Trends in burden and mortality of congenital birth defects in G20 countries (1990-2021) and predictions for 2022-2040.

objectivesCongenital birth defects (CBDs) rank among the top five causes of death in children under the age of five. Despite their significant impact, studies on the burden of CBDs in G20 countries remain limited. This study sought to examine the temporal trends in the disease burden and mortality rates of CBDs across G20 countries from 1990 to 2021, identify potential risk factors contributing to these trends, and project the disease burden and mortality rates for the period 2022-2040.

methodData for this study were obtained from the Global Burden of Disease (GBD) 2021 and GBD 2019 databases. We analyzed trends in disability-adjusted life years (DALYs) and mortality rates for CBDs in G20 countries using absolute numbers, all-age rates, age-standardized rates (ASR), annual percent change (APC), and average annual percent change (AAPC). Joinpoint regression analysis was conducted to identify significant periods of change in ASR. Spearman correlation analysis with locally weighted regression, supplemented by 10,000 bootstrap iterations for robustness validation was used to examine the associations between the socio-demographic index (SDI), healthcare access and quality (HAQ) index, Summary exposure value (SEV) of risk factor exposure, and ASR. Decomposition analysis was performed to investigate the driving factors behind changes in CBDs. Finally, a Bayesian age-period-cohort (BAPC) model was applied to project DALYs and mortality rates for the period 2022-2040.

resultsFrom 1990 to 2021, the total DALYs and the number of deaths in G20 countries decreased by 59.77% (95% UI: 68.14-35.22%) and 63.81% (95% UI: 38.72-71.64%), respectively, with a more pronounced reduction observed in males compared to females. In 2021, India recorded the highest DALYs and deaths, followed by China and Indonesia. Mexico reported the highest age-standardized DALY rate (ASDR) and age-standardized mortality rate (ASMR), followed by Turkey, with Argentina ranking third for ASDR and Brazil third for ASMR. Congenital heart anomalies (CHAs) remained the leading cause of ASDR and ASMR among CBDs in 2021, with digestive congenital anomalies (DCAs) ranking second. Joinpoint regression analysis indicated that the most significant changes in ASDR in G20 countries occurred between 1995 and 2021 (APC = -2.58, 95% CI: -2.61 to -2.55), while the most pronounced changes in ASMR were observed between 2019 and 2021 (APC = -3.75, 95% CI: -4.75 to -2.86). The periods of significant change in ASR varied across countries. Spearman correlation analysis revealed that countries with higher SDI and HAQ index exhibited lower ASR (p < 0.01, 95% BCa CI excluded zero). Eleven level-3 risk factors showed a positive correlation with ASDR (p < 0.05, 95% BCa CI excluded zero), with the highest absolute correlation coefficients observed for occupational noise, unsafe sanitation, and vitamin A deficiency. Decomposition analysis showed that changes in aging and epidemiological patterns contributed to reductions of -26.19% and - 54.21% in DALYs, respectively, while population growth led to a 20.64% increase in DALYs. The driving factors for DALY changes varied across countries. The BAPC model predicted a declining trend in DALYs, deaths, and ASR of CBDs across all G20 countries in the future.

conclusionAlthough the burden of CBDs has declined in G20 countries, significant disparities persist between nations. To effectively reduce these gaps, enhanced international cooperation, increased investment in healthcare resources, and the implementation of more robust preventive measures are essential to effectively reduce the gap in the CBD burden across these countries.