Age-period-cohort analysis, attributable risk factors, and trend prediction of maternal and neonatal disease burden in China and G20 countries from 1990 to 2023

Abstract

Objectives Maternal and neonatal disorders remain leading causes of death and disability, this study analyzes its trends, risks, and projects future burdens. Methods We collected the age-standardized rates for incidence, prevalence, mortality, disability-adjusted life years, and years lived with disability from the GBD database between 1990 and 2023. Joinpoint regression estimated average annual percentage changes. Age-period-cohort models decomposed independent effects of age, period, and birth cohort. Autoregressive integrated moving average models projected trends. Results From 1990 to 2023, age-standardized mortality rates in China declining, outpacing the G20 average. However, age-standardized years lived with disability rates rose persistently in both China (0.97%) and the G20 (1.45%). Age-period-cohort analysis identified the highest incidence in women aged 25–29 years, and in newborns<5 years old; although attributable mortality fell by 97.5% in China, attributable years lived with disability decreased by only 18.3%. The fitted model projects an increase in China's age-standardized incidence rates (1065.11 per 100,000), whereas G20 is expected to decline. Conclusions Despite remarkable mortality reductions, the persistent rise in disability—driven largely by survival of high-risk neonates and environmental risks—signals an urgent need for integrated health system strategies, and build rehabilitation planning capacity.