Fig. 3: Spatiotemporal transitions across the four epidemiologic stages in four example countries: the USA, Japan, Malaysia and Zambia.

Shifts in disease burden across four example countries are shown as they transition through the epidemiologic stages (stage 1, emergence; stage 2, acceleration in incidence; stage 3, compounding prevalence; and stage 4, prevalence equilibrium). The USA is a country with epidemiologic data supporting its progression through the first three stages and is expected to enter stage 4 in the following decades. Japan is a stage 2 country that is on the verge of transitioning to stage 3. Malaysia is a country that only entered stage 2 within the past decade. Zambia’s epidemiologic data suggest it is currently in stage 1, with a projected transition to stage 2 as the country undergoes greater industrialization, urbanization, westernization, and associated lifestyle and dietary changes. Representative burden data were derived from ref. ⁴.