The Agincourt health and socio-demographic surveillance system (HDSS), located in rural northeast South Africa close to the Mozambique border, was established in 1992 to support district health systems development led by the post-apartheid ministry of health. The HDSS (90 000 people), based on an annual update of resident status and vital events, now supports multiple investigations into the causes and consequences of complex health, population and social transitions. Observational work includes cohorts focusing on different stages along the life course, evaluation of national policy at population, household and individual levels and examination of household responses to shocks and stresses and the resulting pathways influencing health and well-being. Trials target children and adolescents, including promoting psycho-social well-being, preventing HIV transmission and reducing metabolic disease risk. Efforts to enhance the research platform include using automated measurement techniques to estimate cause of death by verbal autopsy, full ‘reconciliation’ of in- and out-migrations, follow-up of migrants departing the study area, recording of extra-household social connections and linkage of individual HDSS records with those from sub-district clinics. Fostering effective collaborations (including INDEPTH multi-centre work in adult health and ageing and migration and urbanization), ensuring cross-site compatibility of common variables and optimizing public access to HDSS data are priorities.
Population ageing is a global phenomenon. The United Nations estimates that the world population aged over 60 will have increased 3-fold from 1950 to 2050, to reach 21% of the population. 1 This compositional shift is happening fastest in low-and middle-income countries (LMIC). 2 South Africa in particular is undergoing a dramatic demographic and epidemiological transition, and little is known about the socioeconomic determinants or consequences of transition. This study, following important findings in previous studies in Agincourt 3-6 and South Africa in general, 7-9 is set up to inform us about morbidity, mortality and aetiological factors shaping these trends. Various ageing studies, including the Studies on Global Ageing and Adult Health (SAGE) and the 2015 Global Burden of Disease, found that noncommunicable diseases, driven mainly by population growth and ageing, have become leading causes of death and disability globally, including in LMIC such as South Africa. 10-14 At the same time, the share of the population 60 and above in South Africa is estimated to increase from 7.8% in 2012 to 14.8% in 2050, 15 and the population aged 50 and over living with HIV will triple by 2040. 16 We established the cohort 'Health and Ageing in Africa: A Longitudinal Study of an INDEPTH Community' in South Africa (HAALSI) in the INDEPTH Health and Demographic Surveillance System (HDSS) site of Agincourt, as a harmonized sister study to the Health and Retirement Study (HRS) in the USA 17 and other similar studies worldwide, including ELSA in the UK, 18
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