title: Provincial mortality in South Africa, 2000--priority-setting for now and a benchmark for the future.
abstract: BACKGROUND
  Cause-of-death statistics are an essential component of health information. Despite improvements, underregistration and misclassification of causes make it difficult to interpret the official death statistics.
  
  
  OBJECTIVE
  To estimate consistent cause-specific death rates for the year 2000 and to identify the leading causes of death and premature mortality in the provinces.
  
  
  METHODS
  Total number of deaths and population size were estimated using the Actuarial Society of South Africa ASSA2000 AIDS and demographic model. Cause-of-death profiles based on Statistics South Africa's 15% sample, adjusted for misclassification of deaths due to ill-defined causes and AIDS deaths due to indicator conditions, were applied to the total deaths by age and sex. Age-standardised rates and years of life lost were calculated using age weighting and discounting.
  
  
  RESULTS
  Life expectancy in KwaZulu-Natal and Mpumalanga is about 10 years lower than that in the Western Cape, the province with the lowest mortality rate. HIV/AIDS is the leading cause of premature mortality for all provinces. Mortality due to pre-transitional causes, such as diarrhoea, is more pronounced in the poorer and more rural provinces. In contrast, non-communicable disease mortality is similar across all provinces, although the cause profiles differ. Injury mortality rates are particularly high in provinces with large metropolitan areas and in Mpumalanga.
  
  
  CONCLUSIONS
  The quadruple burden experienced in all provinces requires a broad range of interventions, including improved access to health care; ensuring that basic needs such as those related to water and sanitation are met; disease and injury prevention; and promotion of a healthy lifestyle. High death rates as a result of HIV/AIDS highlight the urgent need to accelerate the implementation of the treatment and prevention plan. In addition, there is an urgent need to improve the cause-of-death data system to provide reliable cause-of-death statistics at health district level.
authors.affiliation: Burden of Disease Research Unit, Medical Research Council of South Africa, Tygerberg, W Cape. Debbie.Bradshaw@mrc.ac.za
authors.forename: Debbie
authors.initials: D
authors.lastname: Bradshaw
authors.forename: Nadine
authors.initials: N
authors.lastname: Nannan
authors.forename: Pam
authors.initials: P
authors.lastname: Groenewald
authors.forename: Jané
authors.initials: J
authors.lastname: Joubert
authors.forename: Ria
authors.initials: R
authors.lastname: Laubscher
authors.forename: Beatrice
authors.initials: B
authors.lastname: Nojilana
authors.forename: Rosana
authors.initials: R
authors.lastname: Norman
authors.forename: Desiréé
authors.initials: D
authors.lastname: Pieterse
authors.forename: Michelle
authors.initials: M
authors.lastname: Schneider
mesh_terms: D000328:Adult; D002423:Cause of Death; D002648:Child; D017281:Cost of Illness; D005260:Female; D015658:HIV Infections / Q000401:mortality; D006708:Homicide / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009026:Mortality; D013019:South Africa / Q000453:epidemiology