Newborn PAH deaths drop globally, but inequalities remain: Analysis
Mortality, disability rates higher in countries with low economic status
Global death rates and levels of disability among newborns with pulmonary arterial hypertension (PAH) have declined since 1990, while the incidence of new cases has remained stable, according to a 30-year analysis.
Still, mortality and disability rates are disproportionately higher in countries with low economic status, “underscoring the critical need for equitable access to neonatal care, improved diagnostics, and targeted health interventions to reduce preventable deaths and disparities,” researchers wrote.
The study, “Trends, Burden, and Inequality in Neonatal Pulmonary Arterial Hypertension: Global Estimates From 1990 to 2021,” was published in Pediatric Pulmonology.
Burden of PAH in the newborn remains poorly defined
Neonatal PAH is a rare but life‐threatening disorder affecting newborns. It’s characterized by a narrowing of the pulmonary arteries, the blood vessels that pass through the lungs, which drives up blood pressure and increases the risk of right heart failure.
Newborns with PAH often present with abnormally low levels of oxygen in the blood, even with oxygen supplementation. In addition to an increased risk of death, many infants face long‐term health problems, including developmental delays and chronic lung complications.
Despite advances in neonatal intensive care, the burden of PAH in newborns remains poorly defined, particularly in low‐ and middle‐income countries, the researchers wrote.
To address this, researchers in China used data from the Global Burden of Disease Study 2021 to estimate the incidence, mortality, and disability burden of PAH in newborns younger than 28 days across 204 countries from 1990 to 2021.
Number of new cases per 100K live births remained stable from 1990 to 2021
Globally, the number of incident, or new, cases of neonatal PAH per 100,000 live births remained stable between 1990 and 2021 (17.82 vs. 17.85). Even so, a marginal increase was observed during 1990 to 1999, followed by a short decline from 1999 to 2016 and a slight uptick from 2016 to 2021. The global incidence rate in 2021 per 100,000 live births was higher for girls with PAH than for boys (0.212 vs. 0.156).
In 1990, the highest incidence rates were observed in Eastern, Western, and Central sub-Saharan Africa, while the lowest rates were found in high-income regions of North America and the Asia Pacific. By 2021, Eastern and Central Sub-Saharan Africa still had the highest incidence rates of neonatal PAH.
Worldwide, the number of neonatal deaths due to PAH per 100,000 live births significantly decreased over this time (12.44 vs. 4.86). The steepest decline occurred between 2011 and 2021, followed by a moderate reduction from 1990 to 2011. The global death rate in 2021 was higher for boys with PAH than for girls (5.9 vs. 3.76).
In 1990, the highest mortality rates were recorded in North Africa and the Middle East, as well as in the Caribbean, all of which remained high in 2021, along with Oceania. Also in 1990, the lowest rates were observed in Southern Sub-Saharan Africa and Central Asia. The most pronounced recent declines in death rates were seen in Eastern Europe, Southern Latin America, and North Africa and the Middle East.
Despite substantial global progress in reducing neonatal PAH mortality and DALYs over the past three decades, persistent incidence rates and widening inequalities underscore ongoing challenges. Addressing these disparities through targeted investments in healthcare infrastructure, diagnostic capabilities, and equitable resource distribution is critical to improving neonatal cardiovascular outcomes worldwide.
The burden of PAH among neonates also substantially decreased globally, as assessed with the disability-adjusted life years (DALYs), or the number of healthy years lost due to disability or premature death. An accelerated decline in DALYs was observed during 2011-2021. The global DALY burden in 2021 was higher in boys with PAH than in girls (530.5 vs. 338.3).
The highest age-standardized DALY rates in 1990 were observed in North Africa and the Middle East, as well as South Asia, while the lowest rates were recorded in Southern Sub-Saharan Africa and Central Asia. By 2021, North Africa and the Middle East, South Asia, and Oceania had the highest DALY rates. Eastern Europe, Southern Latin America, and North Africa and the Middle East had the most substantial decreases in DALYs.
Across all regions, the researchers found a significant relationship between a higher incidence, death rate, and DALY burden of neonatal PAH and a lower socioeconomic status, as indicated by the socio-demographic index (SDI), a composite measure of income, education, and fertility.
Lastly, the death rates due to neonatal PAH, the DALY burden, and the number of new PAH cases have become disproportionately higher in socioeconomically disadvantaged populations with lower SDI rankings.
“Despite substantial global progress in reducing neonatal PAH mortality and DALYs over the past three decades, persistent incidence rates and widening inequalities underscore ongoing challenges,” the researchers concluded. “Addressing these disparities through targeted investments in healthcare infrastructure, diagnostic capabilities, and equitable resource distribution is critical to improving neonatal cardiovascular outcomes worldwide.”
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