Evaluation of Perinatal Prevalence, Geographic Disparities, and Survival of Neural Tube Defects - China, 2006-2024.

INTRODUCTION: Neural tube defects (NTDs) are a major cause of perinatal mortality and lifelong disability. However, long-term trends in NTD prevalence, regional disparities, and survival patterns in China remain poorly characterized. METHODS: Data from the Chinese Birth Defects Monitoring Network (CBDMN) were analyzed for perinatal NTDs occurring between 2006 and 2024. Bayesian Poisson regression models incorporating subtype, geographic strata, maternal age, calendar year, and interaction effects were applied to estimate long-term trends in perinatal prevalence and survival. Joinpoint analysis was employed to estimate annual percentage changes (APCs). RESULTS: The estimated perinatal prevalence of NTDs in China declined from 8.84 per 10,000 births in 2006 to 0.77 per 10,000 births in 2024, representing a 91.29% reduction. Joinpoint analysis identified a three-phase decline pattern, with the APC accelerating from -10.43% (2006-2009) to -16.08% (2009-2016), followed by a slower decline of -10.60% (2016-2024). Similar downward trends were observed across all major NTD subtypes, with anencephaly showing the steepest decline. Long-standing nationwide north-south and urban-rural gaps in NTD prevalence were greatly reduced, with no statistically distinguishable differences observed during the late study period. Meanwhile, overall perinatal survival increased from 23.33% to 46.76%, driven primarily by marked improvements in spina bifida and encephalocele survival. CONCLUSION: From 2006 to 2024, China demonstrated a remarkable decline in perinatal NTD prevalence, alongside a substantial narrowing of the long-standing national north-south and urban-rural gaps in disease burden. The increasing perinatal survival among nonlethal subtypes highlights the emerging need for long-term pediatric care and rehabilitation.