From "Mortality and causes of death in South Africa, 2007: Findings from death notification", Statistics South Africa, November 2 2009

Summary and concluding remarks

This statistical release provides information on mortality and causes of death based on data collected through the civil registration system in South Africa. The information can be used for policy formulation; and implementation and monitoring of health interventions aimed at improving the health status and increasing life expectancy of the population.

The main finding from this release is that the number of deaths in 2007 has declined in the country, as also evidenced by the decline in the number of deaths in the national population register and the decline in crude death rates. The median ages also provide evidence of the decline in mortality, indicated by the increasing median ages at death from 2005. The decline in the number of deaths between 2006 and 2007 was observed in all ages below 55 years. The number of deaths also declined for both males and females, with the decline much higher among females (2,4%) than among males (1,0%). The greatest decrease was observed in age groups 1-4 and 15-34.

The majority of deaths occurred among the black African population group and most deaths occurred in health facilities even though a substantial proportion (about one in three) still occurred at home. Age and sex standardised death rates showed that the highest mortality was in Free State and the lowest in Western Cape.

A great majority of deaths were due to natural causes, mainly certain infectious and parasitic diseases.

However, between 2006 and 2007, the number of deaths due to natural causes declined while those due to non-natural causes increased. A higher percentage of males died due to non-natural causes, as compared to females, as were those aged 5-24 compared to other ages.

Tuberculosis continued to be the leading cause of death in South Africa, accounting for over 10% of deaths in the country. Influenza and pneumonia was the second leading cause, followed by intestinal infectious diseases, other forms of heart disease and cerebrovascular diseases. Human immunodeficiency virus (HIV) disease was the ninth leading cause of death, accounting for about 2,2% of all deaths occurring in 2007. Deaths due to HIV disease, however, declined by almost 10% between 2006 and 2007 while those due to influenza and pneumonia declined by 6,7%; and those due intestinal infectious diseases declined by 5,5%.

The analysis on causes of death, according to sex, shows that nine of the ten leading causes were similar for males and females. The difference between the leading causes of death for males and females was that hypertensive diseases were among the ten leading causes of death for females only and ischaemic heart diseases were among the ten leading causes only for the males. HIV disease was the ninth and the tenth leading cause of death for females and males, respectively. Differences by provinces show that with the exception of Free State and Limpopo, tuberculosis was the leading cause of death in all provinces and influenza and pneumonia the leading cause in the other two provinces.

For the first time, the release provided mortality and causes of death for district municipalities. The results show that tuberculosis was the leading cause of death in many district municipalities. Other leading causes of death were influenza and pneumonia; intestinal infectious diseases; other diseases of the respiratory system; ischaemic heart diseases; and HIV disease.

Intestinal infectious diseases were the leading causes of death for infants in the post-neonatal period, among those aged 1-4 years and for the population aged 0-14; while respiratory and cardiovascular disorders specific to the perinatal period was the leading cause of death for infants in the neonatal period, accounting for nearly half of deaths in this group. Tuberculosis was the leading cause of death in age groups 15-24, 15-49 and 50-64 and cerebrovascular diseases the leading cause in the 65 and older age group.

The findings on non-natural causes indicate that the most common causes were other external causes of accidental injury and events of undetermined intent. Transport accidents and assault each contributed to about one in ten of non-natural deaths. The proportion of deaths due to assault was higher among males while that due to transport accidents was higher among females. Furthermore, the highest proportion of deaths due to assault was in Northern Cape, Eastern Cape and Western Cape, while those due to transport accidents were particularly high in Limpopo where about one in three nonnatural deaths were due to this cause.

The production of mortality and causes of death information from civil registration depend on the quality of input data. It also emphasises the need for enhanced efforts to register deaths and attribute causes.

As such, the areas of improvement in the information on mortality and causes of death include completeness of death registration; accurate and fully completed information on the death notification forms; and correct and detailed certification of causes of death. Some improvements have been observed over time. However, further concerted efforts between the public, the Department of Home Affairs, the Department of Health and Stats SA are needed for timely, accurate and relevant information on mortality and causes of death in the country.

To facilitate further analysis of data on mortality and causes of death, Stats SA provides a dataset on a compact disc and on the Stats SA website. The dataset includes variables presented in this statistical release, as well as several others that are not part of the release, with the expectation that further expert analyses of the data will assist to improve the quality of the data.

Appendix K: Population group differences

Due to a large proportion (25,9%) of death notification forms that did not specify population group, readers are advised to treat the breakdowns of deaths by population group with caution as they may not be very accurate.

The ten leading causes of death that were common to all four population groups were influenza and pneumonia, other forms of heart disease, cerebrovascular diseases, diabetes mellitus, hypertensive diseases and chronic lower respiratory diseases. However, these common causes of death had different ranks and different contributions to the overall number of deaths. For example, influenza and pneumonia was the second leading cause of death among black Africans, contributing 9,6% of deaths in this group and was the seventh leading cause among coloureds, contributing 3,4% of the deaths.

Tuberculosis was the leading underlying natural cause of death for black African and coloured population groups, accounting for 14,8% and 9,8%, respectively, of all deaths in these groups. The leading underlying natural cause of death for the white and Indian/Asian population groups was ischaemic heart diseases, contributing 12,3% of deaths for the white population group and 13,6% of deaths for the Indian/Asian population group. Diabetes mellitus was the second leading cause of death for both Indian/Asian and coloured population groups.

Intestinal infectious diseases, certain disorders involving the immune mechanism, and human immunodeficiency virus [HIV] disease were among the ten leading causes of natural deaths only for the black African population group while ischaemic heart diseases and malignant neoplasms of digestive organs were among the ten leading underlying causes of natural deaths for all population groups, except for the black African population group. In addition, tuberculosis was among the leading

underlying natural cause of death for all population groups, except the white population group, ranking first among black Africans and coloureds and seventh among Indian/Asians. Malignant neoplasms of respiratory and intrathoracic organs were among the ten leading underlying causes of death only for the white and coloured population groups while renal failure was among the ten leading underlying causes of death only for the white and Indian/Asian population groups.

The percentages of deaths due to non-natural causes were highest among the coloured population group (13,0%) and the Indian/Asians (11,1%). The lowest was among the black African (9,2%) and the white (9,8%) population groups.

Source: Stats SA. The full report can be accessed here.

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