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Global mortality and disability from neonatal pulmonary arterial hypertension show a steady decline from 1990 to 2021, yet incidence remains stable and the burden increasingly affects low- and middle-income countries.
Pulmonary arterial hypertension (PAH) in newborns stands as a rare but perilous condition, where rising pressure in the lungs strains the heart and threatens survival. Even with modern advances in neonatal care, its true global impact remains a mystery, especially across low- and middle-income nations. This landmark study set out to map the unseen burden of neonatal PAH, charting three decades of mortality, incidence, and disability-adjusted life years (DALYs) to reveal the hidden inequalities shaping infant survival worldwide.
The group of researchers analyzed neonatal PAH across 204 countries, examining trends by gender, year, and socio-demographic index (SDI). Mortality estimates were explored via the Cause of Death Ensemble modeling approach, while nonfatal outcomes were derived via the DisMod-MR 2.1 framework. With the help of slope index of inequality (SII) and concentration index of inequality (CII), inequalities were examined. Segmented regression and average annual percent change (AAPC) captured global shifts and disparities in neonatal PAH burden.
The findings revealed a remarkable decline in neonatal PAH mortality and disease burden over the past three decades, reflecting advances in neonatal care and early intervention. Table 1 below highlights key shifts in mortality and DALY rates between 1990 and 2021, underscoring significant progress alongside persistent disparities across regions.
Despite declining mortality and DALY rates, the incidence of neonatal PAH remained stable with a slight rise from 2016–2021 (AAPC: +0.15%; 95% confidence interval (CI): 0.09–0.22). The burden stayed highest in low- and lower-middle SDI regions, and widening inequality indices (CII: -0.29 to -0.34) underscored a growing concentration of cases in disadvantaged populations. A significant global decline in neonatal PAH mortality and DALY rates was observed, while incidence remained stable and inequalities intensified, predominantly in low-SDI regions. Advancing equitable neonatal care, enhancing diagnostic precision, and implementing targeted public health strategies were marked as essential to mitigate these persistent disparities.
Pediatric Pulmonology
Trends, Burden, and Inequality in Neonatal Pulmonary Arterial Hypertension: Global Estimates From 1990 to 2021
Xinbao Wang et al.
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