Global and regional mortality rate statistics of mpox (formerly monkeypox): a comprehensive systematic review and meta-analysis

The mortality trends associated with the mpox virus (MPXV) are not well defined. This study aims to systematically assess the mortality rate of mpox and its stratification across different geographical locations. Comprehensive review of articles from the PubMed, Embase, Scopus, and Web of Science databases up to June 2025, focusing on studies reporting mortality rates among patients diagnosed with mpox. A random-effects proportional meta-analysis assessed global and regional mpox mortality rates and their geographical variations. Sensitivity analysis using one-study removal method and meta-regression analyses were conducted. Out of 4,098 records, 30 articles met the selection criteria, comprising a total of 47,311 patients diagnosed with mpox. The pooled global mpox mortality rate was 3.1% (95% CI: 1.6%-5.9%). Mortality was significantly higher before 2016 at 11.4% (95% CI: 5.8%-21.1%), compared to 2.4% (95% CI: 1.2%-4.7%) during 2016-2025, and declined further in the post-COVID era to 1.5% (95% CI: 0.7%-3.4%). Mortality was markedly elevated among individuals with HIV co-infection (83.8%; 95% CI: 74.0%-90.5%). Regionally, mortality was highest in Africa (6.3%) and lowest in Europe (0.1%). Among studies conducted in endemic regions, a notable temporal decline was also observed, with mortality decreasing from 11.4% before 2016 to 4.1% during 2016-2025. Meta-regression identified year of publication as a significant predictor of mortality (p = 0.028), indicating improved outcomes over time. Global mpox mortality has declined over time, particularly in endemic regions and the post-COVID era. However, individuals with HIV remain at exceptionally high risk, underscoring the need for targeted interventions.