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Infant Mortality

Narrative

In 2010, 24,586 infants died before their first birthday, reflecting an infant mortality rate of 6.15 deaths per 1,000 live births. This represents a decrease of 3.8 percent from the 2009 rate (6.39 deaths per 1,000 live births) and 10.5 percent from the 2005 rate (6.87 per 1,000 live births). Currently, about two-thirds of infant deaths in the United States occur before 28 days (neonatal mortality: 4.05 per 1,000 live births), with the remaining third occurring in the postneonatal period between 28 days and under 1 year (2.10 per 1,000 live births). Neonatal mortality is generally related to short gestation and low birth weight, maternal complications of pregnancy, and congenital malformations, while postneonatal mortality is generally related to Sudden Infant Death Syndrome (SIDS), congenital malformations, and unintentional injuries.1 In 2010, the leading causes of infant mortality were congenital malformations, followed by disorders related to short gestation and low birth weight, and SIDS.2

With the exception of 2000 to 2005, infant mortality had been consistently declining at least every few years since it was first assessed in 1915. The substantial infant mortality decline over the 20th century has been attributed to economic growth, improved nutrition, and new sanitary measures, as well as advances in clinical medicine and access to care.3,4 Infant mortality declines in the 1990s were aided particularly by the approval of synthetic surfactants to reduce the severity of respiratory distress syndrome (RDS), a common affliction of preterm infants, and the recommendation that infants be placed on their backs to sleep to prevent Sudden Infant Death Syndrome (SIDS). The lack of progress between 2000 and 2005 has been attributed to increases in preterm birth,5 which have begun to decline in the last several years, perhaps due to practice-based efforts to reduce preterm deliveries that are not medically necessary.6

Despite improvements in infant mortality over time, disparities by race and ethnicity persist. Due to inconsistencies in the reporting of race and ethnicity on the birth and death certificate, infant mortality rates by race and ethnicity are more accurately assessed from maternal race and ethnicity, which is achieved by linking infant death certificates to their correspondersing birth certificates. In 2008, the latest year of available linked data, the infant mortality rate was highest for infants of non-Hispanic Black mothers (12.67 per 1,000 live births)—a rate 2.3 times that of non-Hispanic Whites (5.52 per 1,000). Infant mortality was also higher among infants born to American Indian/Alaska Native and Puerto Rican mothers (8.42 and 7.29 per 1,000, respectively). Although infant mortality was lowest among Asian/Pacific Islanders (4.51 per 1,000), there is considerable variability within this population and higher infant mortality rates have been shown among Native Hawaiians.7

Similar to overall infant mortality, neonatal mortality was highest among infants of non-Hispanic Black mothers (8.28 per 1,000), followed by Puerto Rican and American Indian/Alaska Native mothers (4.98 and 4.18 per 1,000, respectively). Postneonatal mortality was more than twice as high for both non-Hispanic black and American Indian/Alaska Native mothers (4.39 and 4.24 per 1,000, respectively) than for non- Hispanic Whites (2.02 per 1,000). Consistent with these patterns in the timing of excess infant mortality, the majority of the infant mortality disparity for non-Hispanic Blacks compared to non-Hispanic Whites is due to causes related to prematurity and, to a lesser extent, SIDS, congenital malformations, and injury.8,9 The American Indian/Alaska Native infant mortality gap is mostly explained by SIDS, congenital malformations, prematurity, and injury while the excess among Puerto Rican mothers is almost entirely related to prematurity.8,9

1 Centers for Disease Control and Prevention. Quick Stats: Leading Causes of Neonatal and Postneonatal Deaths — United States, 2002. MMWR. 2005; 54(38):966

2 Murphy SL, Xu JQ, Kochanek KD. Deaths: Final data for 2010. National vital statistics reports; vol 61 no 4. Hyattsville, MD: National Center for Health Statistics. 2012.

