Abstract：
BACKGROUND: The absence of high-quality comprehensive civil registration and vital statistics systems across many settings in Africa has led to little empirical data on causes of death in the region. We aimed to use verbal autopsy data to provide comparative, population-based estimates of cause-specific mortality among adolescents and adults in eastern and southern Africa.
METHODS: In this surveillance study, we harmonised verbal autopsy and residency data from nine health and demographic surveillance system (HDSS) sites in Kenya, Malawi, Tanzania, South Africa, Uganda, and Zimbabwe, each with variable coverage from Jan 1, 1995, to Dec 31, 2019. We included all deaths to adolescents and adults aged 12 or over that were residents of the study sites and had a verbal autopsy conducted. InSilicoVA, a probabilistic model, was used to assign cause of death on the basis of the signs and symptoms reported in the verbal autopsy. Levels and trends in all-cause and cause-specific mortality rates and cause-specific mortality fractions were calculated, stratified by HDSS site, sex, age, and calendar periods.
RESULTS: 52 484 deaths and 5 157 802 person-years were reported among 1 071 913 individuals across the nine sites during the study period. 47 961 (91·4%) deaths had a verbal autopsy, of which 46 570 (97·1%) were assigned a cause of death. All-cause mortality generally decreased across the HDSS sites during this period, particularly for adults aged 20-59 years. In many of the HDSS sites, these decreases were driven by reductions in HIV and tuberculosis-related deaths. In 2010-14, the top causes of death were: road traffic accidents, HIV or tuberculosis, and meningitis or sepsis in adolescents (12-19 years); HIV or tuberculosis in adults aged 20-59 years; and neoplasms and cardiovascular disease in adults aged 60 years and older. There was greater between-HDSS and between-sex variation in causes of death for adolescents compared with adults.
CONCLUSIONS: This study shows progress in reducing mortality across eastern and southern Africa but also highlights age, sex, within-HDSS, and between-HDSS differences in causes of adolescent and adult deaths. These findings highlight the importance of detailed local data to inform health needs to ensure continued improvements in survival.
BACKGROUND: National Institute of Child Health and Human Development of the US National Institutes of Health.
METHODS: In this surveillance study, we harmonised verbal autopsy and residency data from nine health and demographic surveillance system (HDSS) sites in Kenya, Malawi, Tanzania, South Africa, Uganda, and Zimbabwe, each with variable coverage from Jan 1, 1995, to Dec 31, 2019. We included all deaths to adolescents and adults aged 12 or over that were residents of the study sites and had a verbal autopsy conducted. InSilicoVA, a probabilistic model, was used to assign cause of death on the basis of the signs and symptoms reported in the verbal autopsy. Levels and trends in all-cause and cause-specific mortality rates and cause-specific mortality fractions were calculated, stratified by HDSS site, sex, age, and calendar periods.
RESULTS: 52 484 deaths and 5 157 802 person-years were reported among 1 071 913 individuals across the nine sites during the study period. 47 961 (91·4%) deaths had a verbal autopsy, of which 46 570 (97·1%) were assigned a cause of death. All-cause mortality generally decreased across the HDSS sites during this period, particularly for adults aged 20-59 years. In many of the HDSS sites, these decreases were driven by reductions in HIV and tuberculosis-related deaths. In 2010-14, the top causes of death were: road traffic accidents, HIV or tuberculosis, and meningitis or sepsis in adolescents (12-19 years); HIV or tuberculosis in adults aged 20-59 years; and neoplasms and cardiovascular disease in adults aged 60 years and older. There was greater between-HDSS and between-sex variation in causes of death for adolescents compared with adults.
CONCLUSIONS: This study shows progress in reducing mortality across eastern and southern Africa but also highlights age, sex, within-HDSS, and between-HDSS differences in causes of adolescent and adult deaths. These findings highlight the importance of detailed local data to inform health needs to ensure continued improvements in survival.
