Statistics South Africa on Mortality and causes of death 2013

HIV moves to third leading underlying cause of death in South Africa: a move from reporting HIV-related causes to reporting HIV disease.

Ranking natural causes of death for deaths that occurred in 2013 has placed HIV disease as the third leading cause of death in South Africa. This disease has moved from being the seventh leading underlying natural cause of death during 2009–2011 and the sixth in 2012. In 2013, it was responsible for 6% of all the deaths, affecting relatively more males (6%, ranked third) than females (5%, ranked fourth).

HIV disease was the leading cause of death in Northern Cape; the second leading cause of death in Eastern Cape and KwaZulu-Natal; and the third leading cause of death in Western Cape. Among those aged 15–44, HIV disease was the second leading cause of death and was responsible for 11% of deaths in this age group.

The increase in the rank of HIV disease and its relative contribution to the overall number of deaths has been coupled with a decrease in the contribution of HIV-related deaths such as tuberculosis, influenza and pneumonia, intestinal infectious diseases and other viral diseases. While tuberculosis and influenza and pneumonia remain the first two leading causes of death, their contribution to the overall number of deaths has been declining consistently. Similarly, deaths due to intestinal infectious diseases, mainly diarrhoea, have reduced substantially such that this group of diseases has moved from being the third leading cause of death in 2009 to eighth in 2013.

Overall results show a consistent decline in the number of deaths due to infectious diseases, yet the number of deaths due to HIV disease is on the increase. The increase is particularly noted where the deceased had both HIV disease and tuberculosis where in these cases HIV disease will most probably be the underlying cause of death.

These results leave a number of questions unanswered: Are doctors becoming more comfortable stating HIV disease as an underlying cause of death rather than certifying immediate causes of death in HIV cases (e.g. tuberculosis, diarrhoea, pneumonia), or use euphemisms for HIV (e.g. “immuno-compromised” or “Retroviral disease positive”)? Did the training of doctors in cause-of-death certification undertaken in 2012/13 have an impact on reporting HIV disease? The training emphasised the importance of certifying correctly, addressed confidentiality issues for HIV reporting; and highlighted the fact that life insurance companies have waived HIV/AIDS exclusions to life and disability covers. Is information on the HIV status of the deceased more readily available to enable proper diagnosis of the underlying cause of death? Is the number of deaths due to HIV disease actually increasing in South Africa?

While further research is required to answer these questions, the results are indicative of changing patterns of reporting HIV-related and HIV specific causes of death in South Africa.

These results were published in a report on Mortality and Causes of Death in South Africa, 2013 published by Statistics South Africa on 02 December 2014. The results are based on 458 933 deaths that occurred in 2013 and were registered at the Department of Home Affairs. The report indicates that the overall number of deaths continue to decrease in the country, with the number of deaths slightly higher for males compared to females. The proportions of death occurring in young adult ages (between 25 and 49) are also continuously decreasing with time, while they are increasing at older ages.

The full report is available on the Statistics South Africa website: www.statssa.gov.za

Dr. Maletela Tuoane-Nkhasi
Executive Manager: Health and Vital Statistics
Tel: 012 310 8317
Cell: 082 804 6895
E-mail: MaletelaT@statssa.gov.za

Media enquiries:
Lesedi Dibakwane
Cell: 082 805 7088
E-mail: LesediD@statssa.gov.za

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