Temporal trends, pathogen distribution, and forecasted burden of neonatal meningitis in China (1990–2023): A descriptive analysis based on Global Burden of Disease 2023

Abstract

Background

Neonatal meningitis remains an important cause of mortality and health loss. We characterized temporal trends, pathogen distributions, and risk-attributable burden in China using Global Burden of Disease (GBD) 2023 estimates.

Methods

We analyzed GBD-modeled incidence, mortality, disability-adjusted life years, years of life lost, and years lived with disability among early (0–6 days) and late (7–27 days) neonates. Trends were assessed using estimated annual percentage change (EAPC) and segmented log-linear regression. Log-exponential smoothing (ETS) projected mortality through 2035, with log-ARIMA as a sensitivity analysis. Pathogen shares and GBD-estimated risk-attributable burden were also assessed.

Results

From 1990 to 2023, modeled incidence and mortality decreased from 715.7 and 98.0 to 79.0 and 4.5 per 100,000, respectively (EAPC = −7.6% [95% confidence interval {CI} −8.2 to −6.9] and −9.6% [95% CI −9.9 to −9.2]). Early-neonatal mortality remained higher than late-neonatal mortality (2023 rate ratio 1.8). Segmented regression identified 1997–2002 as the steepest decline. The 2035 log-ETS forecasts were 4.3 (95% prediction interval [PI] 0.5–10.4), 5.5 (95% PI 0.6–12.5), and 3.9 (95% PI 0.5–9.7) per 100,000 for overall, early, and late neonates. The cumulative share of pathogen-attributable mortality for the top five pathogens increased from 58.9% to 62.9%. Low birth weight and short gestation had the largest attributable fraction (47.7% [95% uncertainty interval 44.0%–51.1%]).

Conclusions

Despite substantial reductions in burden, persistent early-neonatal vulnerability and divergent exploratory forecasts underscore the need for clinical surveillance to validate these modeled findings and inform prevention.