final step called CoDCorrect to rescale the cause specific estimates. This was done using repeated random draws from the uncertainty distributions of each single cause and from the allcause envelope, and proportionately rescaling each single cause estimate so they collectively summed to the envelope estimate. The overall effect is to squeeze or expandcauseswithwideruncertaintyrangesmorethanthosewithnarroweruncertaintyranges. GBD2010results,postCoDCorrect,wereusedasinputstoestimatecausefractionsbycountry,age,sex andyearforcausesofdeathatagesfiveyearsandaboveforwhichdeathregistrationdataand/orWHO and UN Interagency analyses (described in Section 5) were not available. For this set of causes, GBD 2010 countrylevel estimates for death rates at ages 5 and over for years 1990, 1995, 2000, 2005 and 2010 were interpolated to death rates for all years in the range 20002011 using cubic spline interpolation of log(death rates. Cause fraction distributions were then computed for the set of causes excluding WHO/Interagency causespecific estimates. For countries where these cause fractions were used (see Annex Table G), they were applied to the countrylevel residual mortality envelopes by age and sex after the WHO/Interagency causespecific estimates were subtracted from the WHO allcause envelopes. Table 6.1 summarizes the overall percentage change in the GBD 2010 estimates for each of these residual causes resulting from the above process. This provides a rough metric of how much inconsistency there is between the GBD 2010 and the GHE 2010 estimates for ages five and over as a resultofdifferencesinallcauseenvelopesandWHO/Interagencyestimatesforspecificcauses. World Health Organization Page 30
Figure6.1.ComparisonofGHEandIHMEdeathratesper100,000population,majorcausegroups,2010
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Table 6.1. Ratio of GHE total deaths for residual causes to GBD 2010 total deaths for residual causes, low and middleincome countries without useable death registration data, by WHO Region and age group,2000and2011 514 3.70 1.75 1.48 0.95 1.29 1.38 2.47 Ratio2000 1549 5069 1.50 1.36 1.25 1.10 0.91 0.84 0.89 0.98 1.09 1.04 0.78 0.77 1.20 1.06 70+ 1.44 1.01 1.09 1.11 1.11 1.00 1.16 514 4.15 2.05 1.65 0.54 1.05 1.21 2.77 Ratio2011 1549 5069 1.57 1.23 1.28 1.14 0.81 0.88 0.62 0.83 0.83 1.02 0.58 0.68 1.12 1.02 70+ 1.36 1.07 1.12 1.08 1.10 0.95 1.15
AFR AMR EMR EUR SEAR WPR World
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Uncertainty of estimates
Countrylevel estimates of mortality for 2004 and 2008 previously released on the WHO website included guidance to users on the data sources and methods used for each country, in terms of four levelsofevidence.ComprehensiveuncertaintyrangeshavenotyetbeenaddressedfortheGHEcauseof death estimates although uncertainty ranges are available for many of the component analyses for specific causes (refer to the detailed documentation of sources in Sections 4 and 5). General guidance on the quality and uncertainty of these cause of death estimates for years 20002011 is provided in termsof the quality ofdata inputs and methodsused. These are broadlysummarized for WHO Member StatesinAnnexTableFforgeneralmortalityandcauseofdeathmethods. WHOsadoption of healthestimates is affectedby a numberof factors, includinga country consultation process for countrylevel health estimates, existing multiagency and expert group collaborative mechanisms, and compliance with minimum standards around data transparency, data and methods sharing. More detailed information on quality of data sources and methods, as well as estimated uncertaintyintervals,isprovidedinreferencedsourcesforspecificcauses(Sections4and5). Calculated uncertainty ranges depend on the assumptions and methods used. In practice, estimating uncertainty in a consistent way across health indicators has had limited success (i.e., estimates with uncertainty typically reflect some, but not all, source of uncertainty). Most methods for estimation of uncertainty rely on statistical techniques to assess variations across observations and take into account sampling error but are less successful in dealing with unknown systematic bias in observations. In particular, there is not yet sufficient research or consensus on the interpretation and use of verbal autopsy studies to ensure that systematic bias in assigning underlying cause of death can be fully addressedorresultinguncertaintyfullyquantified. The type and complexity of models used for global health estimates varies widely by research/institutionalgroupandhealthestimate.Morecomplexmodelsarenecessarytogeneratemore accurate uncertainty intervals. As expected, these are more difficult to transfer across research groups and require greater researcher expertise and time and computational resources to run. Where data are available and of high quality, estimates from different institutions are generally in agreement. Discrepancies are more likely to arise for countries where data are poor and for conditions where data aresparseandpotentiallybiased.Thisisbestaddressedthroughimprovingtheprimarydata. Country health information systems, including vital registration, need to be strengthened as a matter of priority, in order to provide a more solid empirical basis for monitoring health situation and trends is essential.SuchdataarealsocrucialforMemberStatesmonitoringoflocaltrendsinordertorespondto thechangingneedsoftheirpopulations. To improve monitoring of mortality, morbidity and risk factors the improving health information systemsshouldfocusonstrengthening: Although the GHE estimates for years 20002011 have large uncertainty ranges for some causes and some regions, they provide useful information on broad relativities of disease burden, on the relative World Health Organization Page 33 Death registration through civil registration and vital statistics systems (CRVS), local health and demographicstudiesandothersources Causeofdeathdatacollectionthroughvitalregistrationandverbalautopsyincommunities Regularhouseholdhealthsurveysthatincludebiologicalandclinicaldatacollection Completefacilityrecordingandreportingwithregularqualitycontrol
importance of different causes of death, and on regional patterns and inequalities. The data gaps and limitations in highmortality regions reinforces the need for caution when interpreting global comparative cause of death assessments and the need for increased investment in population health measurementsystems.Theuseofverbalautopsymethodsinsampleregistrationsystems,demographic surveillance systems and household surveys provides some information on causes of death in populations without wellfunctioning death registration systems, but there remain considerable challengesinthevalidationandinterpretationofsuchdata. Figure7.1summarizestheproportionaldistributionsofdeathsbyage,sexandcauseforyears2000and 2011. More detailed regional tabulations of deaths by cause, age and sex for years 2000 and 2011 are available in the WHO Global Health Observatory (www.who.int/gho) and as downloadable Excel spreadsheetsathttp://www.who.int/healthinfo/global_health_estimates/en/. Figure7.1Percentageofdeathsbycauseforglobalagesexgroups,2000and2011.
Males,2000
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 Age(years)
Females,2000
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 Age(years)
Males,2011
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 Age(years)
Females,2011
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 Age(years)
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These estimates for years 20002011 supercede and replace all previous estimates for global and regional causes of death published by WHO. They are not directly comparable with previous WHO estimates for 2008 and earlier years and differences should not be interpreted as trends. Figures 7.2 and 7.3 provide summary comparisons of the GHE estimates for year 2008 with the previous WHO estimatesforyear2008publishedin2011(4,5).Thesefiguresillustratethattherehasbeenlittlechange in the relative ranking for the leading causes of death, although estimated numbers of deaths are somewhat lower for most causes. This partially reflects downwards revision of allcause envelopes in recent successive revisions by UNIGME and UN Population Division, but also reflects accelerating declinesinchildmortality,andtoalesserextent,adultmortalityinrecentyears. Theseareprovisionalestimatesandwillbefurtherrevisedintheprocessofupdatingto2012forrelease at country level in late 2013. WHO and collaborators will continue to include new data and improve methods,anditisanticipatedthatsomecauseswillbefurtherupdatedinthenextrevision. Figure7.2.Changein10leadingcausesofdeathatgloballevel,GHEestimatesfor2011comparedwith previousWHOcauseofdeath(COD)estimatesforyear2008(4,5)
COD08(a)
Diseaseorinjury Is cha emi chea rtdi s ea s e Cerebrovas cul a rdi s ea s e Lowerres pi ratoryi nfecti ons COPD Di a rrhoea l di s ea s es HIV/AIDS Lung ca ncer Di a betes mel l i tus Road i njury Hypertens i ve heartdi s eas e Total deaths (millions) Rank 7.25 6.15 3.46 3.28 2.46 1.78 1.39 1.26 1.21 1.15 1.00 1 2 3 4 5 6 7 8 9 10 13
GHE2011(b)
Total deaths Rank (millions) Diseaseorinjury 1 7.02 Is cha emi cheartdi s eas e 2 3 4 5 6 7 8 9 10 11 6.25 Cerebrova s cul a rdi s eas e 3.20 Lowerres pi ra toryi nfecti ons 2.97 COPD 1.89 Di a rrhoea l di s ea s es 1.59 HIV/AIDS 1.48 Lungca ncer 1.39 Di a betes mel l i tus 1.26 Roa d i njury 1.17 Preterm bi rth compl i ca ti ons 1.06 Hypertens i ve hea rtdi s ea s e
Preterm bi rth compl i ca ti ons
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Figure7.3.Comparisonofdeathratesper100,000forninemajorcausegroups,GHEestimatesforyear 2008andpreviousWHOCODestimatesforyear2008,forworld,highincomecountries,andlowand middleincomecountriesgroupedbyWHOregion

