Leading Causes of Death in Nepal: NCDs vs Communicable Disease

For most of the twentieth century, Nepalis died mainly of communicable, maternal, neonatal and nutritional (CMNN) conditions such as diarrhoeal disease, pneumonia, tuberculosis and complications of childbirth. That pattern has reversed. Non-communicable diseases (NCDs) - long-term conditions such as heart disease, stroke, chronic lung disease, cancer and diabetes - are now the dominant cause of death in the country. The World Health Organization (WHO) estimates that about 66 percent of all deaths in Nepal are due to NCDs, and the Institute for Health Metrics and Evaluation (IHME) Global Burden of Disease (GBD) study puts the figure even higher, at around 71 percent in 2019.

This transition is what public-health researchers call an epidemiological transition: as a country reduces child mortality, controls infections and its population ages, the causes of death move from infectious to chronic. Nepal has compressed this shift into roughly three decades. The Nepal Burden of Disease 2019 report, produced by the Nepal Health Research Council (NHRC) with the Ministry of Health and Population using GBD methods, estimated about 193,331 deaths in Nepal in 2019, of which 71.1 percent were from NCDs, 21.1 percent from CMNN conditions, and 7.8 percent from injuries.

Because authoritative, ranked figures are scattered across IHME visualisations, WHO country profiles and academic papers, this article pulls the most reliable estimates together. Where sources disagree - for example WHO's 66 percent NCD share versus GBD's 71 percent - both figures are given, since they use different models and reference years. Treat all such percentages as modelled estimates rather than exact counts, because Nepal, like most low- and middle-income countries, still lacks complete national death registration.

At the level of broad disease groups, cardiovascular disease (CVD) is the single largest cause of death in Nepal, responsible for about 24 percent of all deaths in 2019 (26.8 percent among men and 20.7 percent among women). Chronic respiratory disease is the next largest category at roughly 21 percent, cancers (neoplasms) at about 11 percent, and digestive diseases at about 6 percent. Respiratory infections and tuberculosis together still account for close to 4 percent of deaths, a reminder that the old infectious burden has not disappeared.

When the data is broken down by specific condition rather than broad category, IHME's Global Burden of Disease study consistently ranks chronic obstructive pulmonary disease (COPD), ischemic (coronary) heart disease and stroke as the three leading causes of death in Nepal. COPD is unusually prominent here compared with global averages - it alone was linked to about 16.3 percent of all Nepali deaths in 2019 - reflecting heavy household air pollution from biomass cooking fuels, high smoking rates and outdoor air pollution. Lower respiratory infections, neonatal disorders and diarrhoeal diseases remain among the top ten, but their share has been falling, while diabetes and road (transport) injuries have been climbing.

The direction of travel is as important as the ranking. Diabetes mellitus caused about 1.8 percent of deaths in 2019, more than four times its 0.43 percent share in 1990, and road-traffic injuries have risen with motorisation, accounting for roughly 4 percent of deaths in recent GBD estimates. The table below and the accompanying facts summarise the leading causes; exact percentages differ slightly between GBD rounds (2017, 2019, 2021 and 2023) and between WHO and IHME, so they are best read as approximate rankings.

Counting deaths tells only part of the story. Epidemiologists also measure the disability-adjusted life year (DALY) - one DALY represents one year of healthy life lost, whether through premature death or through living with illness and disability. This matters because some conditions, such as depression, low back pain, road injuries and diabetes, cause enormous disability without necessarily appearing at the top of the mortality list. By the DALY measure, NCDs accounted for roughly 61 percent of Nepal's total disease burden in 2019.

Cardiovascular disease again leads, contributing about 11.9 percent of all DALYs in Nepal in 2019, with cancers and COPD also ranking among the heaviest contributors. For cardiovascular disease specifically, one GBD-based analysis estimated around 1.2 million prevalent cases, about 46,500 deaths and roughly 1.1 million DALYs in Nepal in 2019, with the CVD share of total DALYs rising from 4.82 percent in 1990 to 11.89 percent in 2019 - a striking measure of how fast heart disease and stroke have grown.

Communicable, maternal, neonatal and nutritional causes still weigh heavily on children and young mothers, but their overall DALY share has shrunk as immunisation, safe-motherhood programmes and better nutrition have taken hold. The net effect is a double burden: Nepal is managing a large and growing chronic-disease caseload while it has not yet fully closed the gap on infections and maternal-child health.

The clearest way to see Nepal's health transition is to track the share of deaths by broad cause over time. A peer-reviewed projection study of Nepal's mortality, published in PLOS ONE, modelled the trend from 1990 to 2040 using GBD data. In 1990, CMNN (communicable, maternal, neonatal and nutritional) conditions caused about 63.6 percent of all deaths, NCDs about 29.9 percent, and injuries about 6.5 percent - the classic profile of a low-income country.

