Mortality transition over a quarter century in rural South Africa: findings from population surveillance in Agincourt 1993-2018
Date
2021-10-04
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Abstract
Background: Mortality burden in South Africa since the mid-1990s has been characterized by
a quadruple disease burden: HIV/AIDS and tuberculosis (TB); other communicable diseases
(excluding HIV/AIDS and TB), maternal causes, perinatal conditions and nutritional deficiencies; non-communicable diseases (NCDs); and injuries. Causes from these broad groupings
have persistently constituted the top 10 causes of death. However, proportions and rankings
have varied over time, alongside overall mortality levels.
Objective: To provide evidence on the contributions of age and cause-of-death to changes in
mortality levels in a rural South African population over a quarter century (1993–2018).
Methods: Using mortality and cause-of-death data from the Agincourt Health and SocioDemographic Surveillance System (HDSS), we derive estimates of the distribution of deaths
by cause, and hazards of death by age, sex, and time period, 1993–2018. We derive estimates
of life expectancies at birth and years of life expectancy gained at age 15 if most common
causes of death were deleted. We compare mortality indicators and cause-of-death trends
from the Agincourt HDSS with South African national indicators generated from publicly
available datasets.
Results: Mortality and cause-of-death transition reveals that overall mortality levels have
returned to pre-HIV epidemic levels. In recent years, the concentration of mortality has shifted
towards older ages, and the mortality burden from cardiovascular diseases and other chronic
NCDs are more prominent as people living with HIV/AIDS access ART and live longer. Changes
in life expectancy at birth, distribution of deaths by age, and major cause-of-death categories
in the Agincourt population follow a similar pattern to the South African population.
Conclusion: The Agincourt HDSS provides critical information about general mortality, causeof-death, and age patterns in rural South Africa. Realigning and strengthening the South
African public health and healthcare systems is needed to concurrently cater for the prevention, control, and treatment of multiple disease conditions.
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Keywords
South Africa; mortality; verbal autopsy; noncommunicable diseases (NCDs); health and sociodemographic surveillance system (HDSS)