The Leading Causes of Death among Adult Mortality: Data Analysis of Sleman Health and Demographic Surveillance System, Indonesia
Downloads
Determining the cause of death (CoD) is crucial for effective health policy and decision-making, particularly in population health programs. The World Health Organization (WHO) developed the Verbal Autopsy (VA) tool to ascertain CoD through verbal information, particularly in countries lacking comprehensive vital registration systems. In Indonesia, the health landscape is shifting from communicable diseases to non-communicable diseases (NCDs), highlighting the need for updated mortality surveillance. This study aimed to determine the major causes of death among adult mortality in Sleman Health and Demographic Surveillance System (HDSS) Indonesia. A demographic surveillance system was employed to monitor vital events, including mortality, with verbal autopsy interviews conducted for each death. A total of 279 adult deaths (ages 15 years and older) from the first two cycles of surveillance were analyzed. Trained enumerators conducted verbal autopsy interviews with informants close to the deceased. The InterVA program was used to process the verbal autopsy data, identifying the CoD for 274 adult deaths. Descriptive analysis was performed to determine the proportion of each cause of death, and Chi-square tests were used to assess differences in proportions. The findings revealed that 68.2% (95% CI: 62.38–73.72) of deaths were due to NCDs, including stroke, heart disease, diabetes, asthma, and chronic liver disease. Infectious diseases accounted for 24.8% (95% CI: 19.82–30.37), while injuries (primarily accidents) contributed to 6.6% (95% CI: 3.94–10.18). Stroke was the leading cause of death, particularly in individuals aged 50–64 years (21.2%, 95% CI: 16.48–26.49), followed by acute respiratory infections, including pneumonia (10.6%, 95% CI: 7.2–14.85). The study concluded that NCDs, particularly stroke, are the leading causes of adult mortality in Sleman HDSS, with significant contributions from acute respiratory infections and injuries. It is recommended for future research to further develop Verbal Autopsy technology, such as AI-based applications that can improve the accuracy of determining the cause of death.
Alexander, S., Sengupta, P. & Benjamin, A. (2013) Causes of adult deaths by verbal autopsy in an urban slum of Ludhiana. Indian Journal of Clinical Practice, 24(7), 623-625.
Aminorroaya, A., Fattahi, N., Azadnajafabad, S., Mohammadi, E., Jamshidi, K., Rouhifard Khalilabad, M., ... & Farzadfar, F. (2024). Burden of non-communicable diseases in Iran: past, present, and future. Journal of Diabetes & Metabolic Disorders, 23(2), 1793-1799. https://doi.org/10.1007/s40200-020-00669-z
Atiim, G. A. & Elliott, S. J. (2016) The global epidemiologic transition: Noncommunicable diseases and emerging health risk of allergic disease in sub-Saharan Africa. Health Education & Behavior, 43(1_suppl): 37S-55S. https://doi.org/10.1177/1090198115606918
Bai, J., Cui, J., Shi, F., & Yu, C. (2023). Global epidemiological patterns in the burden of main non-communicable diseases, 1990–2019: Relationships with socio-demographic index. International Journal of Public Health, 68, 1605502. https://doi.org/10.3389/ijph.2023.1605502
Chai, P., Wan, Q., & Kinfu, Y. (2021). Efficiency and productivity of health systems in prevention and control of non-communicable diseases in China, 2008–2015. The European Journal of Health Economics, 22(2), 267-279. https://doi.org/10.1007/s10198-020-01251-3
Behera, S., & Pradhan, J. (2021). Uneven economic burden of non-communicable diseases among Indian households: A comparative analysis. Plos one, 16(12), e0260628. https://doi.org/10.1371/journal.pone.0260628
Bloom, D. E., Chen, S., Kuhn, M., McGovern, M. E., Oxley, L., & Prettner, K. (2020). The economic burden of chronic diseases: estimates and projections for China, Japan, and South Korea. The Journal of the Economics of Ageing, 17, 100163. https://doi.org/10.1016/j.jeoa.2018.09.002