3 Guyer B, Freedman MA, Strobino DM, and Sondik EJ. Annual summary of vital statistics: trends in the health of Americans during the 20th century. Pediatrics. 2000;106:1307-17

4 Centers for Disease Control and Prevention. Advancements in public health, 1900-1999: healthier mothers and babies. MMWR. 1999; 48:849-58

5 MacDorman MF, Mathews TJ. Recent Trends in Infant Mortality in the United States. NCHS data brief, no 9. Hyattsville, MD: National Center for Health Statistics. 2008

6 Martin JA, Hamilton BE, Ventura SJ, et al. Births: Final data for 2009. National vital statistics reports; vol 60 no 1. Hyattsville, MD: National Center for Health Statistics. 2011

7 Mathews TJ, Menacker F, MacDorman MF. Infant mortality statistics from the 2002 period linked birth/infant death data set. National Vital Statistics Reports; vol 53 no 10. Hyattsville, Maryland: National Center for Health Statistics. 2004

8 MacDorman MF, Mathews TJ. Understanding racial and ethnic disparities in U.S. infant mortality rates. NCHS data brief, no 74. Hyattsville, MD: National Center for Health Statistics. 2011

9 Mathews TJ, MacDorman, MF. Infant Mortality Statistics from the 2008 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports; vol 60 no 5. Hyattsville, MD: National Center for Health Statistics. 2012.

Graphs

This image is described in the Data section.

infant mortality rates graph

This image is described in the Data section.

infant mortality rates graph

Data

Infant, Neonatal, and Postneonatal Mortality Rates,* 1915-2010**
Year Rate per 1,000 Live Births
Infant Neonatal Postneonatal
*Infant deaths are under 1 year; neonatal deaths are under 28 days; postneonatal deaths are between 28 days and under 1 year.
**Data from 1915-1932 are a subset from states with birth registration, which became 100% by 1933.
Sources: National Center for Health Statistics. Vital statistics of the United States, 1993, Vol 11, mortality, part A. Hyattsville, MD. 2002. Sources: Miniño AM, Murphy SL, Xu JQ, Kochanek KD. Deaths: Final data for 2008. National Vital Statistics Reports; vol 59 no 10. Hyattsville, MD: National Center for Health Statistics. 2011. Murphy SL, Xu JQ, Kochanek KD. Deaths: Final Data for 2010. National Vital Statistics Reports; vol 61 no 4. Hyattsville, MD: National Center for Health Statistics. 2012.
1915 99.9 44.4 55.6
1920 85.8 41.5 44.3
1925 71.7 37.8 33.8
1930 64.6 35.7 28.9
1935 55.7 32.4 23.3
1940 47 28.8 18.3
1945 38.3 24.3 13.9
1950 29.2 20.5 8.7
1955 26.4 19.1 7.3
1960 26 18.7 7.3
1965 24.7 17.7 7
1970 20 15.1 4.9
1975 16.1 11.6 4.5
1980 12.6 8.5 4.1
1985 10.6 7 3.7
1990 9.2 5.8 3.4
1995 7.6 4.9 2.7
2000 6.9 4.6 2.3
2005 6.9 4.5 2.3
2010 6.15 4.05 2.1
Infant, Neonatal, and Postneonatal Mortality Rates,* by Race/Ethnicity, 2008
Race/Ethnicity Rate per 1,000 Live births
Neonatal Postneonatal Infant
*Infant deaths are under 1 year; neonatal deaths are under 28 days; postneonatal deaths are between 28 days and under 1 year.
**Includes Hispanics
Source: Mathews TJ, MacDorman, MF. Infant Mortality Statistics from the 2008 Period Linked Birth/Infant Death Data Set. National Vital Statistics Reports; vol 60 no 5. Hyattsville, MD: National Center for Health Statistics. 2012.
Total 4.29 2.32 6.61
Non-Hispanic White 3.5 2.02 5.52
Non-Hispanic Black 8.28 4.39 12.67
American Indian/Alaska Native** 4.18 4.24 8.42
Asian/Pacific Islander** 3.08 1.43 4.51
Hispanic 3.76 1.83 5.59
Mexican 3.78 1.8 5.58
Puerto Rican 4.98 2.3 7.29
Cuban 3.23 1.62 4.9
Central and South American 3.19 1.57 4.76
Other and Unknown Origin 3.76 2.11 5.86