Neonatal mortality trends in the 21st century: findings from the Global Burden of Disease Study 2021

OBJECTIVE: Neonatal mortality remains a significant global health challenge, particularly in low- and middle-income countries. This study aimed to analyze the trends and causes of neonatal mortality from 2000 to 2021. METHODS: Data on all-cause and cause-specific mortality were obtained from the Global Burden of Disease Study 2021. Joinpoint regressions were employed to calculate the annual percentage change and the average annual percentage change. Pearson's correlation was utilized to estimate the relationships between mortality rates and the Human Development Index. RESULTS: The global all-cause neonatal mortality rate has declined by an average of 2.1% per year since 2000, while the absolute number of neonatal deaths remained at 2.19 million globally in 2021. Neonatal disorders continued to be the leading cause of death among neonates in 2021, followed by congenital birth defects, lower respiratory infections, sexually transmitted infections excluding HIV, diarrheal diseases, and malaria. The neonatal mortality rate varied significantly across different countries and territories, ranging from 0.61 per 1000 livebirths in Andorra to 55.35 per 1000 livebirths in South Sudan. By 2021, 120 countries (58.8%) had achieved the Sustainable Development Goal 3.2 target. Additionally, strong negative correlations were found between mortality rates and Human Development Index (r = -0.867, P < 0.001). CONCLUSIONS: Despite significant progress, regional disparities persist; only half of the countries achieved the Sustainable Development Goal 3.2 target by 2021. These findings emphasize prioritized interventions for neonatal disorders in low/middle-income countries and highlight socioeconomic development as critical to equitable mortality reduction within public health frameworks.