Statistics South Africa on Mortality and causes of death 2013

2 Dec 2014

HIV moves to third leading underlying cause of death in South Africa: a move from reporting HIV-related causes to reporting HIV disease.

Ranking natural causes of death for deaths that occurred in 2013 has placed HIV disease as the third leading cause of death in South Africa. This disease has moved from being the seventh leading underlying natural cause of death during 2009-2011 and the sixth in 2012. In 2013, it was responsible for 6% of all the deaths, affecting relatively more males (6%, ranked third) than females (5%, ranked fourth).

HIV disease was the leading cause of death in Northern Cape; the second leading cause of death in Eastern Cape and KwaZulu-Natal; and the third leading cause of death in Western Cape. Among those aged 15-44, HIV disease was the second leading cause of death and was responsible for 11% of deaths in this age group.

The increase in the rank of HIV disease and its relative contribution to the overall number of deaths has been coupled with a decrease in the contribution of HIV-related deaths such as tuberculosis, influenza and pneumonia, intestinal infectious diseases and other viral diseases. While tuberculosis and influenza and pneumonia remain the first two leading causes of death, their contribution to the overall number of deaths has been declining consistently. Similarly, deaths due to intestinal infectious diseases, mainly diarrhoea, have reduced substantially such that this group of diseases has moved from being the third leading cause of death in 2009 to eighth in 2013.

Overall results show a consistent decline in the number of deaths due to infectious diseases, yet the number of deaths due to HIV disease is on the increase. The increase is particularly noted where the deceased had both HIV disease and tuberculosis where in these cases HIV disease will most probably be the underlying cause of death.

These results leave a number of questions unanswered: Are doctors becoming more comfortable stating HIV disease as an underlying cause of death rather than certifying immediate causes of death in HIV cases (e.g. tuberculosis, diarrhoea, pneumonia), or use euphemisms for HIV (e.g. "immuno-compromised" or "Retroviral disease positive")?

Did the training of doctors in cause-of-death certification undertaken in 2012/13 have an impact on reporting HIV disease? The training emphasised the importance of certifying correctly, addressed confidentiality issues for HIV reporting; and highlighted the fact that life insurance companies have waived HIV/AIDS exclusions to life and disability covers. Is information on the HIV status of the deceased more readily available to enable proper diagnosis of the underlying cause of death? Is the number of deaths due to HIV disease actually increasing in South Africa?

While further research is required to answer these questions, the results are indicative of changing patterns of reporting HIV-related and HIV specific causes of death in South Africa.

These results were published in a report on Mortality and Causes of Death in South Africa, 2013 published by Statistics South Africa on 02 December 2014. The results are based on 458 933 deaths that occurred in 2013 and were registered at the Department of Home Affairs.

The report indicates that the overall number of deaths continue to decrease in the country, with the number of deaths slightly higher for males compared to females. The proportions of death occurring in young adult ages (between 25 and 49) are also continuously decreasing with time, while they are increasing at older ages.

The full report is available on the Statistics South Africa website: www.statssa.gov.za (see here - PDF)

Key findings: P0309.3 - Mortality and causes of death in South Africa, 2013: Findings from death notification

This statistical release presents information on mortality and causes of death in South Africa for deaths that occurred in 2013 based on all death notification forms from the civil registration system maintained by the Department of Home Affairs (DHA). Information for the period 1997 to 2012 (updated for late registrations) is also included to show trends in mortality and causes of death.

The number of deaths that occurred in 2013 was 458 933, indicating that the number of deaths continue to decline in the country as observed from 2007. In 2013, the total number of deaths processed by Stats SA decreased by 6,5% from a total of 491 100 deaths that occurred in 2012.

The highest proportion of deaths that occurred in 2013 was amongst those aged 60-64 and the lowest was observed in age groups 5-9 years and 10-14 years. The proportion of deaths was slightly higher for males (52,3%) compared to females (47,7%) and on average, males died earlier (50,3 years) than females (55,9 years). The highest proportion of deaths (21,3%) occurred in Gauteng, followed by KwaZulu-Natal and Eastern Cape each comprising 18,3% and 13,9%, respectively. These provinces also have the largest population sizes in the country.

In 2013, the majority of deaths resulted from the main group of certain infectious and parasitic diseases (22,6%), followed by diseases of the circulatory system (16,7%). Tuberculosis maintained its rank as the number one leading cause of death in South Africa, followed byinfluenza and pneumonia. The most notable change in rank was for human immunodeficiency virus (HIV) disease which moved from being ranked sixth in 2012 accounting for 3,9% to third rank in 2013 accounting for 5,1% deaths.

Sex differentials show that tuberculosis was ranked the first leading cause of death for both males and females. The second leading cause of death amongst males was influenza and pneumonia with HIV disease ranked third. For females, diabetes mellitus was the second leading cause of death, with cerebrovascular diseases ranked third. HIV disease ranked fourth for females.

With regards to age differentials, respiratory and cardiovascular disorders specific to the perinatal period were the leading cause during infancy (age 0). For ages 1-14 intestinal infectious diseases were the leading cause, whilst for age groups 15-44 and 45-54 tuberculosiswas the top ranked cause of death. Cerebrovascular diseases were the leading cause of death for ages 65 years and older.

Causes of death by provinces show that in 2013 diabetes mellitus maintained its ranking as the leading cause of death in Western Cape;HIV disease ranked highest in Northern Cape replacing tuberculosis; and Limpopo province continued to have influenza and pneumoniaas the leading cause of death. Tuberculosis continued to be the first leading cause of death in the remaining six provinces.

Although the number of deaths due to natural causes were higher than the number of deaths due to non-natural causes, the proportion of deaths due to non-natural cause have been on a slight increase in the recent years. Deaths due to non-natural causes were mainly dominated by those due to other external causes of accidental injury (60,1%) followed by event of undetermined intent (14,7%). There were 11,2% non-natural deaths due to traffic accidents and 10,2% due to assault. The province with the highest proportion of deaths due to traffic accidents was Limpopo.

The ages that were mostly affected by non-natural causes were 5-29 years. More males died of non-natural causes compared to females. Furthermore, Western Cape had the highest proportion of deaths due to non-natural causes compared to other provinces.

Statement issued by Dr. Maletela Tuoane-Nkhasi, Executive Manager: Health and Vital Statistics, December 2 2014

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