Liang Xifeng, Lyu Yaning, Li Jing, Li Yu, Chi Cheng
School of Nursing, Jining Medical University, Jining, 272067, Shandong, China.
School of Nursing, Shandong Second Medical University, Weifang, 261021, Shandong, China.
EClinicalMedicine. 2024 Sep 24;76:102840. doi: 10.1016/j.eclinm.2024.102840. eCollection 2024 Oct.
Preterm birth and its complications are leading causes of mortality among children under five years of age. Given the increasing burden of preterm birth on neonatal mortality and long-term health outcomes worldwide, a comprehensive global analysis is essential to guide effective public health interventions and policies. This study aims to assess the burden of preterm birth at the global, regional, and national levels.
Using data from the Global Burden of Disease (GBD) 2021 database, this study analysed trends in age-standardized incidence rates (ASIR), age-standardized mortality rates (ASMR), and disability-adjusted life-years (DALYs) as primary outcomes for preterm birth from 1990 to 2021 at global, regional, and national levels. Data were assessed using joinpoint regression analysis, decomposition analysis, and the health inequality concentration index.
Globally, the incidence, mortality and DALYs due to preterm birth have shown a declining trend, but ASIR started to increase in 2016. Males were more commonly born preterm than females (12329075.82, 95% uncertainty interval [UI]: 12192632.55-12464605.4 vs. 9224694.94, 95% UI: 9113876.1-9330107.89). Changes in DALYs were primarily due to epidemiological change (111.97%) and population (-21.59%). Low Socio-demographic Index (SDI) regions increased in annual incidence cases (43.1%, 95% UI: 40.17-46.09), while high SDI regions decreased in annual incidence cases (-9.6%, 95% UI: -11.45 to -7.79). The highest annual mortality and DALYs respectively occurred in sub-Saharan Africa (295490.66, 95% UI: 241762.78-353624.41) and South Asia (32760273.93, 95% UI: 27295547.76-39070225.69). Western sub-Saharan Africa showed the largest increase in annual incidence (98.95%, 95% UI: 94.77 to 103.09), and Australasia had the lowest annual mortality (287.18, 95% UI: 244.26-339.42) and DALYs (61081.4, 95% UI: 50897.33-73069.96). Western sub-Saharan Africa also had the highest ASMR (21.57, 95% confidence interval [CI]: 17.9-25.89). The highest ASIR (543.78, 95% CI: 535.11-553.21) and age-standardized DALYs (2064.65, 95% CI: 1717.27-2473.36) both occurred in South Asia, while the lowest ASIR and age-standardized DALYs were seen in East Asia (147.31, 95% CI: 144.22-150.85) and High-income Asia Pacific (143.32, 95% CI: 117.9-167.25). India, Nigeria, and Pakistan ranked highest globally in terms of annual incidence cases, mortality, and DALYs, while the lowest annual incidence, mortality and DALYs respectively occurred in Tokelau (2.34, 95% UI: 2.12-2.56), San Marino (0.04, 95% UI: 0.02-0.07) and Tokelau (17.22, 95% UI: 11.11-24.95).
While the global burden of preterm birth has decreased, significant disparities persist, especially in low SDI regions. There is a need for more refined policies and preventive measures to effectively address preterm birth.
No funds, grants, or other support was received.
早产及其并发症是五岁以下儿童死亡的主要原因。鉴于早产对全球新生儿死亡率和长期健康结果的负担日益加重，进行全面的全球分析对于指导有效的公共卫生干预措施和政策至关重要。本研究旨在评估全球、区域和国家层面的早产负担。
本研究使用全球疾病负担（GBD）2021数据库的数据，分析了1990年至2021年全球、区域和国家层面早产的年龄标准化发病率（ASIR）、年龄标准化死亡率（ASMR）和伤残调整生命年（DALY）趋势作为主要结果。使用连接点回归分析、分解分析和健康不平等集中指数对数据进行评估。
全球范围内，早产导致的发病率、死亡率和伤残调整生命年呈下降趋势，但年龄标准化发病率在2016年开始上升。男性早产的情况比女性更常见（12329075.82，95%不确定区间[UI]：12192632.55 - 12464605.4对9224694.94，95% UI：9113876.1 - 9330107.89）。伤残调整生命年的变化主要归因于流行病学变化（111.97%）和人口因素（-21.59%）。社会人口指数（SDI）较低的地区年发病例增加（43.1%，95% UI：40.17 - 46.09），而SDI较高的地区年发病例减少（-9.6%，95% UI：-11.45至-7.79）。年死亡率和伤残调整生命年最高分别出现在撒哈拉以南非洲（295490.66，95% UI：241762.78 - 353624.41）和南亚（32760273.93，95% UI：27295547.76 - 39070225.69）。撒哈拉以南非洲西部年发病率增长幅度最大（98.95%，95% UI：94.77至103.09），澳大拉西亚年死亡率最低（287.18，95% UI：244.26 - 339.42），伤残调整生命年最低（61081.4，95% UI：50897.33 - 73069.96）。撒哈拉以南非洲西部年龄标准化死亡率也最高（21.57，95%置信区间[CI]：17.9 - 25.89）。年龄标准化发病率最高（543.78，95% CI：535.11 - 553.21）和年龄标准化伤残调整生命年最高（2064.65，95% CI：1717.27 - 2473.36）均出现在南亚，而年龄标准化发病率和年龄标准化伤残调整生命年最低出现在东亚（147.31，95% CI：144.22 - 150.85）和高收入亚太地区（143.32，95% CI：117.9 - 167.25）。印度、尼日利亚和巴基斯坦在全球年发病例、死亡率和伤残调整生命年方面排名最高，而年发病率、死亡率和伤残调整生命年最低分别出现在托克劳（2.34，95% UI：2.12 - 2.56）、圣马力诺（0.04，95% UI：0.02 - 0.07）和托克劳（17.22，95% UI：11.11 - 24.95）。
虽然全球早产负担有所下降，但显著差异仍然存在，尤其是在社会人口指数较低的地区。需要更精细的政策和预防措施来有效应对早产问题。
未获得任何资金、赠款或其他支持。
