Burden of congenital birth defects in the ten countries with the highest numbers of births from 1990 to 2023, with projections to 2040: A retrospective population-level ecological study.

ObjectiveCongenital birth defects (CBDs) are major causes of neonatal mortality and lifelong disability worldwide. The ten countries with the highest numbers of births account for over half of global neonates, yet their CBD burden trends remain insufficiently studied. This study aimed to assess the CBD burden and temporal trends in these countries from 1990 to 2023 and project trends to 2040.MethodsWe conducted a retrospective population-level ecological study using publicly available data from the Global Burden of Disease Study 2023 on CBD burden. We analysed incidence, mortality, disability-adjusted life-years (DALYs), and age-standardized rates (ASRs) for CBDs in India, China, Nigeria, Pakistan, Indonesia, the Democratic Republic of the Congo, Ethiopia, the United States, Bangladesh, and Brazil from 1990 to 2023. Temporal trends were assessed using estimated annual percentage change (EAPC), future trends (2024-2040) were projected using ARIMA models, and associations with the Socio-demographic Index (SDI) were evaluated by Spearman correlation.ResultsIn 2023, India had the highest number of CBD cases (1,160,697), followed by Nigeria and China. Ethiopia showed the highest age-standardized incidence rate, while the United States had the lowest. From 1990 to 2023, age-standardized incidence, mortality, and DALYs generally declined, with China showing the largest reductions in mortality and DALYs. Nigeria was the only country with increasing mortality. Congenital heart anomalies were the leading cause of deaths and DALYs across all countries. Neural tube defects showed the greatest decline in incidence, whereas urogenital congenital anomalies demonstrated increasing mortality trends. SDI was negatively correlated with incidence, mortality, and DALYs (all P < 0.05). ARIMA projections suggested increasing ASIR in several countries, particularly China and Indonesia, while China and Nigeria were projected to experience increases in ASMR and ASDR through 2040, particularly among females, while Bangladesh, Ethiopia, and the United States are expected to remain stable or decline.ConclusionThe CBD burden showed marked heterogeneity across the ten countries with the highest numbers of births. Strengthening healthcare systems, prenatal care, and screening in low-SDI countries, together with targeted prevention strategies in countries with projected increases, may help reduce the global CBD burden and improve health equity.