Health trends, inequalities and opportunities in South Africa's provinces, 1990-2019: findings from the Global Burden of Disease 2019 Study.

Autor:	Achoki T; Research, Africa Institute for Health Policy, Nairobi, Kenya.; Center for Pharmaceutical Policy and Regulation, Utrecht University, Utrecht, Netherlands., Sartorius B; Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.; Nuffield Department of Medicine, University of Oxford, Oxford, UK.; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA., Watkins D; Department of Medicine, University of Washington, Seattle, WA, USA.; Department of Medicine, University of Cape Town, Cape Town, South Africa., Glenn SD; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Kengne AP; Department of Medicine, University of Cape Town, Cape Town, South Africa.; Non-communicable Diseases Research Unit, Medical Research Council South Africa, Cape Town, South Africa., Oni T; MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.; School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa., Wiysonge CS; School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa.; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa., Walker A; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Adetokunboh OO; Centre of Excellence for Epidemiological Modelling and Analysis, Stellenbosch University, Stellenbosch, South Africa.; Department of Global Health, Stellenbosch University, Stellenbosch, South Africa., Babalola TK; Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.; Department of Community Health and Primary Care, University of Lagos, Lagos, Nigeria., Bolarinwa OA; Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa., Claassens MM; Department of Biochemistry and Microbiology, University of Namibia, Windhoek, Namibia.; Department of Paediatrics and Child Health, Stellenbosch University, Tygerberg, South Africa., Cowden RG; Department of Psychology, University of the Free State, Park WEst, Free State, South Africa., Day CT; Health Systems Research Unit, Health System Trust, Westville, South Africa., Ezekannagha O; Independent Consultant, Awka, Nigeria.; International Institute of Tropical Agriculture, Ibadan, Nigeria., Ginindza TG; Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa., Iwu CCD; School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa., Iwu CJ; Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.; South African Medical Research Council, Cape Town, South Africa., Karangwa I; Department of Statistics and Population Studies, University of the Western Cape, Cape Town, South Africa., Katoto PD; Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.; Centre for Tropical Diseases and Global Health, Catholic University of Bukavu, Bukavu, Democratic Republic of Congo., Kugbey N; University of Environment and Sustainable Development, Somanya, Ghana., Kuupiel D; School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.; Department of Nursing, Research for Sustainable Development Consult, Sunyani, Ghana., Mahasha PW; Grants, Innovation and Product Development Unit, South African Medical Research Council, Cape Town, South Africa., Mashamba-Thompson TP; Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa., Mensah GA; Department of Medicine, University of Cape Town, Cape Town, South Africa.; Center for Translation Research and Implementation Science, National Institutes of Health, Bethesda, Maryland, USA., Ndwandwe DE; Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa., Nnaji CA; School of Public Health and Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa.; South African Medical Research Council, Cape Town, South Africa., Ntsekhe M; Division of Cardiology, University of Cape Town, Rondebosch, Western Cape, South Africa.; The Cardiac Clinic, Groote Schuur Hospital, Cape Town, South Africa., Nyirenda TE; Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.; European and Developing Countries Clinical Trials Partnership (EDCTP), European Commission, Cape Town, South Africa., Odhiambo JN; Discipline of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa.; Department of Management Science and Technology, Technical University of Kenya, Nairobi, Nairobi, Kenya., Oppong Asante K; Department of Psychology, University of Ghana, Accra, Ghana., Parry CDH; Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa.; Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa., Pillay JD; Department of Basic Medical Sciences, Durban University of Technology, Durban, South Africa., Schutte AE; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.; The George Institute for Global Health, Sydney, New South Wales, Australia., Seedat S; Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa., Sliwa K; Hatter Institute Department of Medicine, University of Cape Town, Cape Town, South Africa., Stein DJ; Unit on Risk and Resilience in Mental Disorders, South African Medical Research Council, Cape Town, South Africa., Tanser FC; University of KwaZulu-Natal, Durban, South Africa.; Africa Health Research Institute, Berea, South Africa., Useh U; Health Sciences Department, North-West University, Mmbatho, South Africa., Zar HJ; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa.; Unit on Child & Adolescent Health, Medical Research Council South Africa, Cape Town, South Africa., Zühlke LJ; Department of Medicine, University of Cape Town, Cape Town, South Africa.; Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa., Mayosi BM; University of Cape Town, Cape Town, South Africa., Hay SI; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA.; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Murray CJL; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA.; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA., Naghavi M; Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, Washington, USA nagham@uw.edu.; Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
Jazyk:	angličtina
Zdroj:	Journal of epidemiology and community health [J Epidemiol Community Health] 2022 Jan 19. Date of Electronic Publication: 2022 Jan 19.
DOI:	10.1136/jech-2021-217480
Abstrakt:	Background: Over the last 30 years, South Africa has experienced four 'colliding epidemics' of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019. Methods: We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990-2007 and 2007-2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance. Results: Across the nine provinces, inequalities in mortality and life expectancy increased over 1990-2007, largely due to differences in HIV/AIDS, then decreased over 2007-2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces. Conclusions: Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic. Competing Interests: Competing interests: AES reports personal fees from Servier, Novartis,Takeda, Omron Healthcare, and Abbott, outside the submitted work. DJS reports personal fees from Lundbeck, Takeda, Johnson & Johnson, and Servier, outside the submitted work. (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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