cod 2013 mortality and causes of death in south africa 2013 the south africa i know, the home i...

COD 2013

The South Africa I know, the home I understandThe South Africa I know, the home I understand

Mortality and causes of

death in South Africa: Findings from death

notification, 2013

@StatsSA#COD

COD 2013

The South Africa I know, the home I understand

is a permanent

disappearance of all

evidence of life after a

live birth has occurred

Death

COD 2013


COD 2013


From death to statistics

Births and Deaths Registration Act, 1992 Statistics Act 1999

Death

occurs

Dr. verifies death &

completes death

DHA 1663 form

1 2

Submitted to DHA

& entered on

population

register

3

Sent to Stats SA to

code causes of death

to ICD-10, process

and analyze

Statistics

released

COD 2013


COD 2013


All diseases, morbid

conditions, or

injuries that either

resulted in or

contributed to death,

and the

circumstances of the

accident or violence

which produced any

such injuries

Underlying

causes of

death

COD 2013


• Statistics compiled in accordance with WHO standards

• General improvements noted in the quality of data

94% complete

Death registration of adults is

of deaths were registered within

the 3 Days of death as

stipulated within the legislation in

2013 it was 75% in 2012

77%

COD 2013


Findings

COD 2013


In 2013,

458 933deaths

occurred in South Africa

COD 2013


100 000

200 000

300 000

400 000

500 000

600 000

700 000

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Nu

mb

er

of

de

ath

s

Year of death

Decline in

recorded

deaths

continues

COD 2013


Provincial

distribution of

South Africa’s

458 933

recorded deaths

-2013-

Foreign = 0,3%Unspecified = 0,2%

COD 2013


LP8,6

MP8,4

KZN8,0

EC9,5

FS12,1

NW9,8

NC11,8

WC7,7

GP7,7

Deaths per 1 000 population

2013

South Africa

8,6

Northern Cape and Free State experienced the

highest number of deaths per 1 000 people

COD 2013


Deaths per 1 000 population by district 2013

1

2

2

Pixley ka Seme - 19

Xhariep -18

Highest

1

eThekwini - 53

Lowest

3

COD 2013


How we die

COD 2013


Other Diseases

Respiratory

system

Cancers/

Neoplasms

Accidents andexternal causes

Circulatory

systemInfectious and

parasitic diseases

Metabolic disorders

23% 17%

10%6%

8%

10%

25%

Total Deaths458 933

Distribution of deaths by

main groups of causes death 2013

COD 2013


Distribution of deaths

by causes death 2013

10%

25%

23%

17%

8%

COD 2013


Ranking of top ten leading causes of death between 2012 and 2013

Tuberculosis (9.9%)

Influenza and pneumonia (5.5%)

Cerebrovascular diseases (5.0%)

Other forms of heart disease (4.6%)

Diabetes mellitus (4.4%)

HIV disease (3.9%)

Hypertensive diseases (3.4)

Other viral diseases (3.1%)

Intestinal infectious diseases (3.1%)

Chronic lower respiratory diseases (2.5%)

Tuberculosis (8.8%)

Influenza and pneumonia (5.2%)

HIV disease (5.1%)

Cerebrovascular diseases (4.9%)

Diabetes mellitus (4.8%)

Other forms of heart disease (4.6%)

Hypertensive diseases (3.7%)

Intestinal infectious diseases (3.4%)

Other viral diseases (3.0%)

Chronic lower respiratory diseases (2.6%)

1

2

3

4

5

6

7

8

9

2012 2013

10 10

1

2

3

4

5

6

7

8

9

COD 2013


Tuberculosis 1 23,791 9.9 1 16,582 7.6

Influenza and pneumonia 2 12,133 5.1 5 11,480 5.3

Human immunodeficiency virus [HIV] disease 3 11,643 4.9 4 11,481 5.3

Other forms of heart disease 4 9,651 4.0 6 11,399 5.2

Cerebrovascular diseases 5 9,518 4.0 3 12,920 5.9

Diabetes mellitus 6 8,699 3.6 2 13,484 6.2

Intestinal infectious diseases 7 7,441 3.1 8 8,259 3.8

Chronic lower respiratory diseases 8 7,262 3.0 10 4,757 2.2

Other viral diseases 9 6,459 2.7 9 7,102 3.3

Hypertensive diseases 10 6,352 2.7 7 10,388 4.8

Diabetes ranks as the second leading COD for women, but falls outside of the Top 5 for men