1400
1200
1000
Suicide,homicideandconflict Otherunintentionalinjuries
800
Roadinjury Othernoncommunicable
600
Cancers Cardiovasculardiseases Maternal,neonatal,nutritional
400
Otherinfectiousdiseases HIV,TBandmalaria
200
0 COD08 GHE COD08 GHE COD08 GHE COD08 GHE
WorldAfricaAmericasEastern Mediterranean
1400
1200
1000
Suicide,homicideandconflict Otherunintentionalinjuries
800
Roadinjury Othernoncommunicable
600
Cancers Cardiovasculardiseases Maternal,neonatal,nutritional
400
Otherinfectiousdiseases HIV,TBandmalaria
200
0 COD08 GHE COD08 GHE COD08 GHE COD08 GHE
HighincomeEuropeSouthEastAsiaWesternPacific
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References
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Annex Table A GHE cause categories and ICD10 codes

Code
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37
GHE cause name

I. Communicable, maternal, perinatal and a nutritional conditions A. Infectious and parasitic diseases 1. Tuberculosis 2. Sexually transmitted diseases (STDs) excluding HIV a. Syphilis b. Chlamydia c. Gonorrhoea d. Trichomoniasis e. Other STDs 3. HIV/AIDS 4. Diarrhoeal diseases
b
ICD-10 code
A00-B99, G00-G04, N70-N73, J00-J22, H65-H68, O00-O99, P00-P96, E00-E02, E40-E46, E50-E64, D50-D53, D64.9, U04 A00-B99, G00, G03-G04, N70-N73 A15-A19, B90 A50-A64, N70-N73 A50-A53 A55-A56 A54 A59 A57-A58, A60-A64, N70-N73 B20-B24 A00, A01, A03, A04, A06-A09 A33-A37, B05 A37 A36 B05 A33-A35 A39, G00, G03
b
5. Childhood-cluster diseases a. Whooping cough b. Diphtheria c. Measles d. Tetanus 6. Meningitis 7. Encephalitis 8. Hepatitis B 9. Hepatitis C 10. Parasitic and vector diseases a. Malaria b. Trypanosomiasis c. Chagas disease d. Schistosomiasis e. Leishmaniasis f. Lymphatic filariasis
A83-A86, B94.1, G04 B16-B19 (minus B17.1, B18.2) B17.1, B18.2 A30, A71, A82, A90-A91, B50-B57, B65, B73, B74.0-B74.2 B50-B54, P37.3, P37.4 B56 B57 B65 B55 B74.0-B74.2 B73 A30 A90-A91 A71 A82 B76-B77, B79 B77 B79 B76 A02, A05, A20-A28, A31, A32, A38, A40-A49, A65-A70, A74A79, A80-A81, A87-A89, A92-A99, B00-B04, B06-B15, B25-B49, B58-B60, B64, B66-B72, B74.3-B74.9, B75,B78, B80-B89, B91B99 (minus B94.1)
g. Onchocerciasis h. Leprosy i. j. Dengue Trachoma
k. Rabies 11. Intestinal nematode infections a. Ascariasis b. Trichuriasis c. Hookworm disease 12. Other infectious diseases
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Code
38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 47 58 59 60
GHE cause name

B. Respiratory infections
b
ICD-10 code
J00-J22, H65-H68,P23, U04 J09-J22, P23, U04 J00-J06 H65-H68 O00-O99 O44-O46, O67, O72 O85-O86 O10-O16 O64-O66 O00-O07 O20-O43, O47-O63, O68-O71, O73-O75, O87-O99 P00-P96 excl P37.3, P37.4
b b
1. Lower respiratory infections 2. Upper respiratory infections 3. Otitis media C. Maternal conditions 1. Maternal haemorrhage 2. Maternal sepsis 3. Hypertensive disorders of pregnancy 4. Obstructed labour 5. Abortion 6. Other maternal conditions D. Neonatal conditions 1. Preterm birth complications
P05, P07, P22, P27-P28 P03, P10-P15, P20-P21, P24-P26, P29 P35-P39 (excluding P37.3, P37.4) P00-P02, P04, P08, P50-P96 E00-E02, E40-E46, E50-E64, D50-D53, D64.9 E40-E46 E00-E02 E50 D50, D64.9 D51-D53, E51-E64 C00-C97, D00-D48, D55-D64 (minus D 64.9), D65-D89, E03E07, E10-E16, E20-E34, E65-E88, F01-F99, G06-G98, H00H61, H68-H93, I00-I99, J30-J98, K00-K92, N00-N64, N75-N98, b b L00-L98, M00-M99, Q00-Q99, X41-X42 , X45 C00-C97
d
2. Birth asphyxia and birth trauma 3. Neonatal sepsis and infections 4. Other neonatal conditions E. Nutritional deficiencies 1. Protein-energy malnutrition 2. Iodine deficiency 3. Vitamin A deficiency 4. Iron-deficiency anaemia 5. Other nutritional disorders II. Noncommunicable diseases
a
61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78
A. Malignant neoplasms 1. Mouth and oropharynx cancers 2. Oesophagus cancer 3. Stomach cancer
d d d
C00-C14 C15 C16 C18-C21 C22 C25 C33-C34 C43-C44 C50 C53
d
4. Colon and rectum cancers 5. Liver cancer 6. Pancreas cancer
7. Trachea, bronchus and lung cancers 8. Melanoma and other skin cancers 9. Breast cancer
d d d
10. Cervix uteri cancer
11. Corpus uteri cancer 12. Ovary cancer 13. Prostate cancer 14. Bladder cancer
d d d
C54-C55 C56 C61 C67

d
15. Lymphomas and multiple myeloma 16. Leukaemia

d
C81-C90, C96 C91-C95 C17, C23, C24, C26-C32, C37-C41, C45-C49, C51, C52,C57C60, C62-C66, C68-C80, C97
17. Other malignant neoplasms
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Code
79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 I.
GHE cause name

