The Changing Burden of Neonatal Disorders in China from 1990 to 2021: A Longitudinal Analysis of Mortality, Disability, and Attributable Risk Factors

Background Despite notable reductions in child mortality over the past three decades in China, neonatal health improvements have lagged. Advancements in medical care have improved survival for high-risk newborns, leading to a critical shift in the disease burden from premature death, measured in Years of Life Lost, toward long-term disability, measured in Years Lived with Disability. In this context, our research investigates the enduring trends, significant risk factors, and anticipated future scenarios of the neonatal disease burden in China spanning the 31 years from 1990 to 2021. Methods Data were obtained from the Global Burden of Disease Study 2021. Key indicators—incidence, prevalence, mortality, disability-adjusted life years (DALYs), YLLs, and YLDs—were extracted for Chinese neonates. Joinpoint regression was used to assess temporal trends (APC, AAPC), and the ARIMA model was applied for 10-year projections. The CRA framework was employed to assess the burden linked to significant risk factors. Results Between 1990 and 2021, neonatal deaths declined by 90.8%, and the age-standardized mortality rate decreased by 81.1%. Incidence declined by 67.5%, while prevalence increased by 10.1%. DALYs and YLLs decreased by 83.9% and 90.8%, respectively. In contrast, YLDs increased by 42.5%, with an age-standardized YLDs rate rising by 32.1%. Low birth weight and preterm birth were the main risk factors, contributing to over 80% of the total burden and nearly all YLDs. ARIMA forecasts suggest ongoing reductions in mortality alongside a minor rise in YLDs. Conclusion While neonatal mortality in China has substantially decreased, the burden has shifted toward long-term disability. Strategic focus should transition from mortality reduction to comprehensive care that includes early rehabilitation and long-term follow-up for high-risk infants.