THE BURDEN OF HEALTH AND DISEASE IN SOUTH AFRICA

Transcription

1 THE BURDEN OF HEALTH AND DISEASE IN SOUTH AFRICA BRIEFING TO SELECT COMMITTEE ON SOCIAL SERVICES 15 March 216 Prof Debbie Bradshaw, Dr Pillay-van Wyk, Ms Ntuthu Somdyala and Dr Marlon Cerf

2 PRESENTATION OUTLINE Trends in health and disease burden Rapid Mortality Surveillance Report 2nd National Burden of Disease Study: Mortality trends SAMRC Eastern Cape Cancer Register Challenges in monitoring health and burden of disease

3 RAPID MORTALITY SURVEILLANCE REPORT 214 Surveillance system based on numbers of deaths recorded on the National Population Register (obtained monthly from Department of Home Affairs) Adjustments made to account for under-registration of deaths and proportion of population without IDs Key health indicators: Life expectancy at birth (e ) and at age 6 (e 6 ) Adult mortality rate ( 45 q 15 ) Under-5, infant and neonatal mortality rates Maternal mortality ratio RAPID MORTALITY SURVEILLANCE REPORT 214

4 TRENDS IN NUMBER OF NATURAL AND UNNATURAL DEATHS BY BROAD AGE GROUP RAPID MORTALITY SURVEILLANCE REPORT 214

5 TREND IN LIFE EXPECTANCY AT BIRTH, year increase in average life expectancy since the low in 25 By 214: Total: 62.9 years Male: 6. years Female: 65.8 years RAPID MORTALITY SURVEILLANCE REPORT 214

6 TREND IN PREMATURE ADULT MORTALITY, Premature mortality between age 15 and 6 years ( 45 q 15 ) has decreased since 25 45q Total 41% 5% 34% Male 48% 55% 4% Female 35% 46% 28% RAPID MORTALITY SURVEILLANCE REPORT 214

7 TREND IN LIFE EXPECTANCY AT AGE 6 YEARS, Little change in average life expectancy at age 6 years (e 6 ) About 19 years for females and about 15 years for males RAPID MORTALITY SURVEILLANCE REPORT 214

8 TREND IN CHILDHOOD MORTALITY, Under-5 mortality rate (U5MR) and infant mortality rate (IMR) increased to a peak in 23 and declined till 211. Levels have stagnated at 4 and 28 deaths per 1 livebirths for the U5MR and IMR respectively. Neonatal mortality rates (NMR) have declined to 11 per 1 livebirths. RAPID MORTALITY SURVEILLANCE REPORT 214

9 MATERNAL MORTALITY RATIO, Maternal deaths are relatively rare and uncertainty about true value of MMR remains. MMR declined from 21 to 155 per 1 live births in 213 based on cause of death data from Stats SA with adjustment for under-registration and under-reporting of maternal causes. RAPID MORTALITY SURVEILLANCE REPORT 214

10 2 ND NATIONAL BURDEN OF DISEASE STUDY CAUSE OF DEATH PROFILE Mortality estimates by broad cause group and disease categories Age distribution of deaths by broad cause group Leading causes of death for SA in 1997 and 21 Mortality estimates by broad cause group by population group, sex and province for 21 2 ND NATIONAL BURDEN OF DISEASE STUDY FOR SOUTH AFRICA: CAUSE OF DEATH PROFILE

11 METHOD AND DATA SOURCES Figure 1: Schematic of data sources and data adjustments cause of death data STATISTICS SOUTH AFRICA DEATHS DATA BASE INJURY MORTALITY SURVEY 29 Multi nomial modeling of the 5 major injury causes by age, sex, province and population group Data cleaning Based on *IMS, adjust + NIMSS 2 profile to reflect population structure in 2 Proportionally redistributed unknown age, sex, population group Compare with Statistics South Africa and apply polynomial smoothing by age, sex and province for ratio Linear regression to estimate cause profiles between + NIMSS 2 and *IMS 29 Estimate overall profile for other unintentional injuries by age and sex Adjust overall completeness Apply derived injury proportions Apply injury completeness Generate scaling factors allowing for provincial boundary change Adjust National completeness for Africans RE ALLOCATION OF MIS CLASSIFEID HIV/AIDS Identify source causes with miss attributed AIDS deaths Model increase of age specific mortality against lagged HIV ANC prevalence to estimate mortality level without HIV/AIDS Estimate non HIV/AIDS trends from mortality rates in the year age group Redistribute ill-defined naturals & garbage ADJUSTED DEATHS Pillay-Van Wyk V, Laubscher R, Msemburi W, et al. Second South African National Burden of Disease Study: Data cleaning, validation and SANBD list. Cape Town: Medical Research Council; 214.

