Evidence map›Paper›PMID 40542376›Full record

ArticlePopulation health metrics2025

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.

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

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Article in Population health metrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1 · What the graph read from it

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3 · Its place in the literature

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1 citing paper in PubMed.

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4 · The record

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5 · Who and what money

Authors and funding

10 authors.

Takwanisa MachemedzeSouth African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. takwanisa.machemedze@wits-vida.org.ORCID 0000-0002-9308-7525
Chodziwadziwa Whiteson KabudulaSouth African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Jean Juste Harrisson BashingwaSouth African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Beth A Tippett BarrNyanja Health Research Institute, Salima, Malawi.
Nellie MyburghSouth African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Sana MahtabSouth African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Cleopas HwinyaSouth African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Stephen TollmanSouth African Medical Research Council/Wits Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Ziyaad DangorSouth African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Shabir A MadhiSouth African Medical Research Council, Vaccines and Infectious Diseases Analytical Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Funding

Gates Foundation INV-030309Gates Foundation INV-050361
6 · The paper itself

Abstract

backgroundBefore 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.

methodsThe 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.

resultsBefore 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.

conclusionsAll-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.

Indexed as

COVID-19MortalityVulnerable PopulationsAdolescentAdultAgedChildChild, PreschoolFemaleHumansInfantMaleMiddle AgedPopulation SurveillanceProportional Hazards ModelsRetrospective StudiesCOVID-19Health and demographic surveillance systemMortalityRiskSouth AfricaVulnerability

Identifiers

PMID40542376
PMCPMC12181823

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LicenceCC BY
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.