Rural life expectancy differences due to TB and violence

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RuralViolenceThe gender differences in adult life expectancy in SA‘s rural KwaZulu-Natal are exceptionally large, atypical for an African population, and largely driven by high male mortality from pulmonary TB and injuries, found a new study.

A ‘remarkable’ difference in men’s and women’s life expectancies in a rural area is due to tuberculosis (TB) and injuries linked to violence, The Times reports a study has found. On average‚ women in the uMkhanyakude District – bordering Mozambique and Swaziland in the north of KwaZulu-Natal – live 10.4 years longer than men.

For HIV negative people the gap is even greater‚ at 13.1 years‚ and the researchers said both figures were “exceptionally large” compared with the worldwide average gap of five years.

Academics from the School of Public Health at the University of the Witwatersrand and the African Health Research Institute at the University of Kwa-Zulu Natal‚ with colleagues from the London School of Hygiene & Tropical Medicine and the School of Public Health, Imperial College London, in the UK and Boston University and the University of Washington – Seattle, in the US‚ attributed 5.6 years of the life expectancy gap in HIV negative people to the higher TB mortality rate among men. “Elevated rates of external injuries among men accounted for 4.1 years of the total sex difference‚” they write.

The report says data used by the scientists came from a demographic surveillance system and HIV prevalence surveys‚ and in some cases goes back to 2000.

Life expectancy was put at 56.4 years for men and 66.8 years for women‚ with the gap “more than four times the World Health Organisation’s 2013 estimate of 2.5 years for the African region as a whole‚” said the researchers‚ led by Georges Reniers from Wits.

Aside from the size of the difference with the regional average‚ two other reasons rendered the results remarkable‚ they said: HIV prevalence in the study population was very high‚ something that usually reduces sex differences in life expectancy; and male mortality was disproportionally high as a result of TB and injuries.

“These results … signal the need to improve efforts to target men with preventative‚ diagnostic and curative health services‚” the report quotes the researchers as saying.

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.

Authors
Georges Reniers, Sylvia Blom, Judith Lieber, Abraham J Herbst, Clara Calvert, Jacob Bor, Till Barnighausen, Basia Zaba, Zehang R Li, Samuel J Clark, Alison D Grant, Richard Lessells, Jeffrey W Eaton, Victoria Hosegood

The Times report
PLOS One abstract


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