Groenewald P, Neethling I, Evans J, Azevedo V, Naledi T, Matzopoulos R, Nannan N, Daniels J, Bradshaw D
Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa.
S Afr Med J. 2017 Nov 27;107(12):1091-1098. doi: 10.7196/SAMJ.2017.v107i12.12458.
The City of Cape Town (CoCT), South Africa, has collected cause-of-death data from death certificates for many years to monitor population health. In 2000, the CoCT and collaborators set up a local mortality surveillance system to provide timeous mortality data at subdistrict level. Initial analyses revealed large disparities in health across subdistricts and directed the implementation of public health interventions aimed at reducing these disparatities.
To describe the changes in mortality between 2001 and 2013 in health subdistricts in the CoCT.
Pooled mortality data for the periods 2001 - 2004 and 2010 - 2013, from a local mortality surveillance system in the CoCT, were analysed by age, gender, cause of death and health subdistrict. Age-specific mortality rates for each period were calculated and age-standardised using the world standard population, and then compared across subdistricts.
All-cause mortality in the CoCT declined by 8% from 938 to 863 per 100 000 between 2001 - 2004 and 2010 - 2013. Mortality in males declined more than in females owing to a large reduction in male injury mortality, particularly firearm-related homicide. HIV/AIDS and tuberculosis (TB) mortality dropped by ~10% in both males and females, but there was a marked shift to older ages. Mortality in children aged <5 years dropped markedly, mostly owing to reductions in HIV/AIDS and TB mortality. Health inequities between subdistricts were reduced, with the highest-burden subdistricts achieving the largest reductions in mortality.
Local mortality surveillance provides important data for planning, implementing and evaluating targeted health interventions at small-area level. Trends in mortality over the past decade indicate some gains in health and equity, but highlight the need for multisectoral interventions to focus on HIV and TB and homicide and the emerging epidemic of non-communicable diseases.
多年来，南非开普敦市（CoCT）一直从死亡证明中收集死因数据，以监测人口健康状况。2000年，CoCT及其合作伙伴建立了一个地方死亡率监测系统，以便在分区层面及时提供死亡率数据。初步分析揭示了各分区之间存在巨大的健康差异，并指导实施了旨在减少这些差异的公共卫生干预措施。
描述2001年至2013年期间CoCT各健康分区的死亡率变化。
对CoCT地方死亡率监测系统中2001 - 2004年和2010 - 2013年期间的汇总死亡率数据，按年龄、性别、死因和健康分区进行分析。计算每个时期的年龄别死亡率，并使用世界标准人口进行年龄标准化，然后在各分区之间进行比较。
2001 - 2004年至2010 - 2013年期间，CoCT的全死因死亡率从每10万人938例降至863例，下降了8%。男性死亡率下降幅度大于女性，这是由于男性伤害死亡率大幅下降，尤其是与枪支相关的杀人案。艾滋病毒/艾滋病和结核病（TB）死亡率在男性和女性中均下降了约10%，但出现了明显向老年人群的转移。5岁以下儿童的死亡率显著下降，主要是由于艾滋病毒/艾滋病和结核病死亡率的降低。各分区之间的健康不平等现象有所减少，负担最重的分区死亡率下降幅度最大。
地方死亡率监测为在小区域层面规划、实施和评估有针对性的健康干预措施提供了重要数据。过去十年的死亡率趋势表明在健康和公平方面取得了一些进展，但突出了需要采取多部门干预措施，重点关注艾滋病毒和结核病、杀人案以及非传染性疾病的新流行趋势。