Male Female

Rank Number % Rank Number %

Top ten leading causes of death

(based on ICD-10) in 2013

COD 2013


LP

MP

KZN

EC

FS

NW

NC

WC

Leading causes of death within each province

Influenza and pneumonia

Tuberculosis

GPDiabetes

HIV disease

COD 2013


Leading cause of death by district

2013

COD 2013


-

100 000

200 000

300 000

400 000

500 000

600 000

700 000

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Certain infectious and parasitic diseases Neoplasms Diseases of the blood and immune mechanism

Endocrine, nutritional and metabolic diseases Diseases of the nervous system Diseases of the circulatory system

Diseases of the respiratory system Diseases of the digestive system Perinatal conditions

Other natural causes External causes of morbidity and mortality

Endocrine, nutritional and metabolic disease

Respiratory system

Circulatorysystem (I00-I99)

Infectious andparasitic diseases (A00-B99) Neoplasms (C00-D48)

Main groups ofbased on underlying

causes 1997- 2013

Percentage of total deaths

Diseases of the circulatory system

Certain infectious and parasitic diseases

Endocrine, nutritional and metabolic diseases

COD 2013


Ages at which we die

COD 2013


0,0

1,0

2,0

3,0

4,0

5,0

6,0

7,0

8,0

9,0

0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+

Pe

rce

nta

ge

Shift from

deaths

occurring at

younger age.

Percentage distribution of deaths by age and sex

2012 vs 2013

2013 Male2013 Female

Male Female

Age group

2012

COD 2013


Neonatal (0-28 days)Post-neonatal (29

days to 11 months)Less than 1 year

The three leading underlying causes of death for infants

22%

15%

5%

0,0

5,0

10,0

15,0

20,0

25,0

30,0

35,0

40,0

Intestinalinfectiousdiseases

Influenza andpneumonia

Malnutrition

14%14%

9%

0,0

5,0

10,0

15,0

20,0

25,0

30,0

35,0

40,0

Respiratory andcardiovascular

disordersspecific to the

perinatal period



COD 2013


The three leading underlying causes of death for children

1-4 years 5-14 years

17%

10%

7%

0%

5%

10%

15%

20%

25%

30%



Malnutrition

15%

11%9%

0%

5%

10%

15%

20%

25%

30%


Respiratory andcardiovascular

disorders


7%6%

5%

0%

5%

10%

15%

20%

25%

30%

Tuberculosis Intestinalinfectiousdiseases


Under 5 years

COD 2013


65+

5%

6%

10%

0% 2% 4% 6% 8% 10% 12%

Cerebrovascular diseases

Diabetes mellitus

Tuberculosis

45-64

6%

11%

15%

0% 5% 10% 15% 20%

Other viral diseases

Human immunodeficiency virus

Tuberculosis

15-44

The three leading underlying causes of death for age groups

8%

8%

9%

0% 2% 4% 6% 8% 10%

Other forms of heart disease

Diabetes mellitus

Cerebrovascular diseases

COD 2013


Communicable,

Non-communicable

and Injuries

COD 2013


0,0

10,0

20,0

30,0

40,0

50,0

60,0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Pe

rce

nta

ge o

f to

tal d

eath

s

Year of death

CommunicableNon CommunicableInjuries

1997

Gap was

24% points

2013

13%

Percentage of deaths: communicable, non-communicable and injuries

COD 2013


0

5 000

10 000

15 000

20 000

25 000

30 000

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Cerebrovascular diseases Diabetes mellitus Other forms of heart disease

Hypertensive diseases Ischaemic heart diseases Malignant neoplasms of digestive organs

Continuous rise in deaths due to diabetes mellitus and

hypertensive diseases

COD 2013


0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+

Pe

rce

nta

ge

of

tota

l d

ea

ths

From Ages 10-44 women have

greater percentage of deaths due to

communicable diseases

Percentage of deaths: Communicable


Age of Death

COD 2013


Percentage of deaths: Non-Communicable

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+

Age group

Group II


%

Females have higher non-

communicable percentage of death

in all age groups

COD 2013


0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

Percentage of deaths due to injuries

for females peaks at 28% and much

younger age group (5-9)

