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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Dying in their prime: determinants and space-time risk of adult mortality in rural South Africa</title>
<author><name sortKey="Sartorius, Benn" sort="Sartorius, Benn" uniqKey="Sartorius B" first="Benn" last="Sartorius">Benn Sartorius</name>
<affiliation><nlm:aff id="A1">Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A2">MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kahn, Kathleen" sort="Kahn, Kathleen" uniqKey="Kahn K" first="Kathleen" last="Kahn">Kathleen Kahn</name>
<affiliation><nlm:aff id="A2">MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A3">Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Sweden</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A4">INDEPTH Network, Accra, Ghana</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Collinson, Mark A" sort="Collinson, Mark A" uniqKey="Collinson M" first="Mark A." last="Collinson">Mark A. Collinson</name>
<affiliation><nlm:aff id="A2">MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A3">Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Sweden</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A4">INDEPTH Network, Accra, Ghana</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sartorius, Kurt" sort="Sartorius, Kurt" uniqKey="Sartorius K" first="Kurt" last="Sartorius">Kurt Sartorius</name>
<affiliation><nlm:aff id="A5">School of Accountancy, Faculty of Commerce, Law and Management, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tollman, Stephen M" sort="Tollman, Stephen M" uniqKey="Tollman S" first="Stephen M." last="Tollman">Stephen M. Tollman</name>
<affiliation><nlm:aff id="A2">MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A3">Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Sweden</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A4">INDEPTH Network, Accra, Ghana</nlm:aff>
</affiliation>
</author>
</titleStmt>
<publicationStmt><idno type="wicri:source">PMC</idno>
<idno type="pmid">23733287</idno>
<idno type="pmc">3725424</idno>
<idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725424</idno>
<idno type="RBID">PMC:3725424</idno>
<date when="2013">2013</date>
<idno type="wicri:Area/Pmc/Corpus">001A52</idno>
<idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">001A52</idno>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Dying in their prime: determinants and space-time risk of adult mortality in rural South Africa</title>
<author><name sortKey="Sartorius, Benn" sort="Sartorius, Benn" uniqKey="Sartorius B" first="Benn" last="Sartorius">Benn Sartorius</name>
<affiliation><nlm:aff id="A1">Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A2">MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Kahn, Kathleen" sort="Kahn, Kathleen" uniqKey="Kahn K" first="Kathleen" last="Kahn">Kathleen Kahn</name>
<affiliation><nlm:aff id="A2">MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A3">Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Sweden</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A4">INDEPTH Network, Accra, Ghana</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Collinson, Mark A" sort="Collinson, Mark A" uniqKey="Collinson M" first="Mark A." last="Collinson">Mark A. Collinson</name>
<affiliation><nlm:aff id="A2">MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A3">Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Sweden</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A4">INDEPTH Network, Accra, Ghana</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Sartorius, Kurt" sort="Sartorius, Kurt" uniqKey="Sartorius K" first="Kurt" last="Sartorius">Kurt Sartorius</name>
<affiliation><nlm:aff id="A5">School of Accountancy, Faculty of Commerce, Law and Management, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
</author>
<author><name sortKey="Tollman, Stephen M" sort="Tollman, Stephen M" uniqKey="Tollman S" first="Stephen M." last="Tollman">Stephen M. Tollman</name>
<affiliation><nlm:aff id="A2">MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A3">Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Sweden</nlm:aff>
</affiliation>
<affiliation><nlm:aff id="A4">INDEPTH Network, Accra, Ghana</nlm:aff>
</affiliation>
</author>
</analytic>
<series><title level="j">Geospatial health</title>
<idno type="ISSN">1827-1987</idno>
<idno type="eISSN">1970-7096</idno>
<imprint><date when="2013">2013</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
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<profileDesc><textClass></textClass>
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</teiHeader>
<front><div type="abstract" xml:lang="en"><p id="P1">A longitudinal dataset was used to investigate adult mortality in rural South Africa in order to determine location, trends, high impact determinants and policy implications. Adult (15-59 years) mortality data for the period 1993-2010 were extracted from the health and socio-demographic surveillance system (HDSS) in the rural sub-district of Agincourt. A Bayesian geostatistical frailty survival model was used to quantify significant associations between adult mortality and various multilevel (individual, household and community) variables. It was found that adult mortality significantly increased over time with a reduction observed late in the study period. Non-communicable disease mortality appeared to increase and decrease in parallel with communicable mortality, whilst deaths due to external causes remained constant. Male gender, unemployment, circular (labour) migrant status, age and gender of household heads, partner and/or other household death, low education and low household socioeconomic status (SES) were identified as significant and highly attributable determinants of adult mortality. Health facility remoteness was also a risk for adult mortality and households falling outside a critical buffering zone were identified. Spatial foci of higher adult mortality risk were observed indicating a strong non-random pattern. Communicable diseases differed from non-communicable diseases with respect to spatial distribution of mortality. Areas with significant excess mortality risk (hotspots) were found to be part of a complex interaction of highly attributable factors that continues to drive differential space-time risk patterns of communicable (HIV/AIDS and Tuberculosis) mortality in Agincourt. The impact of HIV mortality and its subsequent lowering due to the introduction of antiretroviral therapy (ART) was found to be clearly evident in this rural population.</p>
