676 - Global, regional, and national burden of neonatal preterm birth 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Publication Number: 3654.676

Yanping Xu, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (People's Republic)

Background: Preterm birth remains a leading cause of neonatal morbidity and mortality globally, with significant long-term health consequences. Despite efforts to reduce child mortality, the burden of neonatal preterm birth persists, particularly in low- and middle-income countries. Comprehensive, updated estimates are vital for effective health strategies.

Objective: This work aims to inform public health strategies and support evidence-based decision-making to reduce the burden of preterm birth and improve neonatal outcomes globally.

Design/Methods: Using Global Burden of Disease data, we analyzed the global, regional, and national burden of neonatal preterm birth from 1990 to 2021, estimating prevalence, incidence, deaths, DALYs, and age-standardized rates. Trends were assessed via annual percentage change (EAPC), with data stratified by age, sex, location, Socio-demographic Index (SDI) and key risk factors.

Results: In 2021, there were 122.7 million global cases of neonatal preterm birth, representing a 49.7% increase since 1990. The age-standardized prevalence rate (ASPR) increased slightly (EAPC: 0.39; 95% CI: 0.37–0.41) and ASIR decreasing (EAPC: –0.27; 95% CI: –0.34 to –0.20). Despite these improvements, 739,671 deaths and 80.3 million DALYs were attributed to neonatal preterm birth in 2021, with ASDR and DALY rates decreasing (EAPCs: –1.67 and –1.40, respectively). The highest burden was observed in South Asia and Sub-Saharan Africa, particularly in low- and low-middle SDI regions. Risk factor attribution revealed that low birth weight and short gestation accounted for 11.9% of neonatal preterm deaths globally, with the highest proportions in South Asia. From 2021 to 2050, prevalence and incidence are expected to rise slightly (more in females), while mortality and DALYs will decline, reflecting improved neonatal care.

Conclusion(s): Neonatal preterm birth remains a major global issue, especially in high-burden regions. Despite rate improvements, total cases rise due to population growth and care disparities. Targeted action and sustained investment are crucial to reduce its impact.

Funding: This work was supported by National Natural Science Foundation of China No.81873845 and No.82571965, Medical Interdisciplinary Innovation Program 2024，Zhejiang University School of Medicine.

Figure 1. Trends in neonatal preterm birth prevalence, incidence, deaths and disability-adjusted life-years from 1990 to 2021.
Figure 1.pdf

Figure 2. The global disease burden of neonatal preterm birth for both sexes in 204 countries and territories.
Figure 2.pdf