B. Other neoplasms C. Diabetes mellitus D. Endocrine, blood, immune disorders E. Mental and behavioural disorders 1. Unipolar depressive disorders 2. Bipolar affective disorder 3. Schizophrenia 4. Alcohol use disorders 5. Drug use disorders 6. Anxiety disorders 7. Eating disorders 8. Pervasive developmental disorders 9. Childhood behavioural disorders 10. Idiopathic intellectual disability
ICD-10 code
D00-D48 E10-E14 D55-D64 (minus D64.9), D65-D89, E03-E07, E15-E34, E65-E88 F04-F99, X41-X42 , X45 F32-F33, F34.1 F30-F31 F20-F29 F10, X45
c c c c
F11-F16, F18-F19, X41-X42 F40-F44 F50 F84 F90-F92 F70-F79
11. Other mental and behavioural disorders F. Neurological conditions 1. Alzheimers disease and other dementias 2. Parkinson disease 3. Epilepsy 4. Multiple sclerosis 5. Migraine 6. Non-migraine headache 7. Other neurological conditions G. Sense organ diseases 1. Glaucoma 2. Cataracts 3. Refractive errors 4. Macular degeneration 5. Other vision loss 6. Other hearing loss 7. Other sense organ disorders H. Cardiovascular diseases 1. Rheumatic heart disease 2. Hypertensive heart disease 3. Ischaemic heart disease 4. Stroke 5. Cardiomyopathy, myocarditis, endocarditis 6. Other cardiovascular diseases Respiratory diseases 1. Chronic obstructive pulmonary disease 2. Asthma 3. Other respiratory diseases J. Digestive diseases
e e
F04-F09, F17, F34-F39 (minus F34.1), F45-F48, F51-F69, F80F83, F88-F89, F93-F99 F01-F03, G06 -G98 F01-F03, G30-G31 G20-G21 G40-G41 G35 G43 G44 G06-G12, G23-G25, G36-G37, G45-G98 H00-H61, H69-H93 H40 H25-H26 H49-H52 H35.3 H30-H35 (minus H35.3), H53-H54 H90-H91 H00-H21, H27, H43-H47, H55-H61, H69-H83, H92-H93 I00-I99 I01-I09 I10-I15 I20-I25 I60-I69 I30-I33, I38, I40, I42 I00, I26-I28, I34-I37, I44-I51, I70-I99 J30-J98 J40-J44 J45-J46 J30-J39, J47-J98 K20-K92
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Code
122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163
GHE cause name

1. Peptic ulcer disease 2. Cirrhosis of the liver 3. Appendicitis 4. Other digestive diseases K. Genitourinary diseases 1. Kidney diseases 2. Hyperplasia of prostate 3. Urolithiasis 4. Other genitourinary disorders 5. Infertility 6. Gynecological diseases L. Skin diseases M. Musculoskeletal diseases 1. Rheumatoid arthritis 2. Osteoarthritis 3. Gout 4. Back and neck pain 5. Other musculoskeletal disorders N. Congenital anomalies 1. Neural tube defects 2. Cleft lip and cleft palate 3. Down syndrome 4. Congenital heart anomalies 5. Other chromosomal anomalies 6. Other congenital anomalies O. Oral conditions 1. Dental caries 2. Periodontal disease 3. Edentulism III. Injuries A. Unintentional injuries 1. Road injury 2. Poisonings 3. Falls 4. Fire, heat and hot substances 5. Drownings 6. Exposure to forces of nature 7. Other unintentional injuries B. Intentional injuries 1. Self-harm 2. Interpersonal violence 3. Collective violence and legal intervention
f g f
ICD-10 code
K25-K27 K70, K74 K35-K37 K20-K22, K28-K31, K38-K66, K71-K73, K75-K92 N00-N64, N75-N76, N80-N98 N00-N19 N40 N20-N23 N25-N39, N41-N45, N47-N51 N46, N97 N60-N64, N75-N76, N80-N96, N98 L00-L98 M00-M99 M05-M06 M15-M19 M10 M45-M48, M50-M54 M00, M02, M08, M11-M13, M20-M43, M60-M99 Q00-Q99 Q00, Q05 Q35-Q37 Q90 Q20-Q28 Q91-Q99 Q01-Q04, Q06-Q18, Q30-Q34, Q38-Q89 K00-K14 K00-K04, K06-K14 K05 V01-Y89 V01-X40, X43-X44, X46-59, Y40-Y86, Y88, Y89 V01-V04, V06, V09-V80, V87, V89, V99 X40, X43-X44, X46-X49 W00-W19 X00-X19 W65-W74 X30-X39 Rest of V, W20-W64, W75-W99, X20-X29, X50-X59, Y40-Y86, Y88, Y89 X60-Y09, Y35-Y36, Y870, Y871 X60-X84, Y870 X85-Y09, Y871 Y35-Y36
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, not available
Deaths coded to Symptoms, signs and ill-defined conditions (R00-R99) are distributed proportionately to all causes within Group I and Group II.
b
For deaths under age 5, refer to classification in Annex Tables B and C.
As from 2006, deaths from causes F10-F19 with fourth character .0 (Acute intoxication) are coded to the category of accidental poisoning according to the updated ICD-10 instructions. Cancer deaths coded to ICD categories for malignant neoplasms of other and unspecified sites including those whose point of origin cannot be determined, and secondary and unspecified neoplasms (ICD-10 C76, C80, C97) were redistributed pro-rata across the footnoted malignant neoplasm categories within each agesex group, so that the category Other malignant neoplasms includes only malignant neoplasms of other specified sites (Ref Mathers et al 2006 DCP chapter). Ischaemic heart disease deaths may be miscoded to a number of so-called cardiovascular garbage codes. These include heart failure, ventricular dysrhythmias, generalized atherosclerosis and ill-defined descriptions and complications of heart disease. Proportions of deaths coded to these causes were redistributed to ischaemic heart disease as described in (GPE discussion paper). Relevant ICD-10 codes are I47.2, I49.0, I46, I50, I51.4, I51.5, I51.6, I51.9 and I70.9. Injury deaths where the intent is not determined (Y10-Y34, Y872) are distributed proportionately to all causes below the group level for injuries. For countries with 3-digit ICD10 data, for Road injury use: V01-V04, V06, V09-V80, V87, V89 and V99. For countries with 4-digit ICD10 data, for Road injury use: V01.1-V01.9, V02.1-V02.9, V03.1-V03.9, V04.1-V04.9, V06.1-V06.9, V09.2, V09.3, V10.3-V10.9, V11.3-V11.9, V12.3-V12.9, V13.3V13.9, V14.3-V14.9, V15.4-V15.9, V16.4-V16.9, V17.4-V17.9, V18.4-V18.9, V19.4-V19.9, V20.3-V20.9, V21.3-V21.9, V22.3-V22.9, V23.3-V23.9, V24.3-V24.9, V25.3-V25.9, V26.3-V26.9, V27.3-V27.9, V28.3-V28.9, V29.4-V29.9, V30.4.V30.9, V31.4-V31.9, V32.4V32.9, V33.4-V33.9, V34.4-V34.9, V35.4-V35.9, V36.4-V36.9, V37.4-V37.9, V38.4-V38.9, V39.4-V39.9, V40.4-V40.9, V41.4-V41.9, V42.4-V42.9, V43.4-V43.9, V44.4-V44.9, V45.4-V45.9, V46.4-V46.9, V47.4-V47.9, V48.4-V48.9, V49.4-V49.9, V50.4-V50.9, V51.4V51.9, V52.4-V52.9, V53.4-V53.9, V54.4-V54.9, V55.4-V55.9, V56.4-V56.9, V57.4-V57.9, V58.4-V58.9, V59.4-V59.9, V60.4-V60.9, V61.4-V61.9, V62.4-V62.9, V63.4-V63.9, V64.4-V64.9, V65.4-V65.9, V66.4-V66.9, V67.4-V67.9, V68.4-V68.9, V69.4-V69.9, V70.4V70.9, V71.4-V71.9, V72.4-V72.9, V73.4-V73.9, V74.4-V74.9, V75.4-V75.9, V76.4-V76.9, V77.4-V77.9, V78.4-V78.9, V79.4-V79.9, V80.3-V80.5, V81.1, V82.1, V82.8-V82.9, V83.0-V83.3, V84.0-V84.3, V85.0-V85.3, V86.0-V86.3, V87.0-V87.9, V89.2-V89.3, V89.9, V99 and Y850.
g f e d
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Annex Table B Firstlevel categories for analysis of child causes of death