</div>
</front>
</TEI>
<pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<pmc-dir>properties manuscript</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-journal-id">101302943</journal-id>
<journal-id journal-id-type="pubmed-jr-id">33356</journal-id>
<journal-id journal-id-type="nlm-ta">Geospat Health</journal-id>
<journal-id journal-id-type="iso-abbrev">Geospat Health</journal-id>
<journal-title-group><journal-title>Geospatial health</journal-title>
</journal-title-group>
<issn pub-type="ppub">1827-1987</issn>
<issn pub-type="epub">1970-7096</issn>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">23733287</article-id>
<article-id pub-id-type="pmc">3725424</article-id>
<article-id pub-id-type="manuscript">EMS53912</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>Dying in their prime: determinants and space-time risk of adult mortality in rural South Africa</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><name><surname>Sartorius</surname>
<given-names>Benn</given-names>
</name>
<xref ref-type="aff" rid="A1">1</xref>
<xref ref-type="aff" rid="A2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Kahn</surname>
<given-names>Kathleen</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
<xref ref-type="aff" rid="A3">3</xref>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Collinson</surname>
<given-names>Mark A.</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
<xref ref-type="aff" rid="A3">3</xref>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Sartorius</surname>
<given-names>Kurt</given-names>
</name>
<xref ref-type="aff" rid="A5">5</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Tollman</surname>
<given-names>Stephen M.</given-names>
</name>
<xref ref-type="aff" rid="A2">2</xref>
<xref ref-type="aff" rid="A3">3</xref>
<xref ref-type="aff" rid="A4">4</xref>
</contrib>
</contrib-group>
<aff id="A1"><label>1</label>
Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</aff>
<aff id="A2"><label>2</label>
MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa</aff>
<aff id="A3"><label>3</label>
Centre for Global Health Research, Epidemiology and Global Health, Umeå University, Sweden</aff>
<aff id="A4"><label>4</label>
INDEPTH Network, Accra, Ghana</aff>
<aff id="A5"><label>5</label>
School of Accountancy, Faculty of Commerce, Law and Management, University of the Witwatersrand, Johannesburg, South Africa</aff>
<author-notes><corresp id="CR1">Corresponding author: Dr. Benn Sartorius, PhD School of Public Health Faculty of Health Sciences University of the Witwatersrand 27 St Andrews Road Parktown Johannesburg South Africa Tel: +27-11-717-2313 Fax: +27 (0)11 717 2084 <email>benn.sartorius@wits.ac.za</email>
</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted"><day>12</day>
<month>7</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="ppub"><month>5</month>
<year>2013</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>29</day>
<month>7</month>
<year>2013</year>
</pub-date>
<volume>7</volume>
<issue>2</issue>
<fpage>237</fpage>
<lpage>249</lpage>
<abstract><p id="P1">A longitudinal dataset was used to investigate adult mortality in rural South Africa in order to determine location, trends, high impact determinants and policy implications. Adult (15-59 years) mortality data for the period 1993-2010 were extracted from the health and socio-demographic surveillance system (HDSS) in the rural sub-district of Agincourt. A Bayesian geostatistical frailty survival model was used to quantify significant associations between adult mortality and various multilevel (individual, household and community) variables. It was found that adult mortality significantly increased over time with a reduction observed late in the study period. Non-communicable disease mortality appeared to increase and decrease in parallel with communicable mortality, whilst deaths due to external causes remained constant. Male gender, unemployment, circular (labour) migrant status, age and gender of household heads, partner and/or other household death, low education and low household socioeconomic status (SES) were identified as significant and highly attributable determinants of adult mortality. Health facility remoteness was also a risk for adult mortality and households falling outside a critical buffering zone were identified. Spatial foci of higher adult mortality risk were observed indicating a strong non-random pattern. Communicable diseases differed from non-communicable diseases with respect to spatial distribution of mortality. Areas with significant excess mortality risk (hotspots) were found to be part of a complex interaction of highly attributable factors that continues to drive differential space-time risk patterns of communicable (HIV/AIDS and Tuberculosis) mortality in Agincourt. The impact of HIV mortality and its subsequent lowering due to the introduction of antiretroviral therapy (ART) was found to be clearly evident in this rural population.</p>
</abstract>
<kwd-group><kwd>adult mortality</kwd>
<kwd>spatial risk</kwd>
<kwd>survival modelling</kwd>
<kwd>Bayesian inference</kwd>
<kwd>determinants</kwd>
<kwd>attributable fractions</kwd>
<kwd>health and socio-demographic surveillance</kwd>
<kwd>South Africa</kwd>
</kwd-group>
<funding-group><award-group><funding-source country="United Kingdom">Wellcome Trust : </funding-source>
<award-id>069683 || WT</award-id>
</award-group>
<award-group><funding-source country="United Kingdom">Wellcome Trust : </funding-source>
<award-id>058893/Z/99/A || WT</award-id>
</award-group>
</funding-group>
</article-meta>
</front>
</pmc>
</record>
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