Abstract
BackgroundNon-communicable diseases (NCDs) result in more deaths globally than other causes. Monitoring systems require strengthening to attribute the NCD burden and deaths in low and middle-income countries (LMICs). Data from health and demographic surveillance systems (HDSS) can contribute towards this goal.Methods and FindingsBetween 2003 and 2010, 15,228 deaths in adults aged 15 years (y) and older were identified retrospectively using the HDSS census and verbal autopsy in rural western Kenya, attributed into broad categories using InterVA-4 computer algorithms; 37% were ascribed to NCDs, 60% to communicable diseases (CDs), 3% to injuries, and <1% maternal causes. Median age at death for NCDs was 66y and 71y for females and males, respectively, with 43% (39% male, 48% female) of NCD deaths occurring prematurely among adults aged below 65y. NCD deaths were mainly attributed to cancers (35%) and cardio-vascular diseases (CVDs; 29%). The proportionate mortality from NCDs rose from 35% in 2003 to 45% in 2010 (χ2 linear trend 93.4; p<0.001). While overall annual mortality rates (MRs) for NCDs fell, cancer-specific MRs rose from 200 to 262 per 100,000 population, mainly due to increasing deaths in adults aged 65y and older, and to respiratory neoplasms in all age groups. The substantial fall in CD MRs resulted in similar MRs for CDs and NCDs among all adult females by 2010. NCD MRs for adults aged 15y to <65y fell from 409 to 183 per 100,000 among females and from 517 to 283 per 100,000 population among males. NCD MRs were higher among males than females aged both below, and at or above, 65y.ConclusionsNCDs constitute a significant proportion of deaths in rural western Kenya. Evidence of the increasing contribution of NCDs to overall mortality supports international recommendations to introduce or enhance prevention, screening, diagnosis and treatment programmes in LMICs.
Highlights
Between 2003 and 2010, 15,228 deaths in adults aged 15 years (y) and older were identified retrospectively using the health and demographic surveillance systems (HDSS) census and verbal autopsy in rural western Kenya, attributed into broad categories using InterVA-4 computer algorithms; 37% were ascribed to Non-communicable diseases (NCDs), 60% to communicable diseases (CDs), 3% to injuries, and,1% maternal causes
Non-communicable diseases (NCDs) are reported to be responsible for two out of every three deaths worldwide [1]; of 36 m deaths associated with NCDs globally, 80% occur in low- and middle-income countries (LMICs) [2,3,4]
NCD deaths are mainly due to cardiovascular diseases (CVDs), cancers, chronic respiratory diseases and diabetes [3,5,6]; other major causes of NCD mortality include suicide and injury related to depressive disorders, maternal deaths, and road injuries [7]
Summary
Non-communicable diseases (NCDs) are reported to be responsible for two out of every three deaths worldwide [1]; of 36 m deaths associated with NCDs globally, 80% occur in low- and middle-income countries (LMICs) [2,3,4]. The proportional increase in NCD deaths is a result of reducing CD burden, reflecting improvements in population health. It is expected that as the disposable income of LMIC rises, risk factors for NCD disorders such as cardiovascular diseases will increase in tandem, while an ongoing heavy CDs burden will continue [12]. Non-communicable diseases (NCDs) result in more deaths globally than other causes. Monitoring systems require strengthening to attribute the NCD burden and deaths in low and middle-income countries (LMICs). While overall annual mortality rates (MRs) for NCDs fell, cancer-specific MRs rose from 200 to 262 per PLOS ONE | DOI:10.1371/journal.pone.0114010 November 26, 2014
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