South Africa's biggest killers in 2020 after Covid-19 were diabetes, influenza and pneumonia and road traffic fatalities.
Research entity Eighty20 has unpacked mortality rates in South Africa, using the latest information from the Stats SA Mortality Report and data from the UN and World Bank.
According to the data about 500,000 South Africans die in any given year, with the major causes falling into three categories: non-communicable diseases, communicable diseases and injuries.
South Africa has followed a global trend of shifting death rates from communicable, or infectious diseases such as malaria, tuberculosis or Covid-19 to non-communicable diseases, such as heart disease, diabetes and cancer.
Since 2009, the latter, also referred to as “lifestyle” diseases, have become more prevalent and now account for nearly 60% of all deaths in the country — the one exception being Covid-19, which temporarily emerged as the second leading cause of death globally in 2021 and first leading cause in South Africa.
When it came to non-communicable causes of death — the leading one in 2020, after Covid-19, was diabetes, surpassing tuberculosis, which previously held the top spot. Between 2008 to 2018, deaths due to diabetes increased by 36.5%.
The International Diabetes Federation predicts by 2030, 5.4-million South Africans will be living with the disease. This rise is attributed to factors such as urbanisation, sedentary lifestyles, unhealthy diets and increasing obesity rates.
In the communicable causes of death category, the big killers after Covid-19 in 2020, were influenza and pneumonia, tuberculosis and HIV, killing nearly 20,000 people each and together accounting for 12% of all deaths. However, for people who are HIV+, the cause of death could be recorded as any of these.
“Since the implementation of universal ARV therapy in 2004, life expectancy in South Africa has significantly increased. From 2006 to 2017, life expectancy rose from 54 to over 65 years. This improvement is largely due to the reduction in Aids-related deaths,” Eighty20 said.
Non-natural deaths, including accidents, assaults and self-harm, rose significantly, especially among young males.
In 2019, 45% of male deaths in the 20-24 age group were from non-natural causes. With the proportion of deaths due to non-natural causes increasing from 8.7% in 2009 to 12.4% in 2019.
With a considerable proportion of causes not classified, death rates in South Africa suffer from data quality issues
— Andrew Fulton, Eighty20 director
“Road traffic injuries remain a top cause of death, particularly among young people. South Africa effectively experiences 33 road fatalities per day, with a cost to the economy estimated at R43bn in 2018.
“The country also faces high levels of driving under the influence, with offences increasing by 22% from 2020/21 to 2021/22 with a post-pandemic increase in driving.”
The main reported causes of death in South Africa according to the 2020 data were:
- diseases of the circulatory system (blocked arteries, stroke) — 18% of all deaths;
- not classified — 16.5%;
- infectious diseases (including Covid-19, malaria) — 13.5%;
- external causes (murder, accidents) — 9.6%; and
- respiratory diseases (tuberculosis, pneumonia) — 8.8%.
“With a considerable proportion of causes not classified, death rates in South Africa suffer from data quality issues,” said Eighty20 director Andrew Fulton. “This is typically due to delayed registrations, incomplete records, and misclassification of causes (75% of non-natural causes of death are not adequately classified).
“In addition, the complexity of death certificates listing up to six factors can obscure accurate reporting. For example, a death certificate could list traumatic brain injury as the immediate cause, a motor vehicle collision as the underlying cause and alcohol intoxication as a contributing factor. Mortality and causes of death tables are not updated every year.”
When looking at mortality, however, it isn’t all bad news. The life expectancy at birth in South Africa has shifted significantly over the past two decades. It dropped to a low of just under 55 years in 2005, from 63.37 years in 1990. However, since 2005, the median age of death has steadily increased, reaching 66.3 years by 2024, albeit with a major dip during Covid-19.
Fulton said life expectancy in South Africa has been increasing due to several key factors including improved healthcare, “particularly better access to antiretroviral medicine; a reduction in infectious diseases, particularly tuberculosis and malaria; and economic growth leading to better living conditions and access to healthcare”.
“Government has implemented successful public health campaigns focusing on vaccination, maternal health and nutrition.”
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