The impact of HIV/AIDS on mortality at a South African platinum mine

Abstract

ABSTRACT Background: There is a paucity of empirical data on the impact of HIV/AIDS on mortality in the mining industry in the pre-ART era. Such data will provide a baseline against which the efficacy of antiretroviral treatment can be measured into the future. Objectives: To measure all-cause mortality in a population of platinum miners between 1992 and 2002, the impact of HIV/AIDS on mortality in this group and to determine the pattern of other cause-specific mortality. Methods: This was a primary analysis of mortality in an open cohort of male semi- and unskilled workers at a platinum mine. Using Poisson regression, all-cause, HIV/AIDSrelated and other cause-specific mortality rates and rate ratios were calculated by age and calendar year. Results: There were 1986 deaths in the cohort of 29954 subjects who contributed 200657 person years of follow up over the 11 year period of the study. Crude all-cause mortality increased from a base of 5.1 per 1000 person years at risk (pyar) (95% CI 4.2- 6.2) in 1992 to 20.4 per 1000 pyar (95% CI 18.3-22.8) in 2002. Age-adjusted all-cause mortality increased more than three-fold from 1992 to 2002 (RR 3.2, 95% CI 2.5-4.0). The excess mortality was attributed to HIV/AIDS-related deaths which increased from 0% in 1992-1994 to 5.1% of total deaths in 1995 and reached 63.3 % of deaths in 2002. Mortality due to other communicable diseases, non-communicable diseases and injuries remained stable throughout the study period. Conclusion: The impact of the HIV/AIDS epidemic on mortality in this group of platinum mine workers has been profound and comparable to that experienced by the general South African population. The data reported here provide a baseline to measure the impact of antiretroviral treatment on the future course of mortality due to the epidemic.