Urban–Rural Disparity in Preterm Neonatal Mortality in China: A Retrospective Study

Background The neonatal mortality rate (NMR) is a vital indicator for assessing maternal and child health, and preterm birth is one of the leading causes of neonatal mortality. Since 2010, China has implemented multiple maternal and child health policies aimed at reducing neonatal mortality. However, systematic research on urban-rural disparities in neonatal mortality among preterm births remains relatively scarce. In this study, we analyzed the national and subnational cause-specific death rates of preterm neonates in mainland China during 2010 to 2021 to provide data support for the further elimination of neonatal deaths. Methods In this retrospective study, we analyzed empirical data on levels and causes of preterm neonatal mortality data from the China Maternal and Child Health Surveillance System to show the cause-specific death rates, birthplaces and treatment levels at the national and subnational levels. Results Between 2010 and 2021, the top three causes of death in preterm neonates were preterm birth, birth asphyxia and congenital malformations in both urban and rural areas. From 2010 to 2021, the mortality rate among preterm neonates born at 28 to 31 gestational weeks was significantly higher than that among preterm neonates born at 32 to 33 gestational weeks and 34 to 36 gestational weeks in both urban and rural areas. We also found that in urban areas, 95.5% of preterm neonates were born at provincial (or municipal)-level hospitals in 2021, while this proportion was 60.2% in rural areas. Regarding the treatment level, the proportion of preterm neonates in rural areas who were diagnosed at district (or county)-level health facilities decreased from 46.7–21.8% from 2010 to 2021. In contrast, this proportion in urban areas was 6.5% in 2010 and 2.3% in 2021. Conclusions This study reveals the remarkable achievements China has made in reducing preterm neonatal mortality and narrowing the urban-rural disparity, while the gap between urban and rural preterm neonatal mortality is not negligible. Policy interventions have been the primary driving force behind the reduction of the urban-rural gap, while resource scarcity in remote western regions and the economic pressures faced by rural households remain significant challenges.