Further evidence of misclassification of the injury deaths in South Africa: When will the barriers to accurate injury death statistics be removed?

Authors

  • P Groenewald Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • N Kallis Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • C Holmgren Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • T Glass Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • A Anthony Department of Health and Wellness, Western Cape Department of Health, Cape Town, South Africa
  • P Maud Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa
  • Y Akhalwaya Family Centre for Research with Ubuntu (FAM-CRU), Department of Paediatrics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  • E Afonso Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa https://orcid.org/0000-0003-4710-5910
  • I Niewoudt Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  • L J Martin Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Forensic Pathology Service, Western Cape Department of Health, Cape Town, South Africa https://orcid.org/0000-0002-1231-7932
  • C de Vaal Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
  • M Cheyip US Centers for Disease Control and Prevention, Pretoria, South Africa
  • D Morof US Centers for Disease Control and Prevention, Pretoria, South Africa
  • M Prinsloo Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa https://orcid.org/0000-0003-0415-0973
  • R Matzopoulos Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa
  • D Bradshaw Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa https://orcid.org/0000-0002-3588-2184

DOI:

https://doi.org/10.7196/SAMJ.2023.v113i9.836

Keywords:

Mortality, Injury, firearm-related deaths, South Africa

Abstract

Background. Contrary to the World Health Organization’s internationally recommended medical certificate of cause of death, the South African (SA) death notification form (DNF) does not allow for the reporting of the manner of death to permit accurate coding of external causes of injury deaths.

Objectives. To describe the injury cause-of-death profile from forensic pathology records collected for the National Cause-of-Death Validation (NCoDV) Project and compare it with profiles from other sources of injury mortality data. In particular, the recording of firearm use in homicides is compared between sources.

Methods. The NCoDV Project was a cross-sectional study of deaths that occurred during a fixed period in 2017 and 2018, from a nationally representative sample of 27 health subdistricts in SA. Trained fieldworkers scanned forensic records for all deaths investigated at the forensic mortuaries serving the sampled subdistricts during the study period. Forensic practitioners reviewed the records and completed a medical certificate of cause of death for each decedent. Causes of death were coded to the International Statistical Classification of Diseases, 10th revision (ICD-10), using Iris automated coding software. Cause-specific mortality fractions for injury deaths were compared with Injury Mortality Survey 2017 (IMS 2017) and Statistics South Africa 2017 (Stats SA 2017) datasets. The cause profile for all firearm-related deaths was compared between the three datasets.

Results. A total of 5 315 records were available for analysis. Males accounted for 77.6% of cases, and most decedents were aged between 25 and 44 years. Homicide was the leading cause of death (34.7%), followed by transport injuries (32.6%) and suicide (14.7%). This injury cause profile was similar to IMS 2017 but differed markedly from the official statistics, which showed markedly lower proportions of these three causes (15.0%, 11.6% and 0.7%, respectively), and a much higher proportion of other unintentional causes. Investigation of firearm-related deaths revealed that most were homicides in NCoDV 2017/18 (88.5%) and IMS 2017 (93.1%), while in the Stats SA 2017 data, 98.7% of firearm deaths were classified as accidental. Approximately 7% of firearm-related deaths were suicides in NCoDV 2017/18 and IMS 2017, with only 0.3% in Stats SA 2017.

Conclusion. The official cause-of-death data for injuries in SA in 2017 differed substantially from findings from the NCoDV 2017/18 study and IMS 2017. Accurate data sources would ensure that public health interventions are designed to reduce the high injury burden. Inclusion of the manner of death on the DNF, as is recommended internationally, is critically important to enable more accurate, reliable and valid reporting of the injury profile.

Author Biographies

  • N Kallis, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

    Burden of Disease Research Unit

    Clinician Reviewer

  • C Holmgren, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

    Burden of Disease Research Unit

    Clinician reviewer

  • T Glass, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

    Burden of disease Research Unit

    Biostatistician

  • A Anthony, Department of Health and Wellness, Western Cape Department of Health, Cape Town, South Africa

    Department of Health and Wellness

    Acting Chief Executive Officer, Eersteriver Hospital

  • P Maud, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

    Burden of Disease Research Unit

    Clinician reviewer

  • Y Akhalwaya, Family Centre for Research with Ubuntu (FAM-CRU), Department of Paediatrics, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

    FAM-CRU, Department of Paediatrics, Faculty of Health Sciences

  • E Afonso, Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

    Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences

    Specialist forensic pathologist

  • I Niewoudt, Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

    Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences

     

  • L J Martin, Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa; Forensic Pathology Service, Western Cape Department of Health, Cape Town, South Africa

    1. Head, Division of Forensic Medicine and Toxicology, Department of Pathology, University of Cape Town, South Africa. 

    2. Clinical Department Head, WCG Health, Forensic Pathology Service, Western Cape, South Africa

  • C de Vaal, Division of Forensic Medicine, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

    Division of Forensic Medicine and Toxicology, Department of Pathology, University of Cape Town, South Africa

     

  • M Prinsloo, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

    Deputy Director, Burden of Disease Research Unit

    Institute for Lifecourse Development, Faculty of Education, Health and Human Sciences, University of Greenwich, London, UK

  • R Matzopoulos, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa; School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, South Africa

    Director, Burden of Disease Research Unit

    School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

  • D Bradshaw, Burden of Disease Research Unit, South African Medical Research Council, Cape Town, South Africa

    Chief Specialist Scientist, Burden of Disease Research Unit

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Published

2023-09-04

Issue

Section

Research

How to Cite

1.
Groenewald P, Kallis N, Holmgren C, Glass T, Anthony A, Maud P, et al. Further evidence of misclassification of the injury deaths in South Africa: When will the barriers to accurate injury death statistics be removed?. S Afr Med J [Internet]. 2023 Sep. 4 [cited 2024 Jun. 15];113(9):30-5. Available from: https://samajournals.co.za/index.php/samj/article/view/836

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