The association between socioeconomic status and adult mortality in rural KwaZulu-Natal, South Africa

Abstract

Introduction: Although socioeconomic inequality in health and mortality is currently on the top of the epidemiologic debate, studies however on the subject among adult population in Africa has been hampered due to the long absence of data in many countries. With the present reliable records of deaths from emerged demographic surveillance systems on the continent, adult mortality can now be accurately estimated. Objectives: The study‟s main objectives were 1. To calculate and show trend in adult mortality rate in ACDIS between 2001 and 2007. 2. To measure the association between mortality and individual‟s socio-economic status in the ACDIS. Methods: Individuals were selected based on age (15-64 yrs) and residency (Resident in the DSA on 1st January 2001). The total number of adults who met the criteria was 33,677; out of whom 4,058 died during the seven years follow up period. Mortality rates were computed using Kaplan-Meier survival estimates expressed per 1000 PYO. Household wealth index was constructed by use of PCA. The association between SES and adult mortality was assessed using Cox proportional Hazard model controlling for potential confounders such as age, sex and marital status. Results: The High group of the socioeconomic quintile had the highest mortality rate of 22.2 per 1000 PYO, 95% CI (20.7 - 23.7). There was no significant trend in the rates among the SES groups. After adjusting for the potential confounders; the effect of socioeconomic status in the highest SES category was 0.10 times less likelihood for death compared to the lowest SES group [HR=0.90, p=0.042, 95% CI (0.81 - 0.99)]. Conclusion: This study revealed that adult socioeconomic status is not significantly associated with adult mortality. Reducing the gap between the rich and the poor might not be the effective way in reducing adult mortality.