Age and cause decomposition of adult life expectancy changes following the introduction of antiretroviral therapy in Kwazulu-Natal (2000-2013)

Georges Reniers, London School of Hygiene and Tropical Medicine (LSHTM)
Alexandra Martin-Onraet, London School of Hygiene and Tropical Medicine (LSHTM)
Kobus Herbst, Africa Centre for Health and Population Studies
Clara Calvert, London School of Hygiene and Tropical Medicine (LSHTM)
Emma Slaymaker, London School of Hygiene and Tropical Medicine (LSHTM)
Victoria Hosegood, University of Southampton

Adult mortality has dramatically decreased since the introduction of ART, but few population-based estimates exist of (i) changes in the cause of death structure, and (ii) the residual burden of HIV. Data from a demographic surveillance site in Kwazulu-Natal covering 93,645 adults aged 15 to 100 years are used for estimating population-wide gains in adult life expectancy (LE) since the introduction of ART, and the current adult LE deficit (estimated as the difference between LE of HIV negatives and the whole population). LE gains and deficits are further decomposed by age and cause of death. Compared to 2003, population-wide gains in adult LE amount to 10.9 and 16.7 years for men and women, respectively. Despite these mortality reductions, the LE deficit due to HIV is still 5.1 years (95%CI 2.1-11.4) for men and 9.8 years (95%CI 6.2-13.2) for women. Variability in HIV/AIDS-related mortality explains most of LE gains and deficits.