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Yes, cardiovascular disease is second leading cause of death in South Africa


  • Heart disease is the leading cause of death worldwide but both international estimates and data from the statistics office and a medical research council show there are more fatalities from other diseases in South Africa.

  • Infectious and parasitic diseases were the country’s leading cause of death in 2016, with 151,200 deaths. HIV/Aids accounted for the majority of the deaths in this category. 

  • There were 97,600 deaths due to cardiovascular diseases. This broad group included rheumatic heart disease, hypertensive heart disease and stroke.

World Heart Day is marked every year on 29 September. In 2020, to draw attention to deaths caused by cardiovascular disease, the South African Heart Association posted a number of claims on its Facebook page.

The association said that cardiovascular disease was the “leading cause of death after HIV/Aids” in South Africa and “the most frequent cause of death worldwide today”.

In 2017, Africa Check investigated a claim that heart disease was the leading cause of death in South Africa, finding that it was beaten out by other diseases. 

What – if anything – has changed since then? And is it accurate to call cardiovascular disease the second largest cause of death in South Africa?

We looked at the available data. 

Heart disease leading cause of death globally


The heart and a branching system of blood vessels makes up the circulatory system, which distributes blood around the body.

“In its purest form, cardiovascular disease broadly incorporates all diseases of the heart and vascular tree,” Dr Nqoba Tsabedze, head of Charlotte Maxeke Johannesburg Academic Hospital’s division of cardiology, told Africa Check. 

The latest data from the World Health Organization (WHO) shows that these diseases were the leading cause of death globally in 2016. They accounted for around 31% of all deaths that year. 

In South Africa, however, cardiovascular diseases have historically been overshadowed by another cause of death.

Deaths caused by HIV often misreported


Statistics South Africa (Stats SA), the country’s national data agency, published its latest report on causes of death in March 2020. It contains data from 1997 to 2017.

Stats SA recorded tuberculosis (TB) as the leading cause of death in South Africa in 2017, followed by diabetes. Next was “cerebrovascular diseases” (diseases related to blood flow in the brain) in third position and “other forms of heart disease” in fourth. 

HIV was in fifth position. But, as the agency has previously told Africa Check, these figures significantly underestimate the number of deaths due to HIV.

This is because Stats SA records deaths based solely on the cause of death listed on official death certificates. This method has been found to misreport as many as 94% of HIV/Aids deaths.

Cardiovascular disease deaths reported separately


The manner in which  deaths are categorised by different agencies can complicate reporting and comparisons. 

Stats SA splits up all cardiovascular diseases or “diseases of the circulatory system” into more specific subcategories. “Hypertensive diseases” and “ischaemic heart diseases” are, for example, recorded separately.

The South African Medical Research Council classifies diseases in its national burden of disease reports with the South African context in mind.

The council estimated that “HIV/Aids and TB deaths accounted for the highest proportion of deaths” in 2012, followed by cardiovascular deaths. The South African Heart Association told Africa Check this report was the basis of their claim.

Dr Pamela Groenewald, a specialist scientist at the council’s burden of disease research unit, told Africa Check that the organisation compares “HIV/Aids and TB” to broad categories due to the “huge burden” caused by the two diseases. 

WHO: Infectious and parasitic diseases ranked first


The WHO’s most recent data on global deaths groups all causes of deaths into broad categories, making comparisons easier. 

In 2016, the WHO estimated there were 97,600 deaths in South Africa due to cardiovascular diseases. This broad group included rheumatic heart disease, hypertensive heart disease and stroke.

The leading cause of death was “infectious and parasitic diseases”, with 151,200 deaths. This included TB, malaria and sexually transmitted diseases. HIV/Aids accounted for 107,300 of the deaths in this category. 

Conclusion: Estimates from world body confirm association’s claim


The South African Heart Association said that cardiovascular disease is the “leading cause of death after HIV/Aids” in South Africa.

Cause of death data from the WHO shows that cardiovascular diseases accounted for the second highest number of deaths in South Africa in 2016. 

The leading cause of death was infectious and parasitic diseases. HIV/Aids made up 71% of these deaths. We rate the heart association’s claim as mostly correct. 

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