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Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis

BACKGROUND: Understanding the effects of socioeconomic disparities in health outcomes is important to implement specific preventive actions. We assessed socioeconomic disparities in mortality indicators in a rural South African population over the period 2001–13. METHODS: We used data from 21 villag...

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Autores principales: Kabudula, Chodziwadziwa W, Houle, Brian, Collinson, Mark A, Kahn, Kathleen, Gómez-Olivé, Francesc Xavier, Tollman, Stephen, Clark, Samuel J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Ltd 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559644/
https://www.ncbi.nlm.nih.gov/pubmed/28807190
http://dx.doi.org/10.1016/S2214-109X(17)30297-8
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author Kabudula, Chodziwadziwa W
Houle, Brian
Collinson, Mark A
Kahn, Kathleen
Gómez-Olivé, Francesc Xavier
Tollman, Stephen
Clark, Samuel J
author_facet Kabudula, Chodziwadziwa W
Houle, Brian
Collinson, Mark A
Kahn, Kathleen
Gómez-Olivé, Francesc Xavier
Tollman, Stephen
Clark, Samuel J
author_sort Kabudula, Chodziwadziwa W
collection PubMed
description BACKGROUND: Understanding the effects of socioeconomic disparities in health outcomes is important to implement specific preventive actions. We assessed socioeconomic disparities in mortality indicators in a rural South African population over the period 2001–13. METHODS: We used data from 21 villages of the Agincourt Health and socio-Demographic Surveillance System (HDSS). We calculated the probabilities of death from birth to age 5 years and from age 15 to 60 years, life expectancy at birth, and cause-specific and age-specific mortality by sex (not in children <5 years), time period, and socioeconomic status (household wealth) quintile for HIV/AIDS and tuberculosis, other communicable diseases (excluding HIV/AIDS and tuberculosis) and maternal, perinatal, and nutritional causes, non-communicable diseases, and injury. We also quantified differences with relative risk ratios and relative and slope indices of inequality. FINDINGS: Between 2001 and 2013, 10 414 deaths were registered over 1 058 538 person-years of follow-up, meaning the overall crude mortality was 9·8 deaths per 1000 person-years. We found significant socioecomonic status gradients for mortality and life expectancy at birth, with outcomes improving with increasing socioeconomic status. An inverse relation was seen for HIV/AIDS and tuberculosis mortality and socioeconomic status that persisted from 2001 to 2013. Deaths from non-communicable diseases increased over time in both sexes, and injury was an important cause of death in men and boys. Neither of these causes of death, however, showed consistent significant associations with household socioeconomic status. INTERPRETATION: The poorest people in the population continue to bear a high burden of HIV/AIDS and tuberculosis mortality, despite free antiretroviral therapy being made available from public health facilities. Associations between socioeconomic status and increasing burden of mortality from non-communicable diseases is likely to become prominent. Integrated strategies are needed to improve access to and uptake of HIV testing, care, and treatment, and management of non-communicable diseases in the poorest populations. FUNDING: Wellcome Trust, South African Medical Research Council, and University of the Witwatersrand, South Africa.
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spelling pubmed-55596442017-08-24 Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis Kabudula, Chodziwadziwa W Houle, Brian Collinson, Mark A Kahn, Kathleen Gómez-Olivé, Francesc Xavier Tollman, Stephen Clark, Samuel J Lancet Glob Health Articles BACKGROUND: Understanding the effects of socioeconomic disparities in health outcomes is important to implement specific preventive actions. We assessed socioeconomic disparities in mortality indicators in a rural South African population over the period 2001–13. METHODS: We used data from 21 villages of the Agincourt Health and socio-Demographic Surveillance System (HDSS). We calculated the probabilities of death from birth to age 5 years and from age 15 to 60 years, life expectancy at birth, and cause-specific and age-specific mortality by sex (not in children <5 years), time period, and socioeconomic status (household wealth) quintile for HIV/AIDS and tuberculosis, other communicable diseases (excluding HIV/AIDS and tuberculosis) and maternal, perinatal, and nutritional causes, non-communicable diseases, and injury. We also quantified differences with relative risk ratios and relative and slope indices of inequality. FINDINGS: Between 2001 and 2013, 10 414 deaths were registered over 1 058 538 person-years of follow-up, meaning the overall crude mortality was 9·8 deaths per 1000 person-years. We found significant socioecomonic status gradients for mortality and life expectancy at birth, with outcomes improving with increasing socioeconomic status. An inverse relation was seen for HIV/AIDS and tuberculosis mortality and socioeconomic status that persisted from 2001 to 2013. Deaths from non-communicable diseases increased over time in both sexes, and injury was an important cause of death in men and boys. Neither of these causes of death, however, showed consistent significant associations with household socioeconomic status. INTERPRETATION: The poorest people in the population continue to bear a high burden of HIV/AIDS and tuberculosis mortality, despite free antiretroviral therapy being made available from public health facilities. Associations between socioeconomic status and increasing burden of mortality from non-communicable diseases is likely to become prominent. Integrated strategies are needed to improve access to and uptake of HIV testing, care, and treatment, and management of non-communicable diseases in the poorest populations. FUNDING: Wellcome Trust, South African Medical Research Council, and University of the Witwatersrand, South Africa. Elsevier Ltd 2017-08-11 /pmc/articles/PMC5559644/ /pubmed/28807190 http://dx.doi.org/10.1016/S2214-109X(17)30297-8 Text en © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Articles
Kabudula, Chodziwadziwa W
Houle, Brian
Collinson, Mark A
Kahn, Kathleen
Gómez-Olivé, Francesc Xavier
Tollman, Stephen
Clark, Samuel J
Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis
title Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis
title_full Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis
title_fullStr Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis
title_full_unstemmed Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis
title_short Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis
title_sort socioeconomic differences in mortality in the antiretroviral therapy era in agincourt, rural south africa, 2001–13: a population surveillance analysis
topic Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5559644/
https://www.ncbi.nlm.nih.gov/pubmed/28807190
http://dx.doi.org/10.1016/S2214-109X(17)30297-8
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