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Infant Mortality


In 2008, 4,662 infants born to residents of rural or non-metropolitan counties died in the first year of life. The infant mortality rate was higher in small and large rural counties (7.31 and 7.10 deaths per 1,000 live births, respectively) than in urban counties (6.51 per 1,000). Although the infant mortality rate in rural counties was higher than urban counties in both the neonatal (<28 days) and postneonatal periods (28 to 364 days), disparities were only significant in the postneonatal period. For example, postneonatal mortality was 27 percent higher in small rural counties than urban counties, while neonatal mortality was only 5 percent higher. The major causes of postneonatal mortality include sudden infant death syndrome (SIDS), congenital anomalies, injury, and infection.1 These causes may be addressed through improved education for safe sleep practices and injury prevention as well as improved access to health care. SIDS and infection have also been associated with environmental tobacco smoke exposure,2 and smoking has been shown to be higher in rural areas.3

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 Klerman L. Protecting children: reducing their environmental tobacco smoke exposure. Nicotine Tob Res. 2004 Apr; 6 Suppl 2:S239-53.

3 National Center for Health Statistics. Health, United States, 2011: With Special Feature on Socioeconomic Status and Health. Hyattsville, MD. 2012.


This image is described in the Data section.

infant mortality rates in U.S. cities


Infant, Neonatal, and Postneonatal Mortality Rates,* by Rural/Urban Residence,** 2008
Residence Rate per 1,000 Live Births
Neonatal Post Neonatal Infant
*Infant deaths are under 1 year; neonatal deaths are under 28 days; postneonatal deaths are between 28 days and under 1 year.
**Urban includes all metropolitan counties regardless of size, large rural includes non-metropolitan counties with a city of 10,000 or more residents, small rural includes non-metropolitan counties without a city of 10,000 or more residents; follows the National Center for Health Statistics' Urban-Rural Classification Scheme for Counties.
Source: Centers for Disease Control and Prevention, National Center for Health Statistics. 2009 Natality Restricted Access File with Geographic Detail. Analysis conducted by the Maternal and Child Health Bureau.
Urban 4.27 2.23 6.51
Large Rural 4.37 2.73 7.10
Small Rural 4.47 2.84 7.31