Causes of death across the life course in the Association of Southeast Asian Nations (ASEAN): a systematic analysis for the Global Burden of Disease Study 2023
Abstract
Summary Background The drivers of mortality and their associated risk factors evolve throughout the course of life. Understanding these transitions is essential for effective, equitable, and age-appropriate health interventions. Methods As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we examined life expectancy and the probability of death from birth to age 70 years (70q0) from 1990 to 2023 for each Association of Southeast Asian Nations (ASEAN) member state. In addition, we assessed causes of death and risk factor by age and sex across different life stages. Life expectancy was estimated from age-specific mortality rates with standard demographic techniques, and 70q0 from mortality and GBD life tables. Cause-specific mortality was estimated using the Cause of Death Ensemble model, and risk-attributable mortality using the comparative risk assessment framework. Findings In 2023, regional life expectancy was 70·1 years (95% uncertainty interval 69·6–70·7) for males and 76·2 years (75·7–76·7) for females, ranging from 87·5 years (87·3–87·8) for females in Singapore to 62·1 years (60·8–63·5) for males in Myanmar. Correspondingly, all-cause 70q0 was higher for males than for females. Neonatal disorders were the leading cause of mortality among infants younger than 1 year. Road injuries were the primary driver of mortality among males from adolescence through to early adulthood, accounting for 25·0% (17·0–31·0) of total mortality (8230 [5740–10 800] deaths) in males aged 15–19 years, with mortality rates varying from 3·0 per 100 000 population (2·3–3·7) to 49·0 per 100 000 population (25·0–67·1) between countries. Among females, maternal disorders were the leading cause of death in ages 25–34 years. In mid-adulthood, non-communicable diseases such as ischaemic heart disease and stroke emerged as major causes. Tobacco use was the dominant risk factor across most of adulthood in males, whereas high blood pressure was the prevailing risk factor among adult females. Interpretation Although the leading causes of death have converged across countries, the outcomes of these causes remain divergent, reflecting persistent inequalities across the region. These patterns present a strategic opportunity for multilateral action to mobilise collective resources and achieve regional health equity. Funding Gates Foundation.