Global trends, regional disparities and key determinants of neonatal sepsis: A pan-database analysis from 1990 to 2021.

OBJECTIVE

Neonatal sepsis (NS) poses a significant global health challenge, with mortality rates ranging from 11% to 19%. Despite its substantial burden, there is currently a lack of systematic understanding of the global epidemiological trends and influencing factors of NS.

STUDY

DESIGN

We conducted a comprehensive pan-database analysis integrating data from 18 international databases across 201 countries (1990-2021). Through advanced statistical modeling, including correlation analyses, risk parsimonious modeling, and confounder adjustments, we examined temporal trends, regional disparities, and key determinants of NS.

RESULTS

While NS prevalence increased annually due to improved detection, age-standardized rates showed consistent declines. For NS incidence, novel correlates included European ancestry (strongest), systolic/diastolic blood pressure, and inverse associations with Human Development Index. We developed a parsimonious model incorporating diastolic blood pressure, Global Hunger Index, and European ancestry, which showed strong cross-regional predictive capability (r = 0.727). For mortality, socioeconomic factors were primary correlates: positive associations with Global Hunger Index and food insecurity, and inverse associations with Inequality Adjusted HDI.

CONCLUSION

This first comprehensive global analysis reveals that NS outcomes are determined by both medical and socioeconomic factors. While blood pressure metrics and genetic factors influence incidence, mortality is primarily driven by socioeconomic determinants. These findings suggest that reducing NS burden requires a dual approach: enhancing medical care while addressing fundamental socioeconomic disparities, particularly in resource-limited regions.