Trends in Mortality and Years of Life Lost across regions in Ethiopia: A Systematic Subnational Analysis in Global Burden of Disease Study 1990-2019

Abstract

Abstract
Background: Evidence on premature mortality from any cause is vital to understanding disparities in the availability and accessibility of health care and health resource allocation across regions and city administrations, yet this evidence is often lacking. This analysis investigates the levels and trends of mortality and age-standardized Years of Life Lost (YLL) rates and explores the cause-specific burden of disease variations across nine regions and two cities in Ethiopia from 1990 to 2019.
Methods: The Global Burden of Disease (GBD) 2019 utilized various data sources such as national census, demographic surveillance, household surveys, health service utilization, and other relevant data. The aim of GBD 2019 was to provide comprehensive information on the number of deaths, death rates, and years of life lost (YLLs). To determine the causes of death based on age, sex, year, and location, GBD 2019 applied a Cause of Death Ensemble Modelling (CODEm) approach, which involved using mixed-effects linear models and spatiotemporal Gaussian process regression (ST-GPR) models. This report specifically focuses on the trends and levels of deaths from all causes and age-standardized YLL rates for the top 25 causes of death in Ethiopia. The point estimates were accompanied by 95% uncertainty intervals (UI) to provide a measure of uncertainty.
Results: Overall, 559,997 (95% UI: 506,117-621,976) deaths occurred in Ethiopia in 2019 from all causes, with 317,818 (95% UI: 278,395-361,016) male deaths. In 2019 the age-standardized all-cause mortality rate was 993.5 per 100,000 population (95% UI: 915.0-1070.6). Males had a higher rate than females, 1,101.5 (963.4-1,246.0) per 100,000 population among males. A 38.2% decline in the number of deaths, a 58.4% decline in the age-standardized death rate, and a 68.3% decline in the age-standardized YLL rate were observed from 1990 to 2019 in Ethiopia. Age-standardized death rates due to communicable, maternal, neonatal, and nutritional diseases and disorders (CMNND), non-communicable diseases (NCDs), and injuries were 368.6 (95% UI: 329.7-413.5), 553.4 (95% UI: 501.9-604.9), and 71.6 (95% UI: 61.1-82.7) per 100,000 populations respectively in 2019. Neonatal disorders, diarrheal diseases, lower respiratory infections, tuberculosis, and stroke featured among the five leading specific causes of age-standardized YLL rates in all regions with different ranking orders. HIV/AIDS was the leading cause of age-standardized YLL rates in Addis Ababa and Gambella, causing respectively 4,381.9 (95% UI: 3,213.4-5,800.0) and 4,584.1 (95% UI: 2,776.2-7,087.1) YLL per 100,000 population in 2019. Tuberculosis was the leading cause of YLL in the Afar region, with YLL rates of 4,224.4 (95% UI: 3,303.1-5,286.2) per 100,000 populations in 2019.
Conclusion: There was a significant decline in age-standardized YLL rates between 1990 and 2019 across all regions, with some disparities. Neonatal disorders, diarrheal disease, lower respiratory infections, tuberculosis, HIV/AIDS, ischemic heart disease, and stroke were the leading causes of age-standardized YLL rates 2019 across the nation and regions. Federal, regional, and city administrative policymakers should focus on designing strategies, resources, and interventions on disease burden and avoiding leading causes of YLL. [Ethiop. J. Health Dev. 2023;37 (SI-2)]
Keywords: Cause of death, trends in mortality, Years of Life Lost, Ethiopia