From past patterns to future preparedness: a secondary analysis of the Global Burden of Disease Study 2021 on neonatal communicable disease burden in China and the Asia-Pacific region, 1990-2035.

Background: Communicable diseases (CDs) is the leading cause of death among neonates worldwide, and achieving the Sustainable Development Goal (SDG) 3.2 target (ending preventable neonatal deaths) relies on evidence-based analysis of CDs burden trends and risk factors. This study aims to analyze the temporal trends of CDs burden among neonates in China and the Asia-Pacific region from 1990 to 2021 [based on the Global Burden of Disease (GBD) 2021 database], and project future to 2035, to provide targeted evidence for neonatal health interventions. Methods: This population-based secondary analysis of the GBD 2021 database quantified the incidence, prevalence, mortality, and disability-adjusted life years (DALYs) of neonatal CDs (population denominator: neonates in China and the Asia-Pacific region, 1990-2021). Joinpoint regression analysis was employed to evaluate the temporal trends of disease burden and calculate the estimated annual percentage change (EAPC). The autoregressive integrated moving average (ARIMA) model was adopted to forecast the neonatal CD burden from 2022 to 2035. Age-standardized rates [age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), age-standardized mortality rate (ASMR), age-standardized DALYs rate (ASDR)] were calculated to eliminate the impact of age structure differences on cross-regional comparisons. Results: In 2021, the numbers of incident cases, prevalent cases, deaths cases and DALYs cases of neonatal CDs were 3,741,300.85, 324,827.41, 10,443.43, 943,933.69 in China and 20,407,894.81, 1,786,458.55, 628,615.13, 56,613,320.39 in the Asia-Pacific region. From 1990 to 2021, the age-standardized rates of neonatal CDs showed a significant downward trend in both regions. The EAPC of the ASIR, ASPR, ASMR and ASDR of CDs among neonates was -2.48% [95% confidence interval (CI): -2.69, -2.27], -1.81 (95% CI: -1.89, -1.74), -9.40 (95% CI: -10.09, -8.70), -9.39 (95% CI: -10.08, -8.69) in China and -1.31 (95% CI: -1.40, -1.22), -1.02 (95% CI: -1.14, -0.89), -3.71 (95% CI: -3.88, -3.55), -3.71 (95% CI: -3.88, -3.55) in the Asia-Pacific region, with a higher reduction amplitude in China. Male neonates showed a higher disease burden, though the gender gap gradually narrowed. The ARIMA model predicted a continued decline in neonatal CD burden in China and the Asia-Pacific region by 2035, supporting progress toward SDG 3.2. Low birth weight and short gestation were identified as the leading risk factors, highlighting the critical need to strengthen perinatal care. Conclusions: The study reports a sustained decline in neonatal CDs rates across China and the Asia-Pacific region from 1990 to 2021, marking significant progress towards SDG 3.2. To further reduce disease burden and promote health equity, four targeted interventions are recommended: (I) improving perinatal care to lower preterm birth and low birth weight; (II) strengthening environmental controls and public health infrastructure; (III) implementing gender-specific interventions to address disparities; and (IV) ensuring balanced medical resource allocation, particularly in low- and middle-income countries. Projections indicate a continued decline through 2035, supporting regional and global neonatal health planning.