Byass, P., Chandramohan, D., Clark, S. J., D'Ambruoso, L., Fottrell, E., Graham, W. J., Herbst, A. J., Hodgson, A., Hounton, S., Kahn, K., Krishnan, A., Leitao, J., Odhiambo, F., Sankoh, O. A., & Tollman, S. M. (2012). Strengthening standardised interpretation of verbal autopsy data: the new InterVA-4 tool. Global health action, 5, 1–8. https://doi.org/10.3402/gha.v5i0.19281
Cheng, L., Tan, L., Zhang, L., Wei, S., Liu, L., Long, L., Zhang, J., Wu, Y., Zhang, Q. & Nie, S. (2013) Chronic disease mortality in rural and urban residents in Hubei Province, China, 2008–2010. BMC Public Health, 13(1): 1-9. http://dx.doi.org/10.1186/1471-2458-13-713
Goswami, N. (2024). A Dual Burden Dilemma: Navigating the Global Impact of Communicable and Non-Communicable Diseases and the Way Forward. International Journal of Medical Research, 12(3), 65-77. https://doi.org/10.55489/ijmr.123202412
Hambleton, I. R., Caixeta, R., Jeyaseelan, S. M., Luciani, S., & Hennis, A. J. (2023). The rising burden of non-communicable diseases in the Americas and the impact of population aging: a secondary analysis of available data. The Lancet Regional Health–Americas, 21. 100483. https://doi.org/10.1016/j.lana.2023.100483
Herbst, A. J., Mafojane, T. & Newell, M. L. (2011) Verbal autopsy-based cause-specific mortality trends in rural KwaZulu-Natal, South Africa, 2000-2009. Popul Health Metr, 947. https://doi.org/10.1186/1478-7954-9-47
Jana, A., & Chattopadhyay, A. (2022). Prevalence and potential determinants of chronic disease among elderly in India: rural-urban perspectives. Plos one, 17(3), e0264937. https://doi.org/10.1371/journal.pone.0264937
Leitao, J., Chandramohan, D., Byass, P., Jakob, R., Bundhamcharoen, K., Choprapawon, C., De Savigny, D., Fottrell, E., França, E. & Frøen, F. (2013) Revising the WHO verbal autopsy instrument to facilitate routine cause-of-death monitoring. Global Health Action, 6. https://doi.org/10.3402/gha.v6i0.21518
Mendis, S. (2014). Global status report on noncommunicable diseases 2014. Switzerland: World Health Organization. Retrieved from: https://www.who.int/publications/i/item/9789241564854
Murphy, A., Palafox, B., Walli-Attaei, M., Powell-Jackson, T., Rangarajan, S., Alhabib, K. F., ... & McKee, M. (2020). The household economic burden of non-communicable diseases in 18 countries. BMJ global health, 5(2), e002040. https://doi.org/10.1136/bmjgh-2019-002040
National Population and Family Planning Board (BKKBN), Statistics Indonesia (BPS), and the Ministry of Health (Kemenkes) & ICF. (2018). Indonesia Demographic and Health Survey 2017. Jakarta: National Population and Family Planning Board (BKKBN), Statistics Indonesia (BPS), and the Ministry of Health (Kemenkes) & ICF.
Rahayujati B., Dewi F.S.T., Indriani C. & L.C., F. (2015). Pengendalian penyakit menular berbasis data epidemiologi. HDSS Sleman. Unpublished. Retrieved from: https://drive.google.com/file/d/189dZp4W6cqyklii-o7r80TPfXjRClSjd/view
Rai, R. K., Barik, A., Mazumdar, S., Chatterjee, K., Kalkonde, Y. V., Mathur, P., ... & Fawzi, W. W. (2020). Non-communicable diseases are the leading cause of mortality in rural Birbhum, West Bengal, India: a sex-stratified analysis of verbal autopsies from a prospective cohort, 2012–2017. BMJ open, 10(10), e036578. https://doi.org/10.1136/bmjopen-2019-036578
Ren, Y., Yang, J., Yin, P., Liu, W., Long, Z., Zhang, C., ... & Hao, J. (2024). Urban–rural disparities in mortality due to stroke subtypes in China and its provinces, 2015–2020. Chinese Medical Journal, 10-1097. htpps://doi.org/10.1097/CM9.0000000000003135
Streatfield, P. K., Khan, W. A., Bhuiya, A., Hanifi, S. M., Alam, N., Diboulo, E., Niamba, L., Sié, A., Lankoandé, B., Millogo, R., Soura, A. B., Bonfoh, B., Kone, S., Ngoran, E. K., Utzinger, J., Ashebir, Y., Melaku, Y. A., Weldearegawi, B., Gomez, P., Jasseh, M., … Byass, P. (2014a). Mortality from external causes in Africa and Asia: evidence from INDEPTH Health and Demographic Surveillance System Sites. Global health action, 7, 25366. https://doi.org/10.3402/gha.v7.25366
Streatfield, P. K., Khan, W. A., Bhuiya, A., Hanifi, S. M., Alam, N., Diboulo, E., Sié, A., Yé, M., Compaoré, Y., Soura, A. B., Bonfoh, B., Jaeger, F., Ngoran, E. K., Utzinger, J., Melaku, Y. A., Mulugeta, A., Weldearegawi, B., Gomez, P., Jasseh, M., Hodgson, A., … Byass, P. (2014b). Malaria mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites. Global health action, 7, 25369. https://doi.org/10.3402/gha.v7.25369