BACKGROUND: National Institute of Child Health and Human Development of the US National Institutes of Health.
摘要：
背景：非洲许多地区缺乏高质量的全面民事登记和生命统计系统，导致该地区死亡原因的经验数据很少。我们的目标是使用口头尸检数据来提供比较，对东部和南部非洲青少年和成人中特定原因死亡率的基于人群的估计。
方法：在本监测研究中，我们协调了肯尼亚九个健康和人口监测系统(HDSS)站点的口头尸检和居住数据，马拉维,坦桑尼亚,南非,乌干达，津巴布韦,从1995年1月1日至2019年12月31日，每个保险范围都是可变的。我们包括所有12岁或以上的青少年和成年人的死亡，他们是研究地点的居民，并进行了口头尸检。InSilicoVA,一个概率模型，用于根据口头尸检中报告的体征和症状来分配死亡原因。计算了全因死亡率和特定原因死亡率以及特定原因死亡率的水平和趋势，按HDSS站点分层，性别,年龄,和日历周期。
结果：在研究期间，在9个地点的1071913名个体中报告了52484例死亡和5157802人年。47961例(91·4%)死亡病例进行了口头尸检，其中46570人(97·1%)被指定为死因。在此期间，整个HDSS站点的全因死亡率普遍下降，特别是20-59岁的成年人。在许多HDSS网站中，这些减少是由于艾滋病毒和结核病相关死亡人数减少所致.在2010-14年度，死亡的主要原因是：道路交通事故，艾滋病毒或结核病，青少年（12-19岁）的脑膜炎或败血症；20-59岁的成年人的艾滋病毒或结核病；60岁及以上的成年人的肿瘤和心血管疾病。与成年人相比，青少年的死亡原因在HDSS之间和性别之间的差异更大。
结论：这项研究显示了东部和南部非洲在降低死亡率方面取得的进展，但也强调了年龄，性别,在HDSS内，以及青少年和成人死亡原因的HDSS之间的差异。这些发现强调了详细的当地数据的重要性，以告知健康需求，以确保生存的持续改善。
背景：美国国立卫生研究院国家儿童健康与人类发展研究所。
方法：在本监测研究中，我们协调了肯尼亚九个健康和人口监测系统(HDSS)站点的口头尸检和居住数据，马拉维,坦桑尼亚,南非,乌干达，津巴布韦,从1995年1月1日至2019年12月31日，每个保险范围都是可变的。我们包括所有12岁或以上的青少年和成年人的死亡，他们是研究地点的居民，并进行了口头尸检。InSilicoVA,一个概率模型，用于根据口头尸检中报告的体征和症状来分配死亡原因。计算了全因死亡率和特定原因死亡率以及特定原因死亡率的水平和趋势，按HDSS站点分层，性别,年龄,和日历周期。
结果：在研究期间，在9个地点的1071913名个体中报告了52484例死亡和5157802人年。47961例(91·4%)死亡病例进行了口头尸检，其中46570人(97·1%)被指定为死因。在此期间，整个HDSS站点的全因死亡率普遍下降，特别是20-59岁的成年人。在许多HDSS网站中，这些减少是由于艾滋病毒和结核病相关死亡人数减少所致.在2010-14年度，死亡的主要原因是：道路交通事故，艾滋病毒或结核病，青少年（12-19岁）的脑膜炎或败血症；20-59岁的成年人的艾滋病毒或结核病；60岁及以上的成年人的肿瘤和心血管疾病。与成年人相比，青少年的死亡原因在HDSS之间和性别之间的差异更大。
结论：这项研究显示了东部和南部非洲在降低死亡率方面取得的进展，但也强调了年龄，性别,在HDSS内，以及青少年和成人死亡原因的HDSS之间的差异。这些发现强调了详细的当地数据的重要性，以告知健康需求，以确保生存的持续改善。
背景：美国国立卫生研究院国家儿童健康与人类发展研究所。
