Global, regional, and national burden of neonatal disorders and subtypes attributable to air pollution from 1990 to 2021: a systematic analysis of the Global Burden of Disease Study 2021.

Background: Exposure to air pollution is associated with the development of numerous neonatal diseases (NDs). This study aimed to evaluate the worldwide changes in the burden of NDs attributable to air pollution from 1990 to 2021.

Methods: The 2021 Global Burden of Disease Study (GBD) reported neonatal deaths attributable to air pollution and the associated age-standardized rates and disability-adjusted life years (DALYs). To assess the global burden of NDs and the subtypes, age-standardized DALY rates (ASDARs) and age-standardized death rates (ASDRs) were employed. The estimated annual percentage change (EAPC) was used to track global and regional temporal trends from 1990 to 2021. Spearman's rank correlation coefficients were applied to evaluate the relationship between the sociodemographic index (SDI), ASDARs, and ASDRs for NDs. The slope inequality index and concentration index were derived from health inequality analyses to measure international disparities. Finally, frontier analysis were employed to determine optimal burden for NDs at corresponding SDI levels.

Results: In 2021, the air pollution-related NDs resulted in 496,966 deaths and 44,737,311 DALYs worldwide. The burden for NDs showed a decreasing trend globally in past three decades. Neonatal preterm birth was the most severe subtype of NDs in 2021. With the global and regional increase in the SDI, the ASDR and ASDAR for five NDs subtypes have decreased. Significant absolute and relative income disparities in the burden of DALYs and mortality due to NDs were observed worldwide. Frontier analysis indicated inverse correlations between the ASDR/ASDAR and SDI, with the Solomon Islands, a low SDI country, showing the smallest overall differences.

Conclusion: Although the burden of air pollution-induced NDs has decreased, it remains a significant public health concern, with regional disparities. More nuanced policies and preventive measures are needed to reduce the burden of NDs.