Background Neonatal asphyxia is a serious public health issue.This study aimed to determine the epidemiology and region-specific risk factors for low Apgar scores,an important proxy for neonatal asphyxia,in China from 2015 to 2016.Methods The China Labor and Delivery Survey was a multicenter cross-sectional study including 96 hospitals distributed in 24 (out of 34) provinces.Logistic regression analysis was performed to examine the risk factors for a low Apgar score(＜ 7).Correspondence analyses were performed among neonates with low Apgar scores to explore the relationship between risk factors and geographical regions.The population attributable risk percentage (PAR％) was calculated for each region-specific risk factor.Results A total of 72,073 live births,including 320 births with low Apgar scores,were used for the analysis,giving a weighted rate of 3.9/1000 live births.There was a substantial difference in the incidence of low Apgar scores by geographic region,from 2.3/1000 live births in East China to 10.9/1000 live births in Northeast China.Maternal and obstetric factors are the major region-specific risk factors.In Southwest China,hypertensive disorders in pregnancy were more important contributors,with PAR％ being 74.47％;in North and Northwest China,pre-pregnancy underweight was a more significant factor,with PAR％ of 62.92％;in East China,infants born between 0:00 a.m.and 7:59 a.m.were a key factor,with PAR％of 80.44％.Conclusion Strategies based on region-specific risk factors should be considered to reduce the burden of low Apgar scores in China.