Percentage of deaths due to injuries

for males is above 60% in 20-24

Age Group

Percentage of deaths: Injuries


Pe

rce

nta

ge o

f d

eat

hs

Age Group

COD 2013


0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Percentage of deaths that were

non-natural1997-2013

The percentage of non-natural deaths in

South Africa has decreased over the

years, but has increased slightly

since 2009

Non-natural deaths include all external causes of

morbidity and mortality

COD 2013


42000

44000

46000

48000

50000

52000

54000

56000

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Year of death

Number non-natural deaths

1997-2013

Nu

mb

er

of

de

ath

s

COD 2013


LP8,0%

MP10,5%

KZN10,2%

EC10,7%

FS9,5%

NW8,4%

NC11,2%

WC12,8%

GP10,6%

Percentage of deaths that were non-natural 2013

COD 2013


1%

4%

11%

12%

16%

56%

0% 10% 20% 30% 40% 50% 60% 70%

Self-harm

Complications of medical and surgical care

Assault

Transport accidents

Undetermined intent

Other causes of accidental injury

Percentage of non-natural deaths

by broad groups

2013

COD 2013


3%

6%

8%

16%

18%

46%

0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%

Accidental poisoning

Accidental drowning and submersion

Exposure to smoke, fire and flames

Exposure to inanimate mechanical forces

Other accidental threats to breathing

Accidental exposure to other/unspecified factors

Distribution of deaths due to other

external causes of accidental injury

2013

COD 2013


LP30,6%

MP11,7%

KZN11,0%

EC11,6%

FS18,5%

NW14,0%

NC24,1%

WC9,3%

GP3,6%

Transport accident deaths

Percentage of non-natural Deaths within each province

South Africa

11%

Limpopo experienced the highest number of deaths due

to transport accidents as a percent of non-natural deaths

COD 2013


Transport accidents by death month

6,1%

10,4% 10,1%

0%

2%

4%

6%

8%

10%

12%

January February March April May June July August September October November December

Pe

rce

nta

ge o

f Tr

ansp

ort

acc

ide

nts

Death month

Percentage of deaths due

to transport accidents

peaked in the month of

June

COD 2013


LP4,6%

MP3,5%

KZN10,0%

EC15,7%

FS15,6%

NW9,5%

NC23,1%

WC18,7%

GP5,1%

Assault related deaths

Percentage of non-natural Deaths within each province

South Africa

10.2%

Northern Cape experienced the highest number of deaths due to assault as a percent of non-

natural deaths

COD 2013


Deaths due to assault by death month

6,7% 6,7%

9,7%

5,7%

6,6%

9,1%

7,4%

8,3%8,7%

8,1%

9,9%

13,2%

0,0

2,0

4,0

6,0

8,0

10,0

12,0

14,0

January February March April May June July August September October November December

%

Month of death

Percentage of

deaths due to

assault peaked

during November

and December

COD 2013


Assault type Number %

Sharp object (X99) 4 270 85,1

Unspecified means (Y09) 485 9,7

Other and unspecified firearm discharge (X95) 85 1,7

Blunt object (Y00) 61 1,2

Neglect and abandonment (Y06) 39 0,8

Hanging, strangulation and suffocation (X91) 35 0,7

Sexual assault by bodily force (Y05) 14 0,3

By other specified means (Y08) 9 0,2

Bodily force (Y04) 7 0,1

Other maltreatment syndromes (Y07) 6 0,1

Rifle, shotgun and larger forearm discharge (X94) 3 0,1

Drowning and submersion (X92) 2 0,0

Smoke, fire and flames (X97) 2 0,0

Unspecified chemical or noxious substance (X90) 1 0,0

Total deaths 5 019 100,0

Assault deaths in 2013

COD 2013


Assault deaths in 1997-2013

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Sharp Object as a cause of

death, has remained the main

contributing factor, over the

period 1997 and 2013

Other and unspecified firearm discharge

Unspecified means

COD 2013


Where we die

COD 2013


Where we die44,2%

Hospital

1,7%

Emergency

Room

outpatient

2,1%

Dead on arrival

*Other, Unknown or Unspecified 22,9%

23,2%Home 24,9%

2012

2013

1,9%

2012

2013

42,6%

2012

2013

COD 2013


HIV Reporting

COD 2013


1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

HIV 12,0 10,3 11,3 9,6 7,2 6,9 6,6 7,1 7,4 6,8 6,4 7,2 9,2 10,4 11,0 13,6 18,0

HIV-related 88,0 89,7 88,7 90,4 92,8 93,1 93,4 92,9 92,6 93,2 93,6 92,8 90,8 89,6 89,0 86,4 82,0

