Time-Trend Analysis of Low Birthweight in Greece: Mapping a Heavy Public Health Burden

Low birthweight is a critical determinant of neonatal and infant mortality and is further associated with several long-term adverse health outcomes. This study aims to comprehensively analyze low birthweight rate (LBWR) trends in Greece from 1980 to 2023.

National official data on live births in Greece from 1980 to 2023 were obtained from the Hellenic Statistical Authority, based on birth certificate records. A total of 4,593,229 live births were analyzed and categorized by birthweight. The annual LBWR (birthweight < 2,500 g) and very low birthweight rate (VLBWR) (birthweight < 1,500 g) were calculated per 100 total live births. Additionally, the annual moderately low birthweight rate (MLBWR) was computed separately for two subgroups: 1,500-1,999 g and 2,000-2,499 g. Time trends for these rates were evaluated using joinpoint regression analysis, and the annual percent change (APC) was calculated with 95% confidence intervals (95% CI).

After a decade of stability from 1980 to 1990, the LBWR in Greece entered a 20-year period of consistent increase (1990-2010), with an APC of 2.3 (95% CI: 1.9 to 4.9). In the most recent period (2010-2023), the LBWR has plateaued at high levels. The LBWR reached its lowest point in 1982 at 5.58% and increased by 80%, reaching historically high levels in 2022 and 2023 at 10.07% and 10.02%, respectively. Since 2008, it has consistently remained above 9%. The VLBWR exhibited a steady upward trend throughout the entire 1980-2023 period with an APC of 0.9 (95% CI: 0.7 to 1.1) and increased from a low of 0.70% in 1980 to a peak of 1.20% in 2010. For the 2,000-2,499 g category, the MLBWR rose steadily over three decades (1980-2010: APC = 2.0, 95% CI: 1.8 to 2.3) and remained essentially unchanged from 2010 to 2023. In contrast, the MLBWR for the 1,500-1,999 g group showed a non-significant trend during 1980-1990, followed by a rapid increase between 1990 and 2001 (APC = 3.9, 95% CI: 2.9 to 7.9), which continued at a slower pace from 2001 to 2023 (APC = 1.0, 95% CI: 0.5 to 1.3).

During 1980-2023, the LBWR increased by 80%, with significant rising trends in the 1990s and 2000s, resulting in Greece having the highest rates among high-income countries. Whereas the overall LBWR has stabilized since 2010, there has been a continued rise in the proportion of neonates with birthweight < 2,000 g, who face the highest risk of adverse outcomes. Continued monitoring of LBWR is essential, alongside investments in the implementation of effective, targeted interventions.