Persistent burden from non-communicable diseases in South Africa needs strong action

Continued effort and politcal will must be directed towards preventing, delaying the onset of and managing non-communicable diseases in South Africa

Mortality trends and diff erentials in South Africa from 1997 to 2012: second National Burden of Disease Study

Background The poor health of South Africans is known to be associated with a quadruple disease burden. In the second National Burden of Disease (NBD) study, we aimed to analyse cause of death data for 1997–2012 and develop national, population group, and provincial estimates of the levels and causes of mortality. Method We used underlying cause of death data from death notifi cations for 1997–2012 obtained from Statistics South Africa. These data were adjusted for completeness using indirect demographic techniques for adults and comparison with survey and census estimates for child mortality. A regression approach was used to estimate misclassifi ed HIV/AIDS deaths and so-called garbage codes were proportionally redistributed by age, sex, and population group population group (black African, Indian or Asian descent, white [European descent], and coloured [of mixed ancestry according to the preceding categories]). Injury deaths were estimated from additional data sources. Age-standardised death rates were calculated with mid-year population estimates and the WHO age standard. Institute of Health Metrics and Evaluation Global Burden of Disease (IHME GBD) estimates for South Africa were obtained from the IHME GHDx website for comparison. Findings All-cause age-standardised death rates increased rapidly since 1997, peaked in 2006 and then declined, driven by changes in HIV/AIDS. Mortality from tuberculosis, non-communicable diseases, and injuries decreased slightly. In 2012, HIV/AIDS caused the most deaths (29·1%) followed by cerebrovascular disease (7·5%) and lower respiratory infections (4·9%). All-cause age-standardised death rates were 1·7 times higher in the province with the highest death rate compared to the province with the lowest death rate, 2·2 times higher in black Africans compared to whites, and 1·4 times higher in males compared with females. Comparison with the IHME GBD estimates for South Africa revealed substantial diff erences for estimated deaths from all causes, particularly HIV/AIDS and interpersonal violence. Interpretation This study shows the reversal of HIV/AIDS, non-communicable disease, and injury mortality trends in South Africa during the study period. Mortality diff erentials show the importance of social determinants, raise concerns about the quality of health services, and provide relevant information to policy makers for addressing inequalities. Diff erences between GBD estimates for South Africa and this study emphasise the need for more careful calibration of global models with local data

Emerging trends in non-communicable disease mortality in South Africa, 1997 - 2010

Objectives. National trends in age-standardised death rates (ASDRs) for non-communicable diseases (NCDs) in South Africa (SA) were identified between 1997 and 2010.Methods. As part of the second National Burden of Disease Study, vital registration data were used after validity checks, proportional redistribution of missing age, sex and population group, demographic adjustments for registration incompleteness, and identification of misclassified AIDS deaths. Garbage codes were redistributed proportionally to specified codes by age, sex and population group. ASDRs were calculated using mid-year population estimates and the World Health Organization world standard.Results. Of 594 071 deaths in 2010, 38.9% were due to NCDs (42.6% females). ASDRs were 287/100 000 for cardiovascular diseases (CVDs), 114/100 000 for cancers (malignant neoplasms), 58/100 000 for chronic respiratory conditions and 52/100 000 for diabetes mellitus. An overall annual decrease of 0.4% was observed resulting from declines in stroke, ischaemic heart disease, oesophageal and lung cancer, asthma and chronic respiratory disease, while increases were observed for diabetes, renal disease, endocrine and nutritional disorders, and breast and prostate cancers. Stroke was the leading NCD cause of death, accounting for 17.5% of total NCD deaths. Compared with those for whites, NCD mortality rates for other population groups were higher at 1.3 for black Africans, 1.4 for Indians and 1.4 for coloureds, but varied by condition.Conclusions. NCDs contribute to premature mortality in SA, threatening socioeconomic development. While NCD mortality rates have decreased slightly, it is necessary to strengthen prevention and healthcare provision and monitor emerging trends in cause-specific mortality to inform these strategies if the target of 2% annual decline is to be achieved

A subnational analysis of burden of disease in South Africa: mortality levels, causes of death and their forecasts.

