Global, Regional, and National Epidemiology of Postpartum Hemorrhage (1990-2021): A Statistical Analysis of Incidence, Mortality, and DALYs.

BACKGROUND AND AIMS: Postpartum hemorrhage (PPH) is a leading global cause of maternal mortality and morbidity. This study utilizes global burden of disease (GBD) data to assess its long-term trends in incidence, mortality, and disability-adjusted life years (DALYs).

METHODS

Using data from the GBD, we analyzed age-standardized incidence, mortality, and DALY rates among reproductive-aged women (15-49 years). Trend analysis was conducted via Joinpoint regression to estimate annual percentage changes (APCs), while future burden projections were modeled using Bayesian age-period-cohort (BAPC) analysis.

RESULTS

From 1990 to 2021, the global age-standardized incidence rate (ASIR) of PPH declined significantly from 998.26 (95% UI: 654.55-1,438.33) to 722.16 (95% UI: 482.99-1,022.71) per 100,000 population. The estimated annual percentage change (EAPC) was -0.83% (95% UI: -0.90% to -0.77%). Projections suggest this downward trend will continue, with ASIR expected to reach 321.17 (95% UI: 302.55-359.30) by 2035. In 2021, women aged 20-24 years continued to exhibit the highest DALYs, amounting to 749,063 years (95% UI, 629,108.37-894,035.97). From 1990 to 2021, the proportion of DALYs among women of reproductive age attributable to iron deficiency-related PPH increased from 17.19% (95% UI, 8.65% to 21.48%) to 17.96% (95% UI, 8.67% to 23.95%).

CONCLUSION

A sustained decline in the incidence of PPH over the past thirty years-a trend projected to continue through 2035, reflecting the ongoing effectiveness of public health interventions. We also found a potential association with iron deficiency, alongside a consistently higher disease burden observed among women aged 20-24 years.