COD 2013
The South Africa I know, the home I understandThe South Africa I know, the home I understand
Mortality and causes of
death in South Africa: Findings from death
notification, 2013
@StatsSA#COD
COD 2013
The South Africa I know, the home I understand
is a permanent
disappearance of all
evidence of life after a
live birth has occurred
Death
COD 2013
The South Africa I know, the home I understand
COD 2013
The South Africa I know, the home I understand
From death to statistics
Births and Deaths Registration Act, 1992 Statistics Act 1999
Death
occurs
Dr. verifies death &
completes death
DHA 1663 form
1 2
Submitted to DHA
& entered on
population
register
3
Sent to Stats SA to
code causes of death
to ICD-10, process
and analyze
Statistics
released
COD 2013
The South Africa I know, the home I understand
COD 2013
The South Africa I know, the home I understand
All diseases, morbid
conditions, or
injuries that either
resulted in or
contributed to death,
and the
circumstances of the
accident or violence
which produced any
such injuries
Underlying
causes of
death
COD 2013
The South Africa I know, the home I understand
• Statistics compiled in accordance with WHO standards
• General improvements noted in the quality of data
94% complete
Death registration of adults is
of deaths were registered within
the 3 Days of death as
stipulated within the legislation in
2013 it was 75% in 2012
77%
COD 2013
The South Africa I know, the home I understand
In 2013,
458 933deaths
occurred in South Africa
COD 2013
The South Africa I know, the home I understand
100 000
200 000
300 000
400 000
500 000
600 000
700 000
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Nu
mb
er
of
de
ath
s
Year of death
Decline in
recorded
deaths
continues
COD 2013
The South Africa I know, the home I understand
Provincial
distribution of
South Africa’s
458 933
recorded deaths
-2013-
Foreign = 0,3%Unspecified = 0,2%
COD 2013
The South Africa I know, the home I understand
LP8,6
MP8,4
KZN8,0
EC9,5
FS12,1
NW9,8
NC11,8
WC7,7
GP7,7
Deaths per 1 000 population
2013
South Africa
8,6
Northern Cape and Free State experienced the
highest number of deaths per 1 000 people
COD 2013
The South Africa I know, the home I understand
Deaths per 1 000 population by district 2013
1
2
2
Pixley ka Seme - 19
Xhariep -18
Highest
1
eThekwini - 53
Lowest
3
COD 2013
The South Africa I know, the home I understand
Other Diseases
Respiratory
system
Cancers/
Neoplasms
Accidents andexternal causes
Circulatory
systemInfectious and
parasitic diseases
Metabolic disorders
23% 17%
10%6%
8%
10%
25%
Total Deaths458 933
Distribution of deaths by
main groups of causes death 2013
COD 2013
The South Africa I know, the home I understand
Distribution of deaths
by causes death 2013
10%
25%
23%
17%
8%
COD 2013
The South Africa I know, the home I understand
Ranking of top ten leading causes of death between 2012 and 2013
Tuberculosis (9.9%)
Influenza and pneumonia (5.5%)
Cerebrovascular diseases (5.0%)
Other forms of heart disease (4.6%)
Diabetes mellitus (4.4%)
HIV disease (3.9%)
Hypertensive diseases (3.4)
Other viral diseases (3.1%)
Intestinal infectious diseases (3.1%)
Chronic lower respiratory diseases (2.5%)
Tuberculosis (8.8%)
Influenza and pneumonia (5.2%)
HIV disease (5.1%)
Cerebrovascular diseases (4.9%)
Diabetes mellitus (4.8%)
Other forms of heart disease (4.6%)
Hypertensive diseases (3.7%)
Intestinal infectious diseases (3.4%)
Other viral diseases (3.0%)
Chronic lower respiratory diseases (2.6%)
1
2
3
4
5
6
7
8
9
2012 2013
10 10
1
2
3
4
5
6
7
8
9
COD 2013
The South Africa I know, the home I understand
Tuberculosis 1 23,791 9.9 1 16,582 7.6
Influenza and pneumonia 2 12,133 5.1 5 11,480 5.3
