Statistician Pali Lehohla on mortality and causes of death, 2011
18 Mar 2014
Is South Africa at crossroads? A shift in the burden of disease in South Africa points to a reduction in communicable diseases and an increase in injuries and non-communicable diseases.
Statistics South Africa published the 2011 statistical release on Mortality and Causes of Death report which presents statistics on the number and causes of death for 2011 by selected characteristics. In total, 505 803 deaths that occurred in 2011 were registered. The downward trend observed since 2007 in the number of deaths occurring in the country per year continues. The number of deaths between 2010 and 2011 decreased by 7,7% while during 2009/10 and 2008/09 the number of deaths decreased by 5,6% and 2,6%, respectively, which is an indication that the number of deaths are annually decreasing at an increasing rate.
The statistical release also provides information on trends in mortality and causes of deaths that occurred during the period 1997 to 2011.
The release is based on data collected by the Department of Home Affairs (DHA) through the death registration system. It is estimated that this system covered 94% of adult deaths in the country during 2007-2011. For all these periods, the rate of decrease was much higher for females as opposed to males. Between 2010 and 2011 female deaths decreased by 8,2% while male deaths decreased by 7,5%.
Increasing levels of mortality that was observed before 2007 was prominent among females. The increase in the number of deaths was also associated with increases in deaths due to communicable diseases particularly tuberculosis, influenza and pneumonia and intestinal infectious diseases which have remained in the ten leading causes of death in the country since 1997.
The decrease in the number of deaths observed since 2007 has also been associated with decreases in tuberculosis, influenza and pneumonia and intestinal infectious diseases, more so among females. While these causes remain among the ten leading causes of death in the country, their relative importance in mortality is decreasing over time. However, among the ten leading causes of death due to communicable diseases, the proportion of deaths due to HIV disease continues to increase, although at a very slow pace (from 3,1% in 2009 to 3,4% in 2010).
In the recent years, there has been a modest increase in the proportion of deaths due to specific non-communicable diseases. Among the ten leading causes of death, the proportion of death due to the following causes increased: other forms of heart disease (particularly heart failure), cerebrovascular disease (largely stroke), diabetes mellitus, and hypertensive diseases. The contribution of these diseases to the overall number of deaths in 2009 was 15,2% and increased to 17,0% in 2011. The proportion of deaths due to injuries also increased slightly from 8,7% in 2009 to 9,1% in 2011.
On a general note, the proportion of deaths due to certain infectious and parasitic diseases and diseases of the respiratory diseases have declined while there has been an increase in the proportion of deaths due to diseases of the circulatory system; neoplasms (cancers); endocrine, nutritional and metabolic disease; and external causes of morbidity and mortality.
On the one hand, there is clear indication that communicable diseases are decreasing in the country and that the force of mortality is reducing particularly for females. On the other hand, the relative contribution of non-communicable diseases and injuries are on the increase. Do these changes leave the health system at crossroads in terms of what should be prioritised, without losing the battle on the existing burden of communicable diseases and addressing emerging health issues?
KEY FINDINGS:
Mortality and causes of death in South Africa: Findings from death notification, 2011
This statistical release presents information on mortality and causes of death in South Africa, based on all death notification forms received from the Department of Home Affairs (DHA). The main focus of the release is on deaths that occurred in 2011 and were registered at DHA. Deaths that occurred between 1997 and 2010 are also provided to outline emerging trends and differentials in mortality by selected demographic, social and geographic characteristics.
The results indicate that mortality continues to decline in South Africa. This trend has been observed since 2007. A total of 505 803 deaths occurred in 2011, which was a decline of 7,7% from the 547 724 deaths that occurred in 2010. The median age at death was 50,4 years.
The proportion of deaths was slightly higher for males (51,7%) compared to females (48,3%) and on average, males died earlier (49,0 years) than females (52,5 years). Age and sex differentials show that male deaths peaked at age group 35-39 and female deaths at age group 30-34.
Less than half (46,3%) of all deaths occurred at healthcare facilities. The provinces where the highest proportion of deaths occurred were KwaZulu-Natal (20,7%), Gauteng (19,9%) and Eastern Cape (14,4%). These provinces also have the largest population sizes in the country.
In 2011, the majority of deaths resulted from the main group of certain infectious and parasitic diseases (23,1%), followed by diseases of the circulatory system (16,2%). This pattern was also observed in 2010, although the proportion of deaths due to infectious and parasitic diseases decreased between 2010 and 2011 but increased for deaths due to diseases of the circulatory system during the same period.
Tuberculosis maintained its rank as the first leading cause of death in South Africa, a position that it has held since 1997. However, the proportion of deaths due to tuberculosis has decreased in the recent past, contributing 10,7% of deaths in 2011.
The second leading cause of death was influenza and pneumonia (6,6%), which has also maintained its rank as the second leading cause of death. Two major changes were observed in the ranks of the ten leading causes of death in 2011. Intestinal infectious diseases were the third leading cause of death in 2009 and 2010 but moved to sixth position in 2011. Conversely, cerebrovascular diseases were ranked fifth in both 2009 and 2010 but moved to the third position in 2011.
With regards to sex differentials, tuberculosis and influenza and pneumonia were both ranked first and second, respectively, amongst the ten leading causes of death for both males and females. However, the third leading underlying cause of death for females was cerebrovascular diseases while other forms of heart disease was ranked third for males.
Age differentials show that intestinal infectious diseases were ranked the first leading cause of death amongst those aged 0-14 years; tuberculosis was most common among ages 15-64 years; whilst for those aged 65 years and older cerebrovascular diseases were the leading cause of death.
Furthermore, tuberculosis was the leading cause of death in all provinces except for Free State and Limpopo, where influenza and pneumonia were the leading causes of death. Tuberculosis was also the leading cause of death in the majority of district municipalities.
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. For example, 8,9% of deaths in 2009 were due to non-natural causes, increasing to 9,1% in 2011. Deaths due to non-natural causes were mainly dominated by those due to other external causes of accidental injury (61,0%) followed by event of undetermined intent (13,6%).
The ages that were mostly affected by non-natural causes were 5-29 years. More males died of non-natural causes compared to females. Western Cape had the highest proportion of deaths due to non-natural causes compared to other provinces.
The full report is available on the Statistics South Africa website here - PDF.
Statement issued by Statistics South Africa, March 18 2014
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