PT  - JOURNAL ARTICLE
AU  - Tom Achoki
AU  - Benn Sartorius
AU  - David Watkins
AU  - Scott D Glenn
AU  - Andre Pascal Kengne
AU  - Tolu Oni
AU  - Charles Shey Wiysonge
AU  - Alexandra Walker
AU  - Olatunji O Adetokunboh
AU  - Tesleem Kayode Babalola
AU  - Obasanjo Afolabi Bolarinwa
AU  - Mareli M Claassens
AU  - Richard G Cowden
AU  - Candy T Day
AU  - Oluchi Ezekannagha
AU  - Themba G Ginindza
AU  - Chidozie C D Iwu
AU  - Chinwe Juliana Iwu
AU  - Innocent Karangwa
AU  - Patrick DMC Katoto
AU  - Nuworza Kugbey
AU  - Desmond Kuupiel
AU  - Phetole Walter Mahasha
AU  - Tivani Phosa Mashamba-Thompson
AU  - George A Mensah
AU  - Duduzile Edith Ndwandwe
AU  - Chukwudi A Nnaji
AU  - Mpiko Ntsekhe
AU  - Thomas Elliot Nyirenda
AU  - Julius Nyerere Odhiambo
AU  - Kwaku Oppong Asante
AU  - Charles D H Parry
AU  - Julian David Pillay
AU  - Aletta Elisabeth Schutte
AU  - Soraya Seedat
AU  - Karen Sliwa
AU  - Dan J Stein
AU  - Frank C Tanser
AU  - Ushotanefe Useh
AU  - Heather J Zar
AU  - Liesl J Zühlke
AU  - Bongani M Mayosi
AU  - Simon I Hay
AU  - Christopher J L Murray
AU  - Mohsen Naghavi
TI  - Health trends, inequalities and opportunities in South Africa’s provinces, 1990–2019: findings from the Global Burden of Disease 2019 Study
AID  - 10.1136/jech-2021-217480
DP  - 2022 May 01
TA  - Journal of Epidemiology and Community Health
PG  - 471--481
VI  - 76
IP  - 5
4099  - http://jech.bmj.com/content/76/5/471.short
4100  - http://jech.bmj.com/content/76/5/471.full
SO  - J Epidemiol Community Health2022 May 01; 76
AB  - Background Over the last 30 years, South Africa has experienced four ‘colliding epidemics’ of HIV and tuberculosis, chronic illness and mental health, injury and violence, and maternal, neonatal, and child mortality, which have had substantial effects on health and well-being. Using data from the 2019 Global Burden of Diseases, Injuries and Risk Factors Study (GBD 2019), we evaluated national and provincial health trends and progress towards important Sustainable Development Goal targets from 1990 to 2019.Methods We analysed GBD 2019 estimates of mortality, non-fatal health loss, summary health measures and risk factor burden, comparing trends over 1990–2007 and 2007–2019. Additionally, we decomposed changes in life expectancy by cause of death and assessed healthcare system performance.Results Across the nine provinces, inequalities in mortality and life expectancy increased over 1990–2007, largely due to differences in HIV/AIDS, then decreased over 2007–2019. Demographic change and increases in non-communicable diseases nearly doubled the number of years lived with disability between 1990 and 2019. From 1990 to 2019, risk factor burdens generally shifted from communicable and nutritional disease risks to non-communicable disease and injury risks; unsafe sex remained the top risk factor. Despite widespread improvements in healthcare system performance, the greatest gains were generally in economically advantaged provinces.Conclusions Reductions in HIV/AIDS and related conditions have led to improved health since 2007, though most provinces still lag in key areas. To achieve health targets, provincial governments should enhance health investments and exchange of knowledge, resources and best practices alongside populations that have been left behind, especially following the COVID-19 pandemic.Data are available in a public, open access repository. This paper summarises key findings from our analysis of GBD 2019 estimates. Data files containing all GBD 2019 subnational estimates are available on the GHDx (http://ghdx.healthdata.org/gbd-2019). Additional results can be explored through online interactive data visualisations (http://www.healthdata.org/gbd/data-visualizations).