Global, regional, and national trends in maternal hemorrhage, 1992-2021: a hierarchical cluster and age-period-cohort analysis of the Global Burden of Disease Study 2021 and projections to 2036.

BACKGROUND

Maternal hemorrhage (MH) remains a leading cause of maternal morbidity and mortality worldwide. Understanding global trends and future projections is essential for informing effective health strategies.

METHODS

This study drew on data from the Global Burden of Disease (GBD) 2021 study and applied hierarchical cluster analysis, the age-period-cohort (APC) model, and the Bayesian age-period-cohort (BAPC) model to assess MH incidence, age-standardized incidence rates (ASIRs), and net drift from 1992 to 2021, as well as to forecast trends through 2036.

RESULTS

From 1992 to 2021, the global annual incidence of MH modestly increased from 13,847,163 to 13,914,838 cases. Despite this, the ASIR decreased from 948.07 to 722.16 per 100,000 people, with a net drift of -0.83 (95% uncertainty intervals (UIs): -1.03 to -0.64), indicating a reduction in risk, especially in low and low-middle socio-demographic index (SDI) regions. Persistent challenges remain in certain Sub-Saharan Africa countries, Eastern Europe, and East Asia. Saudi Arabia has made significant progress in managing and preventing MH. According to APC model analyses, women aged 20-29 are at the highest risk, although improvements have been observed since 2002, with decreasing risks in subsequent generations. BAPC model projections suggest that by 2036, the number of global MH cases will reduce to 10,287,971, with an expected ASIR of 479.83 per 100,000 people (95% UI: 479.82 to 479.83).

CONCLUSIONS

Although global MH burden has decreased, substantial disparities persist across regions and age groups. Targeted public health efforts are needed, particularly in Europe, East Asia, parts of Sub-Saharan Africa, and among women aged 20-29, to further mitigate the impact of MH.