Thesis (Ph.D.)--University of Washington, 2020Empirical and model based approaches have provided estimates of South Africa’s national and provincial mortality. However, little is known about district-level mortality patterns and differentials. The purpose of this research is to provide reliable estimates of these over three aims. Firstly, district-specific all-cause deaths for each age, sex and year are estimated by adjusting observed vital registration (VR) death numbers using a Bayesian regression model that concurrently addresses under-reporting of deaths and the random noise which typifies small-area samples. For the second aim, district-specific causeof- death proportions for selected causes are determined using a Dirichlet-Multinomial regression model that leverages the South Africa province cause-of-death estimates from the 2017 Global Burden of Disease study to correct the district cause-of-death numbers from VR. In the final aim, the results from the previous aims are forecasted within a compositional data framework (CoDa) by first applying Singular Value Decompositions (SVDs) to the estimated all-cause and multiple decrement life table death matrices for all district-years. Next, estimated time-varying parameters from the resultant low-rank matrix approximations are forecasted using additive models that assume first order autoregressive residuals. Finally, full life table death matrices are reconstructed by combining these forecasts with the non-varying principal components estimated using the SVD-CoDa

Estimating Global and Country-Specific Excess Mortality During the COVID-19 Pandemic

Estimating the true mortality burden of COVID-19 for every country in the world is a difficult, but crucial, public health endeavor. Attributing deaths, direct or indirect, to COVID-19 is problematic. A more attainable target is the "excess deaths", the number of deaths in a particular period, relative to that expected during "normal times", and we estimate this for all countries on a monthly time scale for 2020 and 2021. The excess mortality requires two numbers, the total deaths and the expected deaths, but the former is unavailable for many countries, and so modeling is required for these countries. The expected deaths are based on historic data and we develop a model for producing expected estimates for all countries and we allow for uncertainty in the modeled expected numbers when calculating the excess. We describe the methods that were developed to produce the World Health Organization (WHO) excess death estimates. To achieve both interpretability and transparency we developed a relatively simple overdispersed Poisson count framework, within which the various data types can be modeled. We use data from countries with national monthly data to build a predictive log-linear regression model with time-varying coefficients for countries without data. For a number of countries, subnational data only are available, and we construct a multinomial model for such data, based on the assumption that the fractions of deaths in sub-regions remain approximately constant over time. Based on our modeling, the point estimate for global excess mortality, over 2020-2021, is 14.9 million, with a 95% credible interval of (13.3, 16.6) million. This leads to a point estimate of the ratio of excess deaths to reported COVID-19 deaths of 2.75, which is a huge discrepancy

Tuberculosis remains the leading cause of death attributed to smoking in South Africa: results from the South African death certificate study

Background The question 'Was the deceased a smoker five years ago?' was introduced in mid-1997 on a revised South African death notification form to provide a direct estimate of tobacco attributed mortality, using a case-control method for ongoing monitoring of the tobacco epidemic. This paper updates previous reports (1999 to 2007). Methods This analysis included 772,975 deaths from 2000 to 2013, for persons 35 to 74 years with information about age, year of death, sex, province of death, educational grade, marital status, population group and smoking status (current smoker vs. not). Cases comprised deaths due to diseases expected to be associated with smoking; controls comprised deaths from selected conditions expected to be unrelated to smoking. Deaths due to HIV without TB, external causes, cirrhosis, mental disorders, maternal and perinatal conditions and diabetes were excluded. Smoking-associated relative risks were assumed to be the case/control versus smoker/ex & non-smoker odds ratios, adjusted for 5-year age group, education, province, year of death, marital status. Deaths were extrapolated to the NBD national annual estimates for 2012. Results Smoking-associated relative risks were highest for lung and upper aero-digestive cancers and COPD amongst the white and coloured (mixed race) populations reflecting their relatively higher smoking prevalence. When extrapolated to NBD estimates for 2012, smoking-attributable deaths accounted for approximately 14 329 out of 284 949 total deaths in persons aged 35 - 74 years (5%). Tuberculosis remains the leading cause of smoking-attributable deaths (approx 24%) followed by COPD (approx 19%) and lung cancer (approx 17%). Conclusions Different population groups in South Africa are at different stages of the tobacco epidemic and ongoing monitoring by population group is required. The cause profile of smoking-attributable mortality in South Africa differs from that in developed countries and suggests that tobacco cessation should be incorporated into the South African TB programme

Editorial: Persistent burden from non-communicable diseases in South Africa needs strong action

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The WHO estimates of excess mortality associated with the COVID-19 pandemic

The WHO estimates of excess mortality associated with the COVID-19 pandemic for years 2020 and 2021 by country and month for each of the 194 WHO members states