The Association Between Socioeconomic Status and Adult Mortality in Rural Kwazulu-Natal, South Africa

Objective: To examine the association between socio-economic status and adult mortality in a rural South African community.Methods: Longitudinal data of adults aged 15-64 yrs residing within the Demographic Surveillance Area [DSA] on 1st January 2001 and followed up for seven years, was used. Out of the total 33,677 adults who met the inclusion criteria, 4,058 died during the seven years follow up period. Mortality rates were computed using Kaplan-Meier survival estimates expressed per 1000 person-year of observation (PYO). Household wealth index was constructed by the use of PCA, while the association was assessed using Cox proportional Hazard model controlling for potential confounders such as age, sex and marital status.Results: The high group of the socioeconomic quintile had the highest mortality rate of 22.2 per 1000 PYO, 95% confidence interval (20.7-23.7). After adjusting for the potential confounders, the effect of socioeconomic status in the highest SES category was 0.10 times less likelihood of death compared to the lowest SES group (Hazard Ratio=0.90; p=0.042; 95% confidence interval [0.81-0.99]).Conclusion: This study revealed that adult socioeconomic status is not significantly associated with adult mortality. Reducing the gap between the rich and the poor, though a worthwhile effort; might not be the most effective means of reducing adult mortality.