Mortality trends and differentials in South Africa from 1997 to 2012: second National Burden of Disease Study
Mortality trends and differentials in South Africa from 1997 to 2012: second National Burden of Disease Study
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DOI：
10.1016/s2214-109x(16)30113-9
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发表时间：
2016-09-01
影响因子：
34.3
通讯作者：
Bradshaw, Debbie
中科院分区：
文献类型：
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作者：
Pillay-van Wyk, Victoria;Msemburi, William;Bradshaw, Debbie
背景南非人健康状况不佳被认为与四倍的疾病负担有关。在第二次全国疾病负担(NBD)研究中，我们旨在分析1997-2012年的死因数据，并对死亡水平和原因进行国家、人口群体和省级估计。方法我们使用从南非统计局获得的1997-2012年死亡报告的潜在死因数据。使用成人的间接人口统计技术，并与儿童死亡率的调查和普查估计进行比较，对这些数据的完整性进行了调整。使用回归方法来估计错误分类的艾滋病毒/艾滋病死亡人数，所谓的垃圾代码按年龄、性别和人口群体(非洲黑人、印度人或亚洲人后裔、白人[欧洲后裔]和有色人种[根据上述类别混血])按比例重新分配。受伤死亡人数是从其他数据来源估计的。年龄标准化死亡率是根据年中人口估计数和世卫组织年龄标准计算的。卫生指标与评估全球疾病负担研究所(IHME GBD)对南非的估计来自IHME GHDx网站，以供比较。发现全原因年龄标准化死亡率自1997年以来迅速上升，在2006年达到峰值，然后在艾滋病毒/艾滋病变化的推动下下降。结核病、非传染性疾病和伤害的死亡率略有下降。2012年，艾滋病毒/艾滋病造成的死亡人数最多(29.1%)，其次是脑血管疾病(7.5%)和下呼吸道感染(4.9%)。在死亡率最高的省份，全原因年龄标准化死亡率是死亡率最低的省份的1.7倍，非洲黑人比白人高2.2倍，男性比女性高1.4倍。与IHME GBD对南非的估计相比，所有原因，特别是艾滋病毒/艾滋病和人际暴力的估计死亡人数有很大的差异。这项研究表明，在研究期间，南非艾滋病毒/艾滋病、非传染性疾病和伤害死亡率的趋势发生了逆转。死亡率差异显示了社会决定因素的重要性，引起了人们对卫生服务质量的关注，并为政策制定者提供了解决不平等问题的相关信息。南非的GBD估计与这项研究之间的差异，强调了用当地数据更仔细地校准全球模型的必要性。
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 notifications 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 misclassified 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 differences 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 differentials show the importance of social determinants, raise concerns about the quality of health services, and provide relevant information to policy makers for addressing inequalities. Differences between GBD estimates for South Africa and this study emphasise the need for more careful calibration of global models with local data.