A retrospective assessment of COVID-19 vulnerability index indicators and mortality rates pre-COVID-19 (2018–2020) and during COVID-19 (2020–2022) in a health and demographic surveillance site, Soweto, South Africa
Abstract Background Before COVID-19, knowledge on pandemic vulnerability and mortality in South Africa was largely limited to the context of HIV/AIDS. We evaluated mortality rates and risk of death, prior to and during the COVID-19 pandemic, in relation to an individual’s COVID-19 vulnerability, bas...
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BMC
2025-06-01
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| Series: | Population Health Metrics |
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| Online Access: | https://doi.org/10.1186/s12963-025-00387-9 |
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| author | Takwanisa Machemedze Chodziwadziwa Whiteson Kabudula Jean Juste Harrisson Bashingwa Beth A. Tippett Barr Nellie Myburgh Sana Mahtab Cleopas Hwinya Stephen Tollman Ziyaad Dangor Shabir A. Madhi |
| author_facet | Takwanisa Machemedze Chodziwadziwa Whiteson Kabudula Jean Juste Harrisson Bashingwa Beth A. Tippett Barr Nellie Myburgh Sana Mahtab Cleopas Hwinya Stephen Tollman Ziyaad Dangor Shabir A. Madhi |
| author_sort | Takwanisa Machemedze |
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| description | Abstract Background Before COVID-19, knowledge on pandemic vulnerability and mortality in South Africa was largely limited to the context of HIV/AIDS. We evaluated mortality rates and risk of death, prior to and during the COVID-19 pandemic, in relation to an individual’s COVID-19 vulnerability, based on a scoring algorithm developed in South Africa. Methods The analysis was undertaken using data from a health and demographic surveillance system (HDSS) in Soweto and Thembelihle, Gauteng, South Africa. Health and demographic population-based data have been collected from the HDSS area since 2018. Using indicators included in a COVID-19 Vulnerability Index, previously developed in South Africa, the current study established a composite COVID-19 vulnerability index, stratified into tertiles. The risk of death pre-COVID-19 (1 January 2018–28 February 2020) and during the COVID-19 period (1 March 2020–31 December 2021) was analysed. A Cox proportional hazard model was used to compare the risk of death between the two time periods. Statistical analyses were conducted using Stata software version 17. Results Before COVID-19, overall mortality rates were 8.1 (95% CI 7.6–8.8), 7.0 (95% CI 6.4–7.7) and 6.1 (95% CI 5.5–6.7) per 1000 person-years in the lowest, middle, and highest tertile of vulnerability index, respectively. All cause-mortality across all tertiles more than doubled during the COVID-19 period compared to pre-COVID-19 (15.5 against 7.2). The mortality rates during the COVID-19 era were 17.1 (95% CI 16.3–18.0), 14.5 (95% CI 13.4–15. 7) and 13.7 (95% CI 12.8–14.7) per 1000 person-years in the lowest, middle, and highest tertiles, respectively. Overall, individuals in the highest tertile of COVID-19 vulnerability were at a significantly lower risk of death relative to those in the lowest tertile (aHR 0.9, 95% CI 0.8–1.0, p < 0.05). The risk of dying during the COVID-19 period for vulnerable individuals was at least double compared to the pre-COVID-19 period for each of the individual vulnerability indicators. Conclusions All-cause mortality during the COVID-19 era was significantly higher than the pre- COVID-19 period, with the increase observed across all vulnerability tertiles. It is important to identify vulnerable individuals and communities during the early stages of a pandemic to inform prioritisation of public health intervention. |
| format | Article |
| id | doaj-art-c0a586b1f8cc41e1a547e85efcf6a046 |
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| publishDate | 2025-06-01 |
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| spelling | doaj-art-c0a586b1f8cc41e1a547e85efcf6a0462025-08-20T02:10:34ZengBMCPopulation Health Metrics1478-79542025-06-0123S211110.1186/s12963-025-00387-9A retrospective assessment of COVID-19 vulnerability index indicators and mortality rates pre-COVID-19 (2018–2020) and during COVID-19 (2020–2022) in a health and demographic surveillance site, Soweto, South AfricaTakwanisa Machemedze0Chodziwadziwa Whiteson Kabudula1Jean Juste Harrisson Bashingwa2Beth A. Tippett Barr3Nellie Myburgh4Sana Mahtab5Cleopas Hwinya6Stephen Tollman7Ziyaad Dangor8Shabir A. Madhi9South African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the WitwatersrandSouth African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the WitwatersrandSouth African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the WitwatersrandNyanja Health Research InstituteSouth African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the WitwatersrandSouth African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the WitwatersrandSouth