title: Burden attributable to Cardiometabolic Diseases in Zimbabwe: a retrospective cross-sectional study of national mortality data.
abstract: BACKGROUND
  Cardiometabolic diseases (CMDs) are an important cause of mortality worldwide and the burden associated with them is increasing in Sub-Saharan Africa. The tracking of mortality helps support evidence based health policy and priority setting. Given the growing prevalence of non-communicable diseases in Zimbabwe, a study was designed to determine the mortality attributable to CMDs in Zimbabwe.
  
  
  METHODS
  The study design was a retrospective cross-sectional analysis of national mortality from 1996 to 2007, collated by the Ministry of Health and Child Welfare in Zimbabwe. We employed generalized additive models to flexibly estimate the trend of the CMD mortality and a logistic regression model was used to find significant factors (cause of death according to the death certificate) of the CMD mortality and predict CMD mortality to 2040.
  
  
  RESULTS
  CMDs accounted for 8.13% (95% CI: 8.08% - 8.18%) of all deaths during 1996 to 2007 (p = 0.005). During the study period CMD mortality rate increased by 29.4% (95% CI: 19.9% - 41.1%). The association between gender and CMD mortality indicated female mortality was higher for diabetes (p < 0.001), hypertensive disease (p < 0.001), CVD (p < 0.001) and pulmonary disease (p < 0.001), while male mortality was higher for ischaemic (p = 0.010) and urinary diseases (p < 0.001). There was no gender difference for endocrine disease (p = 0.893). Overall, females have 1.65% higher mortality than males (p < 0.001). CMD mortality is predicted to increase from 9.6 (95% CI: 8.0% - 11.1%) in 2015 to 13.7% (95% CI: 10.2% - 17.2%) in 2040 for males, and from 11.6% (95% CI: 10.2% - 12.9%) in 2015 to 16.2% (95% CI: 13.1% - 19.3%) in 2040 in females.
  
  
  CONCLUSIONS
  The findings of this study indicate a growing prevalence of CMDs and related mortality in Zimbabwe. Health policy decisions and cost-effective preventive strategies to reduce the burden of CMDs are urgently required.
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Australia. mutsa.mutowo@monash.edu.
authors.forename: Mutsa P
authors.initials: MP
authors.lastname: Mutowo
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Australia. alice.owen@monash.edu.
authors.forename: Alice J
authors.initials: AJ
authors.lastname: Owen
authors.affiliation: School of Public Health and Preventive Medicine, Monash University, Melbourne, 3004, Australia. baki.billah@monash.edu.
authors.forename: Baki
authors.initials: B
authors.lastname: Billah
authors.affiliation: Centre for Health Economics, Monash University, Melbourne, 3004, Australia. paula.lorgelly@monash.edu.
authors.forename: Paula K
authors.initials: PK
authors.lastname: Lorgelly
authors.affiliation: Fellow of the Institute of Actuaries (FIA) , Harare, Zimbabwe. kegumbz@googlemail.com.
authors.forename: Kudzai E
authors.initials: KE
authors.lastname: Gumbie
authors.affiliation: Zimbabwe Diabetes Association, PO Box 1797, Harare, Zimbabwe. johnmangwiro.JC@gmail.com.
authors.forename: John C
authors.initials: JC
authors.lastname: Mangwiro
authors.affiliation: School of Social Science and Psychology, University of Western Sydney, Sydney, 2751, , New South Wales, Australia. andre.renzaho@uws.edu.au.
authors.forename: Andre M N
authors.initials: AM
authors.lastname: Renzaho
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D002423:Cause of Death; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006304:Health Status; D006801:Humans; D016015:Logistic Models; D008297:Male; D008659:Metabolic Diseases / Q000401:mortality*; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult; D015030:Zimbabwe / Q000453:epidemiology