Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis
Identifieur interne : 000223 ( Main/Exploration ); précédent : 000222; suivant : 000224Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis
Auteurs : Chodziwadziwa W. Kabudula [Afrique du Sud] ; Brian Houle [Afrique du Sud, Australie, États-Unis] ; Mark A. Collinson [Afrique du Sud, Ghana] ; Kathleen Kahn [Afrique du Sud, Ghana, Suède] ; Francesc Xavier G Mez-Olivé [Afrique du Sud, Ghana] ; Stephen Tollman [Afrique du Sud, Ghana, Suède] ; Samuel J. Clark [Afrique du Sud, États-Unis, Ghana]Source :
- The Lancet. Global Health [ 2214-109X ] ; 2017.
Abstract
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.
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.
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.
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.
Wellcome Trust, South African Medical Research Council, and University of the Witwatersrand, South Africa.
Url:
DOI: 10.1016/S2214-109X(17)30297-8
PubMed: 28807190
PubMed Central: 5559644
Affiliations:
- Afrique du Sud, Australie, Ghana, Suède, États-Unis
- Colorado, Gauteng, Ohio, Région du Grand Accra
- Accra, Johannesbourg
- Université du Witwatersrand
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Kabudula</name><affiliation wicri:level="4"><nlm:aff id="aff1">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><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation></author><author><name sortKey="Houle, Brian" sort="Houle, Brian" uniqKey="Houle B" first="Brian" last="Houle">Brian Houle</name><affiliation wicri:level="4"><nlm:aff id="aff1">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><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff2">School of Demography, Australian National University, Canberra, ACT, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>School of Demography, Australian National University, Canberra, ACT</wicri:regionArea><wicri:noRegion>ACT</wicri:noRegion></affiliation><affiliation wicri:level="2"><nlm:aff id="aff3">CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO</wicri:regionArea><placeName><region type="state">Colorado</region></placeName></affiliation></author><author><name sortKey="Collinson, Mark A" sort="Collinson, Mark A" uniqKey="Collinson M" first="Mark A" last="Collinson">Mark A. 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Accra</region></placeName></affiliation><affiliation wicri:level="1"><nlm:aff id="aff6">Department of Science and Technology/Medical Research Council, South African Population Research Infrastructure Network (SAPRIN), Acornhoek, South Africa</nlm:aff><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>Department of Science and Technology/Medical Research Council, South African Population Research Infrastructure Network (SAPRIN), Acornhoek</wicri:regionArea><wicri:noRegion>Acornhoek</wicri:noRegion></affiliation></author><author><name sortKey="Kahn, Kathleen" sort="Kahn, Kathleen" uniqKey="Kahn K" first="Kathleen" last="Kahn">Kathleen Kahn</name><affiliation wicri:level="4"><nlm:aff id="aff1">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><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>MRC/Wits Rural 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Medicine, Umeå University, Umeå</wicri:regionArea><wicri:noRegion>Umeå</wicri:noRegion></affiliation></author><author><name sortKey="Clark, Samuel J" sort="Clark, Samuel J" uniqKey="Clark S" first="Samuel J" last="Clark">Samuel J. Clark</name><affiliation wicri:level="4"><nlm:aff id="aff1">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><country xml:lang="fr">Afrique du Sud</country><wicri:regionArea>MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg</wicri:regionArea><orgName type="university">Université du Witwatersrand</orgName><placeName><settlement type="city">Johannesbourg</settlement><region type="region" nuts="2">Gauteng</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff3">CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>CU Population Center, Institute of Behavioral Science, University of Colorado at Boulder, Boulder, CO</wicri:regionArea><placeName><region type="state">Colorado</region></placeName></affiliation><affiliation wicri:level="3"><nlm:aff id="aff4">INDEPTH Network, Accra, Ghana</nlm:aff><country xml:lang="fr">Ghana</country><wicri:regionArea>INDEPTH Network, Accra</wicri:regionArea><placeName><settlement type="city">Accra</settlement><region nuts="2">Région du Grand Accra</region></placeName></affiliation><affiliation wicri:level="2"><nlm:aff id="aff7">Department of Sociology, The Ohio State University, Columbus, OH, USA</nlm:aff><country xml:lang="fr">États-Unis</country><wicri:regionArea>Department of Sociology, The Ohio State University, Columbus, OH</wicri:regionArea><placeName><region type="state">Ohio</region></placeName></affiliation></author></analytic><series><title level="j">The Lancet. Global Health</title><idno type="eISSN">2214-109X</idno><imprint><date when="2017">2017</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><title>Summary</title><sec><title>Background</title><p>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.