GBD cause name
All causes I. Communicable, maternal, perinatal and nutritional a conditions HIV/AIDS Diarrhoeal diseases Pertussis Tetanus Measles Meningitis/encephalitis Malaria Acute respiratory infections Prematurity Birth asphyxia & birth trauma Sepsis and other infectious conditions of the newborn Other Group I II. Noncommunicable diseases
a
ICD-10 code
A00-Y89 A00-B99, D50-D53, D64.9, E00-E02, E40-E64, G00, G03-G04, H65-H66, J00J22, J85, N30, N34, N390, N70-N73, O00-P96, U04
B20-B24 A00-A09 A37 A33-A35 B05 A39, A83-A87, G00, G03, G04 B50-B54, P37.3, P37.4 H65-H66, J00-J22, J85, P23, U04 P01.0, P01.1, P07, P22, P25-P28, P61.2, P77 P01.7-P02.1, P02.4-P02.6, P03, P10-P15, P20-P21, P24, P50, P90-P91 P35-P39 (exclude P37.3, P37.4)
Remainder C00-C97, D00-D48, D55-D64 (exclude D64.9), D65-D89, E03-E34, E65-E88, F01F99, G06-G98, H00-H61, H68-H93, I00-I99, J30-J84, J86-J98, K00-K92, L00-L98, M00-M99, N00-N28, N31-N32, N35-N64 (exclude N39.0), N75-N98, Q00-Q99 Q00-Q99 Remainder V01-Y89
Congenital anomalies Other Group II III. Injuries

a
Deaths coded to Symptoms, signs and ill-defined conditions (780-799 in ICD-9 and R00-R99 in ICD-10) are distributed proportionately to all causes within Group I and Group II.
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Annex Table C Reassignment of ICD10 codes for certain neonatal deaths.
Cause A153 A162 A165 A169 A170 A180 A320 A321 A327 A328 A329 A35 A40 A401 A402 A403 A408 A409 A41 A410 A412 A413 A415 A418 A419 B00 B000 B004 B007 B008 B009 B01 B010 B011 B012 B018 B019 B059 B060 B068 continued
Recode P370 P370 P370 P370 P370 P370 P372 P372 P372 P372 P372 A33 P36 P360 P361 P361 P361 P361 P36 P362 P363 P368 P368 P368 P369 P35 P352 P352 P352 P352 P352 P35 P358 P358 P358 P358 P358 P358 P350 P350
Cause D649 D65 D696 D699 E101 E102 E110 E112 E116 E117 E140 E144 E145 E147 E149 E343 E86 E87 E870 E871 E872 E874 E875 E876 E877 E878 F322 F328 F329 F439 G91 G911 G912 G913 G919 G930 G931 G936 G952 I050
Recode P614 P60 D694 P549 P702 P702 P702 P702 P702 P702 P702 P702 P702 P702 P702 P051 P74 P74 P742 P742 P740 P748 P743 P743 P744 P744 P914 P914 P914 P209 Q03 Q039 Q039 Q039 Q039 Q046 P219 P524 P025 Q232
Cause I471 I472 I479 I48 I490 I494 I498 I499 I50 I500 I501 I509 I517 I518 I519 I60 I603 I607 I608 I609 I61 I610 I612 I615 I616 I618 I619 I620 I629 I632 I633 I634 I635 I638 I639 I64 I671 J12 J120 J121
Recode P291 P291 P291 P29 P291 P291 P291 P291 P29 P290 P290 P290 Q248 Q248 Q249 P52 P525 P525 P525 P525 P52 P524 P524 P524 P524 P524 P524 P528 P529 P529 P529 P529 P529 P529 P529 P52 I607 P23 P230 P230
Cause J698 J70 J709 J80 J840 J841 J848 J849 J85 J850 J851 J852 J860 J869 J90 J930 J931 J938 J939 J940 J941 J942 J948 J96 J960 J961 J969 J980 J981 J982 J984 J985 J986 J988 J989 K220 K311 K44 K440 K441
Recode P249 P24 P249 P22 P258 P258 P258 P258 P28 P288 P288 P288 P288 P288 P28 P251 P251 P251 P251 P288 P288 P548 P288 P28 P285 P285 P285 P288 P281 P250 P288 P288 P288 P288 P289 Q395 Q400 Q79 Q790 Q790
Cause K760 K761 K762 K763 K767 K768 K769 K819 K82 K828 K830 K831 K838 K839 K85 K868 K869 K904 K909 K920 K922 K928 K929 N133 N139 N17 N170 N171 N172 N179 N180 N188 N189 N19 N359 N390 N433 N883 R001 R011
Recode P788 P788 P788 P788 P788 P788 P788 P788 P78 P788 P788 P788 P788 P788 P78 P788 P788 P788 P788 P540 P543 P788 P789 Q620 Q623 P96 P960 P960 P960 P960 P960 P960 P960 P96 Q643 P393 P835 P010 P209 P298
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Annex Table C (continued): Re-assignment of ICD-10 codes for certain neonatal deaths.
Cause B069 B09 B25 B250 B251 B258 B259 B270 B370 B371 B372 B373 B374 B375 B376 B377 B378 B379 B509 B54 B582 B589 D500 D609 D62
Recode P350 P35 P35 P351 P351 P351 P351 P358 P375 P375 P375 P375 P375 P375 P375 P375 P375 P375 P373 P37 P371 P371 P549 D610 P61
Cause I059 I071 I080 I340 I348 I35 I350 I351 I352 I359 I370 I379 I38 I42 I420 I421 I422 I429 I442 I443 I455 I458 I459 I460 I469
Recode Q238 Q228 Q238 Q233 Q238 Q23 Q230 Q231 Q238 Q238 Q221 Q223 I42 I42 I424 Q248 I424 I424 Q246 Q246 Q246 Q246 Q246 P291 P291
Cause J128 J129 J13 J14 J15 J150 J151 J152 J153 J154 J155 J156 J157 J158 J159 J16 J18 J180 J181 J188 J189 J386 J439 J69 J690
Recode P230 P230 P23 P23 P23 P236 P235 P232 P233 P236 P234 P236 P236 P236 P236 P23 P23 P239 P239 P239 P239 Q318 P250 P24 P249
Cause K449 K561 K562 K565 K566 K57 K593 K625 K631 K633 K65 K650 K659 K660 K661 K720 K729 K732 K745 K746 K750 K752 K758 K759
Recode Q790 Q438 Q438 Q433 P769 Q43 Q431 P542 P780 P788 P78 P781 P781 Q433 P548 P788 P788 P788 P788 P788 P788 P788 P788 P788
Cause R030 R040 R042 R048 R049 R05 R060 R064 R068 R090 R092 R160 R162 R230 R509 R568 R571 R58 R601 R628 R629 R630 R638 R75
Recode P292 P548 P269 P548 P548 P28 P228 P228 P228 P219 P285 Q447 Q447 Q249 P819 P90 P741 P54 P833 P059 P059 P929 P929 B24
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Annex Table D Country groupings used for regional tabulations

