Space and time clustering of mortality in rural South Africa (Agincourt HDSS), 1992-2007

作者：Sartorius Benn^*; Kahn Kathleen; Vounatsou Penelope; Collinson Mark A; Tollman Stephen M

来源：Global Health Action, 2010, 3(1): 50-58.

DOI：10.3402/gha.v3i0.5225

• all-cause mortality
• demographic surveillance
• clustering
• spatial-temporal

Background: Detailed information regarding the spatial and/or spatial-temporal distribution of mortality is required for the efficient implementation and targeting of public health interventions.
Objectives: Identify high risk clusters of mortality within the Agincourt subdistrict for targeting of public health interventions, and highlight areas for further research.
Design: Mortality data were extracted from the Agincourt health and socio-demographic surveillance system (HDSS) for the period 1992-2007. Mortality rates by age group and time were calculated assuming a Poisson distribution and using precise person-time contribution estimates. A spatial scan statistic (Kulldorff) was used to test for clusters of age group specific all-cause and cause-specific mortality both in space and time.
Results: Many statistically significant clusters of higher all-cause and cause-specific mortality were identified both in space and time. Specific areas were consistently identified as high risk areas; namely, the east/southeast and upper east central regions. This corresponds to areas with higher mortality due to communicable causes (especially HIV/TB and diarrheal disease) and indicates a non-random element to the distribution of potential underlying causative factors e. g. settlements comprising former Mozambican refugees in east/south-east of the site, corresponding higher poverty areas, South African villages with higher HIV prevalence, etc. Clusters of older adult mortality were also observed indicating potential non-random distribution of non-communicable disease mortality.
Conclusion: This study has highlighted distinct clusters of all-cause and cause-specific mortality within the Agincourt subdistrict. It is a first step in prioritizing areas for further, more detailed research as well as for future public health follow-on efforts such as targeting of vertical prevention of HIV/TB and antiretroviral rollout in significant child and adult mortality clusters; and assessment and provision of adequate water and sanitation in the child mortality clusters particularly in the south-east where diarrheal mortality appears high. Underlying causative factors need to be identified and accurately quantified. Other questions for more detailed research are discussed.

• 出版日期2010