Diabetes overtakes infectious diseases as South Africa’s leading recorded cause of death

Diabetes was the leading underlying cause among South Africa’s recorded deaths in 2024, as chronic diseases widened their dominance over infectious illnesses.

South Africa’s latest mortality data point to a striking change in the country’s health burden. Statistics South Africa’s 2024 mortality report shows that diabetes mellitus was the leading underlying cause of death last year, accounting for 6.1% of the 474,366 deaths processed in the reporting period. Hypertensive disease ranked second at 5.5%, followed closely by cerebrovascular disease, which includes stroke, at 5.4%.

That pattern underlines how firmly non-communicable diseases now dominate mortality in South Africa. According to Stats SA, six of the 10 leading causes of death in 2024 were chronic conditions: diabetes, hypertension, cerebrovascular disease, other forms of heart disease, ischaemic heart disease and chronic lower respiratory disease. Infectious illnesses such as tuberculosis and HIV still feature prominently, but the balance has shifted decisively towards long-term conditions linked to age, lifestyle and underlying cardiovascular risk.

The picture looks different once sex is taken into account. Among men, tuberculosis remained the leading underlying cause of death, responsible for 4.8% of male deaths. Cerebrovascular disease and diabetes followed, each at 4.5%. Among women, however, diabetes stood well above the rest, accounting for 7.9% of female deaths, with hypertensive disease next at 7.1% and cerebrovascular disease at 6.4%. HIV continued to appear among the leading causes for both sexes.

Age also reshapes the mortality profile. For infants, respiratory and cardiovascular disorders specific to the perinatal period were the main cause of death. In children aged one to 14, influenza and pneumonia led the list. Among people aged 15 to 44, HIV and tuberculosis were the dominant causes. Diabetes became the leading cause for South Africans aged 45 to 64, while hypertensive disease was most common among those aged 65 and over.

The long-term trend is equally revealing. Stats SA said communicable diseases accounted for 45.6% of deaths in 2003, but only 26% in 2024. Over the same period, non-communicable diseases rose from 44.9% to 60.7% of deaths, despite the temporary disruption caused by the Covid-19 pandemic. The median age at death also climbed sharply, reaching 60 in 2024, compared with 42 in 2005. Stats SA cautioned that the figures are based on registered deaths and that the recording and classification of causes of death still need improvement. At the same time, a separate validation study by the South African Medical Research Council has warned that official cause-of-death data may understate HIV/AIDS mortality, highlighting the importance of treating the numbers with care even as the broader shift towards chronic disease appears unmistakable.