D.1 WHO Regions and Member States
WHO African Region Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comoros, Congo, Cte d'Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, GuineaBissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, South Africa, Swaziland, Togo, Uganda, United Republic of Tanzania,Zambia,Zimbabwe WHO Region of the Americas Antigua and Barbuda, Argentina, Bahamas, Barbados, Belize, Bolivia (Plurinational State of), Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, UnitedStatesofAmerica,Uruguay,Venezuela(BolivarianRepublicof) WHO South-East Asia Region Bangladesh, Bhutan, Democratic People's Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal,SriLanka,Thailand,TimorLeste WHO European Region Albania, Andorra, Armenia, Austria, Azerbaijan, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Georgia, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Luxembourg, Malta, Monaco, Montenegro, Netherlands, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, Tajikistan, The former YugoslavRepublicofMacedonia,Turkey,Turkmenistan,Ukraine,UnitedKingdom,Uzbekistan WHO Eastern Mediterranean Region Afghanistan, Bahrain, Djibouti, Egypt, Iran (Islamic Republic of), Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Qatar, Saudi Arabia, Somalia, South Sudan, Sudan, Syrian Arab Republic, Tunisia,UnitedArabEmirates,Yemen WHO Western Pacific Region Australia, Brunei Darussalam, Cambodia, China, Cook Islands, Fiji, Japan, Kiribati, Lao People's Democratic Republic, Malaysia, Marshall Islands, Micronesia (Federated States of), Mongolia, Nauru, New Zealand, Niue, Palau, Papua New Guinea, Philippines, Republic of Korea, Samoa, Singapore, SolomonIslands,Tonga,Tuvalu,Vanuatu,VietNam
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D.2 Countries grouped by WHO Region and average income per capita*
High income Andorra, Australia, Austria, Bahamas, Bahrain, Barbados, Belgium, Brunei Darussalam Canada, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Luxembourg, Malta, Monaco, Netherlands, ,New Zealand, Norway, Oman, Poland, Portugal, Qatar, Republic of Korea, Saint Kitts and Nevis, San Marino, Saudi Arabia, Singapore, Slovakia, Slovenia, Spain, Sweden, Switzerland, Trinidad and Tobago, United Arab Emirates, United Kingdom,UnitedStatesofAmerica Low and middle income WHO African Region Algeria, Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comoros, Congo, Cte d'Ivoire, Democratic Republic of the Congo, Equatorial Guinea**, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, GuineaBissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, South Africa, Swaziland, Togo, Uganda, United Republic of Tanzania,Zambia,Zimbabwe WHO Region of the Americas Antigua and Barbuda, Argentina, Belize, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Lucia, Saint Vincent and the Grenadines,Suriname,Uruguay,Venezuela(BolivarianRepublicof) WHO South-East Asia Region Bangladesh, Bhutan, Democratic People's Republic of Korea, India, Indonesia, Maldives, Myanmar, Nepal,SriLanka,Thailand,TimorLeste WHO European Region Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Montenegro, Republic of Moldova, Romania, Russian Federation, Serbia, Tajikistan,TheformerYugoslavRepublicofMacedonia,Turkey,Turkmenistan,Ukraine,Uzbekistan WHO Eastern Mediterranean Region Afghanistan, Djibouti, Egypt, Iran (Islamic Republic of), Iraq, Jordan, Lebanon, Libya, Morocco, Pakistan, Somalia,SouthSudan,Sudan,SyrianArabRepublic,Tunisia,Yemen WHO Western Pacific Region Cambodia, China, Cook Islands, Fiji, Kiribati, Lao People's Democratic Republic, Malaysia, Marshall Islands,Micronesia(FederatedStatesof),Mongolia,Nauru,Niue,Palau,PapuaNewGuinea,Philippines, Samoa,SolomonIslands,Tonga,Tuvalu,Vanuatu,VietNam
* This regional grouping classifies WHO Member States according to the World Bank income categories for the year 2011 (WorldBanklistofeconomies,July2012)andtheWHOregion. **EquatorialGuineaisclassifiedbytheWorldBankashighincome,itiskeptherewithuppermiddleincometoavoida regionalgroupingcontainingonlyonecountryandbecauseitsmortalityprofileisnotdissimilartoneighbouringcountries.
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D.3 World Bank income grouping*

Low income Afghanistan, Bangladesh, Benin, Burkina Faso, Burundi, Cambodia, Central African Republic, Chad Comoros, Democratic People's Republic of Korea, Democratic Republic of the Congo, Eritrea, Ethiopia Gambia,Guinea,GuineaBissau,Haiti,Kenya,Kyrgyzstan,Liberia,Madagascar,Malawi,Mali,Mauritania, Mozambique, Myanmar, Nepal, Niger Rwanda, Sierra Leone, Somalia, Tajikistan, Togo, Uganda, United RepublicofTanzania,Zimbabwe Lower middle income Albania, Armenia, Belize, Bhutan, Bolivia (Plurinational State of), Cameroon, Cape Verde, Congo, Cte d'Ivoire, Djibouti, Egypt, El Salvador, Fiji, Georgia, Ghana, Guatemala, Guyana, Honduras, India, Indonesia, Iraq, Kiribati, Lao People's Democratic Republic, Lesotho, Marshall Islands, Micronesia (Federated States of), Mongolia, Morocco, Nicaragua, Nigeria, Pakistan, Papua New Guinea, Paraguay, Philippines, Republic of Moldova, Samoa, Sao Tome and Principe, Senegal, Solomon Islands, South Sudan, Sri Lanka, Sudan, Swaziland, Syrian Arab Republic, TimorLeste, Tonga, Ukraine, Uzbekistan, Vanuatu,VietNam,YemenZambia Upper middle income Algeria, Angola, Antigua and Barbuda, Argentina, Azerbaijan, Belarus, Bosnia and Herzegovina, Botswana, Brazil, Bulgaria, Chile, China, Colombia, Cook Islands, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, Equatorial Guinea**, Gabon, Grenada, Iran (Islamic Republic of), Jamaica, Jordan, Kazakhstan, Latvia, Lebanon, Libya, Lithuania, Malaysia, Maldives, Mauritius, Mexico Montenegro, Namibia,Nauru,Niue,Palau,Panama, Peru,Romania,RussianFederation, SaintLucia,SaintVincent and the Grenadines, Serbia, Seychelles, South Africa, Suriname, Thailand, The former Yugoslav Republic of Macedonia,Tunisia,Turkey,Turkmenistan,Tuvalu,Uruguay,Venezuela(BolivarianRepublicof) High income Andorra, Australia, Austria, Bahamas, Bahrain, Barbados, Belgium, Brunei Darussalam Canada, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Luxembourg, Malta, Monaco, Netherlands, ,New Zealand, Norway, Oman, Poland, Portugal, Qatar, Republic of Korea, Saint Kitts and Nevis, San Marino, Saudi Arabia, Singapore, Slovakia, Slovenia, Spain, Sweden, Switzerland, Trinidad and Tobago, United Arab Emirates, United Kingdom,UnitedStatesofAmerica
*ThisregionalgroupingclassifiesWHOMemberStatesaccordingtotheWorldBankincomecategoriesfortheyear2011 (WorldBanklistofeconomies,July2012) **EquatorialGuineaisclassifiedbytheWorldBankashighincome,itiskeptherewithuppermiddleincometoavoida regionalgroupingcontainingonlyonecountryandbecauseitsmortalityprofileisnotdissimilartoneighbouringcountries.
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D.4 World Bank Regions

High income Andorra, Australia, Austria, Bahamas, Bahrain, Barbados, Belgium, Brunei Darussalam Canada, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, Kuwait, Luxembourg, Malta, Monaco, Netherlands, ,New Zealand, Norway, Oman, Poland, Portugal, Qatar, Republic of Korea, Saint Kitts and Nevis, San Marino, Saudi Arabia, Singapore, Slovakia, Slovenia, Spain, Sweden, Switzerland, Trinidad and Tobago, United Arab Emirates, United Kingdom,UnitedStatesofAmerica East Asia and Pacific Cambodia, China, Cook Islands, Democratic People's Republic of Korea, Fiji, Indonesia, Kiribati, Lao People's Democratic Republic, Malaysia, Marshall Islands, Micronesia (Federated States of), Mongolia, Myanmar, Nauru, Niue, Palau, Papua New Guinea, Philippines, Samoa, Solomon Islands, Thailand, TimorLeste,Tonga,Tuvalu,Vanuatu,VietNam Europe and Central Asia Albania, Armenia, Azerbaijan, Belarus, Bosnia and Herzegovina, Bulgaria, Georgia, Kazakhstan, Kyrgyzstan, Latvia, Lithuania, Montenegro Republic of Moldova, Romania, Russian Federation, Serbia, Tajikistan,TheformerYugoslavRepublicofMacedonia,Turkey,Turkmenistan,Ukraine,Uzbekistan Latin America and Caribbean Antigua and Barbuda, Argentina, Belize, Bolivia (Plurinational State of), Brazil, Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Lucia, Saint Vincent and the Grenadines,Suriname,Uruguay,Venezuela(BolivarianRepublicof) Middle East and North Africa Algeria, Djibouti, Egypt, Iran (Islamic Republic of), Iraq, Jordan, Lebanon ,Libya, Morocco, Syrian Arab Republic,Tunisia,Yemen South Asia Afghanistan,Bangladesh,Bhutan,India,Maldives,Nepal,Pakistan,SriLanka Sub-Saharan Africa Angola,Benin,Botswana,BurkinaFaso,Burundi,Cameroon,CapeVerde,CentralAfricanRepublic,Chad, Comoros, Congo, Cte d'Ivoire, Democratic Republic of the Congo, Equatorial Guinea**, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, GuineaBissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Swaziland, Togo, Uganda, UnitedRepublicofTanzania,Zambia,Zimbabwe
**EquatorialGuineaisclassifiedbytheWorldBankashighincome,itiskeptherewithuppermiddleincometoavoida regionalgroupingcontainingonlyonecountryandbecauseitsmortalityprofileisnotdissimilartoneighbouringcountries.
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D.5 Millennium Development Goal (MDG) Regions

