Long-term mortality rates among Mozambican self-settled refugees in rural South Africa have progressively converged with those of the South African host population over a 25-year period, according to a new study published in Conflict and Health. The research, which utilized longitudinal data from the Agincourt Health and Demographic Surveillance System (HDSS) between 1994 and 2018, reveals that while refugee mortality initially exceeded that of South Africans during the height of the HIV pandemic, it has since declined to levels broadly comparable to the host population.
The study was conducted by a team of researchers including Wonder Agbemavi, Chodziwadziwa Kabudula, and Brian Houle, among others. The primary objective was to examine long-term mortality patterns, cause-specific mortality, and the contribution of socioeconomic status (SES) to mortality inequalities. The analysis focused on four distinct population groups: Mozambican self-settled refugees, South Africans, Mozambican migrant workers, and the general population of Manhiça, Mozambique.
The methodology involved analyzing longitudinal data from two major surveillance systems: the Agincourt HDSS in South Africa, covering the period from 1994 to 2018, and the Manhiça HDSS in Mozambique, covering 1999 to 2018. Age-standardized death rates were employed to describe mortality trends across the different population groups, allowing for fair comparisons despite differences in age structures. Furthermore, logistic and multinomial logistic regression models were used to examine all-cause and cause-specific mortality. These statistical models adjusted for key variables including age, sex, time period, and household socioeconomic status, enabling the researchers to assess the independent contribution of SES to mortality differences.
The results indicated that mortality rates increased across all studied populations during the HIV pandemic, peaking between 2004 and 2008 before subsequently declining. During the initial period of the study, from 1994 to 1998, mortality among Mozambican self-settled refugees was broadly comparable to that of South Africans. However, as the HIV pandemic intensified, refugee mortality began to exceed that of both South Africans and Mozambican labor migrants. By the final period of the study, from 2014 to 2018, mortality among refugees had converged towards that of the South African host population, indicating a narrowing of the mortality gap over time.
Notably, Mozambican labor migrants consistently experienced the lowest mortality rates among the groups studied. However, the study also found that adjustment for household SES largely explained the overall mortality difference between refugees and South Africans, highlighting the profound impact of economic disadvantage on health outcomes.
Despite the overall convergence in all-cause mortality, the study found that refugees remained at higher risk of mortality from HIV/AIDS and tuberculosis and other communicable diseases.
The study concludes that socioeconomic disadvantage explained an important proportion of the observed mortality inequalities between refugees and South Africans. This finding underscores the need for policies that not only ensure equitable access to healthcare but also address the underlying socioeconomic disparities that contribute to poor health outcomes.
Subject of Research: Long-term mortality trends and socioeconomic determinants of health among self-settled refugees in rural South Africa
Article Title: Mortality differentials between self-settled refugees and South Africans in rural South Africa: insights from the Agincourt HDSS, 1994–2018
Article References: Agbemavi, W., Kabudula, C., Nhacolo, A., Nhacolo, A., Matsena, T., Malheia, A., Mandomando, I., Sacoor, C., & Houle, B. (2026). Mortality differentials between self-settled refugees and South Africans in rural South Africa: insights from the Agincourt HDSS, 1994–2018. Conflict and Health. https://doi.org/10.1186/s13031-026-00838-6
Image Credits: AI Generated
DOI: 10.1186/s13031-026-00838-6
Keywords: refugee health, mortality, South Africa, Mozambique, HIV/AIDS, socioeconomic status, demographic surveillance, public health, epidemiology, health disparities, differentials, between
Source: bioengineer.org
