Abstract
Background For public health purposes, it is important to see whether men and women in different age groups die of the same causes in South Africa. Objective We explored sex- and age-specific patterns of causes of deaths in a rural demographic surveillance site in northern KwaZulu-Natal in South Africa over the period 2000–2011. Design Deaths reported through the demographic surveillance were followed up by a verbal autopsy (VA) interview using a standardised questionnaire. Causes of death were assigned likelihoods using the publicly available tool InterVA-4. Cause-specific mortality fractions were determined by age and sex. Results Over the study period, a total of 5,416 (47%) and 6,081 (53%) deaths were recorded in men and women, respectively. Major causes of death proportionally affecting more women than men were (all p<0.0001): human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (20.1% vs. 13.6%), other and unspecified cardiac disease (5.9% vs. 3.2%), stroke (4.5% vs. 2.7%), reproductive neoplasms (1.7% vs. 0.4%), diabetes (2.4% vs. 1.2%), and breast neoplasms (0.4% vs. 0%). Major causes of deaths proportionally affecting more men than women were (all p<0.0001) assault (6.1% vs. 1.7%), pulmonary tuberculosis (34.5% vs. 30.2%), road traffic accidents (3.0% vs. 1.0%), intentional self-harm (1.3% vs. 0.3%), and respiratory neoplasms (2.5% vs. 1.5%). Causes of death due to communicable diseases predominated in all age groups except in older persons. Conclusions While mortality during the 2000s was dominated by tuberculosis and HIV/AIDS, we found substantial sex-specific differences both for communicable and non-communicable causes of death, some which can be explained by a differing sex-specific age structure. InterVA-4 is likely to be a valuable tool for investigating causes of death patterns in other similar Southern African settings.
Highlights
For public health purposes, it is important to see whether men and women in different age groups die of the same causes in South Africa
While mortality during the 2000s was dominated by tuberculosis and HIV/AIDS, we found substantial sex-specific differences both for communicable and non-communicable causes of death, some which can be explained by a differing sex-specific age structure
The fraction of deaths for which no cause of deaths (CODs) could be determined was 10.6% and this did not vary significantly between men and women (10.7 and 10.5%, respectively, p0.05). This fraction of unknown causes of death can be further divided into three categories: for 539 (4.7%) deaths no verbal autopsy (VA) interview had been conducted, so obviously no information was available to assign a probable COD; for a further 192 (1.7%) deaths, the VA interview had been conducted, the quality and breadth of information collected was insufficient or too unspecific for InterVA-4 to be able to assign any causes of death; and the remaining 4.2% represented the residual likelihood of indeterminate causes of death
Summary
It is important to see whether men and women in different age groups die of the same causes in South Africa. Objective: We explored sex- and age-specific patterns of causes of deaths in a rural demographic surveillance site in northern KwaZulu-Natal in South Africa over the period 2000Á2011. Major causes of death proportionally affecting more women than men were (all p B0.0001): human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) (20.1% vs 13.6%), other and unspecified cardiac disease (5.9% vs 3.2%), stroke (4.5% vs 2.7%), reproductive neoplasms (1.7% vs 0.4%), diabetes (2.4% vs 1.2%), and breast neoplasms (0.4% vs 0%). Major causes of deaths proportionally affecting more men than women were (all p B0.0001) assault (6.1% vs 1.7%), pulmonary tuberculosis (34.5% vs 30.2%), road traffic accidents (3.0% vs 1.0%), intentional self-harm (1.3% vs 0.3%), and respiratory neoplasms (2.5% vs 1.5%). InterVA-4 is likely to be a valuable tool for investigating causes of death patterns in other similar Southern African settings
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