Human immunodeficiency virus [HIV] disease 3 11,643 4.9 4 11,481 5.3
Other forms of heart disease 4 9,651 4.0 6 11,399 5.2
Cerebrovascular diseases 5 9,518 4.0 3 12,920 5.9
Diabetes mellitus 6 8,699 3.6 2 13,484 6.2
Intestinal infectious diseases 7 7,441 3.1 8 8,259 3.8
Chronic lower respiratory diseases 8 7,262 3.0 10 4,757 2.2
Other viral diseases 9 6,459 2.7 9 7,102 3.3
Hypertensive diseases 10 6,352 2.7 7 10,388 4.8
Diabetes ranks as the second leading COD for women, but falls outside of the Top 5 for men
Male Female
Rank Number % Rank Number %
Top ten leading causes of death
(based on ICD-10) in 2013
COD 2013
The South Africa I know, the home I understand
LP
MP
KZN
EC
FS
NW
NC
WC
Leading causes of death within each province
Influenza and pneumonia
Tuberculosis
GPDiabetes
HIV disease
COD 2013
The South Africa I know, the home I understand
-
100 000
200 000
300 000
400 000
500 000
600 000
700 000
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Certain infectious and parasitic diseases Neoplasms Diseases of the blood and immune mechanism
Endocrine, nutritional and metabolic diseases Diseases of the nervous system Diseases of the circulatory system
Diseases of the respiratory system Diseases of the digestive system Perinatal conditions
Other natural causes External causes of morbidity and mortality
Endocrine, nutritional and metabolic disease
Respiratory system
Circulatorysystem (I00-I99)
Infectious andparasitic diseases (A00-B99) Neoplasms (C00-D48)
Main groups ofbased on underlying
causes 1997- 2013
Percentage of total deaths
Diseases of the circulatory system
Certain infectious and parasitic diseases
Endocrine, nutritional and metabolic diseases
COD 2013
The South Africa I know, the home I understand
0,0
1,0
2,0
3,0
4,0
5,0
6,0
7,0
8,0
9,0
0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+
Pe
rce
nta
ge
Shift from
deaths
occurring at
younger age.
Percentage distribution of deaths by age and sex
2012 vs 2013
2013 Male2013 Female
Male Female
Age group
2012
COD 2013
The South Africa I know, the home I understand
Neonatal (0-28 days)Post-neonatal (29
days to 11 months)Less than 1 year
The three leading underlying causes of death for infants
22%
15%
5%
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
40,0
Intestinalinfectiousdiseases
Influenza andpneumonia
Malnutrition
14%14%
9%
0,0
5,0
10,0
15,0
20,0
25,0
30,0
35,0
40,0
Respiratory andcardiovascular
disordersspecific to the
perinatal period
Intestinalinfectiousdiseases
Influenza andpneumonia
COD 2013
The South Africa I know, the home I understand
The three leading underlying causes of death for children
1-4 years 5-14 years
17%
10%
7%
0%
5%
10%
15%
20%
25%
30%
Intestinalinfectiousdiseases
Influenza andpneumonia
Malnutrition
15%
11%9%
0%
5%
10%
15%
20%
25%
30%
Intestinalinfectiousdiseases
Respiratory andcardiovascular
disorders
Influenza andpneumonia
7%6%
5%
0%
5%
10%
15%
20%
25%
30%
Tuberculosis Intestinalinfectiousdiseases
Influenza andpneumonia
Under 5 years
COD 2013
The South Africa I know, the home I understand
65+
5%
6%
10%
0% 2% 4% 6% 8% 10% 12%
Cerebrovascular diseases
Diabetes mellitus
Tuberculosis
45-64
6%
11%
15%
0% 5% 10% 15% 20%
Other viral diseases
Human immunodeficiency virus
Tuberculosis
15-44
The three leading underlying causes of death for age groups
8%
8%
9%
0% 2% 4% 6% 8% 10%
Other forms of heart disease
Diabetes mellitus
Cerebrovascular diseases
COD 2013
The South Africa I know, the home I understand
0,0
10,0
20,0
30,0
40,0
50,0
60,0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Pe
rce
nta
ge o
f to
tal d
eath
s
Year of death
CommunicableNon CommunicableInjuries
1997
Gap was
24% points
2013
13%
