Supplementary Material for: Global, Regional, and National Burden of Neonatal Encephalopathy Due to Birth Asphyxia and Trauma, Its Attributable Risk Factors, 1990-2021: Results from the Global Burden of Disease Study 2021

Background: Neonatal encephalopathy due to birth asphyxia and trauma (NEBAT) constitutes a significant component of neonatal mortality, with survivors often suffering from long-term and severe cognitive, behavioral, and developmental impairments. Nevertheless, in-depth research on the global trends and key risk factors of NEBAT remains scarce. Methods: This study analyzed data from the GBD 2021 database. The prevalence, deaths, and corresponding crude rates were quantified globally and across 204 countries and territories from 1990 to 2021. The burden was analyzed by region and socioeconomic development index (SDI), with trends examined using the estimated annual percentage change (EAPC). In addition, we used the Spearman rank test to determine associations between EAPC, NEBAT-related prevalence and death burden, and SDI. Risk factors contributing to the burden of NEBAT-related death were analyzed. Results: From 1990 to 2021, the global prevalence cases of NEBAT increased from 446,841 to 508,909, with the crude prevalence rate rising from 445.1 per 100,000 population to 522.2 per 100,000 population. However, the deaths significantly declined by 31.0%, from 823,812 to 568,255, with the crude mortality rate dropping from 8,205.7 per 100,000 population to 5,831.1 per 100,000 population. Low SDI regions experienced a substantial 112.9% increase in NEBAT cases, while high-middle SDI regions witnessed a significant 34.8% decrease. Although mortality rates declined across all SDI regions, the low SDI region had the smallest decline. More than half of the GBD regions experienced a reduction in NEBAT cases, but Western Sub-Saharan Africa saw a dramatic 151.7% increase. Globally, NEBAT-related mortality cases and rates declined in most countries, while a few countries like Ethiopia saw a significant rise in both. Regions with lower SDI were associated with higher trends of NEBAT prevalence and mortality growth. Low birth weight and short gestation were the primary risk factors for neonatal encephalopathy deaths globally, with notable regional variations. In the past three decades, the attributable proportions of low birth weight and short gestation have slightly increased, while those of household air pollution from solid fuels decreased, and ambient particulate matter pollution increased. Conclusions: NEBAT remains a significant public health concern, particularly in LMICs, where disparities in NEBAT burden are evident. This study highlights the need for targeted interventions to address key risk factors and reduce the NEBAT burden, with a focus on improving the healthcare access and quality in LMICs.