Trends in mortality from pulmonary tuberculosis and HIV/AIDS co-infection in rural South Africa (Agincourt).
This study investigates trends and age-and-sex patterns of mortality in pulmonary tuberculosis (PTB) and PTB/HIV co-infection in a rural population of South Africa. The PTB/HIV mortality emerged in 1994, and has been rising ever since (men: P=0.001; women: P=0.020, test for trend). In the last 2 years, for both sexes combined, 63% (95% CI 51-74%) of PTB deaths were attributable to HIV/AIDS. PTB/HIV death rate was higher in men than in women for all ages combined (RR(MH)=2.48, 95% CI 1.53-4.04, P<0.001). PTB/HIV death rate was also higher in younger individuals (<25 years) compared with PTB without HIV/AIDS (P=0.033), and the median age at death from PTB/HIV in women (28 years) was lower than in men (38 years, P=0.002). While mortality from PTB without HIV remained constant over time, HIV/AIDS explained the rise in PTB mortality. In the last 3 years, the HIV/AIDS epidemic has caused the number of persons dying of PTB to increase by +117%, with the mortality excess being higher in women (+164%) than in men (+103%, P=0.001). Combined PTB and HIV programme activities need to be reinforced to respond to the increase in PTB mortality, particularly in women.
Zwang
Julien
J
ISD-IRD, Institut Biomédical des Cordeliers, Université Paris 6, 15 rue de l'école de médecine, 75270 Paris Cedex 06, France. jzwang@bhdc.jussieu.fr
Garenne
Michel
M
Kahn
Kathleen
K
Collinson
Mark
M
Tollman
Stephen M
SM
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D003644:Death Certificates; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009026:Mortality / Q000639:trends; D012423:Rural Health; D017678:Sex Distribution; D013019:South Africa / Q000453:epidemiology; D015996:Survival Rate; D014397:Tuberculosis, Pulmonary / Q000401:mortality*