Herbert Nyanzi, Uganda
Background: A rise in population aging within lower middle-income countries (LMICs) especially in Sub-Saharan Africa (SSA), may pose a threat to the already over stretched health care systems. This study aimed to describe mortality rates in advanced age and the implications for the health systems in the rural SSA context.
Methods: Analysis of 10-year period mortality, stratified by sex, age-specific categories, all-causes and cause-specific mortality. Mortality related to care category (acute-chronic) was analyzed in the same way. Analysis focused on older persons (50 years and above) residing in the health and demographic surveillance system (HDSS) study area for each year. A passion regression was performed to investigate the patterns mortality rates.
Findings: 1513 deaths among older persons were recorded within the HDSS. A crude all-cause mortality rate of 6.55 per 1000 (95% CI: 6.42-7.62) was seen during this time period. Mortality from non-communicable diseases (NCDs) ranks highest among older persons with 59.6% compared with 28.5% from communicable disease. Since then, the all-cause mortality increased substantially (risk ratio 1.5 (95% CI: 1.44-1.60): P<0.0001) due to a fourfold rise in deaths as a result of NCDs across age categories and sex (4.04 (95% CI: 3.98-5.34): P<0.0001). However, there is a significant difference in the risk of death across sex. The burden of older persons requiring chronic care has substantially increased compared with those requiring acute care (1.68 (1.38-2.02): p< 0.0001 vs 0.6 (0.53-1.53): p=0.0002)
Conclusion: There is a disproportionate increase in the number of deaths resulting from NCDs in advanced age compared to communicable diseases in rural Uganda.