Trends and urban-rural disparities in infant and cause-specific mortality in Shaanxi Province, China, 2014-2023: a population-based study.

BACKGROUND

China has achieved substantial reductions in infant mortality; however, pronounced subnational disparities persist, particularly in western and rural regions. In the context of demographic change and evolving perinatal risk profiles, region-specific evidence is essential to guide targeted interventions and support progress toward Sustainable Development Goal (SDG) 3.2.

METHODS

This population-based observational study analyzed data from the Maternal and Child Health Surveillance System (MCHSS) in Shaanxi Province, China, from 2014 to 2023. A total of 320,259 live births and 954 infant deaths were recorded across 141 surveillance sites. Temporal trends in infant mortality rates (IMRs) were assessed using Joinpoint regression to estimate average annual percentage changes (AAPCs). Urban-rural differences and temporal trends were further evaluated using generalized linear models.

RESULTS

The IMR in Shaanxi Province declined from 4.18 per 1,000 live births in 2014 to 2.16 in 2023 (AAPC: -6.31%, P < 0.001). Declines were observed in rural (AAPC: -10.58%, P < 0.001) and urban areas (AAPC: -5.44%, P = 0.003), although regression analysis did not identify statistically significant differences in temporal trends between residence groups (P = 0.152). Most infant deaths occurred during the neonatal period (62.1%). The leading causes of infant death were congenital heart defects (CHDs), birth asphyxia, pre-term birth and/or low birth weight (preterm/LBW), pneumonia, other congenital anomalies, and accidental asphyxia. Cause-specific mortality from congenital anomalies declined significantly (CHDs: AAPC -6.18%, P = 0.002; other congenital anomalies: AAPC -6.44%, P = 0.002). Pneumonia-related mortality also decreased markedly, particularly in urban areas (AAPC: -41.19%, P = 0.028).

CONCLUSION

Infant mortality in Shaanxi Province declined substantially between 2014 and 2023, with broadly parallel trends in urban and rural populations. Despite this progress, pre-maturity-related conditions and injuries remain important contributors to infant death. Strengthening neonatal care systems, expanding birth defect prevention programs, and implementing targeted injury prevention strategies, particularly in underserved rural areas, may support further reductions in infant mortality and promote equitable progress toward SDG 3.2.