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Findings</title><p>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.</p></sec><sec><title>Interpretation</title><p>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.</p></sec><sec><title>Funding</title><p>Wellcome Trust, South African Medical Research Council, and University of the Witwatersrand, South Africa.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Adler, Ne" uniqKey="Adler N">NE Adler</name></author><author><name sortKey="Newman, K" uniqKey="Newman K">K Newman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Braveman, P" uniqKey="Braveman P">P Braveman</name></author><author><name sortKey="Tarimo, E" uniqKey="Tarimo E">E Tarimo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Link, Bg" uniqKey="Link B">BG Link</name></author><author><name sortKey="Phelan, J" uniqKey="Phelan J">J 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Accra</li></region><settlement><li>Accra</li><li>Johannesbourg</li></settlement><orgName><li>Université du Witwatersrand</li></orgName></list><tree><country name="Afrique du Sud"><region name="Gauteng"><name sortKey="Kabudula, Chodziwadziwa W" sort="Kabudula, Chodziwadziwa W" uniqKey="Kabudula C" first="Chodziwadziwa W" last="Kabudula">Chodziwadziwa W. Kabudula</name></region><name sortKey="Clark, Samuel J" sort="Clark, Samuel J" uniqKey="Clark S" first="Samuel J" last="Clark">Samuel J. Clark</name><name sortKey="Collinson, Mark A" sort="Collinson, Mark A" uniqKey="Collinson M" first="Mark A" last="Collinson">Mark A. Collinson</name><name sortKey="Collinson, Mark A" sort="Collinson, Mark A" uniqKey="Collinson M" first="Mark A" last="Collinson">Mark A. Collinson</name><name sortKey="G Mez Olive, Francesc Xavier" sort="G Mez Olive, Francesc Xavier" uniqKey="G Mez Olive F" first="Francesc Xavier" last="G Mez-Olivé">Francesc Xavier G Mez-Olivé</name><name sortKey="Houle, Brian" sort="Houle, Brian" uniqKey="Houle B" first="Brian" last="Houle">Brian Houle</name><name sortKey="Kahn, Kathleen" sort="Kahn, Kathleen" uniqKey="Kahn K" first="Kathleen" last="Kahn">Kathleen Kahn</name><name sortKey="Tollman, Stephen" sort="Tollman, Stephen" uniqKey="Tollman S" first="Stephen" last="Tollman">Stephen Tollman</name></country><country name="Australie"><noRegion><name sortKey="Houle, Brian" sort="Houle, Brian" uniqKey="Houle B" first="Brian" last="Houle">Brian Houle</name></noRegion></country><country name="États-Unis"><region name="Colorado"><name sortKey="Houle, Brian" sort="Houle, Brian" uniqKey="Houle B" first="Brian" last="Houle">Brian Houle</name></region><name sortKey="Clark, Samuel J" sort="Clark, Samuel J" uniqKey="Clark S" first="Samuel J" last="Clark">Samuel J. Clark</name><name sortKey="Clark, Samuel J" sort="Clark, Samuel J" uniqKey="Clark S" first="Samuel J" last="Clark">Samuel J. Clark</name></country><country name="Ghana"><region name="Région du Grand Accra"><name sortKey="Collinson, Mark A" sort="Collinson, Mark A" uniqKey="Collinson M" first="Mark A" last="Collinson">Mark A. Collinson</name></region><name sortKey="Clark, Samuel J" sort="Clark, Samuel J" uniqKey="Clark S" first="Samuel J" last="Clark">Samuel J. Clark</name><name sortKey="G Mez Olive, Francesc Xavier" sort="G Mez Olive, Francesc Xavier" uniqKey="G Mez Olive F" first="Francesc Xavier" last="G Mez-Olivé">Francesc Xavier G Mez-Olivé</name><name sortKey="Kahn, Kathleen" sort="Kahn, Kathleen" uniqKey="Kahn K" first="Kathleen" last="Kahn">Kathleen Kahn</name><name sortKey="Tollman, Stephen" sort="Tollman, Stephen" uniqKey="Tollman S" first="Stephen" last="Tollman">Stephen Tollman</name></country><country name="Suède"><noRegion><name sortKey="Kahn, Kathleen" sort="Kahn, Kathleen" uniqKey="Kahn K" first="Kathleen" last="Kahn">Kathleen Kahn</name></noRegion><name sortKey="Tollman, Stephen" sort="Tollman, Stephen" uniqKey="Tollman S" first="Stephen" last="Tollman">Stephen Tollman</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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|texte= Socioeconomic differences in mortality in the antiretroviral therapy era in Agincourt, rural South Africa, 2001–13: a population surveillance analysis
}}
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| HfdSelect -Kh $EXPLOR_AREA/Data/Main/Exploration/biblio.hfd \
| NlmPubMed2Wicri -a SidaSubSaharaV1
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