Evolution of chronic diseases and multimorbidity clusters among the deceased in rural northeast South Africa (2012-2022): Insights from verbal autopsy data

Evolution of chronic diseases and multimorbidity clusters among the deceased in rural northeast South Africa (2012-2022): Insights from verbal autopsy data | Research Square Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Evolution of chronic diseases and multimorbidity clusters among the deceased in rural northeast South Africa (2012-2022): Insights from verbal autopsy data Cyril Tamuka Chironda, Tobias Chirwa, Farai Mlambo, Rumbidzai Mupfuti, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8870259/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 23 Jul, 2026 Read the published version in BMC Public Health → Version 1 posted 14 You are reading this latest preprint version Abstract Introduction Rural South Africa is undergoing an epidemiological transition characterised by rising mortality from chronic non-communicable diseases (NCDs) alongside that from persistent infectious diseases. We aimed to investigate trends in the prevalence of chronic disease and multimorbidity clustering among deceased individuals in rural northeast South Africa from 2012 to 2022. Methods Verbal autopsy data for 5,892 deceased individuals collected from the Agincourt Health and socio-Demographic Surveillance System (HDSS) study area in Bushbuckridge, Mpumalanga Province, from 2012–2022 were analysed. We identified reported chronic diseases prior to death and applied cluster analysis, partitioning around medoids (PAM) and latent class analysis (LCA) to identify patterns of co-occurring diseases (multimorbidity clusters). Temporal trends in disease prevalence were assessed using descriptive statistics. Multinomial logistic regression models were used to examine associations of cluster membership with various behavioral factors. Results Over the 11-year period, the prevalence of hypertension among the deceased individuals rose from approximately 25% in 2012 to over 50% by 2022, that of diabetes increased from 10% and reached ~ 25% and that of dementia increased from 1% to over 5%. In contrast, the number of deaths that were reported to have had tuberculosis prior to their deaths declined markedly. Prevalence of HIV remained constant at 20% while that of TB reduced from 23% to 11%. The proportion of deceased individuals with multimorbidity (≥ 2 chronic conditions) increased, and complex multimorbidity (≥ 3 conditions) nearly doubled over time. Over time, multimorbidity clusters shifted from an initial dominance of HIV/TB comorbidity to later patterns dominated by cardiometabolic conditions (hypertension and diabetes), HIV–hypertension, and an emerging neurodegenerative illnesses cluster. Older adults (≥ 65 years) and females experienced the highest multimorbidity burden and were more likely to belong to complex disease clusters. Conclusions Morbidity patterns in this rural population have shifted toward chronic NCDs and multimorbidity. Characterising these trends and identifying disease clusters is essential for targeting patient-centred care early on. Our findings underscore the importance of integrating care for NCDs and infectious diseases in rural health systems to address the growing multimorbidity burden, with particular focus on older adults and women. Chronic Diseases Multimorbidity Clusters Verbal Autopsy Unsupervised Machine Learning Agincourt HDSS South Africa Full Text Additional Declarations No competing interests reported. Supplementary Files Supplementarymaterial.docx Cite Share Download PDF Status: Published Journal Publication published 23 Jul, 2026 Read the published version in BMC Public Health → Version 1 posted Editorial decision: Revision requested 29 Mar, 2026 Reviews received at journal 26 Mar, 2026 Reviews received at journal 24 Mar, 2026 Reviewers agreed at journal 24 Mar, 2026 Reviewers agreed at journal 20 Mar, 2026 Reviewers agreed at journal 11 Mar, 2026 Reviewers agreed at journal 05 Mar, 2026 Reviews received at journal 20 Feb, 2026 Reviewers agreed at journal 20 Feb, 2026 Reviewers invited by journal 20 Feb, 2026 Editor invited by journal 18 Feb, 2026 Editor assigned by journal 16 Feb, 2026 Submission checks completed at journal 16 Feb, 2026 First submitted to journal 13 Feb, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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