0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

100,0

per

cen

tage

HIV and HIV related deaths

HIV HIV-related

COD 2013


0,0

10,0

20,0

30,0

40,0

50,0

60,0

70,0

80,0

90,0

100,0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

HIV HIV RELATED

From 2008 declining HIV related deaths

lead to increasing HIV reporting among

15-44 age group

Perc

enta

ge o

f D

eath

COD 2013


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

HIV HIV RELATED

From 2008 declining HIV

related deaths lead to

increasing HIV reporting

among

45-64 age group

Perc

enta

ge o

f D

eath

COD 2013


0

10

20

30

40

50

60

70

80

90

100

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

15-44 44-64

HIV HIV RELATED

Western Cape main province

driving the reporting of HIV

particularly from 2007

15-44 age group 45-64 age group

Pe

rce

nta

ge o

f D

eat

h

COD 2013


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

HIV HIV RELATED

Improvements in HIV reporting also

pronounced in Northern Cape

especially among 15-44 and 45-64

15-44 age group 45-64 age group

Year

Pe

rce

nta

ge o

f D

eat

h

COD 2013


0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

19

97

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

20

10

20

11

20

12

20

13

15-44 44-64

HIV HIV RELATED

Reporting of HIV among 15-44 and 45-64

in KwaZulu-Natal also one of the

contributing factors to increasing

reporting of deaths in HIV.

15-44 age group

Pe

rce

nta

ge o

f D

eat

h

COD 2013


0

10 000

20 000

30 000

40 000

50 000

60 000

70 000

80 000

90 000

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Tuberculosis Influenza & pneumonia HIV disease Instestinal infectious diseases Other viral diseases

Trends in underlying causes of death, 1997-2013

COD 2013


-

2 000

4 000

6 000

8 000

10 000

12 000

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Number of deaths due to HIV disease andspecified causes: co-morbidity

HIV and Influenza and pneumonia HIV and Intestinal infectious diseases HIV and TB

Nu

mb

er o

f D

eat

hs

COD 2013


6 239

23 203

-

5000,0

10000,0

15000,0

20000,0

25000,0

1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Nu

mb

er

of

HIV

dea

ths

Death Year

COD 2013


Excerpts from Dr’s Trained

in death certification

COD 2013


Dr. Level of comfort in statingHIV before and aftertraining

Reason

1 Very comfortableWith the changes in the Notification of Death form, there is good confidentiality - not perfect, but good.

2 Very comfortableIf HIV is the main cause of death then it must be stated. The 4th page of the NOD is confidential and I have never had a problem writing HIV/AIDS there.

3 Very comfortableInsurance forms not an issue in my place of work Forms are confidential

COD 2013


Dr. Level of comfort in stating HIV before training

Reason Level of comfort in stating HIV after training

Reason

1Somewhat comfortable

Was unsure of the legislation regarding the reporting of HIV

Very comfortable No legal implications


Would not write HIV often.

Very comfortable

It has to be written to assist in getting proper statistics and for the Dept. of Health to report correct figures and proper planning be done.


I had some reservations due to confidentiality limitations as well as lack of clarity on the legal provisions governing such disclosure

Very comfortable Clear on the causal sequencing

COD 2013


Dr. Level of comfort in stating HIV beforetraining

Reason Level of comfort in stating HIV after training

Reason


I realised the issue of confidentiality should not matter.

Very comfortable I indicate HIV if relevant


I was reluctant because insurance companies were giving the concerned families problems with the pay outs for funeral arrangements of life covers.

Very comfortable

I know and confident that it is important to furnish correct information for accurate statistics purposes and appropriate strategic planning. I realise it is not a problem to indicate HIV disease as a cause of death

COD 2013


Dr. Level of comfort in stating HIV

beforetraining

Reason Level of comfort in

stating HIV aftertraining

Reason

1Not comfortable at all

Because of family members who will tell me that if the cause is HIV then the insurance won't pay them the money

Very comfortable

We were told that the insurance is having right to have access to the patient 's medical records, and it's for statistic purposes


I was afraid of legal implications. Very comfortableNow I know that I am protected by law.


HIV causes panic amongst family members (stigma) and the term was not divulged in any form as far as possible. Rather the condition resulting from HIV was documented. Furthermore, health insurance companies were not paying out if death was associated with HIV

Not comfortable at all

Not comfortable indicating HIV as a cause of death but comfortable in indicating it as a condition which led to a sequence of events leading to death

cod 2013 mortality and causes of death in south africa 2013 the south africa i know, the home i...

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