Key findings: P0309.3 - Mortality and causes of death in South Africa: Findings from death notification, 2016

This report provides information on levels, trends and patterns in mortality and cause-of-death statistics by socio-demographic and geographic characteristics. The main focus is on 2016 death occurrences, however, information on deaths that occurred during the period 1997 to 2015 is included in order to show trends in mortality. The cause-of-death statistics in this statistical release provide information on the leading underlying natural causes of death, patterns and trends in non-natural underlying causes of deaths, as well as comparison between immediate, contributing and underlying causes of death.

The results on mortality levels and trends indicate that mortality continues to decline in the country. The general trend of registered deaths processed by Stats SA indicated an increase in death occurrences from 1997 to 2006 when the number of deaths peaked to 614 248, and a decrease thereafter. In 2016, a total of 456 612 deaths occurred marking a decline of 3,5% from the 473 266 death occurrences for 2015 that have been updated for late registration. Overall, mortality now occurs at older ages for both sexes, which is an indication of decline in premature mortality. In 2016, male deaths peaked at age group 60-64 years (8,6%), while female deaths peaked at a much older age group (75−79 years [8,3%]). Largely, there were more male deaths observed and the sex ratio at death was 112 male deaths per 100 female deaths. When disaggregated by age, deaths were characterised by higher male deaths from infancy to 70-74 years, with excess female deaths from ages 75 years and older. Median ages at death, further highlighted improvements in mortality as it increased from 42,6 years in 2005 to 56,4 years in 2016. Female deaths had a higher median age at death than their male counterparts (62,0 years and 52,7 years, respectively). This translates to female deaths surpassing the national average by 5,6 years and outliving males by 9,3 years. Other mortality differentials indicated that most 2016 death occurrences occurred in the most populous provinces Gauteng (21,3%) and KwaZulu-Natal (18,6%). It is worth noting that a high proportion of deaths continue to occur at home instead of health care facilities and this may impact on the accuracy of the certification of causes of deaths. In 2016, about 22,6% of the deaths occurred at home.

Overall, 405 370 (88,8%) deaths that took place in 2016 were due to natural causes and 51 242 (11,2%) were attributed to non-natural causes. The proportion of deaths due to non-natural causes were higher for males compared to females at all ages, with the proportions of deaths due to this group particularly high for males aged 20-24 years (66,1%). By province of death, Western Cape (13,3%) had the highest proportion, followed by KwaZulu-Natal (12,1%) and Eastern Cape (11,7%). All these provinces exceeded the aforementioned national average of 11,2% of deaths. For the first time, since 1997 diseases of the circulatory system were the top ranking underlying main group of natural causes. Generally, non-communicable diseases accounted for 57.4% of deaths in 2016 while communicable diseases were responsible for 31,3% of deaths in 2016. Tuberculosis maintained its rank as the leading cause of death in South Africa, albeit with declining proportions (down to 6,5% in 2016 from 8,3% in 2014). Diabetes mellitus (5,5%) was the second leading natural cause of deaths followed by other forms of heart disease and cerebrovascular diseases both ranked third place at 5,1% each. Human immunodeficiency virus [HIV] disease moved from the sixth position in 2014 and remained on the fifth position for both 2015 and 2016 deaths. Information on the leading causes of death by sex showed that in 2016 more male deaths (7,6%) were attributable to tuberculosis, while most female deaths(7,2%) were due to diabetes mellitus. Tuberculosis moved from the third position in 2015 to the fifth position for females in 2016, while among males diabetes mellitus ranked sixth in both 2015 and 2016.  Based on provincial differentials diabetes mellitus in Western Cape, other forms of heart diseases in Gauteng and influenza and pneumonia in Limpopo were the leading underlying natural causes. For the rest of the provinces tuberculosis was the top-ranked natural cause.

Overall, the results show a considerable burden of disease from non-communicable diseases and concerning signs of a sizable proportion of deaths associated with diabetes mellitus, particularly for females. In conclusion, South Africa is characterised by declining levels of mortality, declining but still high prevalence of communicable diseases and a growing tide of non-communicable diseases. Consequently, these findings are essential for evidence-based decision making and for planning to meet the demand for appropriate public health services and interventions.