Death trends for 2010 - 2022 for members of a large private medical scheme in South Africa
DOI:
https://doi.org/10.7196/SAMJ.2024.v114i7.1597Keywords:
causes of death, Death, Standardised mortality rates, COVID-19, South AfricaAbstract
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.
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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