By 2015 the picture had almost exactly inverted: CMNN causes had fallen to about 26.8 percent, NCDs had risen to about 63.2 percent, and injuries stood at about 13 percent (the 2015 injury figure was inflated by the Gorkha earthquake of that year). Projecting forward, the study estimated that by 2040 NCDs could account for roughly 78.6 percent of deaths, CMNN causes for only about 12.5 percent, and injuries for about 8.9 percent. In other words, within a single lifetime Nepal has moved from a country where infections were the main killer to one where chronic disease overwhelmingly is.

This shift is driven by three forces working together: falling infectious and child mortality thanks to vaccines, sanitation and maternal-health programmes; an ageing population, since NCDs cluster at older ages; and rising exposure to NCD risk factors such as tobacco, unhealthy diets, physical inactivity and air pollution. Understanding this trajectory is essential for planning - hospitals, insurance schemes and the health workforce all need to reorient from acute infectious care toward long-term management of heart disease, diabetes, cancer and lung disease.

Most NCD deaths in Nepal trace back to a small set of modifiable risk factors. In the Nepal Burden of Disease 2019 analysis, tobacco (smoking) was the single most important risk factor for death, linked to about 17.7 percent of all deaths and 8.5 percent of all DALYs. Grouped together, behavioural risks (tobacco, diet, alcohol and physical inactivity) were associated with roughly 38 percent of deaths, environmental and occupational risks (chiefly air pollution) with about 31 percent, and metabolic risks (high blood pressure, high blood sugar, high body-mass index and raised cholesterol) with about 23 percent.

Air pollution deserves special mention. Both household air pollution from burning wood, dung and crop residue for cooking, and ambient outdoor pollution in the Kathmandu Valley and Terai, contribute heavily to COPD, heart disease, stroke and lower respiratory infections. In its most recent GBD 2023 country summary, IHME highlighted air pollution as a leading risk factor for death and disability in Nepal. The WHO STEPS survey of 2019 also documented widespread risk: about 28.9 percent of adults used tobacco, 24.5 percent had raised blood pressure, 24.3 percent were overweight or obese, and an overwhelming 96.7 percent ate fewer than the recommended five servings of fruit and vegetables a day.

Crucially, metabolic risk factors are projected to grow fastest. The PLOS ONE projection estimated that the combined metabolic-risk share of deaths could climb from about 10.4 percent in 1990 to about 37 percent by 2040, with high systolic blood pressure and high fasting blood glucose (a marker of diabetes) becoming dominant. This means blood-pressure control, diabetes screening and dietary change are among the highest-value interventions for Nepal's future.

Although NCDs now lead, communicable disease has not been eliminated, and framing Nepal's health only around chronic disease would be misleading. Lower respiratory infections (pneumonia and similar) remain a top-ten cause of death, particularly among young children and the elderly, and are worsened by the same air pollution that drives COPD. Tuberculosis continues to circulate widely; together with respiratory infections it was tied to roughly 4 percent of deaths in 2019, and Nepal remains a high-TB-burden setting.

Diarrhoeal disease and neonatal disorders, once among the very top killers, have declined sharply thanks to oral rehydration, immunisation, improved water and sanitation, and safe-motherhood programmes - but they still cause preventable deaths, especially in remote hill and mountain districts and among the poorest households. Seasonal and vector-borne threats such as dengue, which has expanded dramatically into new districts and higher altitudes, and periodic outbreaks of influenza and other infections, add to the load. Climate change is reshaping where and when these diseases occur.

The result is a double burden of disease: Nepal's health system must finish the job on infections, maternal and child health while scaling up lifelong management of NCDs. For a low-income country with a large rural population and heavy out-of-pocket health spending, doing both at once is a formidable challenge.

Nepal has recognised the NCD threat at the highest levels. The Government of Nepal, with WHO support, endorsed a Multisectoral Action Plan for the Prevention and Control of NCDs (the first covering 2014-2020 and a second plan from 2021), and it has adopted the WHO Package of Essential Non-communicable disease interventions (PEN) to bring hypertension and diabetes screening down to primary health centres. Tobacco-control laws, including large pictorial health warnings on cigarette packs, are among the strongest in the region. WHO estimates the probability that a Nepali aged 30 to 70 will die prematurely from one of the four major NCDs (cardiovascular disease, cancer, chronic respiratory disease or diabetes) at about 22 percent - a key target under the Sustainable Development Goals.

For students, journalists and health workers, the practical takeaway is that reliable answers to questions like 'what is the most common disease in Nepal' or 'leading causes of death in Nepal' should come from GBD (IHME), WHO country profiles and the NHRC Nepal Burden of Disease reports, not from single hospital datasets. These sources use consistent, comparable methods across countries and years, which is why this article's rankings - COPD, ischemic heart disease and stroke at the top, with an NCD share around two-thirds - are quoted with confidence even though the exact decimals shift between editions.

Ultimately, the numbers point to a clear prevention agenda: reduce tobacco use and air pollution, control blood pressure and blood sugar, improve diets and physical activity, and keep strengthening the maternal, child and infectious-disease gains already made. Because the leading causes of death in Nepal are now overwhelmingly chronic and largely preventable, the biggest gains lie in prevention and primary care rather than in hospital treatment alone.