Developed regions Albania, Andorra, Australia, Austria, Belarus, Belgium, Bosnia and Herzegovina, Bulgaria, Canada, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Israel, Italy, Japan, Latvia, Lithuania, Luxembourg, Malta, Monaco, Montenegro, Netherlands, New Zealand, Norway, Poland, Portugal, Republic of Moldova, Romania, Russian Federation, San Marino, Serbia, Slovakia, Slovenia, Spain, Sweden, Switzerland, The former Yugoslav Republic of Macedonia,Ukraine,UnitedKingdom,UnitedStatesofAmerica Developing regions Caucasus and Central Asia Armenia,Azerbaijan,Georgia,Kazakhstan,Kyrgyzstan,Tajikistan,Turkmenistan,Uzbekistan Eastern Asia China,DemocraticPeople'sRepublicofKorea,Mongolia,RepublicofKorea Latin America and the Caribbean AntiguaandBarbuda,Argentina,Bahamas,Barbados,Belize,Bolivia(PlurinationalStateof),Brazil,Chile, Colombia, Costa Rica, Cuba, Dominica, Dominican Republic, Ecuador, El Salvador, Grenada, Guatemala, Guyana, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, Paraguay, Peru, Saint Kitts and Nevis, Saint Lucia, Saint Vincent and the Grenadines, Suriname, Trinidad and Tobago, Uruguay, Venezuela (BolivarianRepublicof) Northern Africa Algeria,Egypt,Libya,Morocco,Tunisia Oceania Cook Islands, Fiji, Kiribati, Marshall Islands, Micronesia (Federated States of), Nauru, Niue, Palau, Papua NewGuinea,Samoa,SolomonIslands,Tonga,Tuvalu,Vanuatu South-eastern Asia Brunei Darussalam, Cambodia, Indonesia, Lao People's Democratic Republic, Malaysia, Myanmar, Philippines,Singapore,Thailand,TimorLeste,VietNam Southern Asia Afghanistan,Bangladesh,Bhutan,India,Iran(IslamicRepublicof),Maldives,Nepal,Pakistan,SriLanka Sub-Saharan Africa Angola,Benin,Botswana,BurkinaFaso,Burundi,Cameroon,CapeVerde,CentralAfricanRepublic,Chad, Comoros, Congo, Cte d'Ivoire, Democratic Republic of the Congo, Djibouti, Equatorial Guinea, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guinea, GuineaBissau, Kenya, Lesotho, Liberia, Madagascar, Malawi, Mali, Mauritania, Mauritius, Mozambique, Namibia, Niger, Nigeria, Rwanda, Sao Tome and Principe, Senegal, Seychelles, Sierra Leone, Somalia, South Africa, South Sudan, Sudan, Swaziland, Togo, Uganda, UnitedRepublicofTanzania,Zambia,Zimbabwe Western Asia Bahrain,Iraq,Jordan,Kuwait,Lebanon,Oman,QatarSaudiArabia,SyrianArab Republic,Turkey,UnitedArabEmirates,Yemen World Health Organization Page 55
Annex Table E Mapping of India MDS categories to GHE causes

MDS Cause 1A01 1B01 1B02 1C01 1D01 1E01 1E02 1E03 1F01 1F02 1G01 1H01 1I01 1I02 1I03 1I04 1I05 1J01 1K01 1K02 1L01 1M01 1M02 1M03 1M04 1M05 1M06 1N01 1N02 1N03 1O01 1O02 1P01 MillionDeathStudyCauseCategory Tuberculosis Syphilis Other sexually transmitted infections (excl.HIV/AIDS) HIV/AIDS Diarrhoealdiseases Tetanus Measles Othervaccinepreventablediseases Meningitis/encephalitis Rabies Hepatitis Malaria Protozoaldiseases Leprosy Arthropodborneviralfevers Trachoma Helminthiases Acuterespiratoryinfections SevereSystemicInfection SevereLocalizedInfection Otherinfectiousdiseases Maternalhaemorrhage Maternalsepsis Hypertensivedisordersofpregnancy Obstructedlabour Abortion Othermaternalconditions Lowbirthweight/preterm Birthasphyxiaandbirthtrauma Otherperinatalconditions Proteinenergymalnutrition Iron, vitamin deficiencies nutritionalanaemias Feverofunknownorigin and GHE causes 3 5 9 10 11 16 15 13,14 17,18 32 19,20 22 26 29 30 31 34 3941 37 37 37 43 44 45 46 47 48 50 51 52,53 55 5659 ApportionedtoaccordingtoGBD2010causefractions Redistributedprorataacrossinfectiousdiseasecategories ApportionedusingWHOCHERGcausefractions Acutebacterialsepsis ApportionedtoaccordingtoGBD2010causefractions ApportionedtoaccordingtoGBD2010causefractions WHOmalariamortalityestimatesused ApportionedtoaccordingtoGBD2010causefractions OtherSTDsestimatedaccordingtoGBD2010causefractions Comment
Communicable,maternal,perinatalandnutritionalconditions
Noncommunicablediseases 2A 2B01 2C01 Neoplasms Diabetesmellitus Endocrineandimmunedisorders 6279 80 81 ReplacedbyWHO/IARCcancerestimates
Page 56

