Mortality variability and differentials by age and causes of death in rural South Africa, 1994–2018

Datos Bibliográficos

ID21879017
AutoresBrian Houle (0000-0003-2157-3118, Australian National University, autor de correspondencia), Chodziwadziwa Kabudula (0000-0002-5867-0336, University of the Witwatersrand), A Mojola (0000-0002-2610-2625, University of the Witwatersrand), Nicole Angotti (0000-0002-9206-5914, American University), Francesc Xavier Gómez-Olivé (0000-0002-4876-0848, University of the Witwatersrand), Dickman Gareta (0000-0002-4004-5655, Africa Health Research Institute), Kobus Herbst (0000-0002-5436-9386, Africa Health Research Institute), Samuel J Clark (0000-0002-4929-6231, University of the Witwatersrand), Jane Menken (0000-0002-0008-0325, University of Colorado Boulder), Vladimir Canudas-Romo (0000-0001-6532-0089, Australian National University)
Año2024
Volumen9
Número4
Páginase013539
Fecha de publicación2024-04-01
Peer ReviewedSí
Open AccessSí
TipoARTICLE
RevistaBMJ Global Health (JOURNAL)
Identificadores de la revistaISSN: 2059-7908 • E-ISSN: 2059-7908
EditorialBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2023-013539
PMID38589045
OpenAlexW4394565962
IdiomaEN
Citas recibidas3
Referencias citadas33

INTRODUCTION: Understanding mortality variability by age and cause is critical to identifying intervention and prevention actions to support disadvantaged populations. We assessed mortality changes in two rural South African populations over 25 years covering pre-AIDS and peak AIDS epidemic and subsequent antiretroviral therapy (ART) availability. METHODS: Using population surveillance data from the Agincourt Health and Socio-Demographic Surveillance System (AHDSS; 1994-2018) and Africa Health Research Institute (AHRI; 2000-2018) for 5-year periods, we calculated life expectancy from birth to age 85, mortality age distributions and variation, and life-years lost (LYL) decomposed into four cause-of-death groups. RESULTS: The AIDS epidemic shifted the age-at-death distribution to younger ages and increased LYL. For AHDSS, between 1994-1998 and 1999-2003 LYL increased for females from 13.6 years (95% CI 12.7 to 14.4) to 22.1 (95% CI 21.2 to 23.0) and for males from 19.9 (95% CI 18.8 to 20.8) to 27.1 (95% CI 26.2 to 28.0). AHRI LYL in 2000-2003 was extremely high (females=40.7 years (95% CI 39.8 to 41.5), males=44.8 years (95% CI 44.1 to 45.5)). Subsequent widespread ART availability reduced LYL (2014-2018) for women (AHDSS=15.7 (95% CI 15.0 to 16.3); AHRI=22.4 (95% CI 21.7 to 23.1)) and men (AHDSS=21.2 (95% CI 20.5 to 22.0); AHRI=27.4 (95% CI 26.7 to 28.2)), primarily due to reduced HIV/AIDS/TB deaths in mid-life and other communicable disease deaths in children. External causes increased as a proportion of LYL for men (2014-2018: AHRI=25%, AHDSS=17%). The share of AHDSS LYL 2014-2018 due to non-communicable diseases exceeded pre-HIV levels: females=43%; males=40%. CONCLUSIONS: Our findings highlight shifting burdens in cause-specific LYL and persistent mortality differentials in two populations experiencing complex epidemiological transitions. Results show high contributions of child deaths to LYL at the height of the AIDS epidemic. Reductions in LYL were primarily driven by lowered HIV/AIDS/TB and other communicable disease mortality during the ART periods. LYL differentials persist despite widespread ART availability, highlighting the contributions of other communicable diseases in children, HIV/AIDS/TB and external causes in mid-life and non-communicable diseases in older ages

Environmental health · Life expectancy · Mortality rate · Population · Public health · Demography · Global Maternal and Child Health · HIV/AIDS Impact and Responses · HIV/AIDS Research and Interventions · Medicine · Epidemiology · Gerontology · Internal Medicine