Urban-rural disparity in preterm neonatal mortality in China: a retrospective study

The neonatal mortality rate (NMR) is a vital indicator for assessing maternal and child health, and preterm birth is one of the leading causes of neonatal mortality. Since 2010, China has implemented multiple maternal and child health policies aimed at reducing neonatal mortality. However, systematic research on urban-rural disparities in neonatal mortality among preterm births remains relatively scarce. In this study, we analyzed the national and subnational cause-specific death rates of preterm neonates in mainland China during 2010 to 2021 to provide data support for the further elimination of neonatal deaths.

In this retrospective study, we analyzed empirical data on levels and causes of preterm neonatal mortality data from the China Maternal and Child Health Surveillance System to show the cause-specific death rates, birthplaces and treatment levels at the national and subnational levels.

From 2010 to 2021, the neonatal mortality rate due to complications of prematurity declined from 289 to 88 per 100,000 live births in rural areas, and from 126 to 41 in urban areas. Although rural rates remained higher, the absolute gap narrowed over time. According to the definitions used in the Maternal and Child Health Surveillance System (MCHSS), live births were registered only for neonates with signs of life who were born at ≥ 28 weeks of gestation or had a birth weight > 1000 g (if gestational age was unavailable), mortality was consistently highest among neonates born at 28 to 31 gestational weeks in both settings. In 2021, 95.5% of preterm neonates in urban areas were born at provincial-level hospitals, compared to 60.2% in rural areas. The proportion of preterm neonates diagnosed at county-level facilities in rural areas dropped from 46.7% to 21.8%, while in urban areas it fell from 6.5% to 2.3%.

This study demonstrates persistent urban-rural disparities in cause-specific mortality and gestational age distribution among preterm neonates. Findings may help local governments develop targeted strategies to further reduce overall neonatal mortality.