Global and China burden of maternal sepsis and infections: a systematic global burden of disease 2021 analysis with projections to 2036

BACKGROUND: Maternal sepsis and maternal infections (MSMIs) pose significant risks to maternal, fetal, and neonatal health. This study examines the burden trends of MSMIs in China from 1990 to 2021, comparing them with global patterns. METHODS: The burden of MSMIs in China and worldwide was evaluated using data from the Global Burden of Disease (GBD) spanning 1990-2021. Temporal trends were assessed through Joinpoint regression, calculating average annual percentage changes (AAPC) with 95% confidence intervals. Future burden projections up to 2036 were estimated using ARIMA modeling. Cross-regional comparisons were conducted to identify variations in disease impact. RESULTS: Between 1990 and 2021, China exhibited distinct trends in the burden of MSMIs compared to global patterns. The country's age-standardized incidence rate (ASIR) declined from 29.62 to 23.95 per 100,000, reflecting an annual reduction of -0.73%, in contrast to a global increase to 37.40. Mortality indicators showed significant declines, with China's age-standardized mortality rate (ASMR) dropping by 77.7% to 4.04 (-5.10% per year), compared to a 56.9% global reduction. Disease burden indicators demonstrated accelerated improvements, as China's age-standardized disability-adjusted life years rate (ASDR) fell by 78.3% to 93.73 (-5.31% per year), exceeding the global reduction of 53.1%. Prevalence patterns showed a contraction in China's age-standardized prevalence rate (ASPR) to 390.24 (-0.47% per year), whereas international prevalence rose to 513.68. Age-stratified analysis revealed inverse relationships: ASIR declined progressively with aging, while mortality and disability indicators intensified in older populations, differing from the bimodal prevalence distribution that peaked in middle age. CONCLUSION: From 1990 to 2021, China experienced a significant decline in the MSMIs burden, diverging from rising global trends. Projections suggest this divergence will persist, with China's burden continuing to decrease by 2036, while global rates increase. Urgent targeted interventions are needed for high-risk regions and populations.