Percentage of deaths: communicable, non-communicable and injuries
COD 2013
The South Africa I know, the home I understand
0
5 000
10 000
15 000
20 000
25 000
30 000
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Cerebrovascular diseases Diabetes mellitus Other forms of heart disease
Hypertensive diseases Ischaemic heart diseases Malignant neoplasms of digestive organs
Continuous rise in deaths due to diabetes mellitus and
hypertensive diseases
COD 2013
The South Africa I know, the home I understand
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+
Pe
rce
nta
ge
of
tota
l d
ea
ths
From Ages 10-44 women have
greater percentage of deaths due to
communicable diseases
Percentage of deaths: Communicable
2013 Male2013 Female
Age of Death
COD 2013
The South Africa I know, the home I understand
Percentage of deaths: Non-Communicable
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+
Age group
Group II
2013 Male2013 Female
%
Females have higher non-
communicable percentage of death
in all age groups
COD 2013
The South Africa I know, the home I understand
0 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
Percentage of deaths due to injuries
for females peaks at 28% and much
younger age group (5-9)
Percentage of deaths due to injuries
for males is above 60% in 20-24
Age Group
Percentage of deaths: Injuries
2013 Male2013 Female
Pe
rce
nta
ge o
f d
eat
hs
Age Group
COD 2013
The South Africa I know, the home I understand
0%
2%
4%
6%
8%
10%
12%
14%
16%
18%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Percentage of deaths that were
non-natural1997-2013
The percentage of non-natural deaths in
South Africa has decreased over the
years, but has increased slightly
since 2009
Non-natural deaths include all external causes of
morbidity and mortality
COD 2013
The South Africa I know, the home I understand
42000
44000
46000
48000
50000
52000
54000
56000
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Year of death
Number non-natural deaths
1997-2013
Nu
mb
er
of
de
ath
s
COD 2013
The South Africa I know, the home I understand
LP8,0%
MP10,5%
KZN10,2%
EC10,7%
FS9,5%
NW8,4%
NC11,2%
WC12,8%
GP10,6%
Percentage of deaths that were non-natural 2013
COD 2013
The South Africa I know, the home I understand
1%
4%
11%
12%
16%
56%
0% 10% 20% 30% 40% 50% 60% 70%
Self-harm
Complications of medical and surgical care
Assault
Transport accidents
Undetermined intent
Other causes of accidental injury
Percentage of non-natural deaths
by broad groups
2013
COD 2013
The South Africa I know, the home I understand
3%
6%
8%
16%
18%
46%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Accidental poisoning
Accidental drowning and submersion
Exposure to smoke, fire and flames
Exposure to inanimate mechanical forces
Other accidental threats to breathing
Accidental exposure to other/unspecified factors
Distribution of deaths due to other
external causes of accidental injury
2013
COD 2013
The South Africa I know, the home I understand
LP30,6%
MP11,7%
KZN11,0%
EC11,6%
FS18,5%
NW14,0%
NC24,1%
WC9,3%
GP3,6%
Transport accident deaths
Percentage of non-natural Deaths within each province
South Africa
11%
Limpopo experienced the highest number of deaths due
to transport accidents as a percent of non-natural deaths
COD 2013
The South Africa I know, the home I understand
Transport accidents by death month
6,1%
10,4% 10,1%
0%
2%
4%
6%
8%
10%
12%
January February March April May June July August September October November December
Pe
rce
nta
ge o
f Tr
ansp
ort
acc
ide
nts
Death month
Percentage of deaths due
to transport accidents
peaked in the month of
June
COD 2013
The South Africa I know, the home I understand
LP4,6%
MP3,5%
KZN10,0%
EC15,7%
