Returning home to die: circular labour migration and mortality in South Africa.
OBJECTIVE
To examine the hypothesis that circular labour migrants who become seriously ill while living away from home return to their rural homes to convalesce and possibly to die.


METHODS
Drawing on longitudinal data collected by the Agincourt health and demographic surveillance system in rural northeastern South Africa between 1995 and 2004, discrete time event history analysis is used to estimate the likelihood of dying for residents, short-term returning migrants, and long-term returning migrants controlling for sex, age, and historical period.


RESULTS
The annual odds of dying for short-term returning migrants are generally 1.1 to 1.9 times (depending on period, sex, and age) higher than those of residents and long-term returning migrants, and these differences are generally highly statistically significant. Further supporting the hypothesis is the fact that the proportion of HIV/TB deaths among short-term returning migrants increases dramatically as time progresses, and short-term returning migrants account for an increasing proportion of all HIV/TB deaths.


CONCLUSIONS
This evidence strongly suggests that increasing numbers of circular labour migrants of prime working age are becoming ill in the urban areas where they work and coming home to be cared for and eventually to die in the rural areas where their families live. This shifts the burden of caring for them in their terminal illness to their families and the rural healthcare system with significant consequences for the distribution and allocation of health care resources.
Department of Sociology, University of Washington, USA. samclark@u.washington.edu
Samuel J
SJ
Clark
Mark A
MA
Collinson
Kathleen
K
Kahn
Kyle
K
Drullinger
Stephen M
SM
Tollman
D017088:AIDS-Related Opportunistic Infections / Q000401:mortality*; D000328:Adult; D000368:Aged; D019058:Community Networks; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D004641:Emigration and Immigration; D005260:Female; D015658:HIV Infections / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012423:Rural Health; D012424:Rural Population; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014171:Transients and Migrants / Q000706:statistics & numerical data; D014397:Tuberculosis, Pulmonary / Q000401:mortality*