12 ESTIMATED NUMBER OF AIDS DEATHS BY REPORTED CAUSE OF DEATH AND AGE FOR THE PERIOD (N=2,812,) 5 4 Deaths Reported HIV HIV pseudonyms Tuberculosis Lower respiratory Diarrhoeal Other causes Ill-defined 2 ND NATIONAL BURDEN OF DISEASE STUDY FOR SOUTH AFRICA: CAUSE OF DEATH PROFILE

13 Number of deaths Age standardised death rates per 1 population NUMBER OF DEATHS (a) AND DEATH RATES (b) BY BROAD CAUSE, SOUTH AFRICA, a. Number of deaths b. Age-standardised death rates Years Years 2 ND NATIONAL BURDEN OF DISEASE STUDY FOR SOUTH AFRICA: CAUSE OF DEATH PROFILE

14 Number of deaths Number of deaths Number of deaths Number of deaths NUMBER OF DEATHS BY BROAD CAUSE AND AGE GROUP, SOUTH AFRICA 1997, 2, 25 and Persons N= Persons N= Age group (years) Age group (years) 6 25 Persons N= Persons N= Age group (years) Age group (years)

15 Age standardised death rates per 1 population TREND IN DISEASE CATEGORIES, HIV/AIDS & TB Infectiouss and Parasitic Other Type 1 Cancers Diabetes Cardiovascular Disease Other Type 2 Unintentional Injuries Intentional Injuries Year 2 ND NATIONAL BURDEN OF DISEASE STUDY FOR SOUTH AFRICA: CAUSE OF DEATH PROFILE

16 Age standardised death rates per 1 population TREND IN DISEASE CATEGORIES, Infectiouss and Parasitic Other Type 1 Cancers Diabetes Cardiovascular Disease Other Type 2 Unintentional Injuries Intentional Injuries Year 2 ND NATIONAL BURDEN OF DISEASE STUDY FOR SOUTH AFRICA: CAUSE OF DEATH PROFILE

17 Age-standardised deaths per 1 population Age-standardised deaths per 1 population Death rates for cardiovascular diseases, diabetes and renal disease for males (a) and females (b), SA a. Males b. Females Years Years

18 Age-standardised deaths per 1 population Age-standardised deaths per 1 population DEATH RATES FOR CANCERS, SOUTH AFRICA a. Males b. Females Years Years

19 LEADING CAUSES OF DEATH, Cause of Death Deaths % HIV/AIDS Cerebrovascular disease Interpersonal violence Tuberculosis Ischaemic heart disease Lower respiratory disease Diarrhoeal diseases Hypertensive heart disease Road injuries Diabetes mellitus Top 1 causes Total deaths Cause of Death Deaths % HIV/AIDS Cerebrovascular disease Lower respiratory infections Tuberculosis Ischaemic heart disease Hypertensive heart disease Diarrhoeal diseases Interpersonal violence Diabetes mellitus Road injuries Top 1 causes Total deaths ND NATIONAL BURDEN OF DISEASE STUDY FOR SOUTH AFRICA: CAUSE OF DEATH PROFILE

20 CAUSES OF DEATH IN CHILDREN UNDER-5 YEARS, 21 N=6,56 Congenital 2% Other childhood conditions 13% Injuries 4% Preterm 1% Pneumonia 11% Neonatal deaths 22% Birth asphyxia 5% Tuberculosis 2% Diarrhoea 18% HIV/AIDS 28% Severe infections 3% Other neonatal 4% 2 ND NATIONAL BURDEN OF DISEASE STUDY FOR SOUTH AFRICA: CAUSE OF DEATH PROFILE

21 KwaZulu-Natal Mpumalanga Eastern Cape Free State Limpopo North West Northern Cape Gauteng Western Cape South Africa Deaths per 1 live births UNDER-5 MORTALITY RATE BY PROVINCE 2, 25, , 6, 6,1 65,8 41,6 54,5 45,3 43,2 24,9 51,8

22 Age standardised deaths rates per 1 population DEATH RATES BY BROAD CAUSE GROUP BY PROVINCE 1997, 2, 25 and South Africa Western Cape Limpopo Gauteng North West Northern Cape Mpumalanga Eastern Cape Free State KwaZulu Natal

23 LEADING CAUSES OF PREMATURE MORTALITY (YEARS OF LIFE LOST) BY PROVINCE IN 21

24 OVERVIEW Huge gains with HIV/AIDS, need to continue and strengthen current programmes Decrease in interpersonal violence mortality rates remain high Increase in death rate for renal disease and diabetes mellitus Increase in death rate for prostate and breast cancer Highest deaths rates in adults and children in Kwa-Zulu Natal 2 ND NATIONAL BURDEN OF DISEASE STUDY FOR SOUTH AFRICA: CAUSE OF DEATH PROFILE

25 CANCER INCIDENCE IN SELECTED MUNICIPALITIES OF THE EASTERN CAPE PROVINCE High incidence of cancer of oesophagus was first noticed amongst the Xhosa-speaking people of the Transkei region of the Eastern Cape Province in the early 195s. A register which was dedicated to record each and every cancer case in this area was started in 1955 so that scientists could investigate oesophageal cancer the Bantu Registry in East London. The SAMRC has continued and expanded the population based cancer register and contributes to the international data base on cancers. CANCER INCIDENCE IN SELECTED MUNICIPALITIES OF THE EASTERN CAPE PROVINCE

