Death trends for 2010 - 2022 for members of a large private medical scheme in South Africa

Authors

  • L Steenkamp Data Science Unit, Discovery Health, Johannesburg, South Africa
  • S Collie Data Science Unit, Discovery Health, Johannesburg, South Africa
  • T A Moultrie Centre for Actuarial Research, Faculty of Commerce, University of Cape Town, South Africa https://orcid.org/0000-0003-1949-535X
  • H Moultrie Centre for Tuberculosis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa
  • G Gray South African Medical Research Council, Johannesburg, South Africa https://orcid.org/0000-0003-4649-1477

DOI:

https://doi.org/10.7196/SAMJ.2024.v114i7.1597

Keywords:

causes of death, Death, Standardised mortality rates, COVID-19, South Africa

Abstract

Background. In the absence of more recent national data on underlying causes of death in South Africa (SA), we examined mortality trends from 2010 to 2022 among members of a large private medical scheme. This analysis sheds light on the health profile of this specific demographic. Objective. To investigate trends in Discovery Health Medical Scheme (DHMS) members’ death rates and underlying cause of death patterns between 2010 and 2022.

Methods. All-cause deaths were compared across years accounting for demographic changes, by analysing age- and sex-standardised rates using 2019 age and sex population weightings. We used underlying cause-of-death data from death notifications.

Results. The 2019 age- and sex-standardised death rate was lower than the 2010 rate by 10%, with a steady decline experienced between 2010 and 2019. We have seen reduced age- and sex-standardised death rates from HIV/AIDS during this period, and despite the high prevalence, reduced age- and sex-standardised death rates from non-communicable diseases. Malignant neoplasms and cardiovascular disease have been and remained the two leading causes of death for Discovery Health Medical Scheme (DHMS) clients between 2012 and 2022. Age- and sex- standardised death rates, however, reached historic high levels during the first 2 years of the COVID-19 pandemic in SA. In 2020, overall age- and sex-standardised death rates for DHMS members increased to 542 deaths per 100 000 life years, which was higher than pre-pandemic levels. Age- and sex-standardised death rates went on to reach their highest level in the history of the scheme in 2021, at 767 deaths per 100 000 life years. Age- and sex-standardised death rates, however, had returned to near 2019 (pre-pandemic) levels by 2022, at 477 deaths per 100 000 life years. Males experienced a higher increase in age-standardised death rates during 2020 and remained at an increased risk of death in 2022 compared with pre-pandemic levels. When COVID-19 -related deaths are excluded, the age-standardised rates for both females and males in 2022 was lower than observed in the pre-pandemic years. While the low mortality experience could be related to competing causes and mortality displacement, further analysis over a longer period is needed to confirm this.

Conclusion. DHMS experienced the highest level of age- and sex-standardised death rates during 2020 and 2021, the initial 2 years of the COVID-19 pandemic. Most of this increase was explained by COVID-19 deaths.

Author Biographies

  • S Collie, Data Science Unit, Discovery Health, Johannesburg, South Africa

    I have 15+ years experience working as a healthcare actuary at Discovery Health. I have lead the health intelligence team in my role as Chief Health Analytics Actuary, which included clinical claims analysis, clinical predictive modelling, provider contract measurement, quality measurement, forensic analysis and operational analysis for our client schemes.

    My experience also includes lecturing in the department of actuarial science at the University of Witwatersrand, supervising actuarial science honours research papers, and contributing to the syllabus of the Actuarial Society of South Africa’s specialist health care technical subject.

    Over the course of the COVID19 pandemic, I have had the privilege of contributing research of global relevance on behalf of Discovery Health. I am passionate about sustainable healthcare system design, scientific research and approaching innovation with an entrepreneurial 'lean' mindset.

    With a deep-rooted passion for medical science, I have decided with my team at BioInformatiCo to take the leap to progress data management and analytic services in Sub-Saharan Africa, where we can fully leverage our expertise and further drive meaningful impact.

    BioInformatiCo ensures the seamless collection, integration, and validation of high-quality, reliable, and statistically sound data from clinical trials. We are born out of a public private partnership with the South African Medical Research Council, and are committed to capacity development in Sub-Saharan Africa and beyond.

    It is an honour to have the opportunity to continue with my relationship with Discovery, while simultaneously addressing the need for robust data that will ensure the registration of products aimed to improve the lives of people in South Africa and worldwide.

  • T A Moultrie, Centre for Actuarial Research, Faculty of Commerce, University of Cape Town, South Africa

    Thomas Austin Moultrie is a professor of demography, and director of the Centre for Actuarial Research (CARe) at the University of Cape Town, South Africa. His areas of expertise include the demography of Southern Africa, technical demography as applied to limited and defective data, vital registration systems, and some experience in epidemiological and virological modelling.

    He is a member of the Union for African Population Studies (UAPS); the Population Association of America, and the International Union for the Scientific Study of Population (IUSSP). From 2014 to 2017, he served as the IUSSP Council Member for Africa. He has been an editor of Population Studies, a leading international journal since 2012, and holds a B2 rating from the South African National Research Foundation (2015).

  • H Moultrie, Centre for Tuberculosis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa

    Harry is a Senior researcher at University of Witwatersrand. He has been involved in numerous publications.

