SOUTH AFRICAN NON-COMMUNICABLE DISEASES (NCD) REPORT

PUBLISHED: FEBRUARY 2021

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The South African Non-Communicable Diseases Report (150 pages) provides a synthesis of medical research, examining global and SA

prevalence, current treatment, new medical research and advancements for these major NCDs: Cardiovascular Diseases, Hyperlipidemia,

Hypertension, Cerebrovascular Diseases, Diabetes Mellitus, Cancer, Rheumatoid Arthritis, Alzheimer’s Disease, Parkinson's Disease.

SOME KEY QUESTIONS THE REPORT WILL HELP YOU TO ANSWER:

For the Global and SA Burden of Diseases Sections:

o What are the global and SA health indicators? (mortality, life expectancy, and fertility)

o What is the global and SA burden of disease?

o What are the global and SA top 10 causes of death?

o What are the characteristics of the leading global and SA communicable and non-communicable causes of death?

o What is the global and SA prevalence and mortality rate of COVID-19?

For the Non-Communicable Diseases Section:

o What are the definitions and characteristics of each of the Non-Communicable Diseases?

o What are the demographics and prevalence for each of the Non-Communicable Diseases?

o What are the current treatments used for each of the Non-Communicable Diseases?

o What are the latest new treatments, research, and medical advancements for each of the Non-Communicable Diseases?

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REPORT OVERVIEW

150-page report filled with detailed charts, graphs, and insights

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SCREENSHOTS FROM REPORT

Based on the Global Burden of Disease cause list, which

groups underlying causes of deaths into Communicable

Diseases, Non-Communicable Diseases, and External

Causes of Mortality, the majority of deaths in South Africa

were caused by Non-Communicable Diseases in 2017.

o In 2017, 57.8% of recorded deaths in South Africa resulted from Non-

Communicable Diseases, an increase of 0.5% from 2016, when 57.3% of

deaths were due to Non-Communicable Diseases, as illustrated in the

adjacent graph.

o Interestingly, from 2005 to 2017, the country had witnessed a steady and

significant increase in the number of deaths due to Non-Communicable

Diseases, and an associated decrease in the numbers of deaths due to

Communicable Diseases

o In addition, there had been a steady increase in the number of deaths

resulting from External Causes of Mortality, such as injuries, from the

period 2005 to 2017. 9.0% of all deaths recorded in 2005 were due to

External Causes of Mortality, whilst in 2017, deaths due to External

Causes of Mortality made up 11.5% of all recorded deaths, representing

an increase of 2.5 percentage points.

o Interestingly, for the period for 2004 to 2008, the number of deaths

resulting from Communicable Diseases exceeded that from Non-

Communicable Diseases.

2020 | 7Source: StatsSA (Access Date: 14 July 2020)

o Since 2010, the gap between deaths due to Non-Communicable and

Communicable Diseases has steadily increased, with the number of

deaths due to the former increasing, and the latter decreasing. This

pattern reflects an epidemiological shift in terms of main causes of death

from Communicable to Non-Communicable.

SAMPLE FROM REPORTSA BURDEN OF DISEASE: MAIN GROUPS OF CAUSES OF DEATH

48.1%

44.5%

41.5%

39.2%

38.2%

36.4%

33.3%

31.4%

30.7%

42.9%

46.6%

49.3%

50.9%

51.4%

52.9%

55.5%

57.3%

57.8%

9.0%

9.0%

9.1%

9.9%

10.5%

10.7%

11.3%

11.4%

11.5%

0% 20% 40% 60% 80% 100%

2005

2010

2011

2012

2013

2014

2015

2016

2017

DISTRIBUTION OF SOUTH AFRICAN DEATHS AMONG THE THREE MAIN GROUPS OF CAUSES OF DEATH:

2000-2017 (IN PERCENTAGE)

CommunicableDiseases

Non-CommunicableDiseases

External Causes ofMortality

o Other types of CVDs include congenital heart disease, rheumatic heart

disease, cardiomyopathies (diseases of the heart muscle), and cardio

arrhythmias (disorders of the electrical conduction system of the heart).

These CVDs are, in general, less common than CVDs which cause heart

attacks and strokes.

