Returning home to die: Circular labour migration and mortality in South Africa 1

TLDR

The study tests whether seriously ill circular labour migrants return home to recover or die. Using Agincourt longitudinal data (1995‑2004) and discrete‑time event history analysis, the authors compare mortality odds among residents, short‑term and long‑term returning migrants while controlling for sex, age, and period. Short‑term returning migrants exhibit 1.1–1.9 times higher annual mortality odds than residents and long‑term returners, with HIV/TB deaths rising over time and comprising an increasing share of all such deaths, suggesting that many working‑age migrants become ill in urban settings and die at home, thereby shifting terminal care burdens to rural families and health systems.

Abstract

Aim: To examine the hypothesis that circular labour migrants who become seriously ill while living away from home return to their rural homes to convalesce and possibly to die. Methods: Drawing on longitudinal data collected by the Agincourt health and demographic surveillance system in rural northeastern South Africa between 1995 and 2004, discrete time event history analysis is used to estimate the likelihood of dying for residents, short-term returning migrants, and long-term returning migrants controlling for sex, age, and historical period. Results: The annual odds of dying for short-term returning migrants are generally 1.1 to 1.9 times (depending on period, sex, and age) higher than those of residents and long-term returning migrants, and these differences are generally highly statistically significant. Further supporting the hypothesis is the fact that the proportion of HIV/TB deaths among short-term returning migrants increases dramatically as time progresses, and short-term returning migrants account for an increasing proportion of all HIV/TB deaths. Conclusions: This evidence strongly suggests that increasing numbers of circular labour migrants of prime working age are becoming ill in the urban areas where they work and coming home to be cared for and eventually to die in the rural areas where their families live. This shifts the burden of caring for them in their terminal illness to their families and the rural healthcare system with significant consequences for the distribution and allocation of health care resources.