virtual: https://us02web.zoom.us/j/7905645674

Codi: 1984

Title.- Multimorbidity and causes of death in the context of a double burden of diseases: Evidence from rural South Africa.

Abstract.- In sub-Saharan Africa (SSA), population is ageing and experience a ‘double burden’ of disease due to the rising burden of non-communicable diseases (NCDs), alongside persistent infectious diseases. This presents major health challenges, particularly in terms of multimorbidity. In high-income countries, death certificates are used to study multiple cause-of-death, but in SSA data is scarce and most information relies on verbal autopsies (VAs) i.e. reported information collected from the kin of a deceased in some local settings. Focusing on HIV, tuberculosis (TB), hypertension and diabetes, this study investigates multimorbidity at death, using data from the Africa Health Research Institute’s Health and Demographic Surveillance System (AHRI HDSS) in rural South Africa. We analyze 7,653 adult deaths (2009–2019) linked with VA, health surveys and clinical records to assess chronic diseases at death and identify co-morbid condition clusters. Findings show 72% of the deceased had at least one chronic disease, 40% having two or more and 9% had both an infectious and NCD. However, VA-assigned causes significantly underrepresented these chronic diseases. Associations with causes of death reveal high comorbidity between HIV and TB and within cardio-metabolic diseases, but also associations between NCDs and respiratory diseases (infectious or chronic) and malnutrition – suggesting a “double burden” of disease at the individual level. Highlighting the importance of complex morbid processes, this study advocates for further research to adapt future VA tools to better understand the role of multimorbidity in mortality in SSA.