Sartorius Benn, Kahn Kathleen, Collinson Mark A, Sartorius Kurt, Tollman Stephen M
Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Geospat Health. 2013 May;7(2):237-49. doi: 10.4081/gh.2013.83.
A longitudinal dataset was used to investigate adult mortality in rural South Africa in order to determine location, trends, high impact determinants and policy implications. Adult (15-59 years) mortality data for the period 1993-2010 were extracted from the health and demographic surveillance system in the rural sub-district of Agincourt. A Bayesian geostatistical frailty survival model was used to quantify significant associations between adult mortality and various multilevel (individual, household and community) variables. It was found that adult mortality significantly increased over time with a reduction observed late in the study period. Non-communicable disease mortality appeared to increase and decrease in parallel with communicable mortality, whilst deaths due to external causes remained constant. Male gender, unemployment, circular (labour) migrant status, age and gender of household heads, partner and/or other household death, low education and low household socio-economic status were identified as significant and highly attributable determinants of adult mortality. Health facility remoteness was a risk for adult mortality and households falling outside a critical buffering zone were identified. Spatial foci of higher adult mortality risk were observed, indicating a strong non-random pattern. Communicable diseases differed from non-communicable diseases with respect to spatial distribution of mortality. Areas with significant excess mortality risk (hot spots) were found to be part of a complex interaction of highly attributable factors that continues to drive differential space-time risk patterns of communicable (HIV/AIDS and tuberculosis) mortality in Agincourt. The impact of HIV mortality and its subsequent lowering due to the introduction of antiretroviral therapy was found to be clearly evident in this rural population.
为了确定地点、趋势、高影响因素及政策影响，使用了一个纵向数据集来调查南非农村地区的成人死亡率。1993年至2010年期间的成人（15 - 59岁）死亡率数据从阿金库尔农村分区的健康与人口监测系统中提取。采用贝叶斯地理统计脆弱性生存模型来量化成人死亡率与各种多层次（个体、家庭和社区）变量之间的显著关联。研究发现，成人死亡率随时间显著上升，在研究后期有所下降。非传染性疾病死亡率似乎与传染性疾病死亡率同步上升和下降，而外部原因导致的死亡人数保持不变。男性、失业、循环（劳动力）移民身份、户主的年龄和性别、伴侣和/或其他家庭成员死亡、低教育水平以及低家庭社会经济地位被确定为成人死亡率的显著且高度可归因的决定因素。卫生设施偏远是成人死亡的一个风险因素，并且确定了处于关键缓冲区域之外的家庭。观察到成人死亡风险较高的空间聚集点，表明存在强烈的非随机模式。传染性疾病和非传染性疾病在死亡率的空间分布方面存在差异。发现死亡率显著过高的地区（热点地区）是高度可归因因素复杂相互作用的一部分，这些因素继续推动阿金库尔地区传染性（艾滋病毒/艾滋病和结核病）死亡率的时空差异风险模式。在这一农村人口中，艾滋病毒死亡率的影响以及由于引入抗逆转录病毒疗法导致的死亡率随后降低的情况明显可见。
