Multimorbidity and Causes of Death in the Context of a Double Burden of Disease: Evidence from Rural South Africa

Ariane Sessego, Ecole Normale Supérieure
Géraldine Duthé, Institut National d'Études Démographiques (INED)
Alison Castle, Massachussets General Hospital
Kobus Herbst, Africa Health Research Institute (AHRI) and DSI-MRC South African Population Research Infrastructure (SAPRIN)

In sub-Saharan Africa (SSA), the rising burden of non-communicable diseases (NCDs) alongside persistent infectious diseases, resulting in a double burden of disease, poses significant health challenges, particularly in terms of multimorbidity. While high-income countries use a multiple cause-of-death approach to study complex multimorbid processes, data in SSA remains limited, relying on verbal autopsies (VA) collected at local levels due to the scarcity of death certificates. This study investigates multimorbidity at death by focusing on four chronic diseases: HIV, tuberculosis, hypertension, and diabetes. Using data from the Africa Health Research Institute’s Health and Demographic Surveillance System (HDSS) in rural KwaZulu-Natal, South Africa, it examines 10,489 adult deaths between 2009 and 2021. By linking VAs with health surveys and clinical records, the study assesses the prevalence of chronic diseases at death and explores clusters of co-morbid conditions and their association with causes of death. Preliminary findings show that 60% of the deceased had at least one chronic disease, with 31% experiencing two or more. HIV and TB co-occurred in 47% of multimorbid cases, while 42% involved hypertension and diabetes. Additionally, 22% of individuals presented both communicable and NCDs, suggesting the presence of a "double burden" of disease at the individual level.

Keywords: Mortality and Longevity, Health and Morbidity, Linked data sets , Data and Methods

See extended abstract.