26 NINE PROVINCES OF SOUTH AFRICA Qunu Location Of Cancer Registry Within Eastern Cape Province

27 METHODS Data sources 15 collaborating hospitals in and around registration area 1 pathology laboratory Active and passive data collection CANCER INCIDENCE IN SELECTED MUNICIPALITIES OF THE EASTERN CAPE PROVINCE

28 Rural but with facilities such as tarred roads, making access to hospitals easy Bambisana Hospital Registry staff visiting Bambisana Hospital

29 METHODS Data processing Geographic coding and ICD-O coding Capture of data using CANREG 5 Data checking Analysis Rates calculated using census data Age standardised using IARC world standard CANCER INCIDENCE IN SELECTED MUNICIPALITIES OF THE EASTERN CAPE PROVINCE

30 MOST COMMON CANCERS FOR MALES Males Site ICD-1 No. of cases % of total Oesophagus C Prostate C Oral cavity & pharynx C-C Kaposi sarcoma C Lung C33-C Liver C Larynx C Colon-rectum C18-C Non-Hodgkin Lymphoma C82-C Stomach C CANCER INCIDENCE IN SELECTED MUNICIPALITIES OF THE EASTERN CAPE PROVINCE

31 MOST COMMON CANCERS FOR FEMALES Females Site ICD-1 No. of cases % of total Cervix Uteri C Oesophagus C Breast C Kaposi sarcoma C Ovary C Corpus Uteri C Liver C Colon-rectum C18-C Lung C33-C Non-Hodgkin Lymphoma C82-C CANCER INCIDENCE IN SELECTED MUNICIPALITIES OF THE EASTERN CAPE PROVINCE

32 THE IMPORTANCE OF KEEPING A CANCER REGISTER

33 TRENDS IN COMMON CANCERS AMONG MALES AGE STANDARDISED RATES PER 1 POPULATION Oesophagus Prostate Kaposi sarcoma Liver Lung CANCER INCIDENCE IN SELECTED MUNICIPALITIES OF THE EASTERN CAPE PROVINCE

34 TRENDS IN COMMON CANCERS AMONG FEMALES AGE STANDARDISED RATES PER 1 POPULATION Cervix Oesophagus Breast Liver Ovary CANCER INCIDENCE IN SELECTED MUNICIPALITIES OF THE EASTERN CAPE PROVINCE

35 OESOPHAGEAL CANCER RATES BY TOWN AGE STANDARDISED RATES PER 1 POPULATION 6 5 MALES 6 5 FEMALES CANCER INCIDENCE IN SELECTED MUNICIPALITIES OF THE EASTERN CAPE PROVINCE

36 CONCLUSIONS 1. Gains in child mortality are consistent with provision of PMTCT, ARTs and immunizations. Improved socio-economic and environmental conditions are needed to reduce rates further and improved health care is needed to improve the outcomes of newborns. 2. Maternal mortality has improved since 21 - quality of health care must be improved to reduce MMR further. 3. Life expectancy gains are consistent with roll out of ARTs and strengthening TB control programme, but also gradual declines in certain non-communicable diseases and injuries. Further gains will need a comprehensive health promotion and disease prevention approach together with improved health services. 4. Cancer surveillance is the tool both to monitor trends of cancers and evaluate cancer control programmes. Oesophageal cancer remains the leading cancer in the area under surveillance. Kaposi s sarcoma and prostate cancer have increased among men while cervical and breast cancer have increased among women.

37 CHALLENGES 1. Civil registration and vital statistics (CRVS) is well established in South Africa and has improved considerably since The quality of medical certification and the inclusion of information about the external causes of injuries needs to be improved. 2. Morbidity data systems need to be strengthened there is little data currently available to track the incidence of key conditions. 3. Demographic, epidemiological and biostatistical skills and capacity need to be strengthened. BURDEN OF DISEASE RESEARCH UNIT

38 BURDEN OF DISEASE RESEARCH UNIT Director: Prof Debbie Bradshaw Mission: To assess and monitor the country's health status and determinants of disease Key projects: 2nd National Burden of Disease Study & Comparative Risk Assessment Improving mortality surveillance South African Demographic and Health Survey (with NDOH and Stats SA) Eastern Cape Cancer Register Evaluation of clinically coded information WHO-FIC Collaborating Centre BURDEN OF DISEASE RESEARCH UNIT

39 ACKNOWLEDGEMENTS Department of Home Affairs, Stats SA and Department of Health are thanked for providing data the interpretation of the data is that of the authors. Collaborating hospitals in Eastern Cape and KwaZulu Natal and the National Health Laboratory Services. Members of the SAMRC Burden of Disease Research Unit and contributors to the reports presented. BURDEN OF DISEASE RESEARCH UNIT