Trends and burden of maternal disorders in China from 1990 to 2023: Analysis of the Global Burden of Disease Study 2023.

Abstract

Background: Maternal morbidity and mortality are one of the key indicators of social development and are among the most challenging public health problems. This study aimed to analyze the trends and burden of maternal disorders in China from 1990 to 2023.

Methods: The crude and age-standardized prevalence, mortality, and disability-adjusted life years (DALYs) for maternal disorders from 1990 to 2023 were analyzed using data on maternal disorders in China from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023. The changing trends of prevalence, mortality, and DALYs were evaluated by the average annual percentage change (AAPC) calculated using a log-transformed linear regression model. The ranks of the leading causes for maternal disorders in terms of prevalence, mortality, and DALYs in 1990, 2015, and 2023 were estimated to determine the impact of changes in the fertility strategy on maternal disorder patterns as China implemented the two-child policy in 2015.

Results: In 2023, the age-standardized prevalence, mortality, and DALYs of maternal disorders among reproductive women aged 15-49 years in China were 193.04 (95% confidence interval [CI]: 192.56-193.54), 0.30 (95% CI: 0.28-0.32), and 27.78 (95% CI: 27.59-27.97) per 100,000 population, respectively. The prevalence showed a declining trend with fluctuations, and the mortality and DALYs both showed consistent decrease from 1990 to 2023, with AAPCs of -1.41% (95% CI: -1.92% to -0.90%), -10.64% (95% CI: -11.18% to -10.11%), and -9.37% (95% CI: -9.87% to -8.88%), respectively. In terms of the leading cause of death among the 10 available maternal disorders in GBD, maternal hemorrhage ranked first in 1990 (3.53 per 100,000) but decreased to third in 2015 (0.10 per 100,000) and 2023 (0.05 per 100,000). Among the 10 available maternal disorders in GBD 2023, the prevalence of maternal hypertensive disorders changed from first in 1990 to second both in 2015 and 2023. The other direct maternal disorders became the leading causes of prevalence and DALY during 2015 to 2023. Indirect maternal deaths ranked as the leading cause of mortality during 2015 to 2023.

Conclusions: There has been a substantial decline in prevalence, mortality, and burden of maternal disorders in China during the past three decades. However, additional efforts are needed for decreasing the burden of maternal disorders, especially for maternal hypertensive disorders.