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Tuberculosis mortality and the male survival deficit in rural South Africa: an observational community cohort study

Tuberculosis mortality and the male survival deficit in rural South Africa: an observational community cohort study
Tuberculosis mortality and the male survival deficit in rural South Africa: an observational community cohort study
Background: Women live on average five years longer than men, and the sex difference in longevity is typically lower in populations with high mortality. South Africa – a high mortality population with a large sex disparity – is an exception, but the causes of death that contribute to this difference are not well understood.

Methods: Using data from a demographic surveillance system in rural KwaZulu-Natal (2000-2014), we estimate differences between male and female adult life expectancy by HIV status. The contribution of causes of death to these life expectancy differences are computed with demographic decomposition techniques. Cause of death information comes from verbal autopsy interviews that are interpreted with the InSilicoVA tool.

Results: Adult women lived an average of 10.4 years (95% confidence Interval 9.0-11.6) longer than men. Sex differences in adult life expectancy were even larger when disaggregated by HIV status: 13.1 (95% confidence interval 10.7-15.3) and 11.2 (95% confidence interval 7.5-14.8) years among known HIV negatives and positives, respectively. Elevated male mortality from pulmonary tuberculosis (TB) and external injuries were responsible for 43% and 31% of the sex difference in life expectancy among the HIV negative population, and 81% and 16% of the difference among people living with HIV.

Conclusions: The sex differences in adult life expectancy in rural KwaZulu-Natal are exceptionally large, atypical for an African population, and largely driven by high male mortality from pulmonary TB and injuries. This is the case for both HIV positive and HIV negative men and women, signalling a need to improve the engagement of men with health services, irrespective of their HIV status.
1-13
Reniers, Georges
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Blom, Sylvia
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Lieber, Judith
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Herbst, Abraham J.
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Calvert, Clara
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Bor, Jacob
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Barnighausen, Till
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Zaba, Basia
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Li, Zehang R.
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Clark, Samuel J.
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Grant, Alison D.
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Lessells, Richard J.
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Eaton, Jeffrey W.
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Hosegood, Victoria
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Reniers, Georges
bd430841-97fb-496f-810f-c1302f69e057
Blom, Sylvia
cbcb9cc1-76fd-4ec5-9822-65a82e41fa87
Lieber, Judith
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Herbst, Abraham J.
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Calvert, Clara
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Bor, Jacob
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Barnighausen, Till
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Zaba, Basia
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Li, Zehang R.
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Clark, Samuel J.
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Grant, Alison D.
38cd3253-55b3-45f2-947c-ae3dd9523a28
Lessells, Richard J.
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Eaton, Jeffrey W.
38f42083-2bd0-48d3-a34f-efe05b4c53eb
Hosegood, Victoria
c59a89d5-5edc-42dd-b282-f44458fd2993

Reniers, Georges, Blom, Sylvia, Lieber, Judith, Herbst, Abraham J., Calvert, Clara, Bor, Jacob, Barnighausen, Till, Zaba, Basia, Li, Zehang R., Clark, Samuel J., Grant, Alison D., Lessells, Richard J., Eaton, Jeffrey W. and Hosegood, Victoria (2017) Tuberculosis mortality and the male survival deficit in rural South Africa: an observational community cohort study. PLoS ONE, 12 (10), 1-13, [e0185692]. (doi:10.1371/journal.pone.0185692).

Record type: Article

Abstract

Background: Women live on average five years longer than men, and the sex difference in longevity is typically lower in populations with high mortality. South Africa – a high mortality population with a large sex disparity – is an exception, but the causes of death that contribute to this difference are not well understood.

Methods: Using data from a demographic surveillance system in rural KwaZulu-Natal (2000-2014), we estimate differences between male and female adult life expectancy by HIV status. The contribution of causes of death to these life expectancy differences are computed with demographic decomposition techniques. Cause of death information comes from verbal autopsy interviews that are interpreted with the InSilicoVA tool.

Results: Adult women lived an average of 10.4 years (95% confidence Interval 9.0-11.6) longer than men. Sex differences in adult life expectancy were even larger when disaggregated by HIV status: 13.1 (95% confidence interval 10.7-15.3) and 11.2 (95% confidence interval 7.5-14.8) years among known HIV negatives and positives, respectively. Elevated male mortality from pulmonary tuberculosis (TB) and external injuries were responsible for 43% and 31% of the sex difference in life expectancy among the HIV negative population, and 81% and 16% of the difference among people living with HIV.

Conclusions: The sex differences in adult life expectancy in rural KwaZulu-Natal are exceptionally large, atypical for an African population, and largely driven by high male mortality from pulmonary TB and injuries. This is the case for both HIV positive and HIV negative men and women, signalling a need to improve the engagement of men with health services, irrespective of their HIV status.

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Accepted/In Press date: 19 September 2017
e-pub ahead of print date: 10 October 2017

Identifiers

Local EPrints ID: 414877
URI: http://eprints.soton.ac.uk/id/eprint/414877
PURE UUID: 0992ee83-496f-4e66-986d-17ec1faba45d
ORCID for Victoria Hosegood: ORCID iD orcid.org/0000-0002-2244-2518

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Date deposited: 13 Oct 2017 16:30
Last modified: 17 Dec 2019 01:40

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