School of Demography, The Australian National University, Acton, Australian Capital Territory, Australia
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa.
BMJ Glob Health. 2024 Apr 8;9(4):e013539. doi: 10.1136/bmjgh-2023-013539.
Understanding mortality variability by age and cause is critical to identifying intervention and prevention actions to support disadvantaged populations. We assessed mortality changes in two rural South African populations over 25 years covering pre-AIDS and peak AIDS epidemic and subsequent antiretroviral therapy (ART) availability.
Using population surveillance data from the Agincourt Health and Socio-Demographic Surveillance System (AHDSS; 1994-2018) and Africa Health Research Institute (AHRI; 2000-2018) for 5-year periods, we calculated life expectancy from birth to age 85, mortality age distributions and variation, and life-years lost (LYL) decomposed into four cause-of-death groups.
The AIDS epidemic shifted the age-at-death distribution to younger ages and increased LYL. For AHDSS, between 1994-1998 and 1999-2003 LYL increased for females from 13.6 years (95% CI 12.7 to 14.4) to 22.1 (95% CI 21.2 to 23.0) and for males from 19.9 (95% CI 18.8 to 20.8) to 27.1 (95% CI 26.2 to 28.0). AHRI LYL in 2000-2003 was extremely high (females=40.7 years (95% CI 39.8 to 41.5), males=44.8 years (95% CI 44.1 to 45.5)). Subsequent widespread ART availability reduced LYL (2014-2018) for women (AHDSS=15.7 (95% CI 15.0 to 16.3); AHRI=22.4 (95% CI 21.7 to 23.1)) and men (AHDSS=21.2 (95% CI 20.5 to 22.0); AHRI=27.4 (95% CI 26.7 to 28.2)), primarily due to reduced HIV/AIDS/TB deaths in mid-life and other communicable disease deaths in children. External causes increased as a proportion of LYL for men (2014-2018: AHRI=25%, AHDSS=17%). The share of AHDSS LYL 2014-2018 due to non-communicable diseases exceeded pre-HIV levels: females=43%; males=40%.
Our findings highlight shifting burdens in cause-specific LYL and persistent mortality differentials in two populations experiencing complex epidemiological transitions. Results show high contributions of child deaths to LYL at the height of the AIDS epidemic. Reductions in LYL were primarily driven by lowered HIV/AIDS/TB and other communicable disease mortality during the ART periods. LYL differentials persist despite widespread ART availability, highlighting the contributions of other communicable diseases in children, HIV/AIDS/TB and external causes in mid-life and non-communicable diseases in older ages.
了解按年龄和死因划分的死亡率变化对于确定支持弱势群体的干预和预防措施至关重要。我们评估了南非两个农村地区人群在 25 年期间的死亡率变化，包括艾滋病前和艾滋病流行高峰期以及随后抗逆转录病毒治疗 (ART) 的可及性。
使用来自 Agincourt 健康和社会人口学监测系统 (AHDSS；1994-2018 年) 和非洲健康研究所 (AHRI；2000-2018 年) 的人群监测数据，我们计算了从出生到 85 岁的预期寿命、死亡率年龄分布和变化，以及分解为四个死因组的生命年损失 (LYL)。
艾滋病流行将死亡年龄分布转移到更年轻的年龄，并增加了 LYL。对于 AHDSS，1994-1998 年和 1999-2003 年，女性的 LYL 从 13.6 岁（95%CI 12.7-14.4）增加到 22.1（95%CI 21.2-23.0），男性从 19.9（95%CI 18.8-20.8）增加到 27.1（95%CI 26.2-28.0）。AHRI 在 2000-2003 年的 LYL 非常高（女性=40.7 岁（95%CI 39.8-41.5），男性=44.8 岁（95%CI 44.1-45.5））。随后广泛提供 ART 降低了 LYL（2014-2018 年），女性（AHDSS=15.7（95%CI 15.0-16.3）；AHRI=22.4（95%CI 21.7-23.1））和男性（AHDSS=21.2（95%CI 20.5-22.0）；AHRI=27.4（95%CI 26.7-28.2）），主要是因为中年时 HIV/AIDS/TB 死亡和儿童其他传染病死亡减少。男性的外部原因在 LYL 中的比例增加（2014-2018 年：AHRI=25%，AHDSS=17%）。AHDSS 2014-2018 年 LYL 中由于非传染性疾病导致的比例超过了艾滋病毒前水平：女性=43%；男性=40%。
我们的研究结果强调了两个经历复杂流行病学转变的人群中特定死因 LYL 和持续死亡率差异的变化。研究结果表明，艾滋病流行高峰期儿童死亡对 LYL 的贡献很大。在 ART 期间，HIV/AIDS/TB 和其他传染病死亡率的降低是 LYL 减少的主要原因。尽管广泛提供了 ART，但 LYL 差异仍然存在，这突出表明，在中年时，其他传染病对儿童、HIV/AIDS/TB 和外部原因的贡献，以及在老年时非传染性疾病的贡献。
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