Rural and urban differentials in adult mortality in Sub-Saharan Africa

Guy Stecklov, Hebrew University of Jerusalem
Ashira Menashe-Oren, Hebrew University of Jerusalem

Research from Sub-Saharan Africa consistently shows that urban mortality levels are substantially lower than those found in rural areas. Rural populations are disadvantaged in household characteristics, educational and economic opportunities and have little access to health services. This translates into higher rural mortality. Yet, what is less recognised is that this research is heavily based on infant and child mortality measures or occasionally on maternal mortality. In fact, despite recognition of the value of lowering mortality in Sub-Saharan Africa, there is shockingly little empirical evidence on how mortality levels for adults compare across urban and rural sectors. Furthermore, this question becomes particularly salient as AIDS mortality shifted the burden of disease to urban centres so dramatically over the past three decades. This research aims to examine whether and to what extent a difference exists in adult mortality between rural and urban populations. The lack of population registration data and mortality records make it exceedingly difficult of estimate mortality rates. However, using an indirect measure of adult mortality, the orphanhood method, it is possible to derive rural and urban life tables separately. Drawing upon data from Demographic and Health Surveys for 18 Sub-Saharan African countries between 1990 to 2014, we estimate separate urban and rural adult mortality levels. Results indicate that the probability of dying between ages 15 and 50 is consistently higher in urban areas in Central-East Africa, where HIV prevalence is higher. Furthermore in these countries there is an increase in adult mortality probabilities over time. In West African countries the probability of dying between ages 15 and 50 is lower and declining over time, with heterogeneity in urban/rural mortality differentials. Overall the differences in urban/rural mortality are greater amongst men.