{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:39:19Z","timestamp":1787017159645,"version":"build-2736575974"},"reference-count":53,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T00:00:00Z","timestamp":1624579200000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000764","name":"King's College London","doi-asserted-by":"publisher","award":["N\/A (see manuscript)"],"award-info":[{"award-number":["N\/A (see manuscript)"]}],"id":[{"id":"10.13039\/501100000764","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000855","name":"University of Birmingham","doi-asserted-by":"publisher","award":["N\/A (see manuscript)"],"award-info":[{"award-number":["N\/A (see manuscript)"]}],"id":[{"id":"10.13039\/501100000855","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,5,18]]},"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Cardiovascular diseases are the second leading cause of mortality behind HIV\/AIDS in South Africa. This study investigates cardiovascular disease mortality trends in rural South Africa over 20+ years and the associated barriers to accessing care, using verbal autopsy data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A mixed-methods approach was used, combining descriptive analysis of mortality rates over time, by condition, sex and age group, quantitative analysis of circumstances of mortality (CoM) indicators and free text narratives of the final illness, and qualitative analysis of free texts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>This study was done using verbal autopsy data from the Health and Socio-Demographic Surveillance System site in Agincourt, rural South Africa.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Deaths attributable to cardiovascular diseases (acute cardiac disease, stroke, renal failure and other unspecified cardiac disease) from 1993 to 2015 were extracted from verbal autopsy data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Between 1993 and 2015, of 15 305 registered deaths over 1 851 449 person-years of follow-up, 1434 (9.4%) were attributable to cardiovascular disease, corresponding to a crude mortality rate of 0.77 per 1000 person-years. Cardiovascular disease mortality rate increased from 0.34 to 1.12 between 1993 and 2015. Stroke was the dominant cause of death, responsible for 41.0% (588\/1434) of all cardiovascular deaths across all years. Cardiovascular disease mortality rate was significantly higher in women and increased with age. The main delays in access to care during the final illness were in seeking and receiving care. Qualitative free-text analysis highlighted delays not captured in the CoM, principally communication between the clinician and patient or family. Half of cases initially sought care outside a hospital setting (50.9%, 199\/391).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The temporal increase in deaths due to cardiovascular disease highlights the need for greater prevention and management strategies for these conditions, particularly for the women. Strategies to improve seeking and receiving care during the final illness are needed.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-048592","type":"journal-article","created":{"date-parts":[[2021,6,25]],"date-time":"2021-06-25T12:36:03Z","timestamp":1624624563000},"page":"e048592","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Mortality trends and access to care for cardiovascular diseases in Agincourt, rural South Africa: a mixed-methods analysis of verbal autopsy data"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2399-9358","authenticated-orcid":false,"given":"Jessica","family":"Newberry Le Vay","sequence":"first","affiliation":[{"name":"Policy & Implementation Research, Cancer Research UK, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9203-8692","authenticated-orcid":false,"given":"Andrew","family":"Fraser","sequence":"additional","affiliation":[{"name":"Education Centre, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Byass","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Global Health, Umea Universitet, Ume\u00e5, Sweden"},{"name":"Medical Research Council\/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand School of Public Health, Johannesburg, South Africa"},{"name":"Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0744-7588","authenticated-orcid":false,"given":"Stephen","family":"Tollman","sequence":"additional","affiliation":[{"name":"Medical Research Council\/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand School of Public Health, Johannesburg, South Africa"},{"name":"INDEPTH Network, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3339-3931","authenticated-orcid":false,"given":"Kathleen","family":"Kahn","sequence":"additional","affiliation":[{"name":"Medical Research Council\/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand School of Public Health, Johannesburg, South Africa"},{"name":"INDEPTH Network, Accra, Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8505-3368","authenticated-orcid":false,"given":"Lucia","family":"D\u2019Ambruoso","sequence":"additional","affiliation":[{"name":"Medical Research Council\/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand School of Public Health, Johannesburg, South Africa"},{"name":"Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, School of Medicine Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK"},{"name":"WHO Collaborating Centre for Verbal Autopsy, Ume\u00e5 Centre for Global Health Research, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6834-1838","authenticated-orcid":false,"given":"Justine I","family":"Davies","sequence":"additional","affiliation":[{"name":"Medical Research Council\/Wits University Rural Public Health and Health Transitions Research Unit, Faculty of Health Sciences, University of the Witwatersrand School of Public Health, Johannesburg, South Africa"},{"name":"Institute of Applied Health Research, University of Birmingham, Birmingham, UK"},{"name":"Centre for Global Surgery, Department of Global Health, Stellenbosch University, Cape Town, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,6,25]]},"reference":[{"key":"2025121411112840000_11.6.e048592.1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czw118"},{"key":"2025121411112840000_11.6.e048592.2","unstructured":"Organization, W.H . 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