Mortality trends and causes of death in a South African hospital complex pre- and during COVID-19

Abstract

BACKGROUND : Before coronavirus disease 2019 (COVID-19), global health was improving, with declining mortality trends. The pandemic disrupted this progress, increasing mortality in South Africa between April 2020 and March 2022. Pre-pandemic data establishes a baseline for assessing COVID-19’s impact on all-cause mortality. OBJECTIVES : This study examines changes in hospital-based mortality trends in a Gauteng hospital complex from April 2018 to March 2022, addressing the scarcity of such studies during the COVID-19 era. METHOD : A retrospective review of 7815 deaths from April 2018 to March 2022 was conducted. Chi-squared tests were used to analyse deaths by age group and gender, with correlations reported. RESULTS : Mortality rates rose from 3.2% in 2018–2019, peaked at 5.1% in 2020–2021, and declined to 4.2% in 2021–2022. Patients aged 15 years–64 years had the highest death rates, with an increase among those over 65. Male deaths exceeded female deaths, with the smallest difference observed in 2020–2021. Leading causes of death included diseases of the circulatory and respiratory systems, neoplasms, digestive system diseases, and infectious and parasitic diseases. CONCLUSION : The study highlights COVID-19’s impact on mortality, showing variations by year, age, gender, and disease. Contribution: Excess non-COVID-19 deaths likely stemmed from disrupted healthcare services. These findings underscore the need for ongoing monitoring of hospital mortality to identify pandemic-related service disruptions and guide interventions to strengthen healthcare services, improve access to care, and enhance referral systems during unexpected disasters.