Unnatural deaths in South African Platinum Miners, 1992-2008

Introduction
The mortality rate from unnatural deaths for South Africa is nearly double the world average. Reliable data are limited by inaccurate and incomplete ascertainment of specific causes of unnatural death. This study describes trends in causes of unnatural death between 1992 and 2008 in a cohort of South African miners.

Methods
The study used routinely-collected retrospective data with cause of death determined from multiple sources including the mine’s human resources database, medical records, death registration, and autopsy. Cause-specific mortality rates and Poisson regression coefficients were calculated by calendar year and age group.

Results
The cohort included 40,043 men. One quarter of all 2937 deaths were from unnatural causes (n=805). The three leading causes of unnatural deaths were road traffic accidents (38%, 109/100,000py), homicides (30%, 88/100,000py) and occupational injuries (17%, 50/100,000py). Rates of unnatural deaths declined by 2% (95%CI: -4%,-1%) per year over the study period, mainly driven by declining rates of road traffic accidents. The rate of occupational injury mortality did not change significantly over time (-2% per year, 95%CI: -5%,+2%).

Discussion
Unnatural deaths were a common cause of preventable and premature death in this cohort of miners. While unnatural death rates declined between 1992 and 2008, occupational fatalities remained at a high level and were four fold higher than in the mining industry in the United States. Evidence-based prevention strategies to address these avoidable deaths are urgently needed.