September is Heart Awareness Month in South Africa, aiming to focus attention on cardiovascular disease. But could it be South Africa's leading cause of death?
Researched by Ina Skosana
South Africa's leading cause of death is heart disease... if we go by the tweet of a local health and wellness website.
"Heart disease is the leading cause of death in SA, four times more than murder," Health24 posted on the social media platform.
Africa Check asked the publication for the source of this claim, but did not receive a response.
A follower of the publication took them to task for posting an "incorrect tweet". Several hours later, Health24 deleted it.
But we caught it and did the digging.
"Heart disease is the leading cause of death in South Africa"
Data from death certificates places tuberculosis at the top of South Africa's killers in 2015, having claimed 33,063 lives.
"This has been the case for the past 20 years," deputy-director of births and deaths data at Statistics South Africa (Stats SA), Vusi Nzimakwe, told Africa Check. "This is in line with what is expected for any developing country."
However, as we reported in 2016, South Africa's death certificates aren't an accurate reflection of AIDS-related deaths.
Researchers from the South African Medical Research Council explained why in a 2016 journal article: "Most HIV/AIDS deaths in South Africa have been misclassified as AIDS indicator causes (eg. tuberculosis) because of medical doctors' reluctance to report HIV on the death certificate or possibly because of not knowing the HIV status of the deceased."
The article was based on the Medical Research Council's most recent Burden of Disease study, which adjusts for the data deficiencies in South Africa's death registration system. The study showed that AIDS-related illnesses were the leading cause of death in South Africa, accounting for 29.1% of all deaths in 2012, or 153,661 in total.
Given the undercounting of AIDS-related deaths in South Africa on death certificates, Stats SA annually estimates the true count. This is based on a number of sources, such as data from clinics which pregnant women attend, as well as the number of people receiving antiretroviral therapy.
Their latest estimate shows that the agency expects the share of people dying from AIDS-related illnesses to drop to a quarter of all deaths in 2017.
"Heart disease [accounts for] four times more [deaths] than murder
Dr Victoria Pillay-van Wyk, a specialist scientist in the burden of disease unit at the Medical Research Council (MRC), told Africa Check that "one needs to understand what is meant by heart disease".
"In our research, we look at cardiovascular disease, which is a vast category that includes strokes," she said.
The MRC's 2012 Burden of Disease study, which is the latest available, found that cardiovascular disease accounted for the second highest share of deaths after AIDS-related causes. It claimed 97,627 lives in 2012, or 18.5% of the total.
Deaths due to interpersonal violence made up 3.5% of the total, causing 18,741 deaths.
But the two categories should not be compared, Pillay-van Wyk said. "Once you have a cluster of causes, they are no longer comparable to single causes."