Trends and urban–rural disparities in infant and cause-specific mortality in Shaanxi Province, China, 2014–2023: a population-based study

Background: China has achieved substantial reductions in infant mortality; however, pronounced subnational disparities persist, particularly in western and rural regions. In the context of demographic change and evolving perinatal risk profiles, region-specific evidence is essential to guide targeted interventions and support progress toward Sustainable Development Goal (SDG) 3.2. Methods: This population-based observational study analyzed data from the Maternal and Child Health Surveillance System (MCHSS) in Shaanxi Province, China, from 2014 to 2023. A total of 320,259 live births and 954 infant deaths were recorded across 141 surveillance sites. Temporal trends in infant mortality rates (IMRs) were assessed using Joinpoint regression to estimate average annual percentage changes (AAPCs). Urban-rural differences and temporal trends were further evaluated using generalized linear models. Results: = 0.028). Conclusion: Infant mortality in Shaanxi Province declined substantially between 2014 and 2023, with broadly parallel trends in urban and rural populations. Despite this progress, pre-maturity-related conditions and injuries remain important contributors to infant death. Strengthening neonatal care systems, expanding birth defect prevention programs, and implementing targeted injury prevention strategies, particularly in underserved rural areas, may support further reductions in infant mortality and promote equitable progress toward SDG 3.2.