It is largely because of the spotty progress in increasing life expectancy at birth that we live in a world where an estimated 13 million people die before they turn fifty each year; including 5.7 million children under five years of age, 4.7 million adults men and 2.7 million adult women, according to the Global Burden of Disease. There are wide gender gaps among early deaths for adults with men comprising 63% of early adult deaths, largely due to additional male deaths from road injuries and heart disease. If we add in the estimated 1.4 million unborn females who are victims of sex selection every year (largely in China and India), the gender gap shrinks but is not eliminated. If we include female deaths from sex selection during pregnancy and the estimated 1.9 million stillbirths that occur every year we have a population of 16.3 million whose lives are cut short every year.
The majority of early deaths occur in just ten countries, including India, Nigeria, China, Pakistan, Indonesia, the Democratic Republic of Congo, Brazil, the USA, Russia and Ethiopia. Four countries – India, Nigeria, China and Pakistan – account for 5.4 million early deaths or 41% of the global total. In many of these countries early deaths represent a large proportion of overall deaths, above the global average of 23%, and far above Japan’s 3% – the world’s best. For example, in Nigeria, home to the world’s second-largest concentration of early deaths, 67% of all deaths occur among people under fifty. In the Democratic Republic of Congo it is 56%, in Pakistan 52% and in Ethiopia 41%.
A handful of causes account for the vast majority of early deaths, including neonatal disorders, pneumonia, road injuries, diarrhea, heart disease, HIV/AIDS, malaria, congenital defects, self-harm and tuberculosis. The major causes of death vary by age and by gender. Children under five are much more likely to die from neonatal disorders and infectious diseases (especially pneumonia, diarrhea and malaria), while adults are more likely to die from road injuries, heart disease and HIV/AIDS. Infectious diseases are also leading causes of death among children aged five to 14 (especially typhoid, diarrhea, pneumonia and malaria), but road injuries and drowning are also big killers.
Road injuries are the largest cause of death among 15 to 49-year-olds, followed by heart disease, HIV/AIDS and self-harm. Other leading killers for this population include tuberculosis, cirrhosis and stroke. The leading causes of death for men and women under 50 are similar, but road injuries, heart disease and self-harm claim the lives of many more young men. HIV/AIDS kills more young women than men and death in pregnancy and childbirth remains a major killer, claiming 194,000 lives.
The leading risk factors for death before 50 years include low birth weight, short gestation (preterm birth), child wasting, high blood pressure, alcohol use, household air pollution, unsafe sex, unsafe water, outdoor air pollution and high body mass. Leading risk factors vary by geography and by gender. For example, in Sub-Saharan Africa, low birth weight, child wasting, short gestation, unsafe sex, unsafe water, and household air pollution are leading risk factors for early death. In South Asia, low birth weight, short gestation, child wasting, high blood pressure and household air pollution are the top five risk factors. The leading risk factors for early death among females are low birth weight, short gestation, child wasting, unsafe sex, and high body mass. In contrast, low birth weight, short gestation, alcohol, high blood pressure and smoking are the leading risks for early death among males.