A comparison of all-cause and cause-specific mortality by household socioeconomic status across seven INDEPTH network health and demographic surveillance systems in sub-Saharan Africa.

Autor: Coates MM; a Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change , Harvard Medical School , Boston , USA., Kamanda M; b INDEPTH Network , Accra , Ghana., Kintu A; c Department of Global Health and Population , Harvard T.H. Chan School of Public Health , Boston , USA., Arikpo I; b INDEPTH Network , Accra , Ghana.; d Cross River Health & Demographic Surveillance System (CRHDSS) , University of Calabar , Calabar , Nigeria., Chauque A; b INDEPTH Network , Accra , Ghana.; e Centro de Investigação em Saúde da Manhiça (CISM) , Mozambique., Mengesha MM; b INDEPTH Network , Accra , Ghana.; f College of Health and Medical Sciences , Haramaya University , Harar , Ethiopia., Price AJ; b INDEPTH Network , Accra , Ghana.; g Department of Population Health , London School of Hygiene & Tropical Medicine , London , UK.; h Malawi Epidemiology and Intervention Research Unit , Lilongwe , Malawi., Sifuna P; b INDEPTH Network , Accra , Ghana.; i US Army Medical Research Directorate-Kenya (USAMRD-K)/Kenya Medical Research Institute (KEMRI) , Kisumu , Kenya., Wamukoya M; b INDEPTH Network , Accra , Ghana.; j African Population and Health Research Center , Nairobi , Kenya., Sacoor CN; b INDEPTH Network , Accra , Ghana.; e Centro de Investigação em Saúde da Manhiça (CISM) , Mozambique., Ogwang S; b INDEPTH Network , Accra , Ghana.; i US Army Medical Research Directorate-Kenya (USAMRD-K)/Kenya Medical Research Institute (KEMRI) , Kisumu , Kenya., Assefa N; b INDEPTH Network , Accra , Ghana.; f College of Health and Medical Sciences , Haramaya University , Harar , Ethiopia., Crampin AC; b INDEPTH Network , Accra , Ghana.; g Department of Population Health , London School of Hygiene & Tropical Medicine , London , UK.; h Malawi Epidemiology and Intervention Research Unit , Lilongwe , Malawi., Macete EV; b INDEPTH Network , Accra , Ghana.; e Centro de Investigação em Saúde da Manhiça (CISM) , Mozambique., Kyobutungi C; b INDEPTH Network , Accra , Ghana.; j African Population and Health Research Center , Nairobi , Kenya., Meremikwu MM; b INDEPTH Network , Accra , Ghana.; d Cross River Health & Demographic Surveillance System (CRHDSS) , University of Calabar , Calabar , Nigeria., Otieno W; b INDEPTH Network , Accra , Ghana.; i US Army Medical Research Directorate-Kenya (USAMRD-K)/Kenya Medical Research Institute (KEMRI) , Kisumu , Kenya.; k Department of Paediatrics and Child Health , Maseno University School of Medicine , Kisumu , Kenya., Adjaye-Gbewonyo K; l University College London , London , UK., Marx A; a Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change , Harvard Medical School , Boston , USA., Byass P; b INDEPTH Network , Accra , Ghana.; m Department of Epidemiology and Global Health , Umeå University , Umeå , Sweden.; n Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.; o Institute of Applied Health Sciences , University of Aberdeen , Aberdeen , Scotland., Sankoh O; b INDEPTH Network , Accra , Ghana.; p Statistics Sierra Leone , Freetown , Sierra Leone.; q College of Medicine and Allied Health Sciences , University of Sierra Leone , New England , Sierra Leone.; r School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa., Bukhman G; a Department of Global Health and Social Medicine, Program in Global Noncommunicable Diseases and Social Change , Harvard Medical School , Boston , USA.; s Division of Global Health Equity , Brigham and Women's Hospital , Boston , MA , USA.; t Partners In Health , Boston , MA , USA.
Jazyk: angličtina
Zdroj: Global health action [Glob Health Action] 2019; Vol. 12 (1), pp. 1608013.
DOI: 10.1080/16549716.2019.1608013
Abstrakt: Background: Understanding socioeconomic disparities in all-cause and cause-specific mortality can help inform prevention and treatment strategies.
Objectives: To quantify cause-specific mortality rates by socioeconomic status across seven health and demographic surveillance systems (HDSS) in five countries (Ethiopia, Kenya, Malawi, Mozambique, and Nigeria) in the INDEPTH Network in sub-Saharan Africa.
Methods: We linked demographic residence data with household survey data containing living standards and education information we used to create a poverty index. Person-years lived and deaths between 2003 and 2016 (periods varied by HDSS) were stratified in each HDSS by age, sex, year, and number of deprivations on the poverty index (0-8). Causes of death were assigned to each death using the InterVA-4 model based on responses to verbal autopsy questionnaires. We estimated rate ratios between socioeconomic groups (2-4 and 5-8 deprivations on our poverty index compared to 0-2 deprivations) for specific causes of death and calculated life expectancy for the deprivation groups.
Results: Our pooled data contained almost 3.5 million person-years of observation and 25,038 deaths. All-cause mortality rates were higher among people in households with 5-8 deprivations on our poverty index compared to 0-2 deprivations, controlling for age, sex, and year (rate ratios ranged 1.42 to 2.06 across HDSS sites). The poorest group had consistently higher death rates in communicable, maternal, neonatal, and nutritional conditions (rate ratios ranged 1.34-4.05) and for non-communicable diseases in several sites (1.14-1.93). The disparities in mortality between 5-8 deprivation groups and 0-2 deprivation groups led to lower life expectancy in the higher-deprivation groups by six years in all sites and more than 10 years in five sites.
Conclusions: We show large disparities in mortality on the basis of socioeconomic status across seven HDSS in sub-Saharan Africa due to disparities in communicable disease mortality and from non-communicable diseases in some sites. Life expectancy gaps between socioeconomic groups within sites were similar to the gaps between high-income and lower-middle-income countries. Prevention and treatment efforts can benefit from understanding subpopulations facing higher mortality from specific conditions.
Databáze: MEDLINE
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