Global, regional, and national time trends in disability-adjusted life years for neonatal preterm birth, from 1992 to 2021: an age-period-cohort analysis for the Global Burden of Disease Study 2021

Yuhang Wu¹Jianzhong Zuo²Chu Liu¹Ziye Li¹Le Zhang²Yao Zou²Xiaochan Wang^2*Lizhang Chen^1*Tingting Wang^1*

• ¹Central South University, Changsha, China
• ²Xiangtan Central Hospital, Xiangtan, Hunan Province, China

Background: Neonatal preterm birth emerges as a leading cause of neonatal mortality and morbidity. Although there is a growing recognition of the urgent need to address the global health challenges posed by neonatal preterm birth, the underlying causes behind the complex and multidimensional trends contributing to its burden, as well as potential intervention pathways, remain unclear. We aim to characterize and deeply analyze the global, regional, and national neonatal preterm birth burden and their trends from 1992 to 2021. Methods: Data on the number, all-age rate, age-standardized rate (ASR), and the relative change of neonatal preterm birth disability-adjusted life years (DALYs) were obtained from the Global Burden of Disease Study (GBD) 2021. Correlations of ASR with Socio-demographic Index (SDI) were evaluated by Spearman's rank correlation analyses. Furthermore, age-period-cohort modeling was used to estimate the net drift (overall annual percentage change), local drift (age-specific annual percentage change), age, period, and cohort effects over the past three decades. Results: Globally, the number of neonatal preterm birth DALYs decreased by 34.0% from 121633 in 1992 to 80335 in 2021, and the ASR in 2021 was 1254.24 per 100,000 population, representing a reduction of 35.2% from 1992. The net drift ranged from 0.257% for high SDI region to 1.382% for low SDI region. A negative correlation was observed between ASR and SDI in 2021 at national levels. There has been a transition of DALYs from the neonatal population to older age groups (≥5 years) from 1992 to 2021. Regions and countries exhibited similar age-effect patterns, with decreasing risk with increasing age, and varying period and cohort effects. Conclusions: The global burden of neonatal preterm birth showed an overall declining trend from 1992 to 2021, but persistent health inequalities between regions and countries were driven by socioeconomic disparities. Neonatal preterm birth remains a crucial issue in children, and its growing long-term impact must not be overlooked. Each country presents unique trends, and tailored public health strategies in different settings are critical to managing the burden of preterm neonatal birth.