Overall and cause-specific mortality and associated risk factors among middle-aged and older South Africans: findings from the health and ageing in Africa: a longitudinal study of an INDEPTH community in rural South Africa (HAALSI).

BACKGROUND: Assessing mortality levels, causes of death and associated risk factors is critical for strengthening health systems and guiding targeted health interventions. We examined overall and cause-specific mortality and their associated risk factors among middle-aged and older adults in a rural, rapidly transitioning South African setting. METHODS: Data were drawn from the Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community (HAALSI) cohort. Risk factors for mortality from 2014/2015 to 2021 were analysed using Cox-Proportional Hazards and Fine and Gray competing-risk models. RESULTS: The 5059 adults aged 40 years and older at enrolment in the HAALSI cohort in 2014/2015 experienced 1116 (22.1%) deaths over 28 955 person-years of follow-up by 2021. Overall, mortality was higher in men (48.3 deaths per 1000 person-years) than women (30.7 deaths per 1000 person-years). Risk of death increased with age and was significantly associated with male sex, lower education, history of smoking or alcohol use, poor self-rated health, underweight, limitations in activities of daily living, slower walk speed, lower grip strength and histories of hypertension, diabetes, stroke, tuberculosis and unsuppressed Human Immunodeficiency Virus (HIV) infection. Cardiovascular diseases were the leading causes of death (30.3%) in both men (25.9%) and women (35.8%), followed by other infectious diseases (23.8%), neoplasms (14.4%), HIV/AIDS and tuberculosis (10.1%). CONCLUSION: These findings highlight the dual mortality burden from non-communicable and infectious diseases among older adults in rural South Africa. Integrated interventions targeting non-communicable diseases, infectious diseases and physical function are urgently needed to reduce premature mortality and improve health outcomes.