Objective To analyze the long-term trends in the disease burden of neonatal disorders (NDs) and their subtypes in China from 1990 to 2023, and to project the burden from 2024 to 2038, thereby providing evidence for optimizing neonatal health strategies.

Methods Data on the incidence, prevalence, mortality, disability-adjusted life years (DALYs), years lived with disability (YLDs), and years of life lost (YLLs) for NDs and their subtypes [neonatal preterm birth (NPB), neonatal encephalopathy (NE), neonatal sepsis and other neonatal infections (NS), hemolytic disease and other neonatal jaundice (HD), and other neonatal disorders (ONDs)] in China from 1990 to 2023 were extracted from the Global Burden of Disease Study 2023. Joinpoint regression models were used to identify trend turning points in age-standardized rates (ASR), and ARIMA models were applied to project the ASR from 2024 to 2038.

Results In 2023, the age-standardized mortality rate (ASMR) of NDs in China was 2.30 per 100,000 [95%UI (1.88, 2.74)] and the age-standardized DALY rate (ASDR) was 365.97 per 100,000 [95%UI (315.07, 430.52)], representing decreases of 93.37% and 88.72%, respectively, compared with 1990. Regarding disability burden, the overall age-standardized YLD rate (ASR-YLD) increased by 30.19% relative to 1990. The ASR-YLD for NE showed an upward trend, whereas that for NPB showed a downward trend. Age-subgroup analysis revealed that early neonates bore a higher burden of mortality and YLLs, while late neonates bore a higher burden of prevalence and YLDs. Joinpoint regression indicated that the ASMR, ASDR, and age-standardized YLL rate (ASR-YLL) for NDs decreased at an accelerated pace from 2008 to 2021, with the rate of decline slowing after 2021. Predictive analysis indicates that by 2038, the age-standardized incidence rate of NDs in China is expected to show a slow downward trend, while the age-standardized prevalence and YLD rates will continue to rise. The ASMR, ASDR, and ASR-YLL, on the other hand, will keep declining and remain at relatively low levels.

Conclusion Between 1990 and 2023, the burden of NDs in China was characterized by a decline in mortality rates, sub-categorization of the burden of disability, and differences across age groups; over the next 15 years, prevention and control efforts should focus on the long-term management of late-onset neonatal deaths and subtypes such as NE.

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