Streatfield, P. K., Khan, W. A., Bhuiya, A., Hanifi, S. M. A., Alam, N., Millogo, O., … Byass, P. (2014c). HIV/AIDS-related mortality in Africa and Asia: evidence from INDEPTH health and demographic surveillance system sites. Global Health Action, 77, 25370. https://doi.org/10.3402/gha.v7.25370
Thanh, P. T., & Duong, P. B. (2022). The economic burden of non-communicable diseases on households and their coping mechanisms: evidence from rural Vietnam. World Development, 151, 105758. https://doi.org/10.1016/j.worlddev.2021.105758
Vardell, E. (2020) Global Health Observatory Data Repository. Medical Reference Services Quarterly, 39(1): 67-74. https://doi.org/10.1080/02763869.2019.1693231
Verma, V. R., Kumar, P., & Dash, U. (2021). Assessing the household economic burden of non-communicable diseases in India: evidence from repeated cross-sectional surveys. BMC public health, 21(1), 881. https://doi.org/10.1186/s12889-021-10828-3
Wahab, A., Choiriyyah, I. & Wilopo, S. A. (2017) Determining the cause of death: mortality surveillance using verbal autopsy in Indonesia. The American Journal of Tropical Medicine and Hygiene, 97(5),1461. https://doi.org/10.4269/ajtmh.16-0815
Weisz, G. .(2016). Infections, chronic disease, and the epidemiological transition: a new perspective by Alexander Mercer. Bulletin of the History of Medicine, 90(1): 183-184. https://doi.org/10.1353/bhm.2016.0012
WHO. (2020). The top 10 causes of death. Geneva: WHO. Retrieved from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
WHO. (2014). Non-communicable disease country profiles 2014. Geneva: WHO. Retrieved from:https://iris.who.int/bitstream/handle/10665/128038/9789241507509_eng.pdf?sequence=1
Copyright (c) 2025 JURNAL INFO KESEHATAN
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Copyright notice
Ownership of copyright
The copyright in this website and the material on this website (including without limitation the text, computer code, artwork, photographs, images, music, audio material, video material and audio-visual material on this website) is owned by JURNAL INFO KESEHATAN and its licensors.
Copyright license
JURNAL INFO KESEHATAN grants to you a worldwide non-exclusive royalty-free revocable license to:
- view this website and the material on this website on a computer or mobile device via a web browser;
- copy and store this website and the material on this website in your web browser cache memory; and
- print pages from this website for your use.
- All articles published by JURNAL INFO KESEHATAN are licensed under the Creative Commons Attribution 4.0 International License. This permits anyone to copy, redistribute, remix, transmit and adapt the work provided the original work and source is appropriately cited.
JURNAL INFO KESEHATAN does not grant you any other rights in relation to this website or the material on this website. In other words, all other rights are reserved.
For the avoidance of doubt, you must not adapt, edit, change, transform, publish, republish, distribute, redistribute, broadcast, rebroadcast or show or play in public this website or the material on this website (in any form or media) without appropriately and conspicuously citing the original work and source or JURNAL INFO KESEHATAN prior written permission.
Permissions
You may request permission to use the copyright materials on this website by writing to jurnalinfokesehatan@gmail.com.
Enforcement of copyright
JURNAL INFO KESEHATAN takes the protection of its copyright very seriously.
If JURNAL INFO KESEHATAN discovers that you have used its copyright materials in contravention of the license above, JURNAL INFO KESEHATAN may bring legal proceedings against you seeking monetary damages and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of JURNAL INFO KESEHATAN copyright materials that contravenes or may contravene the license above, please report this by email to jurnalinfokesehatan@gmail.com
Infringing material
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to jurnalinfokesehatan@gmail.com.