FS15,6%
NW9,5%
NC23,1%
WC18,7%
GP5,1%
Assault related deaths
Percentage of non-natural Deaths within each province
South Africa
10.2%
Northern Cape experienced the highest number of deaths due to assault as a percent of non-
natural deaths
COD 2013
The South Africa I know, the home I understand
Deaths due to assault by death month
6,7% 6,7%
9,7%
5,7%
6,6%
9,1%
7,4%
8,3%8,7%
8,1%
9,9%
13,2%
0,0
2,0
4,0
6,0
8,0
10,0
12,0
14,0
January February March April May June July August September October November December
%
Month of death
Percentage of
deaths due to
assault peaked
during November
and December
COD 2013
The South Africa I know, the home I understand
Assault type Number %
Sharp object (X99) 4 270 85,1
Unspecified means (Y09) 485 9,7
Other and unspecified firearm discharge (X95) 85 1,7
Blunt object (Y00) 61 1,2
Neglect and abandonment (Y06) 39 0,8
Hanging, strangulation and suffocation (X91) 35 0,7
Sexual assault by bodily force (Y05) 14 0,3
By other specified means (Y08) 9 0,2
Bodily force (Y04) 7 0,1
Other maltreatment syndromes (Y07) 6 0,1
Rifle, shotgun and larger forearm discharge (X94) 3 0,1
Drowning and submersion (X92) 2 0,0
Smoke, fire and flames (X97) 2 0,0
Unspecified chemical or noxious substance (X90) 1 0,0
Total deaths 5 019 100,0
Assault deaths in 2013
COD 2013
The South Africa I know, the home I understand
Assault deaths in 1997-2013
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Sharp Object as a cause of
death, has remained the main
contributing factor, over the
period 1997 and 2013
Other and unspecified firearm discharge
Unspecified means
COD 2013
The South Africa I know, the home I understand
Where we die44,2%
Hospital
1,7%
Emergency
Room
outpatient
2,1%
Dead on arrival
*Other, Unknown or Unspecified 22,9%
23,2%Home 24,9%
2012
2013
1,9%
2012
2013
42,6%
2012
2013
COD 2013
The South Africa I know, the home I understand
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
HIV 12,0 10,3 11,3 9,6 7,2 6,9 6,6 7,1 7,4 6,8 6,4 7,2 9,2 10,4 11,0 13,6 18,0
HIV-related 88,0 89,7 88,7 90,4 92,8 93,1 93,4 92,9 92,6 93,2 93,6 92,8 90,8 89,6 89,0 86,4 82,0
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
100,0
per
cen
tage
HIV and HIV related deaths
HIV HIV-related
COD 2013
The South Africa I know, the home I understand
0,0
10,0
20,0
30,0
40,0
50,0
60,0
70,0
80,0
90,0
100,0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
HIV HIV RELATED
From 2008 declining HIV related deaths
lead to increasing HIV reporting among
15-44 age group
Perc
enta
ge o
f D
eath
COD 2013
The South Africa I know, the home I understand
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
HIV HIV RELATED
From 2008 declining HIV
related deaths lead to
increasing HIV reporting
among
45-64 age group
Perc
enta
ge o
f D
eath
COD 2013
The South Africa I know, the home I understand
0
10
20
30
40
50
60
70
80
90
100
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
15-44 44-64
HIV HIV RELATED
Western Cape main province
driving the reporting of HIV
particularly from 2007
15-44 age group 45-64 age group
Pe
rce
nta
ge o
f D
eat
h
COD 2013
The South Africa I know, the home I understand
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
HIV HIV RELATED
Improvements in HIV reporting also
pronounced in Northern Cape
especially among 15-44 and 45-64
15-44 age group 45-64 age group
Year
Pe
rce
nta
ge o
f D
eat
h
COD 2013
The South Africa I know, the home I understand
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
20
07
20
08
20
09
20
10
20
11
20
12
20
13
15-44 44-64
HIV HIV RELATED
Reporting of HIV among 15-44 and 45-64
in KwaZulu-Natal also one of the
contributing factors to increasing
reporting of deaths in HIV.