Definition and Basic Characteristics:

o Cardiovascular disease (CVD) generally refers to a group of conditions

involving the heart and its blood vessels. These conditions result from

poor blood supply resulting from a diseased vascular supply.

o Typically, CVD is associated with, or results from, atherosclerosis, which

has been found to be responsible for a large proportion of CVDs. CVDs,

due to atherosclerosis, generally refers to conditions involving narrowed or

blocked blood vessels that can lead to a heart attack, chest pain, or a

stroke (if the blood clot travels to the brain).

o In essence, atherosclerosis is a complex pathological process in the walls

of blood vessels which develops over several years. During this process,

deposits of fatty material and cholesterol build-up inside the lumen of

medium- and large blood vessels (i.e. arteries). In turn, these deposits, or

plaques, cause the inner surface of blood vessels to become irregular,

thereby narrowing the lumen, constricting blood flow and causing blood

vessels to become less pliable. In due course, plaques can rupture,

triggering the formation of blood clots, which can cause a heart attack

(when the clot develops in the heart) or stroke (when the clot develops in

the brain). However, CVD can also be associated with damage to arteries

in other organs, including the heart, brain, kidneys, and eyes.

o The different types of CVDs due to atherosclerosis, include ischaemic

heart disease (also called coronary heart disease or coronary artery

disease), cerebrovascular disease (to be discussed in a separate section),

and diseases of the aorta and arteries (including hypertension and

peripheral vascular disease).

2020 | 8Source: WHO; Nhs; Mayoclinic; Image1

SAMPLE FROM REPORTCARDIOVASCULAR DISEASES: DEFINITION AND CHARACTERISTICS

Demographics and Prevalence:

o According to the Global Burden of Disease, Injuries, and Risk Factors

Study (GBD), approximately 20 million people were living with rheumatoid

arthritis (RA) in 2017. Furthermore, the study estimates that over a million

new cases are diagnosed each year. This trajectory is reflected in the

increase in the prevalence of RA cases, which grew by 7.4% between

1990 and 2017.

o In terms of South Africa specifically, approximately 1% of the South

African population is affected by rheumatoid arthritis. Of this figure,

women are two to three times more likely to suffer from RA than men.

o Moreover, according to the GBD study, the prevalence of RA in South

Africa increased from approximately 116,466 cases annually in 2010 to

approximately 118,895 cases in 2017, as illustrated in the adjacent graph.

Furthermore, of the 118,895 cases of RA in 2017 approximately 76,249

were amongst females, and approximately 42,646 were amongst males.

o This gender disparity is also reflected in the most recent South Africa

Demographic and Health Survey released in 2019. In particular, this study

found that 1.2% of women surveyed reported using prescription

medication regularly for Arthritis, as opposed to 0.9% of men surveyed.

However, only 1.0% of all the participants surveyed reported regularly

using prescription medication for Arthritis.

o While this gender difference diminishes with age, this disease is more

prevalent in older people. Approximately 80% of those who develop the

disease are between the ages of 35 and 50.

2020 | 9

SAMPLE FROM REPORT RHEUMATOID ARTHRITIS DEMOGRAPHICS AND PREVALENCE

Source: MedicineMatters; Health24; GHDX; SADHS2016

77,320 76,249

39,14642,646

116,466118,895

0.00

20,000.00

40,000.00

60,000.00

80,000.00

100,000.00

120,000.00

140,000.00

2010 2017

PREVALENCE OF RHEUMATOID ARTHRITIS IN SOUTH AFRICA: 2010 VS 2017

Females

Males

Total

Current Treatment:

o Breast cancer can be treated in different ways. This includes therapies

that affect the breast, removing cancer present in the breast, or in the

nearby lymph glands, and therapies that remove the Breast cancer cells

that could have spread in the body.

o The main treatments for Breast cancer include local treatments to the

breast and whole-body treatments, in order to find any cancer that has

spread in the body. Local treatments refer to surgery and radiation, while

treatments for the whole body include chemotherapy, hormone therapy,

targeted therapy, immunotherapy, and radiation.

o Surgery can take place more than once, either for diagnosis, treatment, or

reconstruction. There are different types of surgeries for Breast cancer

including the following:

✓ Breast-Conserving Surgery: This type of surgery is an operation to

remove the cancer and some normal tissue around the breast, but not

the breast itself. In certain instances, a part of the chest wall lining may

also be removed if the cancer is near it. Breast-conserving surgery is

also known as lumpectomy, partial mastectomy, quadrantectomy,

segmental mastectomy, or breast-sparing surgery.

2020 | 10Source: Cansa; MyBreast; NCI; FlatIcon; Image

SAMPLE FROM REPORT BREAST CANCER CURRENT TREATMENT

✓ Total Mastectomy: This type of surgery involves the removal of the

whole breast that has been diagnosed with cancer. Some of the lymph

nodes under the arm may be removed and checked for cancer as well.

The lymph nodes may be removed at the same time as the breast surgery

or after through a separate incision. The total mastectomy surgery is also

known as a simple mastectomy.

✓ Modified Radical Mastectomy: This type of surgery removes the whole

breast that contains cancer, as well as many of the lymph nodes under the

arm, the lining over the chest muscles, and sometimes, a part of the chest

wall muscles.

o This amount may seem small, but it could make the difference between

blood pressure that is considered normal and elevated. Overall, the study

solidifies previous research that suggests that being more physically

active can help lower blood pressure.

o Other lifestyle factors, such as long working hours, have also been found

to be linked to high blood pressure. A new study conducted by a Canadian

research team, found that working 49 or more hours each week is linked

to a 70% greater likelihood of having masked Hypertension, as well as a

66% likelihood of having sustained Hypertension-elevated blood pressure

readings.

o In addition, working between 41 and 48 hours each week was linked to a

54% greater likelihood of having masked Hypertension and a 42% greater

likelihood of having sustained Hypertension. Therefore, this study

highlights the relationship between long work hours and heart health, and

further stresses the fact that people should check their blood pressure

over time at home, as masked Hypertension does not appear during a

regular blood pressure test and often goes undetected.

New Treatments, Research and Medical Advancements:

o In the past year, advancements have been made in terms of developing

new treatments with less side effects, as well as identifying more

conclusive preventative measures that would decrease blood pressure

without the use of medication.

o New Approved Treatment Agents: The United States (US) Food and

Drug Administration (FDA) recently approved a new drug, Conjupri

(levoamlodipine), for the treatment of Hypertension in December 2019.

Manufactured by the CSPC Pharmaceutical Group, Conjupri’s active

ingredient is levoamlodipine, which is a purified version of amlodipine, a

third-generation calcium channel blocker, that was first developed and

marketed by Pfizer as NORVASC.

o Levoamlodipine has been shown in clinical trials to have less adverse

events than amlodipine and is now qualified to be the reference standard

for medications with the same active ingredient. The medication is

suitable for use in both adults and children who are six years and older.

o New Research and Advancements in Preventative Measures: A

research project that formed part of the Framingham Heart Study,

analysed data from 638 study participants who were asked to wear an

Apple Watch daily and record their blood pressure at home weekly.

o After accounting for demographic factors, the study found that

participants’ systolic blood pressure was about 0.45 points lower for every

1,000 daily steps taken, meaning that a person taking 10,000 steps daily

would have a systolic blood pressure of 2.25 points lower than a person

just taking 5,000 steps daily, on average. 2020 | 11

Source: Conjupri1; Conjupri2; Framingham; Sciencedaily; Image1; Image2

SAMPLE FROM REPORT HYPERTENSION: NEW TREATMENTS AND MEDICAL ADVANCEMENTS

2020 | 12

TABLE OF CONTENTS

EXECUTIVE SUMMARY (17 Pages)

Summary of Findings: Global Burden of Disease

Summary of Findings: South African Burden of Disease

Summary of Findings: Cardiovascular Diseases and Ischaemic Heart Disease; Hyperlipidaemia; Hypertension; Cerebrovascular Diseases; Diabetes Mellitus; Cancer;

Rheumatoid Arthritis; Alzheimer’s Disease; Parkinson’s Disease

1. GLOBAL AND SOUTH AFRICAN BURDEN OF DISEASE (15 Pages)

1.1 GLOBAL BURDEN OF DISEASE (8 Pages)

1.1.1 Global Health Indicators: Mortality, Life Expectancy and Fertility: GLOBAL POPULATION (IN BILLION): 1970-2050*; GLOBAL POPULATION YEARLY

GROWTH RATE (IN PERCENTAGE): 1970-2050* (Graphs and Table)

1.1.2 Global Burden of Disease: GLOBAL DISTRIBUTION OF DEATHS AMONGST THE THREE MAIN CAUSE GROUPS: 2017 (IN PERCENTAGE); REGIONAL

DISTRIBUTION OF DEATHS AMONG THE THREE MAIN CAUSE GROUPS: 2017 (IN PERCENTAGE) (Graphs)

1.1.3 Global Top 10 Causes of Death: GLOBAL TOP 10 NUMBER OF DEATHS BY CAUSE: 2000 VS 2017 (IN MILLIONS) (Graph)

1.1.4 Global Non-Communicable Diseases: LEADING CAUSES OF NCD DEATHS: 2000 VS 2017 (IN PERCENTAGE) (Graph)

1.1.5 Global Communicable Diseases: LEADING CAUSES OF COMMUNICABLE DEATHS: 2000 VS 2017 (IN PERCENTAGE) (Graph)

1.1.6 Global Communicable Diseases: COVID-19: GLOBAL COVID-19 DEATHS: FEBRUARY 2020- FEBRUARY 2021 (IN THOUSANDS); TOTAL CUMULATIVE COVID-19

DEATHS BY REGION: 21 FEBRUARY 2021 (IN THOUSANDS); TOTAL CUMULATIVE COVID-19 DEATHS BY TOP 6 COUNTRIES: 21 FEBRUARY 2021 (IN

THOUSANDS) (Graphs)

2020 | 13

TABLE OF CONTENTS

1. GLOBAL AND SOUTH AFRICAN BURDEN OF DISEASE (15 Pages) (CONTINUED)

1.2 SOUTH AFRICAN BURDEN OF DISEASE (7 Pages)

1.2.1 South African Health Indicators: Mortality, Life Expectancy and Fertility: SOUTH AFRICAN POPULATION: 1970-2050* (IN MILLIONS); SOUTH AFRICA LIFE

EXPECTANCY AT BIRTH: 1970-2018 (IN YEARS); CRUDE DEATH RATE: 1970-2018 (PER 1,000 PEOPLE) (Graphs and Table)

1.2.2 South African Burden of Disease: ANNUAL NUMBER OF REGISTERED DEATHS IN SOUTH AFRICA: 2010–2017; DISTRIBUTION OF NATURAL AND NON-

NATURAL CAUSES OF DEATH: 2010-2017 (IN PERCENTAGE) (Graphs)

1.2.3 South African Burden of Disease: Natural Causes of Death: TOP 10 NATURAL CAUSES OF DEATH IN SOUTH AFRICA: 2017 (IN PERCENTAGE); TOP 10

NATURAL CAUSES OF DEATH IN SOUTH AFRICA: 2015 VS 2017 (IN PERCENTAGE) (Graphs)

1.2.4 South African Burden of Disease: Main Groups of Causes of Death: DISTRIBUTION OF SOUTH AFRICAN DEATHS AMONG THE THREE MAIN GROUPS OF

CAUSES OF DEATH: 2000-2017 (IN PERCENTAGE) (Graph)

1.2.5 South African Burden of Disease: Non-Communicable Diseases: TOP NON-COMMUNICABLE CAUSES OF DEATH IN SOUTH AFRICA: 2015-2017 (Graph)

1.2.6 South African Burden of Disease: Communicable Diseases: TOP COMMUNICABLE CAUSES OF DEATH IN SOUTH AFRICA: 2015-2017 (Graph)

1.2.7 Communicable Diseases: COVID-19: TOTAL DEATHS IN SOUTH AFRICA DUE TO COVID-19: MARCH 2020-FEBRUARY 2021 (Graph)

2020 | 14

TABLE OF CONTENTS

2. NON-COMMUNICABLE DISEASES (97 Pages)

2.1 CARDIOVASCULAR DISEASES (13 Pages)

2.1.1 Cardiovascular Diseases: Definition and Characteristics

2.1.2 Cardiovascular Diseases: Demographics and Prevalence: PREVALENCE OF CARDIOVASCULAR DISEASES IN SOUTH AFRICA: 2010-2017 (IN MILLIONS)

(Graph)

2.1.3 Cardiovascular Diseases: Ischaemic Heart Disease: Definition, Characteristics, Demographics and Prevalence

2.1.4 Cardiovascular Diseases: Ischaemic Heart Disease: Demographics and Prevalence: PREVALENCE VS MORTALITY OF ISCHAEMIC HEART DISEASE IN

SOUTH AFRICA: 2010-2017 (IN THOUSANDS) (Graph)

2.1.5 Cardiovascular Disease & Ischaemic Heart Disease: Current Treatments

2.1.6 Cardiovascular Diseases: New Treatments, Research and Medical Advancements

2.2 HYPERLIPIDEMIA (7 Pages)

2.2.1 Hyperlipidemia: Definition And Characteristics

2.2.2 Hyperlipidemia: Demographics and Prevalence: ESTIMATED NUMBER OF HYPERLIPIDEMIA CASES IN SOUTH AFRICA: BY PROVINCE (2018) (IN

THOUSANDS) (Graph)

2.2.3 Hyperlipidemia: Current Treatment

2.2.4 Hyperlipidemia: New Treatments, Research And Medical Advancements

2020 | 15

TABLE OF CONTENTS

2. NON-COMMUNICABLE DISEASES (97 Pages) (CONTINUED)

2.3 HYPERTENSION (7 Pages)

2.3.1 Hypertension: Definition and Characteristics

2.3.2 Hypertension : Demographics and Prevalence: SOUTH AFRICAN POPULATION SUFFERING FROM HYPERTENSION AS DIAGNOSED BY A MEDICAL

PRACTITIONER OR NURSE, BY GENDER: 2012-2018 (IN THOUSANDS) (Graph)

2.3.3 Hypertension: Current Treatment

2.3.4 Hypertension: New Treatments, Research And Medical Advancements

2.4 CEREBROVASCULAR DISEASES (16 Pages)

2.4.1 Cerebrovascular Diseases: Definition and Characteristics

2.4.2 Cerebrovascular Diseases: Demographics and Prevalence: STROKE PREVALENCE IN SOUTH AFRICA BY AGE: 2017 (Graph); SA PREVALENCE OF STROKE

BY GENDER: 2017 (IN THOUSANDS); SA PREVALENCE OF STROKE BY TYPE: 2017 (IN PERCENTAGE) (Graphs)

2.4.4 Cerebrovascular Diseases: Ischaemic Stroke: Demographics And Prevalence

2.4.5 Cerebrovascular Diseases: Ischaemic Stroke: Current Treatment

2.4.6 Cerebrovascular Diseases: Ischaemic Stroke: New Treatments, Research And Medical Advancements

2.4.7 Cerebrovascular Diseases: Haemorrhagic Stroke: Demographics And Prevalence

2.4.8 Cerebrovascular Diseases: Haemorrhagic Stroke: Current Treatment

2.4.9 Cerebrovascular Diseases: Haemorrhagic Stroke: New Treatments, Research And Medical Advancements

2020 | 16

TABLE OF CONTENTS

2. NON-COMMUNICABLE DISEASES (97 Pages) (CONTINUED)

2.4 CEREBROVASCULAR DISEASES (16 Pages) (Continued)

2.4.10 Cerebrovascular Diseases: Carotid Stenosis: Demographics And Prevalence

2.4.11 Cerebrovascular Diseases: Carotid Stenosis: Current Treatment

2.4.12 Cerebrovascular Diseases: Carotid Stenosis: New Treatments, Research And Medical Advancements

2.4.13 Cerebrovascular Diseases: Arteriovenous Malformation: Demographics And Prevalence

2.4.14 Cerebrovascular Diseases: Arteriovenous Malformation: Current Treatment

2.4.15 Cerebrovascular Diseases: Arteriovenous Malformation: New Treatments, Research And Medical Advancements

2.5 DIABETES MELLITUS (7 Pages)

2.5.1 Diabetes Mellitus: Definition and Characteristics

2.5.2 Diabetes Mellitus: Demographics and Prevalence: TOP 10 COUNTRIES OR TERRITORIES FOR NUMBER OF ADULTS (20-79 YEARS) WITH DIABETES: 2019 (IN

MILLIONS) (Graph)

2.5.3 Diabetes Mellitus: Current Treatment

2.5.4 Diabetes Mellitus: New Treatments, Research And Medical Advancements

2020 | 17

TABLE OF CONTENTS

2. NON-COMMUNICABLE DISEASES (97 Pages) (CONTINUED)

2.6 CANCER (27 Pages)

2.6.1 Cancer: Definition and Characteristics

2.6.2 Cancer: Demographics and Prevalence: ESTIMATED NUMBER OF INCIDENT CASES AND DEATHS BY CANCER TYPE IN SOUTH AFRICA:

MALES (2018); ESTIMATED NUMBER OF INCIDENT CASES AND DEATHS BY CANCER TYPE IN SOUTH AFRICA: FEMALES (2018) (Graphs)

2.6.3 Cancer: Current Treatments

2.6.4 Cancer: Breast Cancer: Definition and Characteristics

2.6.5 Cancer: Breast Cancer: Demographics and Prevalence

2.6.6 Cancer: Breast Cancer: Current Treatments

2.6.7 Cancer: Breast Cancer: New Treatments, Research and Medical Advancements

2.6.8 Cancer: Prostate Cancer: Definition and Characteristics

2.6.9 Cancer: Prostate Cancer: Demographics and Prevalence

2.6.10 Cancer: Prostate Cancer: Current Treatments

2.6.11 Cancer: Prostate Cancer: New Treatments, Research and Medical Advancements

2.6.12 Cancer: Lung Cancer: Definition and Characteristics

2.6.13 Cancer: Lung Cancer: Demographics and Prevalence

2.6.14 Cancer: Lung Cancer: Current Treatments

2.6.15 Cancer: Lung Cancer: New Treatments, Research and Medical Advancements

2020 | 18

TABLE OF CONTENTS

2. NON-COMMUNICABLE DISEASES (97 Pages) (CONTINUED)

2.6 CANCER (27 Pages) (Continued)

2.6.16 Cancer: Colorectal Cancer: Definition and Characteristics

2.6.17 Cancer: Colorectal Cancer: Demographics and Prevalence

2.6.18 Cancer: Colorectal Cancer: Current Treatments

2.6.19 Cancer: Colorectal Cancer: New Treatments, Research and Medical Advancements

2.7 RHEUMATOID ARTHRITIS (5 Pages)

2.7.1 Rheumatoid Arthritis: Definition and Characteristics

2.7.2 Rheumatoid Arthritis: Demographics and Prevalence: PREVALENCE OF RHEUMATOID ARTHRITIS IN SOUTH AFRICA (Graph)

2.7.3 Rheumatoid Arthritis: Current Treatments

2.7.4 Rheumatoid Arthritis: New Treatments, Research and Medical Advancements

2020 | 19

TABLE OF CONTENTS

2. NON-COMMUNICABLE DISEASES (97 Pages) (CONTINUED)

2.8 ALZHEIMER’S DISEASE (8 Pages)

2.8.1 Alzheimer's Disease: Definition and Characteristics

2.8.2 Alzheimer’s Disease: Demographics and Prevalence: PREVALENCE VS. MORTALITY OF ALZHEIMER’S AND OTHER DEMENTIAS IN SOUTH AFRICA: 2010-

2017 (Graph)

2.8.3 Alzheimer’s Disease: Current Treatments

2.8.4 Alzheimer’s Disease: New Treatments, Research and Medical Advancements

2.9 PARKINSON'S DISEASE (7 Pages)

2.9.1 Parkinson's Disease: Definition And Characteristics

2.9.2 Parkinson's Disease: Demographics and Prevalence: PREVALENCE OF PARKINSON’S DISEASES IN SOUTH AFRICA: 2007 vs 2017 (Graph)

2.9.3 Parkinson's Disease: Current Treatment

2.9.4 Parkinson's Disease: New Treatments, Research And Medical Advancements

2020 | 20

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