Department of Sociology, The Ohio State University, Columbus, OH, USA; Institute for Population Research, The Ohio State University, Columbus, OH, USA; Translational Data Analytics Institute, The Ohio State University, Columbus, OH, USA.
Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK.
Lancet Glob Health. 2024 Aug;12(8):e1278-e1287. doi: 10.1016/S2214-109X(24)00171-2.
The absence of high-quality comprehensive civil registration and vital statistics systems across many settings in Africa has led to little empirical data on causes of death in the region. We aimed to use verbal autopsy data to provide comparative, population-based estimates of cause-specific mortality among adolescents and adults in eastern and southern Africa.
In this surveillance study, we harmonised verbal autopsy and residency data from nine health and demographic surveillance system (HDSS) sites in Kenya, Malawi, Tanzania, South Africa, Uganda, and Zimbabwe, each with variable coverage from Jan 1, 1995, to Dec 31, 2019. We included all deaths to adolescents and adults aged 12 or over that were residents of the study sites and had a verbal autopsy conducted. InSilicoVA, a probabilistic model, was used to assign cause of death on the basis of the signs and symptoms reported in the verbal autopsy. Levels and trends in all-cause and cause-specific mortality rates and cause-specific mortality fractions were calculated, stratified by HDSS site, sex, age, and calendar periods.
52 484 deaths and 5 157 802 person-years were reported among 1 071 913 individuals across the nine sites during the study period. 47 961 (91·4%) deaths had a verbal autopsy, of which 46 570 (97·1%) were assigned a cause of death. All-cause mortality generally decreased across the HDSS sites during this period, particularly for adults aged 20-59 years. In many of the HDSS sites, these decreases were driven by reductions in HIV and tuberculosis-related deaths. In 2010-14, the top causes of death were: road traffic accidents, HIV or tuberculosis, and meningitis or sepsis in adolescents (12-19 years); HIV or tuberculosis in adults aged 20-59 years; and neoplasms and cardiovascular disease in adults aged 60 years and older. There was greater between-HDSS and between-sex variation in causes of death for adolescents compared with adults.
This study shows progress in reducing mortality across eastern and southern Africa but also highlights age, sex, within-HDSS, and between-HDSS differences in causes of adolescent and adult deaths. These findings highlight the importance of detailed local data to inform health needs to ensure continued improvements in survival.
National Institute of Child Health and Human Development of the US National Institutes of Health.
由于许多非洲国家缺乏高质量的综合民事登记和人口动态统计系统，导致该地区关于死亡原因的实际数据很少。我们旨在利用死因推断数据，提供东非和南非青少年和成年人特定原因死亡率的比较性、基于人群的估计。
在这项监测研究中，我们对来自肯尼亚、马拉维、坦桑尼亚、南非、乌干达和津巴布韦的 9 个健康和人口监测系统（HDSS）站点的死因推断和居住数据进行了协调，每个站点的覆盖范围从 1995 年 1 月 1 日至 2019 年 12 月 31 日不等。我们纳入了所有居住在研究地点且进行了死因推断的 12 岁及以上青少年和成年人的死亡。基于死因推断中报告的体征和症状，使用概率模型 InSilicoVA 来确定死亡原因。计算了全因和特定原因死亡率以及特定原因死亡率分数的水平和趋势，按 HDSS 站点、性别、年龄和日历时期进行分层。
在研究期间，9 个站点报告了 1071913 人中有 52484 例死亡和 5157802 人年，其中 47961 例（91.4%）有死因推断，其中 46570 例（97.1%）确定了死因。在整个 HDSS 站点中，全因死亡率总体呈下降趋势，尤其是 20-59 岁的成年人。在许多 HDSS 站点中，这种下降主要是由于艾滋病毒和结核病相关死亡的减少。在 2010-14 年，青少年（12-19 岁）的主要死亡原因是道路交通意外、艾滋病毒或结核病以及脑膜炎或败血症；20-59 岁成年人的主要死亡原因是艾滋病毒或结核病；60 岁及以上成年人的主要死亡原因是肿瘤和心血管疾病。与成年人相比，青少年的死亡率在 HDSS 站点之间和性别之间存在更大的差异。
本研究表明，东非和南非的死亡率有所下降，但也突显了青少年和成年人死亡原因在年龄、性别、HDSS 内部和 HDSS 之间的差异。这些发现强调了详细的本地数据对于确定卫生需求的重要性，以确保生存状况的持续改善。
美国国立卫生研究院国家儿童健康与人类发展研究所。
