title: Premature adult mortality in urban Zambia: a repeated population-based cross-sectional study.
abstract: OBJECTIVE
  To measure the sex-specific and community-specific mortality rates for adults in Lusaka, Zambia, and to identify potential individual-level, household-level and community-level correlates of premature mortality. We conducted 12 survey rounds of a population-based cross-sectional study between 2004 and 2011, and collected data via a structured interview with a household head.
  
  
  METHODS
  Households in Lusaka District, Zambia, 2004-2011.
  
  
  METHODS
  43,064 household heads (88% female) who enumerated 123,807 adult household members aged between 15 and 60 years.
  
  
  METHODS
  Premature adult mortality.
  
  
  RESULTS
  The overall mortality rate was 16.2/1000 person-years for men and 12.3/1000 person-years for women. The conditional probability of dying between age 15 and 60 (45q15) was 0.626 for men and 0.537 for women. The top three causes of death for men and women were infectious in origin (ie, tuberculosis, HIV and malaria). We observed an over twofold variation of mortality rates between communities. The mortality rate was 1.98 times higher (95% CI 1.57 to 2.51) in households where a family member required nursing care, 1.44 times higher (95% CI 1.22 to 1.71) during the cool dry season, and 1.28 times higher (95% CI 1.06 to 1.54) in communities with low-cost housing.
  
  
  CONCLUSIONS
  To meet Zambia's development goals, further investigation is needed into the factors associated with adult mortality. Mortality can potentially be reduced through focus on high-need households and communities, and improved infectious disease prevention and treatment services.
authors.affiliation: Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Sujit D
authors.identifier: http://orcid.org/0000-0001-8783-7724
authors.initials: SD
authors.lastname: Rathod
authors.affiliation: Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK Centre for Actuarial Research, University of Cape Town, Cape Town, South Africa.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Timæus
authors.affiliation: Research, Publications and Dissemination Unit, Zambia Central Statistical Office, Lusaka, Zambia.
authors.forename: Richard
authors.initials: R
authors.lastname: Banda
authors.affiliation: Department of Gender Studies, University of Zambia, Lusaka, Zambia.
authors.forename: Kusanthan
authors.initials: K
authors.lastname: Thankian
authors.affiliation: Centre for Infectious Disease Research in Zambia, Lusaka, Zambia.
authors.forename: Roma
authors.identifier: http://orcid.org/0000-0003-0221-9527
authors.initials: R
authors.lastname: Chilengi
authors.affiliation: Department of Population Studies, University of Zambia, Lusaka, Zambia.
authors.forename: Andrew
authors.initials: A
authors.lastname: Banda
authors.affiliation: Department of Population Studies, University of Zambia, Lusaka, Zambia.
authors.forename: Musonda
authors.initials: M
authors.lastname: Lemba
authors.affiliation: University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Jeffrey S A
authors.initials: JS
authors.lastname: Stringer
authors.affiliation: University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Chi
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D061213:Mortality, Premature; D011159:Population Surveillance; D012044:Regression Analysis; D012111:Residence Characteristics; D018570:Risk Assessment; D017678:Sex Distribution; D012959:Socioeconomic Factors; D055815:Young Adult; D015024:Zambia / Q000453:epidemiology
keywords: Zambia>epidemiology; adult; cause of death; cross-sectional studies; mortality>trends