Kahn Kathleen, Garenne Michel L, Collinson Mark A, Tollman Stephen M
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, University of Witwatersrand, South Africa.
Scand J Public Health Suppl. 2007 Aug;69:26-34. doi: 10.1080/14034950701355668.
This paper examines trends in age-specific mortality in a rural South African population from 1992 to 2003, a decade spanning major sociopolitical change and emergence of the HIV/AIDS pandemic. Changing mortality patterns are discussed within a health-transition framework.
Data on population size, structure, and deaths, obtained from the Agincourt health and demographic surveillance system, were used to calculate person-years at risk and death rates. Life tables were computed by age, sex and calendar year. Mortality rates for the early period 1992-93 and a decade later, 2002-03, were compared.
Findings demonstrate significant increases in mortality for both sexes since the mid-1990s, with a rapid decline in life expectancy of 12 years in females and 14 years in males. The increases are most prominent in children (0-4) and young adult (20-49) age groups, in which increases of two- and fivefold respectively have been observed in the past decade. Sex differences in mortality patterns are evident with increases more marked in females in most adult age groups.
Empirical data demonstrate a marked "counter transition" with mortality increasing in children and young adults, "epidemiologic polarization" with vulnerable subgroups experiencing a higher mortality burden, and a "protracted transition" with simultaneous emergence of HIV/AIDS together with increasing non-communicable disease in older adults. The health transition in rural South Africa is unlikely to predict patterns elsewhere; hence the need to examine trends in as many contexts as have the data to support such analyses.
本文研究了1992年至2003年南非农村人口特定年龄死亡率的趋势，这十年经历了重大社会政治变革以及艾滋病毒/艾滋病大流行的出现。在健康转型框架内讨论了不断变化的死亡率模式。
从阿金库尔健康与人口监测系统获得的有关人口规模、结构和死亡的数据，用于计算风险人年数和死亡率。按年龄、性别和历年编制生命表。比较了1992 - 1993年早期和十年后的2002 - 2003年的死亡率。
研究结果表明，自20世纪90年代中期以来，两性死亡率均显著上升，女性预期寿命迅速下降12岁，男性下降14岁。这种上升在儿童（0 - 4岁）和青年成人（20 - 49岁）年龄组中最为显著，在过去十年中分别增长了两倍和五倍。死亡率模式存在性别差异，在大多数成年年龄组中女性的增长更为明显。
实证数据表明存在明显的“逆向转型”，即儿童和青年成人死亡率上升；“流行病学两极分化”，即弱势群体承受更高的死亡负担；以及“长期转型”，即艾滋病毒/艾滋病与老年人中日益增加的非传染性疾病同时出现。南非农村的健康转型不太可能预测其他地方的模式；因此需要在有数据支持此类分析的尽可能多的背景下研究趋势。
