The global burden of disease attributable to preterm birth and low birth weight in 204 countries and territories from 1990 to 2019: An analysis of the Global Burden of Disease Study

Abstract

Background: Preterm birth and low birth weight (PBLBW), recognised globally as primary contributors to infant mortality in children under five, have not been sufficiently investigated in terms of their worldwide impact. In this study we aimed to thoroughly evaluate the contemporary trends in disease burden attributable to PBLBW.

Methods: We analysed data from 204 countries and territories between 1990-2019, as sourced from the 2019 Global Burden of Disease Study. We analysed the global incidence of mortality and disability-adjusted life years (DALYs) associated with PBLBW, stratified by age, gender, year, and geographic location, alongside the socio-demographic index (SDI). We calculated the annual percentage changes to evaluate the dynamic trends over time. We employed a generalised linear model and scrutinised the relationship between the SDI and the disease burden attributed to PBLBW.

Results: In 2019, the global age-standardised rate of deaths and DALYs related to PBLBW showed significant declines. Over the period 1990-2019, both death and DALY rates displayed substantial downward trends, with similar change trends observed for both females and males. Age-specific ratios revealed a decrease in PBLBW-related deaths and DALYs with increasing age, primarily during the neonatal stages (zero to 27 days). The leading three causes of PBLBW-related DALYs in 2019 were neonatal disorders, lower respiratory infections, and sudden infant death syndrome. Furthermore, the association between SDI and PBLBW-related DALYs indicated that the age-standardised DALY rates in 204 countries and territories worldwide were negatively correlated with SDI in 2019. From 1990 to 2019, the age-standardised DALY rates decreased linearly in most regions, except sub-Saharan Africa.

Conclusions: The persistent global burden of disease associated with PBLBW is particularly pronounced in neonates aged less than 28 days and in regions with low SDI. In this study, we highlighted the critical need for tailored interventions aimed at mitigating the detrimental effects of PBLBW to attain specific sustainable development goals, particularly those centred on enhancing child survival and overall well-being.

Figure 1

Age-specific numbers and rates of deaths and DALYs attributable to preterm birth and low birth weight by sex in 2019. Panel A. Deaths. Panel B. DALYs. DALY – disability-adjusted life year.

Figure 2

Age-standardised death and DALY rates attributable to preterm birth and low birth weight in 2019. Panel A. Deaths. Panel B. DALYs. DALY – disability-adjusted life year.

Figure 3

Fraction of neonatal disorders, lower respiratory infections and sudden infant death syndrome age-standardised death DALYs attributable to PBLBW by region for females and males in 2019. The three leading GBD-level three causes of PBLBW-related DALYs are shown. DALY – disability-adjusted life year, PBLBW – preterm birth and low birth weight, GBD – Global Burden of Disease Study.

Figure 4

Age-standardised DALY rates attributable to preterm birth and low birth weight across 21 GBD regions by socio-demographic index (1990–2019). For each region, points from left to right depict estimates from each year from 1990 to 2019. DALY – disability-adjusted life year, GBD – Global Burden of Disease Study.

Figure 5

Age-standardised DALY rates attributable to preterm birth and low birth weight across 204 countries and territories by socio-demographic index in 2019. DALY – disability-adjusted life year.