Evolution of chronic diseases and multimorbidity clusters among the deceased in rural northeast South Africa (2012–2022): insights from verbal autopsy data
- 1SAMRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand
- 2Division of Epidemiology and Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand
- 3Graduate School of Business Administration, Wits Business School, Faculty of Commerce, Law and Management, University of the Witwatersrand
Abstract
Introduction Rural South Africa is undergoing an epidemiological transition characterised by rising mortality from chronic non-communicable diseases (NCDs) alongside that from persistent infectious diseases. We aimed to investigate trends in the prevalence of chronic disease and multimorbidity clustering among deceased individuals in rural northeast South Africa from 2012 to 2022. Methods Verbal autopsy data for 5,892 deceased individuals collected from the Agincourt Health and socio-Demographic Surveillance System (HDSS) study area in Bushbuckridge, Mpumalanga Province, from 2012 to 2022 were analysed. We identified reported chronic diseases prior 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 disease prevalence were assessed using descriptive statistics. Multinomial logistic regression models were used to examine associations of cluster membership with various behavioral factors. Results Over the 11-year period, the prevalence of hypertension among the deceased individuals rose from approximately 25% in 2012 to over 50% by 2022, that of diabetes increased from 10% and reached ~ 25% and that of dementia increased from 1% to over 5%. In contrast, the number of deaths that were reported to have had tuberculosis prior to their deaths declined markedly TB reducing from 23% to 11%. HIV prevalence fluctuated within a narrow range around 20% (approximately 18–22%). The proportion of deceased individuals with multimorbidity (≥ 2 chronic conditions) increased, and complex multimorbidity (≥ 3 conditions) nearly doubled between 2012 and 2019 (from 8% to 15%), with relative stability observed in the 2020–2022 period. Over time, multimorbidity clusters shifted from an initial dominance of HIV/TB comorbidity to later patterns dominated by cardiometabolic conditions (hypertension and diabetes), HIV–hypertension, and an emerging neurodegenerative illnesses cluster. Older adults (≥ 65 years) and females experienced the highest multimorbidity burden and were more likely to belong to complex disease clusters. Conclusions Morbidity patterns in this rural population have shifted toward chronic NCDs and multimorbidity. Characterising these trends and identifying disease clusters is essential for targeting patient-centred care early on. Our findings underscore 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.
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BibTeX
@article{chironda2026evolution,
title = {{Evolution of chronic diseases and multimorbidity clusters among the deceased in rural northeast South Africa (2012–2022): insights from verbal autopsy data}},
author = {Cyril Tamuka Chironda and Tobias Chirwa and Farai Mlambo and Rumbidzai Mupfuti and Daniel Ohene-Kwofie and Belinda J Njiro and Jean Juste Harrisson Bashingwa and Stephen Tollman and Kathleen Kahn and F. Xavier Gomez-Olive and Chodziwadziwa. W. Kabudula},
journal = {BMC Public Health},
year = {2026},
month = jul,
doi = {10.1186/s12889-026-28636-y},
url = {https://doi.org/10.1186/s12889-026-28636-y},
note = {CC BY},
}
RIS
TY - JOUR
TI - Evolution of chronic diseases and multimorbidity clusters among the deceased in rural northeast South Africa (2012–2022): insights from verbal autopsy data
AU - Cyril Tamuka Chironda
AU - Tobias Chirwa
AU - Farai Mlambo
AU - Rumbidzai Mupfuti
AU - Daniel Ohene-Kwofie
AU - Belinda J Njiro
AU - Jean Juste Harrisson Bashingwa
AU - Stephen Tollman
AU - Kathleen Kahn
AU - F. Xavier Gomez-Olive
AU - Chodziwadziwa. W. Kabudula
PY - 2026
DA - 2026/07/01
JO - BMC Public Health
DO - 10.1186/s12889-026-28636-y
UR - https://doi.org/10.1186/s12889-026-28636-y
AB - Introduction Rural South Africa is undergoing an epidemiological transition characterised by rising mortality from chronic non-communicable diseases (NCDs) alongside that from persistent infectious diseases. We aimed to investigate trends in the prevalence of chronic disease and multimorbidity clustering among deceased individuals in rural northeast South Africa from 2012 to 2022. Methods Verbal autopsy data for 5,892 deceased individuals collected from the Agincourt Health and socio-Demographic Surveillance System (HDSS) study area in Bushbuckridge, Mpumalanga Province, from 2012 to 2022 were analysed. We identified reported chronic diseases prior 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 disease prevalence were assessed using descriptive statistics. Multinomial logistic regression models were used to examine associations of cluster membership with various behavioral factors. Results Over the 11-year period, the prevalence of hypertension among the deceased individuals rose from approximately 25% in 2012 to over 50% by 2022, that of diabetes increased from 10% and reached ~ 25% and that of dementia increased from 1% to over 5%. In contrast, the number of deaths that were reported to have had tuberculosis prior to their deaths declined markedly TB reducing from 23% to 11%. HIV prevalence fluctuated within a narrow range around 20% (approximately 18–22%). The proportion of deceased individuals with multimorbidity (≥ 2 chronic conditions) increased, and complex multimorbidity (≥ 3 conditions) nearly doubled between 2012 and 2019 (from 8% to 15%), with relative stability observed in the 2020–2022 period. Over time, multimorbidity clusters shifted from an initial dominance of HIV/TB comorbidity to later patterns dominated by cardiometabolic conditions (hypertension and diabetes), HIV–hypertension, and an emerging neurodegenerative illnesses cluster. Older adults (≥ 65 years) and females experienced the highest multimorbidity burden and were more likely to belong to complex disease clusters. Conclusions Morbidity patterns in this rural population have shifted toward chronic NCDs and multimorbidity. Characterising these trends and identifying disease clusters is essential for targeting patient-centred care early on. Our findings underscore 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.
SN - 1471-2458
ER -