{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T04:10:17Z","timestamp":1793506217789,"version":"4.5.0"},"reference-count":31,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T00:00:00Z","timestamp":1748304000000},"content-version":"unspecified","delay-in-days":146,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100012166","name":"National Key Research and Development Program of China","doi-asserted-by":"publisher","award":["2022YFA0806900"],"award-info":[{"award-number":["2022YFA0806900"]}],"id":[{"id":"10.13039\/501100012166","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005089","name":"Natural Science Foundation of Beijing Municipality","doi-asserted-by":"publisher","award":["JQ24047"],"award-info":[{"award-number":["JQ24047"]}],"id":[{"id":"10.13039\/501100005089","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,4,30]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Approximately 3%\u20136% of infants were born with congenital birth defects worldwide every year, which ranked as the third leading cause of deaths among the population under 20 years of age in 2021.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>By adopting the methodology from Global Burden of Disease Study 2021, we systematically analysed the burden and temporal trend of congenital birth defects at the global and regional levels. Correlations between these metrics and Healthcare Access and Quality (HAQ) Index were investigated by the Spearman correlation analyses.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In 2021, there were 7.2 million cases of congenital birth defects and 0.53 million associated deaths. The highest incidence rates were observed in Central Asia, Central Sub-Saharan Africa and Western Sub-Saharan Africa, while the highest mortality rates were reported in Oceania, Western Sub-Saharan Africa and the Caribbean. Congenital heart anomalies remained the leading cause of deaths and disability-adjusted life years (DALYs). The proportion of years lived with disability (YLD) in total DALY increased significantly from 1990 to 2021, indicating a shift from fatal to non-fatal burden. The global age-standardised mortality rate markedly declined from 1990 to 2021, while the YLD rate remained relatively stable. Negative correlations were observed between the incidence, mortality, years of life lost (YLL) and DALY rates of congenital birth defects and HAQ Index of 204 countries and territories, whereas positive correlations were found for prevalence and YLD.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Although remarkable progress has been made in reducing the global burden of congenital birth defects, it remains a major health issue in low sociodemographic index regions lacking equitable access to healthcare facilities. The shift from fatal to non-fatal burden underscores specific medical conditions for the increasing number of adult patients with congenital birth defects to promote postoperative rehabilitation and prevent complications.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/bmjph-2024-001608","type":"journal-article","created":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T23:30:24Z","timestamp":1748302224000},"page":"e001608","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":27,"title":["Global and regional burden of congenital birth defects, 1990\u20132021: persistent healthcare disparities and emerging challenges from non-fatal health burden"],"prefix":"10.1136","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1455-304X","authenticated-orcid":false,"given":"Junchao","family":"Duan","sequence":"first","affiliation":[{"name":"Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2464-5594","authenticated-orcid":false,"given":"Ruiyang","family":"Ding","sequence":"additional","affiliation":[{"name":"Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yongbo","family":"Yu","sequence":"additional","affiliation":[{"name":"Beijing Key Laboratory for Pediatric Diseases of Otolaryngology, Head and Neck Surgery, Beijing Pediatric Research Institute, Beijing Children\u2019s Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menglong","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Child and Maternal Health, School of Public Health, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanping","family":"Ruan","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Centre in Fetal Heart Disease, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4611-2206","authenticated-orcid":false,"given":"Yifei","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Child and Maternal Health, School of Public Health, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yihua","family":"He","sequence":"additional","affiliation":[{"name":"Maternal-Fetal Medicine Centre in Fetal Heart Disease, Beijing Key Laboratory of Maternal-Fetal Medicine in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4470-9743","authenticated-orcid":false,"given":"Zhiwei","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Toxicology and Sanitary Chemistry, School of Public Health, Capital Medical University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"key":"2025083109451791000_3.1.e001608.1","doi-asserted-by":"crossref","first-page":"1104","DOI":"10.15585\/mmwr.mm6439a3","article-title":"CDC Grand Rounds: Understanding the Causes of Major Birth Defects - Steps to Prevention","volume":"64","author":"Simeone","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025083109451791000_3.1.e001608.2","doi-asserted-by":"crossref","DOI":"10.15585\/mmwr6607a4","article-title":"Announcement: World Birth Defects Day - March 3, 2017","volume":"66","year":"2017","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2025083109451791000_3.1.e001608.3","unstructured":"IHME . GBD compare. 2024. Available: https:\/\/vizhub.healthdata.org\/gbd-compare"},{"key":"2025083109451791000_3.1.e001608.4","doi-asserted-by":"crossref","unstructured":"Wright NJ , Anderson JE , Ozgediz D , et al . Addressing paediatric surgical care on World Birth Defects Day. Lancet 2018;391. doi:10.1016\/S0140-6736(18)30501-4","DOI":"10.1016\/S0140-6736(18)30501-4"},{"key":"2025083109451791000_3.1.e001608.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31575-6"},{"key":"2025083109451791000_3.1.e001608.6","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(24)00757-8"},{"key":"2025083109451791000_3.1.e001608.