The Global Burden of Neonatal sepsis Attributable to Air Pollution From 1990 to 2021: findings from the Global Burden of Disease Study 2021

Qizhi Fu^1,2*jiajia Duan^1,2Ying Yu³Tao Jiang²Chuanxin Liu²Xiaoyang Bai²Min Wang²Hongxia Hu²Ruyan Chen²Dongxia Liu²Hetao Chen²Qiang Liu⁴Zhifeng Qu²Hong Fu⁴

• ¹Henan University of Science and Technology, Luoyang, China
• ²The First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China
• ³The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
• ⁴The Third People’s Provincial Hospital of Henan Province, Zhengzhou, China

Abstract Background Neonatal sepsis remains a major disease threatening the lives of newborns. With the escalating global air pollution, substantial evidence indicates that air pollution is among the primary environmental threats to children's health. However, its contribution to the global burden of neonatal sepsis and other neonatal infections remains unclear. Although existing studies have established associations between air pollution and adverse neonatal outcomes, a comprehensive evaluation differentiating pollution types and accounting for socio-economic disparities across geographic regions remains lacking. This study fills this critical evidence gap. Methods Based on data from the Global Burden of Disease (GBD) Study 2021, we analyzed associations between air pollution, particulate matter pollution, household air pollution from solid fuels, and ambient particulate matter pollution and neonatal sepsis and other neonatal infections, calculating deaths, disability-adjusted life years (DALYs), and their corresponding age-standardized rates (ASRs). Subsequently, cluster analysis and decomposition analysis were conducted to identify regional patterns and quantify contributing factors. Finally, an autoregressive integrated moving average (ARIMA) model was employed to forecast the disease burden from 2022 to 2050. Result In 2021, global deaths from neonatal sepsis and related infections attributable to air pollution numbered 54,026 (95% UI: 45,371-64,084), a 23.48% decrease from 1990, with age-standardized death rates dropping 1.49% annually (EAPC = -1.49). Deaths from household solid fuel pollution fell by 30.65%, while ambient particulate matter pollution caused a 13.05% increase to 13,080 deaths. Low-SDI regions bore the highest death burden with 31,063 cases, and Western Africa showed the highest age-standardized mortality rate of 2.21. African countries like Sierra Leone ranked top globally. Male deaths and DALYs consistently exceeded female figures. Population growth was the primary driver of global burden increase, contributing 621.99% to deaths, mitigated by epidemiological improvements. Projections indicate continuous declines in air/household pollution-related deaths 2022-2050, steeper in females, while ambient particulate matter deaths may peak in 2027 before easing. Conclusion Overall, air pollution remains a significant public health challenge threatening neonatal health. Implementing targeted, geographically tailored interventions is essential to reduce disease burden resulting from air pollution.