Includes its own copy of sqlite3, you don't use the system one, which is good to ensure compatibility. The version is shown at: github.com/mapbox/node-sqlite3/blob/918052b538b0effe6c4a44c74a16b2749c08a0d2/deps/common-sqlite.gypi#L3 SQLite source is tracked compressed in-tree: github.com/mapbox/node-sqlite3/blob/918052b538b0effe6c4a44c74a16b2749c08a0d2/deps/sqlite-autoconf-3360000.tar.gz horrendous. This explains why it takes forever to clone that repository. People who don't believe in git submodules, there's even an official Git mirror at: github.com/sqlite/sqlite
It appears to spawn its own threads via its C extension (since JavaScript is single threaded and and SQLite is not server-based), which allows for parallel queries using multiple threads: github.com/mapbox/node-sqlite3/blob/v5.0.2/src/threading.h
Hello world example: nodejs/node-sqlite3/index.js.
As of 2021, this had slumped back a bit, as maintainers got tired. Unmerged pull requests started piling more, and better-sqlite3 Node.js package started pulling ahead a little.