2D01 2D02 Epilepsy Otherneuropsychiatricdisorders 97 8393, 95, 96, 98101 133 135139 103109 150 111 113 112 114 ApportionedtoaccordingtoGBD2010causefractions ApportionedtoaccordingtoGBD2010causefractions ApportionedtoaccordingtoGBD2010causefractions
2F01 2F02 2F03 2F04 2G01 2G02 2G03 2G04 2G05 2G06 2H01 2H02 2J01 2J02
Skindiseases Musculoskeletaldisorders Senseorgandisorders Oralconditions Rheumaticheartdisease Ischaemicheartdiseases Hypertensiveheartdiseases Cerebrovasculardisease Heartfailure Othercardiovasculardiseases Asthma and chronic pulmonarydisease obstructive
115,116 118,119 120 122 86, 123, 125,154 124,125 127 128132 141146
Redistributedprorataacrosscardiovascularcausecategoriesexcluding cerebrovasculardisease ApportionedtoaccordingtoGBD2010causefractions ApportionedtoaccordingtoGBD2010causefractions
Otherchronicrespiratorydiseases Gastrooesophagealdiseases Lliverandalcoholrelateddiseases
Apportioned to alcohol use disorders, liver cirrhosis, other gastrointestinal,andaccidentalpoisoningaccordingtoGBD2010cause fractions ApportionedtoaccordingtoGBD2010causefractions
2J03 2K01 2K02 2L01 Injuries 3A01 3A02 3A03 3A04 3A05 3A06 3A07 3B01 3B02 3C01
Otherdigestivediseases Nephritisandnephrosis Othergenitourinarysystemdiseases Congenitalanomalies
ApportionedtoaccordingtoGBD2010causefractions ApportionedtoaccordingtoGBD2010causefractions
Transportaccidents Poisonings Falls Fires Drownings Venomoussnakes,animalsandplants Otherunintentionalinjuries Selfinflictedinjuries(suicide) War, violence and other intentional injuries UndeterminedIntent
153,159 154 155 156 157 159 159 161 162
NonroadtransportinjuryestimatedusingGBD2010analysis
Redistributedprorataacrossintentional&unintentionalinjurycauses.
Symptoms,signsandIlldefinedconditions 4A01 4A02 4A03 Senility Other Illdefined and abnormal findings Unspecifieddeaths Redistributedprorataacrossnoninjurycausecategories. Redistributedprorataacrossnoninjurycausecategories. Redistributedprorataacrossallcausecategories.
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Annex Table F Methods used for estimation of child and adult mortality levels, and causes of death, by country, 20002011
Mortality method groups: A: B: Lifetablesbasedondeathratescomputedfromvitalregistrationdata. Projection of life table parameters l5 and l60 from adjusted vital registration data, smoothed with moving average, projected using modified logit system with latest available year's lx as standard; childmortalityfromtheUNIGME. Lifetablesbasedondeathratescomputedfromneighbouringregionalvitalregistrationdata. Life tables based on UNPDs World Population Prospects the 2010 revision, and child mortality estimatesfromtheUNIGME. Life tables based on UNPDs World Population Prospects the 2010 revision, updated with the latestHIV/AIDSmortalityfromUNAIDSandchildmortalityestimatesfromtheUNIGME. Life tables using method E together with unpublished draft updates provided by UN Population Division(seetext).
C: D: E: F:
Abbreviations VA VR Verbalautopsy Vital(death)registration
Note (a): WHO and UN Interagency causespecific estimates for all Member States as documented in SectionXabove.
Country Afghanistan Albania Algeria Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus
All-cause mortality method F A D C E A B A B B A B B D B B
Under 5 child cause of death method VA multicause models VR multicause models VA multicause models VR multicause models VA multicause models VR data VR data VR multicause models VR data VR data VA multicause models VR data VR data VA multicause models VR data VR multicause models
Cause of death methods for ages 5+ GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data
Latest available VR data
Average useability 2000+
2004
55%
2010 2011 2011 2011 2007
79% 66% 95% 90% 84%
2009
88%
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All-cause mortality method B B E D D B E A A B E E D E B A E E B Latest available VR data Average useability 2000+
Country Belgium Belize Benin Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile
Under 5 child cause of death method VR data VR data VA multicause models VA multicause models VA multicause models VR multicause models VA multicause models VR data VR multicause models VR data VA multicause models VA multicause models VA multicause models VA multicause models VR data VR multicause models VA multicause models VA multicause models VR data National VA model based on subnational Chinese studies only VR data VA multicause models VA multicause models VR multicause models VR data VA multicause models VR data VR data VR multicause models VR data VA multicause models VA multicause models VR data VA multicause models VR data VA multicause models VR multicause models VR multicause models
Cause of death methods for ages 5+ VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data
2009
88%
2010 2011
76% 79%
2009 2009 2009 2011 2011 2010 2011 2011
94% 94% 89% 87% 87% 90% 73% 88%
China Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Ecuador Egypt
F A D E B A E B B B B D E B E B A A B
GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) VR data VR data VR data VR data GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a)
2011
87%
2010 2011
59% 61%
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All-cause mortality method A E E B E D B B E E A B E B B A E E A E D B B A D D D B B B A B D A E A B A D Latest available VR data Average useability 2000+
Country El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Grenada Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hungary Iceland India Indonesia Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic
Under 5 child cause of death method VR multicause models VA multicause models VA multicause models VR data VA multicause models VR multicause models VR data VR data VA multicause models VA multicause models VR multicause models VR data VA multicause models VR data VR data VA multicause models VA multicause models VA multicause models VR data VA multicause models VR multicause models VR data VR data State-level Indian-specific VA model VA multicause models VA multicause models VA multicause models VR data VR data VR data VR multicause models VR data VR multicause models VA multicause models VA multicause models VA multicause models VR data VA multicause models VA multicause models
Cause of death methods for ages 5+ GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) VR data VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data VR data VR data GBD 2010 plus (a) VR data GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) VR data VR data GBD 2010 plus (a)
2009
58%
2011 2011 2009
94% 97% 85%
2010 2011 2010 2009
53% 87% 75% 73%
2011 2009 2010 2010 2010 2011 2010 2011 2010
94% 94% 94% 90% 90% 89% 83% 87% 90%
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All-cause mortality method B D E E D B B D E A A E B A D B B D C B B D E D D D B B A D E A B D D B A D A A Latest available VR data Average useability 2000+
Country Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay
Under 5 child cause of death method VR data VR multicause models VA multicause models VA multicause models VR multicause models VR data VR data VA multicause models VA multicause models VR multicause models VR multicause models VA multicause models VR data VA multicause models VA multicause models VR data VR data VA multicause models VR multicause models VA multicause models VR data VA multicause models VA multicause models VA multicause models VA multicause models VA multicause models VA multicause models VR data VR data VR multicause models VA multicause models VA multicause models VR multicause models VR data VR multicause models VA multicause models VR multicause models VR data VA multicause models VR multicause models
Cause of death methods for ages 5+ VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a)
2010
92%
2010
94%
2011 2010 2009
90% 95% 70%
2011 2009 2011 2009
86% 97% 89% 80%
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All-cause mortality method A B B B B B B B E B B B D B D D D B B E B B B D D A #N/A B A D B E B B D A A B D Latest available VR data Average useability 2000+
Country Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand The former Yugoslav Republic of Macedonia Timor-Leste
Under 5 child cause of death method VR multicause models VA multicause models VR data VR data VR multicause models VR data VR data VR data VR multicause models VA multicause models VR data VR data VR data VR multicause models VR data VA multicause models VR multicause models VA multicause models VR data VR multicause models VA multicause models VR data VR data VR data VA multicause models VA multicause models VA multicause models VR data VR multicause models VA multicause models VR data VA multicause models VR data VR data VR multicause models VA multicause models VR multicause models VR data VA multicause models
Cause of death methods for ages 5+ GBD 2010 plus (a) VR data GBD 2010 plus (a) VR data GBD 2010 plus (a) VR data VR data VR data VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) VR data VR data VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a)
2008 2011 2011 2009 2011 2011 2011 2010
83% 74% 82% 74% 85% 88% 92% 95%
2011 2011 2010 2010 2009 2011 2006 2010 2010
72% 74% 94% 89% 68% 89% 55% 89% 89%
2006 2010
48% 84%
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All-cause mortality method E A B A D A A E B D B E B B A D A D D E E Latest available VR data Average useability 2000+
Country Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Yemen Zambia Zimbabwe
Under 5 child cause of death method VA multicause models VR multicause models VR data VR multicause models VR multicause models VA multicause models VR multicause models VA multicause models VR multicause models VR multicause models VR data VA multicause models VR data VR data VA multicause models VR multicause models VR data VR multicause models VA multicause models VA multicause models VA multicause models
Cause of death methods for ages 5+ GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) VR data GBD 2010 plus (a) VR data GBD 2010 plus (a) VR data VR data VR data GBD 2010 plus (a) VR data GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a) GBD 2010 plus (a)
2008 2011 2010 2008 2009 2009 2009
95% 96% 93% 93% 83% 86% 86%
Page 63
Annex Table G Methods used to estimate road traffic deaths for 182 participating countries
Country
Afghanistan Albania Andorra Angola Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bhutan Bolivia (Plurinational State of) Bosnia and Herzegovina Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia
Group
4 4 3 4 1 4 1 1 1 1 1 4 1 1 1 1 4 4 4 4 4 1 1 1 4 4 4 4 1 4 4 4 1 1 1
Method
Regression estimate Regression estimate Reported deaths (small population) Regression estimate Projected death registration data Regression estimate Projected death registration data Death registration data Reported deaths (replacing death registration estimate) Projected death registration data Projected death registration data Regression estimate Reported deaths (replacing death registration estimate) Projected death registration data Projected death registration data Projected death registration data Regression estimate Regression estimate Regression estimate Regression estimate Regression estimate Projected death registration data Projected death registration data Reported deaths (replacing death registration estimate) Regression estimate Regression estimate Regression estimate Regression estimate Death registration data Regression estimate Regression estimate Reported deaths (replacing regression estimate) Death registration data Death registration data (refer to section 3.5) Projected death registration data
Latest VR data
2009
2006 2010 2007 2008 2009
2008 2009 2006 2009
2009 2009 2010
2010
2010 2010 2008
Page 64
Country
Comoros Congo Cook Islands Costa Rica Cte d'Ivoire Croatia Cuba Cyprus Czech Republic Democratic Korea People's Republic of
Group
4 4 3 1 4 1 1 1 1 4 4 1 3 4 1 1 1 4 1 4 1 1 1 4 4 1 1 4 1 1 4 4 1 4 1 1 2 4
Method
Regression estimate Regression estimate Reported deaths (small population) Death registration data Regression estimate Death registration data Projected death registration data Death registration data Death registration data Regression estimate Regression estimate Projected death registration data Reported deaths (small population) Regression estimate Projected death registration data Death registration data Projected death registration data Regression estimate Death registration data Regression estimate Death registration data Reported deaths (replacing death registration estimate) Reported deaths (replacing death registration estimate) Reported deaths (replacing regression estimate) Regression estimate Projected death registration data Death registration data Regression estimate Projected death registration data Projected death registration data Regression estimate Regression estimate Projected death registration data Regression estimate Death registration data Projected death registration data Regression estimate projected from 2001-2003 data (32, 33) Regression estimate
Latest VR data
2010
2010 2009 2010 2010
Democratic Republic of the Congo Denmark Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Guatemala Guinea Guinea-Bissau Guyana Honduras Hungary Iceland India Indonesia
2006 2010
2009 2010 2009
2010
2010 2010 2008
2009 2010
2009 2009
2008
2010 2009 2010
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Country
Iran (Islamic Republic of) Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Lithuania Luxembourg Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia (Federated States of) Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nepal Netherlands
Group
2 4 1 1 1 1 1 4 1 4 3 1 1 4 1 4 4 4 1 1 4 4 4 1 4 1 3 4 1 1 3 4 1 4 4 4 4 4 1
Method
Projected death registration data Regression estimate Death registration data Projected death registration data Projected death registration data Projected death registration data Projected reported deaths (replacing death registration estimate) Regression estimate Death registration data Regression estimate Reported deaths (small population) Projected death registration data Projected death registration data Regression estimate Death registration data Regression estimate Regression estimate Regression estimate Death registration data Projected death registration data Regression estimate Regression estimate Reported deaths (replacing regression estimate) Reported deaths(replacing death registration estimate) Regression estimate Death registration data Reported deaths (small population) Regression estimate Death registration data Projected reported deaths (replacing death registration estimate) Reported deaths (small population) Reported deaths (replacing regression estimate) Projected death registration data Regression estimate Regression estimate Regression estimate Reported deaths (replacing regression estimate) Regression estimate Death registration data
Latest VR data
2006
2010 2009 2009 2006 2010
2010
2009 2009
2010
2010 2009
2008
2010
2010 2010
2009
2010
Page 66
Country
New Zealand Nicaragua Niger Nigeria Niue Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Qatar Republic of Korea Republic of Moldova Romania Russian Federation Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands South Africa Spain
Group
1 4 4 4 3 1 1 4 3 1 4 1 4 1 1 1 1 1 1 1 1 4 3 1 3 4 3 4 4 4 1 3 4 1 1 1 4 1 1
Method
Projected death registration data Regression estimate Regression estimate Regression estimate Reported deaths (small population) Reported deaths (replacing death registration estimate) Death registration data Regression estimate Reported deaths (small population) Projected death registration data Regression estimate Projected death registration data Regression estimate Projected death registration data Death registration data Death registration data Death registration data Projected death registration data Death registration data Reported deaths (replacing death registration estimate) Reported deaths (replacing death registration estimate) Regression estimate Reported deaths (small population) Projected death registration data Reported deaths (small population) Regression estimate Reported deaths (small population) Reported deaths (replacing regression estimate) Reported deaths (replacing regression estimate) Regression estimate Death registration data Reported deaths (small population) Regression estimate Death registration data Death registration data Death registration data Regression estimate Projected death registration data Reported deaths (replacing death registration est.)
Latest VR data
2008
2010 2010
2009
2009
2008 2010 2010 2010 2009 2010 2010 2010
2008 2006 2010
2010 2009
2010 2010 2010
2009 2009
Page 67
Country
Sri Lanka Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Tajikistan Thailand The Former Yugoslav Republic of Macedonia Timor-Leste Togo Tonga Trinidad and Tobago Tunisia Turkey Uganda Ukraine United Arab Emirates United Kingdom United Republic of Tanzania United States of America Uruguay Uzbekistan Vanuatu Venezuela (Bolivarian Republic of) Viet Nam West Bank and Gaza Strip Yemen Zambia Zimbabwe
Group
4 4 1 4 1 1 4 4 2 1 4 4 3 1 4 4 4 1 4 1 4 1 1 1 4 1 2 1 4 4 1
Method
Regression estimate Regression estimate Projected death registration data Regression estimate Death registration data Projected death registration data Regression estimate Regression estimate Projected death registration data Death registration data Regression estimate Regression estimate Reported deaths (small population) Projected death registration data Regression estimate Regression estimate Regression estimate Death registration data Regression estimate Death registration data Regression estimate Projected death registration data Projected death registration data Projected death registration data Regression estimate Projected death registration data Projected national verbal autopsy survey data Reported deaths (replacing regression estimate) Regression estimate Regression estimate Reported deaths (replacing regression estimate)
Latest VR data
2009
2010 2007
2008 2010
2007
2010
2010
2008 2009 2005
2007 2006 2010
Page 68