15-44 age group
Pe
rce
nta
ge o
f D
eat
h
COD 2013
The South Africa I know, the home I understand
0
10 000
20 000
30 000
40 000
50 000
60 000
70 000
80 000
90 000
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Tuberculosis Influenza & pneumonia HIV disease Instestinal infectious diseases Other viral diseases
Trends in underlying causes of death, 1997-2013
COD 2013
The South Africa I know, the home I understand
-
2 000
4 000
6 000
8 000
10 000
12 000
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Number of deaths due to HIV disease andspecified causes: co-morbidity
HIV and Influenza and pneumonia HIV and Intestinal infectious diseases HIV and TB
Nu
mb
er o
f D
eat
hs
COD 2013
The South Africa I know, the home I understand
6 239
23 203
-
5000,0
10000,0
15000,0
20000,0
25000,0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Nu
mb
er
of
HIV
dea
ths
Death Year
COD 2013
The South Africa I know, the home I understand
Excerpts from Dr’s Trained
in death certification
COD 2013
The South Africa I know, the home I understand
Dr. Level of comfort in statingHIV before and aftertraining
Reason
1 Very comfortableWith the changes in the Notification of Death form, there is good confidentiality - not perfect, but good.
2 Very comfortableIf HIV is the main cause of death then it must be stated. The 4th page of the NOD is confidential and I have never had a problem writing HIV/AIDS there.
3 Very comfortableInsurance forms not an issue in my place of work Forms are confidential
COD 2013
The South Africa I know, the home I understand
Dr. Level of comfort in stating HIV before training
Reason Level of comfort in stating HIV after training
Reason
1Somewhat comfortable
Was unsure of the legislation regarding the reporting of HIV
Very comfortable No legal implications
2Somewhat comfortable
Would not write HIV often.
Very comfortable
It has to be written to assist in getting proper statistics and for the Dept. of Health to report correct figures and proper planning be done.
3Somewhat comfortable
I had some reservations due to confidentiality limitations as well as lack of clarity on the legal provisions governing such disclosure
Very comfortable Clear on the causal sequencing
COD 2013
The South Africa I know, the home I understand
Dr. Level of comfort in stating HIV beforetraining
Reason Level of comfort in stating HIV after training
Reason
1Somewhat comfortable
I realised the issue of confidentiality should not matter.
Very comfortable I indicate HIV if relevant
2Somewhat comfortable
I was reluctant because insurance companies were giving the concerned families problems with the pay outs for funeral arrangements of life covers.
Very comfortable
I know and confident that it is important to furnish correct information for accurate statistics purposes and appropriate strategic planning. I realise it is not a problem to indicate HIV disease as a cause of death
COD 2013
The South Africa I know, the home I understand
Dr. Level of comfort in stating HIV
beforetraining
Reason Level of comfort in
stating HIV aftertraining
Reason
1Not comfortable at all
Because of family members who will tell me that if the cause is HIV then the insurance won't pay them the money
Very comfortable
We were told that the insurance is having right to have access to the patient 's medical records, and it's for statistic purposes
2Not comfortable at all
I was afraid of legal implications. Very comfortableNow I know that I am protected by law.
3Not comfortable at all
HIV causes panic amongst family members (stigma) and the term was not divulged in any form as far as possible. Rather the condition resulting from HIV was documented. Furthermore, health insurance companies were not paying out if death was associated with HIV
Not comfortable at all
Not comfortable indicating HIV as a cause of death but comfortable in indicating it as a condition which led to a sequence of events leading to death