The leading cause of death in South Africa may surprise you

South Africa’s latest mortality figures reveal a major shift in what is driving deaths across the country, with non-communicable diseases now accounting for most of the leading causes.

The latest Statistics South Africa (Stats SA) mortality report, covering deaths registered in 2024, shows that 474 366 deaths were processed during the latest reporting period.

While infectious diseases such as tuberculosis and HIV continue to feature prominently, particularly among younger South Africans and men, the overall picture is increasingly being shaped by chronic conditions.

And one condition has emerged as the country’s leading underlying cause of death.

South Africa’s leading cause of death

According to Stats SA, diabetes mellitus was the leading underlying cause of death in South Africa in 2024, accounting for 6.1% of all deaths.

It was followed by hypertensive diseases (high blood pressure), which accounted for 5.5%, and cerebrovascular diseases like strokes, which accounted for 5.4%.

All three are non-communicable diseases.

Stats SA also found that six of the country’s 10 leading causes of death were non-communicable diseases.

These include diabetes, hypertension, cerebrovascular diseases, other forms of heart disease, ischaemic heart disease and chronic lower respiratory diseases.

The picture is different for men and women

The overall figures also hide an important difference between men and women.

For men, tuberculosis remained the leading underlying cause of death, accounting for 4.8% of male deaths.

Cerebrovascular diseases and diabetes mellitus followed, both accounting for 4.5% of deaths among men.

For women, however, diabetes was clearly the leading cause, accounting for 7.9% of female deaths.

Hypertensive diseases were second at 7.1%, followed by cerebrovascular diseases at 6.4%.

HIV also remained among the leading causes for both men and women.

The causes of death change with age

The Stats SA figures also show how dramatically the leading causes vary depending on a person’s age.

Among infants, the leading cause was respiratory and cardiovascular disorders specific to the perinatal period, accounting for 14.9% of deaths.

For children aged 1 to 14, influenza and pneumonia were the leading causes, accounting for 5.5%.

Among people aged 15 to 44, HIV was the leading underlying cause of death at 7.7%, followed by tuberculosis at 7.0%.

Diabetes moved to the top for people aged 45 to 64, accounting for 7.1% of deaths.

For those aged 65 and older, hypertensive diseases were the leading cause, accounting for 9.4%.

South Africa’s biggest killers have changed

The latest figures form part of a much longer shift in South Africa’s mortality profile.

In 2003, communicable diseases accounted for 45.6% of deaths. By 2024, this had fallen to 26%.

Over the same period, non-communicable diseases increased from 44.9% of deaths to 60.7%.

The change was temporarily disrupted by the Covid-19 pandemic, but the longer-term trend remains clear: chronic, non-communicable conditions now account for the majority of deaths recorded in South Africa.

There has also been a substantial change in the age at which South Africans are dying.

Stats SA reported that the median age at death reached 60 in 2024, compared with 42 in 2005.

The median age was 55 for men and 65 for women.

The report cautions, however, that the figures are based on registered deaths and that improvements are still needed in the reporting and classification of causes of death.