African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the WitwatersrandSouth African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the WitwatersrandSouth African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the WitwatersrandSouth African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the WitwatersrandAbstract Background Before COVID-19, knowledge on pandemic vulnerability and mortality in South Africa was largely limited to the context of HIV/AIDS. We evaluated mortality rates and risk of death, prior to and during the COVID-19 pandemic, in relation to an individual’s COVID-19 vulnerability, based on a scoring algorithm developed in South Africa. Methods The analysis was undertaken using data from a health and demographic surveillance system (HDSS) in Soweto and Thembelihle, Gauteng, South Africa. Health and demographic population-based data have been collected from the HDSS area since 2018. Using indicators included in a COVID-19 Vulnerability Index, previously developed in South Africa, the current study established a composite COVID-19 vulnerability index, stratified into tertiles. The risk of death pre-COVID-19 (1 January 2018–28 February 2020) and during the COVID-19 period (1 March 2020–31 December 2021) was analysed. A Cox proportional hazard model was used to compare the risk of death between the two time periods. Statistical analyses were conducted using Stata software version 17. Results Before COVID-19, overall mortality rates were 8.1 (95% CI 7.6–8.8), 7.0 (95% CI 6.4–7.7) and 6.1 (95% CI 5.5–6.7) per 1000 person-years in the lowest, middle, and highest tertile of vulnerability index, respectively. All cause-mortality across all tertiles more than doubled during the COVID-19 period compared to pre-COVID-19 (15.5 against 7.2). The mortality rates during the COVID-19 era were 17.1 (95% CI 16.3–18.0), 14.5 (95% CI 13.4–15. 7) and 13.7 (95% CI 12.8–14.7) per 1000 person-years in the lowest, middle, and highest tertiles, respectively. Overall, individuals in the highest tertile of COVID-19 vulnerability were at a significantly lower risk of death relative to those in the lowest tertile (aHR 0.9, 95% CI 0.8–1.0, p < 0.05). The risk of dying during the COVID-19 period for vulnerable individuals was at least double compared to the pre-COVID-19 period for each of the individual vulnerability indicators. Conclusions All-cause mortality during the COVID-19 era was significantly higher than the pre- COVID-19 period, with the increase observed across all vulnerability tertiles. It is important to identify vulnerable individuals and communities during the early stages of a pandemic to inform prioritisation of public health intervention.https://doi.org/10.1186/s12963-025-00387-9COVID-19VulnerabilityRiskMortalitySouth AfricaHealth and demographic surveillance system |
| spellingShingle | Takwanisa Machemedze Chodziwadziwa Whiteson Kabudula Jean Juste Harrisson Bashingwa Beth A. Tippett Barr Nellie Myburgh Sana Mahtab Cleopas Hwinya Stephen Tollman Ziyaad Dangor Shabir A. Madhi A retrospective assessment of COVID-19 vulnerability index indicators and mortality rates pre-COVID-19 (2018–2020) and during COVID-19 (2020–2022) in a health and demographic surveillance site, Soweto, South Africa Population Health Metrics COVID-19 Vulnerability Risk Mortality South Africa Health and demographic surveillance system |
| title | A retrospective assessment of COVID-19 vulnerability index indicators and mortality rates pre-COVID-19 (2018–2020) and during COVID-19 (2020–2022) in a health and demographic surveillance site, Soweto, South Africa |
| title_full | A retrospective assessment of COVID-19 vulnerability index indicators and mortality rates pre-COVID-19 (2018–2020) and during COVID-19 (2020–2022) in a health and demographic surveillance site, Soweto, South Africa |
| title_fullStr | A retrospective assessment of COVID-19 vulnerability index indicators and mortality rates pre-COVID-19 (2018–2020) and during COVID-19 (2020–2022) in a health and demographic surveillance site, Soweto, South Africa |
| title_full_unstemmed | A retrospective assessment of COVID-19 vulnerability index indicators and mortality rates pre-COVID-19 (2018–2020) and during COVID-19 (2020–2022) in a health and demographic surveillance site, Soweto, South Africa |
| title_short | A retrospective assessment of COVID-19 vulnerability index indicators and mortality rates pre-COVID-19 (2018–2020) and during COVID-19 (2020–2022) in a health and demographic surveillance site, Soweto, South Africa |
| title_sort | retrospective assessment of covid 19 vulnerability index indicators and mortality rates pre covid 19 2018 2020 and during covid 19 2020 2022 in a health and demographic surveillance site soweto south africa |
| topic | COVID-19 Vulnerability Risk Mortality South Africa Health and demographic surveillance system |
| url | https://doi.org/10.1186/s12963-025-00387-9 |
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