Research

Mortality trends in the City of Cape Town between 2001 and 2013: Reducing inequities in health

P Groenewald, I Neethling, J Evans, V Azevedo, T Naledi, R Matzopoulos, N Nannan, J Daniels, D Bradshaw

Abstract


Background. 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.

Objectives. To describe the changes in mortality between 2001 and 2013 in health subdistricts in the CoCT.

Methods. 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.

Results. 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.

Conclusions. 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.

 


Authors' affiliations

P Groenewald, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

I Neethling, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

J Evans, Western Cape Government: Health, Cape Town, South Africa

V Azevedo, City Health, City of Cape Town, South Africa

T Naledi, Western Cape Government: Health, Cape Town, South Africa

R Matzopoulos, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

N Nannan, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

J Daniels, City Health, City of Cape Town, South Africa

D Bradshaw, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

Full Text

PDF (658KB)

Keywords

Mortality; Health inequity; Public health; Small area

Cite this article

South African Medical Journal 2017;107(12):1091-1098. DOI:10.7196/SAMJ.2017.v107i12.12458

Article History

Date submitted: 2017-11-27
Date published: 2017-11-27

Article Views

Abstract views: 1174
Full text views: 944

Comments on this article

*Read our policy for posting comments here