Understanding a population’s mortality burden and its variation by socioeconomic status (SES) is important for setting locally-relevant health and development priorities, identifying critical elements for strengthening of health systems, and determining the focus of health services and programmes. We examine changes in mortality levels, cause composition, and variation by socioeconomic status in Agincourt, rural South Africa over the period 1993-2013. The population experienced steady and substantial increases in overall and communicable disease related mortality from the mid-1990s to the mid-2000s, peaking around 2005-07 due to the HIV/AIDS epidemic. Overall mortality steadily declined afterwards following reduction in HIV/AIDS-related mortality due to the widespread introduction of free antiretroviral therapy (ART) available from public health facilities. By 2013, however, the cause of death distribution was yet to reach the levels it occupied in the early 1990s. Overall, the poorest individuals in the population experienced the highest mortality burden and HIV/AIDS and tuberculosis mortality persistently showed an inverse relation with SES throughout the period 2001-13. Although mortality from non-communicable diseases (NCDs) increased over time in both sexes and injuries were a prominent cause of death in males, neither of these causes of death showed consistent, significant associations with household SES. These findings highlight the need for integrated health-care planning and programme delivery strategies to increase access to and uptake of HIV testing, linkage to care and ART, and prevention and treatment of NCDs to achieve further reduction in mortality. Greater attention is especially needed for the poorest individuals to reduce associated socioeconomic inequalities.
Chodziwadziwa (Cho) Whiteson Kabudula is a Data Scientist and Researcher at the MRC/Wits Rural Public Health & Health Transitions Research Unit (the MRC/Wits-Agincourt Research Unit) at the School of Public Health, University of the Witwatersrand in South Africa. He is the 2017 John C Caldwell Population, Health and Development Visiting at the National Centre for Epidemiology & Population Health and School of Demography at the Australian National University. His research focuses on integrating population-level socio-demographical, behavioural, disease and risk factor prevalence data from surveillance populations with clinical, treatment and laboratory data and applying demographic, statistical, computational and informatics techniques to study population-level morbidity, mortality and utilisation of health services.