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)00367-2"},{"key":"2025083109451791000_3.1.e001608.8","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30818-8"},{"key":"2025083109451791000_3.1.e001608.9","doi-asserted-by":"crossref","first-page":"e1715","DOI":"10.1016\/S2214-109X(22)00429-6","article-title":"Assessing performance of the Healthcare Access and Quality Index, overall and by select age groups, for 204 countries and territories, 1990\u20132019: a systematic analysis from the Global Burden of Disease Study 2019","volume":"10","author":"Haakenstad","year":"2022","journal-title":"Lancet Glob Health"},{"key":"2025083109451791000_3.1.e001608.10","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1001\/jamapediatrics.2022.1622","article-title":"Global, Regional, and National Incidence and Mortality of Neonatal Preterm Birth, 1990-2019","volume":"176","author":"Cao","year":"2022","journal-title":"JAMA Pediatr"},{"key":"2025083109451791000_3.1.e001608.11","doi-asserted-by":"crossref","DOI":"10.1136\/bmj.m234","article-title":"Trends and risk factors of mortality and disability adjusted life years for chronic respiratory diseases from 1990 to 2017: systematic analysis for the Global Burden of Disease Study 2017","volume":"368","author":"Li","year":"2020","journal-title":"BMJ"},{"key":"2025083109451791000_3.1.e001608.12","doi-asserted-by":"crossref","first-page":"795","DOI":"10.1016\/j.jhep.2021.05.022","article-title":"Burden of non-alcoholic fatty liver disease in Asia, the Middle East and North Africa: Data from Global Burden of Disease 2009-2019","volume":"75","author":"Golabi","year":"2021","journal-title":"J Hepatol"},{"key":"2025083109451791000_3.1.e001608.13","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1016\/S2352-4642(23)00051-2","article-title":"Current status and challenges in prenatal and neonatal screening, diagnosis, and management of congenital heart disease in China","volume":"7","author":"Zhang","year":"2023","journal-title":"Lancet Child Adolesc Health"},{"key":"2025083109451791000_3.1.e001608.14","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)31527-6"},{"key":"2025083109451791000_3.1.e001608.15","doi-asserted-by":"crossref","first-page":"186","DOI":"10.7196\/SAMJ.9136","article-title":"Need for services for the care and prevention of congenital disorders in South Africa as the country\u2019s epidemiological transition evolves","volume":"105","author":"Malherbe","year":"2015","journal-title":"S Afr Med J"},{"key":"2025083109451791000_3.1.e001608.16","doi-asserted-by":"crossref","first-page":"1089","DOI":"10.1016\/j.jpedsurg.2019.01.034","article-title":"Incidence and prevalence of congenital anomalies in low- and middle-income countries: A systematic review","volume":"54","author":"Toobaie","year":"2019","journal-title":"J Pediatr Surg"},{"key":"2025083109451791000_3.1.e001608.17","doi-asserted-by":"crossref","DOI":"10.1186\/s12887-021-02525-2","article-title":"Burden and consequence of birth defects in Nepal-evidence from prospective cohort study","volume":"21","author":"Paudel","year":"2021","journal-title":"BMC Pediatr"},{"key":"2025083109451791000_3.1.e001608.18","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1007\/s10995-022-03538-8","article-title":"Association Between Maternal Factors and Risk of Congenital Heart Disease in Offspring: A Systematic Review and Meta-Analysis","volume":"27","author":"Wu","year":"2023","journal-title":"Matern Child Health J"},{"key":"2025083109451791000_3.1.e001608.19","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-020-09988-5","article-title":"Non-communicable diseases among adolescents: current status, determinants, interventions and policies","volume":"20","author":"Akseer","year":"2020","journal-title":"BMC Public Health"},{"key":"2025083109451791000_3.1.e001608.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)01024-7"},{"key":"2025083109451791000_3.1.e001608.21","doi-asserted-by":"crossref","DOI":"10.4103\/2277-9175.124629","article-title":"The protective effects of breastfeeding on chronic non-communicable diseases in adulthood: A review of evidence","volume":"3","author":"Kelishadi","year":"2014","journal-title":"Adv Biomed Res"},{"key":"2025083109451791000_3.1.e001608.22","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2024.102873","article-title":"The global, regional, and national patterns of change in the burden of congenital birth defects, 1990-2021: an analysis of the global burden of disease study 2021 and forecast to 2040","volume":"77","author":"Bai","year":"2024","journal-title":"EClinicalMedicine"},{"key":"2025083109451791000_3.1.e001608.23","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.110.946343"},{"key":"2025083109451791000_3.1.e001608.24","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehab388"},{"key":"2025083109451791000_3.1.e001608.25","doi-asserted-by":"publisher","DOI":"10.1177\/2047487313494030"},{"key":"2025083109451791000_3.1.e001608.26","doi-asserted-by":"crossref","first-page":"662","DOI":"10.1038\/nrcardio.2013.127","article-title":"Interventional cardiology in adults with congenital heart disease","volume":"10","author":"Singh","year":"2013","journal-title":"Nat Rev Cardiol"},{"key":"2025083109451791000_3.1.e001608.27","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e318265ee8a"},{"key":"2025083109451791000_3.1.e001608.28","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2010.166"},{"key":"2025083109451791000_3.1.e001608.29","doi-asserted-by":"crossref","first-page":"305","DOI":"10.2217\/fca.12.8","article-title":"Changing lesion demographics of the adult with congenital heart disease: an emerging population with complex needs","volume":"8","author":"Stuart","year":"2012","journal-title":"Future Cardiol"},{"key":"2025083109451791000_3.1.e001608.30","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/S2352-4642(23)00053-6","article-title":"Improving long-term care and outcomes of congenital heart disease: fulfilling the promise of a healthy life","volume":"7","author":"Su","year":"2023","journal-title":"Lancet Child Adolesc Health"},{"key":"2025083109451791000_3.1.e001608.31","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)30977-6"}],"container-title":["BMJ Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjph-2024-001608","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,31]],"date-time":"2025-08-31T16:45:32Z","timestamp":1756658732000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjpublichealth.bmj.com\/lookup\/doi\/10.1136\/bmjph-2024-001608"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1]]},"references-count":31,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,5,26]]},"published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1136\/bmjph-2024-001608"],"URL":"https:\/\/doi.org\/10.1136\/bmjph-2024-001608","relation":{},"ISSN":["2753-4294"],"issn-type":[{"value":"2753-4294","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1]]}}}