The Health in the Americas+¹ country profiles are based on the interagency indicators available as of the dates referenced. The sources are referenced in this table. In some cases, the values of the indicators may differ from the most recent data available in the country.

Environmental and social determinants of health

In 2000 the total population of Nicaragua was 5 022 633 inhabitants; by 2024 this figure had risen to 6 916 140, representing a 37.7% increase. Regarding the country’s demographic profile, in 2024 people over 65 years of age accounted for 5.5% of the total population, an increase of 2.0 percentage points compared to the year 2000. In 2024, there were 103.3 women per 100 men and 19.2 older people (65 years or older) per 100 children under 15 years of age, as can be seen in the country’s population pyramids, distributed by age group and sex (Figure 1). Considering the population between 15 and 64 years of age to be potentially active (i.e., potential participants in the labor force), this group represented 65.7% of the total population of the country in 2024 (4 544 425 people). When we add these figures to the potentially passive population (1 989 004 under 15 years of age and 382 711 over 65 years of age), the result is a dependency ratio of 52.2 potentially passive people per 100 potentially active people. This ratio was 78.0 in 2000.

Life expectancy at birth in 2024 was 75.1 years, lower than the average for the Region of the Americas and 8.7 years higher that in 2000 (66.4).

The unemployment rate in 2023 was 4.7%. Disaggregated by sex, the rate was 4.9% for women and 4.7% for men. The literacy rate was 91.6% in 2015. In men, this figure was 93.6%; in women, 89.6%. In addition, 24.9% of the population were below the national poverty line in 2016, a decrease from 45.8% in 2001. In 2014, 3.9% of the population was living in poverty, defined as the percentage of the population with an income of less than US$ 2.15 per day; this is below the regional average of 2.6%.

During the period 2000-2022, the country improved its score on the Human Development Index, with an increase of 18.8% (from a score of 0.563 to a score of 0.669); during the same period, the index rose 14.6% internationally and 11.2% in Latin America (Figure 2).

In 2021, public expenditure on health accounted for 6.14% of gross domestic product (GDP) (Figure 3) and 20.09% of total public expenditure, while out-of-pocket spending on health accounted for 30.82% of total health expenditure.

Digital coverage

In 2021, 57.1% of the population had an internet connection, representing a considerable increase from 2000, when 1% of the population had an internet connection.

Health situation

Maternal and child health

Between 2001 and 2022, infant mortality in Nicaragua decreased from 30 to 12.7 deaths per 1000 live births, a decrease of 57.7% (Figure 4). The percentage of low-weight births (less than 2500 g) decreased from 8.2% to 7.8% between 2001 and 2019, while exclusive breastfeeding in the child population up to 6 months of age was 31.1% in 2001 and 30.67% in 2006 (latest available data).

Regarding the immunization strategy, measles vaccination coverage was 100% in 2022, the same percentage as in 2000.

The maternal mortality ratio in 2020 was estimated at 77.9 deaths per 100 000 live births, representing a 53.9% reduction compared to the estimated value in 2000 (Figure 5). In relation to fertility, it is estimated that in 2024 women had an average of 2.2 children throughout their reproductive lives. In the specific case of adolescent fertility, there was a 18.4% decrease, from 114.1 live births per 1000 women aged 15 to 19 years in 2000 to 93.2 in 2024. Between 2008 and 2020 the percentage of pregnant people who had four or more consultations for antenatal care increased from 61% to 95.4%. In 2020, 96.8% of births were attended by skilled birth personnel. These data are not in line with the country's reports, which state a maternal mortality ratio of 73.3 for 2000 (93 maternal deaths) and 31.4 for 2021 (37 maternal deaths), a reduction of 57% for the period 2000–2021.

Communicable diseases

In 2022, there were 30 new cases of tuberculosis per 100 000 population in Nicaragua. In 2019, the overall tuberculosis mortality rate (age-adjusted and per 100 000 population) was 2.2 (1.5 in women and 3.0 in men).

In 2022, the estimated human immunodeficiency virus (HIV) infection incidence rate (new diagnoses) was 16.8 per 100 000 population. The age-adjusted mortality rate for HIV was 2.4 per 100 000 population in 2019. It should be noted that during the 2000-2019 period this indicator decreased by 27.2%. There were no reported cases of human rabies in the country in 2022.

Noncommunicable diseases and risk factors

In Nicaragua, the prevalence of overweight and obesity among people aged 15 and older was 67.2% in 2022.

In 2015, the reported prevalence of arterial hypertension (high blood pressure) among people aged 18 years or older was 20.8%, a decrease of 2.5 percentage points compared to 2000 (23.3%). The prevalence of diabetes mellitus, which stood at 7.9% in 2000, increased to 10.1% in 2014.

Mortality

In 2019, the adjusted rate of potentially preventable premature mortality in Nicaragua was 272.4 deaths per 100 000 population, a decrease of 11.7% compared to the rate of 308.6 in 2000. This meant that, in 2019, the rate in the country was 20.2% higher than the average rate reported for the Region of the Americas as a whole. Among potentially preventable premature deaths, the rate for preventable causes was 129.9 per 100 000 population in 2019, which is 5.3% lower than the regional average rate; and the rate for treatable causes was 142.5 per 100 000 population, above the regional average of 89.6.

The overall age-adjusted mortality rate was 6.5 per 1000 population in 2019, a decrease of 5.8% compared to 2000 (6.9 deaths per 1000 population).

When deaths are categorized into three main groups, it is observed that, in 2019, the age-adjusted mortality rate from communicable diseases was 51.1 per 100 000 population (59.7 per 100 000 in men and 44.1 per 100 000 in women), while the age-adjusted mortality rate from noncommunicable diseases was 547.6 per 100 000 population (670.5 per 100 000 in men and 453.2 per 100 000 in women). The rate of age-adjusted mortality from external causes was 48.8 per 100 000 population (81.7 per 100 000 in men and 19.5 per 100 000 in women), including road traffic accidents (18.7 per 100 000 population), homicides (9.5 per 100 000 population) and suicides (4.7 per 100 000 population). In 2000, the percentage distribution of causes was 64.4% for noncommunicable diseases, 24.0% for communicable diseases, and 11.4% for external causes; in 2019, the percentages were 81.6%, 9.5%, and 8.9%, respectively (Figure 6).

Cancer mortality

Regarding cancer mortality from tumors, in 2019, the adjusted mortality rate from prostate cancer was 20.6 per 100 000 men; lung cancer, 8.1 per 100 000; and colorectal cancer, 6.9 per 100 000. In women, these values were 10.1 deaths per 100 000 for breast cancer; 4.3 per 100 000 for lung cancer; and 6.4 per 100 000 for colorectal cancer.

The sources of the interagency indicators used in this profile can be found in this table.