Major Global Burdens of Disease

The global landscape of ill health has shifted over recent decades from predominantly infectious and maternal–perinatal conditions towards chronic non-communicable diseases (NCDs) and injuries, reflecting demographic ageing, urbanisation and changes in lifestyle. Cardiovascular disorders, notably ischaemic heart disease and stroke, alongside cancers and chronic respiratory diseases, now account for the majority of death and disability-adjusted life-years (DALYs) worldwide. Yet in low-resource settings communicable diseases—such as lower respiratory infections, diarrhoeal illnesses, HIV/AIDS and malaria—remain significant, particularly among children under five. Maternal and neonatal disorders persist in areas lacking access to safe childbirth services. Injuries, including road traffic crashes, falls and violence, contribute substantially to premature mortality and long-term disability. Across all income levels, the social determinants of health—poverty, education, housing, nutrition and access to care—exert a powerful influence on disease patterns, perpetuating inequities in outcomes. Age-standardised rates of many infectious conditions have fallen, but NCDs continue to rise in middle- and high-income countries, driven by tobacco use, unhealthy diets, sedentary lifestyles, harmful alcohol consumption and air pollution. The resultant dual burden of communicable and non-communicable diseases calls for integrated strategies combining prevention, early detection, treatment and health-system strengthening.

Research from Nature Portfolio

Recent mechanistic work has revealed that the immune checkpoint BTLA is markedly upregulated on CD4+ T cells in hepatitis B-related acute-on-chronic liver failure, driving T-cell exhaustion through IL-6/TNF-mediated PI3K–Akt signalling. Antibody-mediated BTLA blockade restores T-cell function, reduces bacterial translocation and improves survival in preclinical models, highlighting a novel immunotherapeutic approach. Complementary foundational studies have validated the CLIF-C organ failure and ACLF scores for hepatitis B-associated cirrhosis, demonstrating their superior accuracy over MELD in predicting short-term mortality. These criteria, which integrate multi-organ assessments and inflammatory markers, support risk stratification and inform allocation of critical care resources.

Major Global Burdens of Disease publication trend

The graph below shows the total number of articles in major global burdens of disease across all publications each year (not limited to Nature Index journals).

Technical terms

Disability-Adjusted Life Year (DALY): A summary measure of health loss combining years of life lost to premature death and years lived with disability.

Years Lived with Disability (YLD): The number of years spent in less than full health due to disease or injury, weighted by severity.

Age-standardised rate: A rate adjusted to a standard age distribution, permitting valid comparisons of incidence or mortality across populations with different age structures.

Socio-Demographic Index (SDI): A composite measure of development based on income per capita, educational attainment and fertility rates.

CLIF-C ACLF score: A prognostic index incorporating organ failure assessments and inflammatory markers to predict mortality in acute-on-chronic liver failure.

References

1. The Global Burden of Disease and Risk Factors.
2. BTLA contributes to acute-on-chronic liver failure infection and mortality through CD4+ T-cell exhaustion. Nature Communications (2024).
3. Characteristics, Diagnosis and Prognosis of Acute-on-Chronic Liver Failure in Cirrhosis Associated to Hepatitis B.. Scientific Reports (2016).
4. The carcinogenicity of opium consumption: a systematic review and meta-analysis. European Journal of Epidemiology (2023).
5. Global, Regional, and National Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life-Years for 29 Cancer Groups, 1990 to 2017. JAMA Oncology (2019).
6. The global, regional, and national burden of colorectal cancer and its attributable risk factors in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet Gastroenterology & Hepatology (2019).
7. National and subnational burden of female and male breast cancer and risk factors in Iran from 1990 to 2019: results from the Global Burden of Disease study 2019. Breast Cancer Research (2023).