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methods and data sources for global causes of death 20002011

World Health Organization

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Population and allcause mortality estimates for years 20002011

2.1 Allcause mortality and population estimates

2.2 Estimation of neonatal, infant and under5 mortality rates

World Health Organization

2.3 Allcause mortality computed from civil registration data

2.4 Allcause mortality projected from civil registration data

2.5 Countries with other information on levels of adult mortality

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2.6 Mortality shocks epidemics, conflicts and disasters

Countries with useable death registration data

3.1 Data and estimates

World Health Organization

World Health Organization

World Health Organization

World Health Organization Page 10

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3.4 Mapping to GHE cause lists

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World Health Organization Page 13

3.5 Interpolation and extrapolation for missing countryyears

3.6 Adjustment of specific causes

3.7 Other nationallevel information on causes of death

DiseaseSurveillance Points 430,994 437,490 347,057 401,008 424,683 437,550 453,211

Vitalregistration system 117,183,678 102,889,945 55,288,841 57,272,144 72,240,261 79,101,646 90,158,748

DiseaseSurveillance Points 71,173,205 71,487,277 66,012,299 71,476,477 73,928,499 75,020,489 78,766,626

World Health Organization

World Health Organization

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Child mortality by cause

4.2 Causes of neonatal death (deaths at less than 28 days of age)

World Health Organization

4.5 Causes of child death for China and India

4.6 Inclusion of WHOCHERG estimates in Global Health Estimates 2000 2011

World Health Organization

Methods for specific causes with additional information

5.2 HIV/AIDS and sexually transmitted diseases

World Health Organization

5.4 Whooping cough

5.7 Maternal causes of death

5.9 Alcohol use and drug use disorders

5.11 Road injuries

World Health Organization

ln(vehiclesper capita) Roaddensity Nationalspeedlimits onruralroads Nationalspeedlimits onurbanroads Healthsystemaccess

A,B,C A,B,C A,B,C A,B,C A,B,C

Alcoholapparent consumption Populationworking Percentage motorbikes Corruptionindex

Nationalpoliciesfor walking/cycling Population

World Health Organization

5.12 Conflict and natural disasters

1990 2000 2000 2000 2004 2005 2008 2010

502 656 834

310(b) 230(c) 187(d) 182(e) 238(f) 182(g)

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Other causes of death for countries without useable data

World Health Organization

AFR AMR EMR EUR SEAR WPR World

World Health Organization

World Health Organization

Preterm bi rth compl i ca ti ons

World Health Organization

Figure7.3.Comparisonofdeathratesper100,000forninemajorcausegroups,GHEestimatesforyear 2008andpreviousWHOCODestimatesforyear2008,forworld,highincomecountries,andlowand middleincomecountriesgroupedbyWHOregion