Poverty and non-communicable diseases in South Africa.
BACKGROUND
High levels of wealth inequality with improved health statistics in South Africa (SA) provide an important opportunity to investigate non-communicable diseases (NCDs) among the poor.


OBJECTIVE
This paper uses two distinct national data sets to contrast patterns of mortality in rich and poor areas and explore the associations between poverty, risk factors, health care and selected NCDs diseases in South African adults.


METHODS
Causes of premature mortality in 1996 experienced in the poorest magisterial districts are compared with those in the richest, using average household wealth to classify districts. Logistic and multinomial regression are used to investigate the association of a household asset index and selected chronic conditions, related risk factors and healthcare indicators using data from the 1998 South African Demographic and Health Survey.


RESULTS
NCDs accounted for 39% and 33% of premature mortality in rich and poor districts respectively. The household survey data showed that the risk factors hypertension and obesity increased with increasing wealth, while most of the lifestyle factors, such as light smoking, domestic exposure to ;;smoky'' fuels and alcohol dependence were associated with poverty. Treatment status for hypertension and asthma was worse for poor people than for rich people.


CONCLUSIONS
The study suggests that NCDs and lifestyle-related risk factors are prevalent among the poor in SA and treatment for chronic diseases is lacking for poor people. The observed increase in hypertension and obesity with wealth suggests that unless comprehensive health promotion strategies are implemented, there will be an unmanageable chronic disease epidemic with future socioeconomic development in SA.
Schneider
Michelle
M
Burden of Disease Research Unit, South African Medical Research Council. michelle.schneider@mrc.ac.za
Bradshaw
Debbie
D
Steyn
Krisela
K
Norman
Rosana
R
Laubscher
Ria
R
D000328:Adult; D002423:Cause of Death; D002648:Child; D002908:Chronic Disease / Q000401:mortality*; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D011203:Poverty; D012307:Risk Factors; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology