Changes in chronic diseases prevalence and multimorbidity clusters among the deceased in rural northeast South Africa (2012-2022)
1
School of public health, University of the Witswatersrand, johanesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Rural South Africa is undergoing an epidemiological transition, with chronic non-communicable diseases (NCDs) increasingly contributing to mortality alongside traditionally high infectious disease burdens. We aimed to investigate changes in chronic disease prevalence and multimorbidity clusters among deceased individuals in rural northeast South Africa from 2012 to 2022.
METHODS:
Verbal autopsy data collected at the Agincourt Health and Demographic Surveillance Site (HDSS) from 2012–2022 were analysed. A total of 5,892 deceased individuals were included. We identified reported chronic conditions leading to death and applied cluster analysis, Partitioning Around Medoids (PAM) and latent class analysis (LCA) to identify patterns of co-occurring diseases (multimorbidity clusters). Temporal trends in condition prevalence were assessed, and multinomial logistic regression was used to examine associations of cluster membership with various behavioural factors.
RESULTS:
Over the 11-year period, hypertension prevalence among decedents rose from approximately 25% in 2012 to over 50% by 2022, with diabetes reaching ~25% and dementia over 10%. In contrast, deaths reported due to tuberculosis and HIV declined markedly. The proportion of decedents with multimorbidity (≥2 chronic conditions) increased, and complex multimorbidity (≥3 conditions) nearly doubled over time. Dominant multimorbidity clusters evolved from an early focus on HIV/TB comorbidity to later clusters centered on cardiometabolic conditions (e.g., hypertension–diabetes) and neurodegenerative illnesses. Older adults (≥65 years) and females experienced the highest multimorbidity burden, being more likely to have multiple chronic conditions and to belong to the complex disease clusters.
CONCLUSIONS:
Mortality patterns in this rural population have shifted toward chronic NCDs and multimorbidity. Following these trends and identifying disease clusters is essential for targeting patient-centred care. Our findings review the importance of integrating care for NCDs and infectious diseases in rural health systems to address the growing multimorbidity burden, with particular focus on older adults and women.
Rural South Africa is undergoing an epidemiological transition, with chronic non-communicable diseases (NCDs) increasingly contributing to mortality alongside traditionally high infectious disease burdens. We aimed to investigate changes in chronic disease prevalence and multimorbidity clusters among deceased individuals in rural northeast South Africa from 2012 to 2022.
METHODS:
Verbal autopsy data collected at the Agincourt Health and Demographic Surveillance Site (HDSS) from 2012–2022 were analysed. A total of 5,892 deceased individuals were included. We identified reported chronic conditions leading to death and applied cluster analysis, Partitioning Around Medoids (PAM) and latent class analysis (LCA) to identify patterns of co-occurring diseases (multimorbidity clusters). Temporal trends in condition prevalence were assessed, and multinomial logistic regression was used to examine associations of cluster membership with various behavioural factors.
RESULTS:
Over the 11-year period, hypertension prevalence among decedents rose from approximately 25% in 2012 to over 50% by 2022, with diabetes reaching ~25% and dementia over 10%. In contrast, deaths reported due to tuberculosis and HIV declined markedly. The proportion of decedents with multimorbidity (≥2 chronic conditions) increased, and complex multimorbidity (≥3 conditions) nearly doubled over time. Dominant multimorbidity clusters evolved from an early focus on HIV/TB comorbidity to later clusters centered on cardiometabolic conditions (e.g., hypertension–diabetes) and neurodegenerative illnesses. Older adults (≥65 years) and females experienced the highest multimorbidity burden, being more likely to have multiple chronic conditions and to belong to the complex disease clusters.
CONCLUSIONS:
Mortality patterns in this rural population have shifted toward chronic NCDs and multimorbidity. Following these trends and identifying disease clusters is essential for targeting patient-centred care. Our findings review the importance of integrating care for NCDs and infectious diseases in rural health systems to address the growing multimorbidity burden, with particular focus on older adults and women.
| eISSN: | 2654-1459 |
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