title: Deaths ascribed to non-communicable diseases among rural Kenyan adults are proportionately increasing: evidence from a health and demographic surveillance system, 2003-2010.
abstract: BACKGROUND
  Non-communicable diseases (NCDs) result in more deaths globally than other causes. Monitoring systems require strengthening to attribute the NCD burden and deaths in low and middle-income countries (LMICs). Data from health and demographic surveillance systems (HDSS) can contribute towards this goal.
  
  
  RESULTS
  Between 2003 and 2010, 15,228 deaths in adults aged 15 years (y) and older were identified retrospectively using the HDSS census and verbal autopsy in rural western Kenya, attributed into broad categories using InterVA-4 computer algorithms; 37% were ascribed to NCDs, 60% to communicable diseases (CDs), 3% to injuries, and <1% maternal causes. Median age at death for NCDs was 66y and 71y for females and males, respectively, with 43% (39% male, 48% female) of NCD deaths occurring prematurely among adults aged below 65y. NCD deaths were mainly attributed to cancers (35%) and cardio-vascular diseases (CVDs; 29%). The proportionate mortality from NCDs rose from 35% in 2003 to 45% in 2010 (χ2 linear trend 93.4; p<0.001). While overall annual mortality rates (MRs) for NCDs fell, cancer-specific MRs rose from 200 to 262 per 100,000 population, mainly due to increasing deaths in adults aged 65y and older, and to respiratory neoplasms in all age groups. The substantial fall in CD MRs resulted in similar MRs for CDs and NCDs among all adult females by 2010. NCD MRs for adults aged 15y to <65y fell from 409 to 183 per 100,000 among females and from 517 to 283 per 100,000 population among males. NCD MRs were higher among males than females aged both below, and at or above, 65y.
  
  
  CONCLUSIONS
  NCDs constitute a significant proportion of deaths in rural western Kenya. Evidence of the increasing contribution of NCDs to overall mortality supports international recommendations to introduce or enhance prevention, screening, diagnosis and treatment programmes in LMICs.
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom; Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Penelope A
authors.initials: PA
authors.lastname: Phillips-Howard
authors.affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Nyaguara
authors.initials: N
authors.lastname: Amek
authors.affiliation: Center for Public Health, Liverpool John Moores University, Liverpool, United Kingdom.
authors.forename: Caryl M
authors.initials: CM
authors.lastname: Beynon
authors.affiliation: Department of Non-Communicable Diseases, Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Sonia Y
authors.initials: SY
authors.lastname: Angell
authors.affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Sammy
authors.initials: S
authors.lastname: Khagayi
authors.affiliation: Umeå Centre for Global Health Research, Umeå University, Umeå, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Byass
authors.affiliation: Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Hamel
authors.affiliation: Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, United Kingdom.
authors.forename: Anne M
authors.initials: AM
authors.lastname: van Eijk
authors.affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya; Division of Global HIV and AIDS, Centers for Disease Control and Prevention, Kisumu, Kenya.
authors.forename: Emily
authors.initials: E
authors.lastname: Zielinski-Gutierrez
authors.affiliation: Division of Parasitic Diseases and Malaria, Centers for Disease Control and Prevention, Atlanta, GA, United States of America.
authors.forename: Laurence
authors.initials: L
authors.lastname: Slutsker
authors.affiliation: Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States of America; Center for Global Health, Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya.
authors.forename: Kevin M
authors.initials: KM
authors.lastname: De Cock
authors.affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: John
authors.initials: J
authors.lastname: Vulule
authors.affiliation: Centre for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya.
authors.forename: Frank O
authors.initials: FO
authors.lastname: Odhiambo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002423:Cause of Death; D003141:Communicable Diseases / Q000453:epidemiology*; D003625:Data Collection; D005260:Female; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D007674:Kidney Diseases / Q000453:epidemiology; D008171:Lung Diseases / Q000453:epidemiology; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology*; D011159:Population Surveillance; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population; D055815:Young Adult