  • G Gray, South African Medical Research Council, Johannesburg, South Africa

    Prof Glenda Gray is the President & CEO of the South African Medical Research Council. She is a Research Professor of Paediatrics at the University of the Witwatersrand, and a director at the Perinatal HIV Research Unit in Soweto. Trained as a pediatrician, she was awarded a Fogarty Training Fellowship at Columbia University in 1999 and also completed an intensive program on clinical epidemiology at Cornell University. Based in South Africa, she is the Co-PI of the HVTN and Director of HVTN Africa Programs. She is a member of the Vaccine and Infectious Disease Division at the Fred Hutch. She has expertise in the field of mother to child transmission of HIV, adolescent HIV prevention and treatment, and HIV vaccine and microbicide research. She received the Femina "Woman of the Nineties" Award, for her contribution to Perinatal HIV Research. In 2002, together with James McIntyre, she was awarded the Nelson Mandela Health and Human Rights Award for pioneering work done in the field of Mother-to-Child Transmission of HIV-1. Glenda was awarded the IAPAC "Hero of Medicine" award for work done in the field of HIV treatment in children and adults. In 2009, together with James McIntyre, she received the N'Galy-Mann lectureship at CROI in recognition of their HIV research contribution in South Africa. She is a member of the Academy of Science in South Africa, Chair of their Standing Committee on Health, and has served on a number of expert panels for the Academy in the field of infant health, nutrition, and HIV. She was elected as a foreign associate into the US Institute of Medicine of the National Academy of Sciences and serves on their Board of Global Health. She is also a Fellow of the American Academy of Microbiology. She serves on IAVI’s Scientific Advisory Committee and is a member of the Scripps CHAVI-ID Scientific Advisory Board. In 2013, she received the Order of Mapungubwe, South Africa’s highest honor, for achievements in the international arena which have served South Africa's interests. In the same year, she received the EDCTP Outstanding African Scientist award. Glenda became involved in HIV Vaccine research in 2000 and led the first clinical trials involving HIV vaccines in the Republic of South Africa (RSA). She was the Protocol Chair for the first phase 2B HIV vaccine trial to be conducted in sub-Saharan Africa and was in charge of the early clinical development of South Africa's first two candidate DNA and MVA HIV vaccines, which have been tested in both the USA and RSA under FDA and MCC regulations. She was the International Vice-Chair for Vaccines for the NIH-funded IMPAACT network until 2010. She has published extensively in the field of HIV.

References

Statistics South Africa. Mortality and causes of death in South Africa: Findings from death notification. Statistical release P0309.3. Pretoria: Stats SA, 2018.

World Health Organization. Global health estimates. The top 10 causes of death. Geneva: WHO, 2020. 3. World Health Organization. International Classification of Diseases and related health problems, vol 2,

nd ed. Tenth revision. Geneva: WHO, 2004.

World Health Organization. Methods and data sources for country-level causes of death 2000-2019.

Geneva: WHO, 2020.

World Health Organization. International guidelines for certification and classification (coding) of

COVID-19 as cause of death. Based on ICD (International Statistical Classification of Diseases). Geneva:

WHO, 2020.

StatisticsSouthAfrica.Mid-yearpopulationestimates.StatisticalreleaseP0302.Pretoria:StatsSA,2019. 7. GBD 2019 Collaborators. Global burden of 369 diseases and injuries in 204 countries and

territories, 1990 - 2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet

;396(10258):1204-1222. https://doi.org/10.1016/S0140-6736(20)30925-9

InternationalBankforReconstructionandDevelopment/TheWorldBank.Overcomingpovertyand inequality in South Africa. An assessment of drivers, constraints and opportunities. World Bank:

March 2018.

Saydah SH, Imperatore G, Beckles GL. Socioeconomic status and mortality: Contribution of healthcare

access and psychological distress among US adults with diagnosed diabetes. Diabetes Care 2013;36(1):49-55.

https://doi.org/10.2337/dc11-1864

Balia S, Jones AM. Mortality, lifestyle and socio-economic status. J Health Econ 2008;27(1):1-26. 11. Navsaria PH, Nicol AJ, Parry CDH, et al. The effect of lockdown on intentional and non-intentional injury during the COVID-19 pandemic in Cape Town, South Africa: A preliminary report. S Afr Med J

;111(2):110-113. https://doi.org/10.7196/SAMJ.2021.v111i2.15318

University of South Africa. Injury Mortality Surveillance 2018 - 2022: Impact of COVID-19 in

Mpumalanga. Pretoria: Unisa and South African Medical Research Council, 2023.

Moultrie TA, Dorrington RE, Laubscher R, et al. Unnatural deaths, alcohol bans and curfews: Evidence from a quasi-natural experiment during COVID-19. S Afr Med J 2021 ;111(9):834-837. https://doi.

org/10.7196/SAMJ.2021.v111i9.15813

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Published

2024-07-01

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Section

Research

How to Cite

1.
Steenkamp L, Collie S, Moultrie TA, Moultrie H, Gray G. Death trends for 2010 - 2022 for members of a large private medical scheme in South Africa. S Afr Med J [Internet]. 2024 Jul. 1 [cited 2024 Jul. 18];114(7):e1597. Available from: https://samajournals.co.za/index.php/samj/article/view/1597

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