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Johannesburg - In Tshwane and Cape Town the leading killers are diabetes and other heart diseases, while the Northern Cape is the first province since 1997 to record HIV/Aids as the most common cause of death.

A complex picture of what killed South Africans last year emerged in Statistics South Africa’s “Mortality and Causes of Death in South Africa 2013: Findings from death notification”, released on Tuesday.

Overall 458 933 deaths were recorded. TB, flu and pneumonia emerged as the leading killers overall. TB accounted for 8.8 percent of all deaths and flu and pneumonia 5.2 percent.

HIV/Aids was the third most common cause at 5.1 percent, but this was ascribed to a better reporting regime rather than actual numbers.

The Stats SA report uses death certificates’ underlying causes of death to compile its report, and it appears doctors have become more comfortable identifying HIV/Aids as a cause of death.

One of the reasons for this is believed to be the legislative changes for the insurance sector, which - before the new laws came into effect - often did not pay out when a person died because of HIV/Aids.

Even as the number of overall deaths decreased again - there were 491 100 deaths in 2012 - the increasing deaths from diabetes and hypertensive diseases emerged as a concern.

The Western Cape and Gauteng recorded the lowest death rate, or number of deaths per 1 000 residents, at 7.7.

The Free State and Northern Cape topped the provincial death stakes with 12.1 and 11.8 respectively.

The national average death rate was 8.6 for every 1 000.

TB was the leading cause of death in six provinces, except in the Western Cape, where it was diabetes; the Northern Cape, where it was HIV; and Limpopo, where flu and pneumonia were the top killers.

Where one lives, alongside sex and age, emerged as key determining factors in death, according to the Stats SA breakdown of the country’s 52 districts.

Well above national average death rates were recorded in the Northern Cape’s Pixley ka Isaka Seme (19), where HIV/Aids emerged as the leading cause of death, followed by Xhariep (18) in the Free State.

In contrast, eThekwini recorded the lowest death rate at five for every 1 000 people.

While diabetes displaced TB as the leading cause of death overall in the Western Cape last year compared with 2012, HIV/Aids was the leading cause of death in the Cape Winelands district.

HIV/Aids was also the leading cause of death in uMkhanyakude in KwaZulu-Natal, the province where districts - except eThekwini - recorded TB as a leading cause, with HIV/Aids a close second.

In the eThekwini metro, the main cause of death was TB, followed by diabetes and other heart diseases, then cerebrovascular diseases such as hypertension and stroke.

TB was the leading cause of death across districts in Gauteng except for Tshwane and Sedibeng, where flu and pneumonia killed the most people, followed by TB.

Apart from Joburg, where HIV/Aids ranked as the fourth most common cause of death, elsewhere in Gauteng it featured in the lower ranks of the top 10 most common causes - between seventh spot and 10th on the West Rand. However, heart disease featured high among the top 10 causes of death in Gauteng.

Babies aged up to 28 days mostly died from respiratory diseases, while most of them under 11 months died of intestinal infectious diseases such as diarrhoea, and 3 percent from malnutrition.

Infectious intestinal diseases remain the top killers for those aged younger than 5 years.

But in the 5 to 14 age bracket, TB emerged as the leading cause of death, followed by intestinal infectious diseases and flu and pneumonia.

Between 15 and 44 years of age, TB remained the top killer, followed by HIV/Aids.

Sex also determines how South Africans died last year.

While most men and women died of TB, the second leading cause of death among men was flu and pneumonia, but diabetes for women.

HIV/Aids was the third most common killer for men, but the fourth for women, who were more affected by cerebrovascular diseases such as hypertension and stroke.

About 10 percent of all deaths recorded last year were from non-natural causes, in a development that bucked the overall declining number of deaths for the third consecutive year.

External causes of accidental injury was the leading non-natural cause of death.

But only in the Western Cape was assault the second most common cause - at a rate more than three times that recorded in Gauteng.

The highest level of non-natural deaths was in the Central Karoo district and the third highest in Cape Town. Second place was held by Namakwa in the Northern Cape.

March, June, November and December emerged as the months recording the most deaths from assault.

The overwhelming majority of the assault-related deaths were from a sharp object (85.1 percent). This was followed by “unspecified means” (9.7 percent) and firearms (1.7 percent).

In contrast, transport accidents were the second most common cause of non-natural death in Limpopo, the Northern Cape, Free State and Mpumalanga.

In Gauteng, KwaZulu-Natal, Eastern Cape and North West, the second most common cause of non-natural deaths was “events of undetermined intent”.

Suicides accounted for 1 percent of deaths - and most of them happened to be in the Northern Cape.

Political Bureau