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Recent Declines in Infant Mortality in the United States

Recent Declines in Infant Mortality in the United States. Marian MacDorman, PhD and T.J. Mathews, MS Division of Vital Statistics National Center for Health Statistics. Vital Statistics Infant Mortality Data.

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Recent Declines in Infant Mortality in the United States

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  1. Recent Declines in Infant Mortality in the United States Marian MacDorman, PhD and T.J. Mathews, MS Division of Vital Statistics National Center for Health Statistics

  2. Vital Statistics Infant Mortality Data • Based on birth and death certificates filed in state vital statistics offices, and transmitted to NCHS. • National data files produced: • Birth (natality) data set – 2011 preliminary and 2010 final currently available • Main mortality file – 2011 preliminary and 2010 final currently available • Linked birth/infant death data set • Links birth and death certificate data for all infant deaths. • Purpose: To use more detailed data from the birth certificate for infant mortality analysis. • Currently available through 2008; 2009 expected by Jan. 2013

  3. Infant, neonatal and postneonatal mortality rates, United States, 2000-2011 Source: NCHS linked birth/infant death data set, 2000-2009, mortality data set 2010, and preliminary mortality data set, 2011.

  4. Percentage of preterm births: United States, 2000-2011 11.9 Source: Births: Final data for 2010; Births, preliminary data for 2011.

  5. Percent distribution of births by gestational age, US, 2006 and 2010 Completed weeks of gestation SOURCE: National Vital Statistics System, NCHS, CDC.

  6. Infant mortality rate and percent of preterm births, US, 2000-2011 Percent of preterm births Source: CDC/NCHS; national vital statistics system

  7. Infant mortality rates by gestational age, US, 2008 Completed weeks of gestation Source: NCHS, linked birth/infant death data set.

  8. Percent of births and infant deaths by gestational age (weeks), US, 2008 Source: CDC/NCHS Linked birth/infant death data set, 2008

  9. Components of infant mortality The overall infant mortality rate can be partitioned into two key components: 1. The distribution of births by gestational age; 2. Gestational age-specific infant mortality rates (i.e. the mortality rate for infants at a given gestational age) Component 1 available through 2011; component 2 through 2008 Preliminary modeling suggests that both must have declined to yield the current infant mortality rate

  10. Race/Ethnic Differences

  11. Infant mortality rates by maternal race/ethnicity, US, 2008 Non- American Puerto Total Mexican Non- Cuban Central Asian or Hispanic Indian Rican Hispanic or South Pacific black white American Islander Source: CDC/NCHS linked birth/infant death data set, 2008.

  12. Percent contribution of two components to race and ethnic differences in infant mortality rates, 2007 Note: NHB=non-Hispanic black; NHW=non-Hispanic white; PR=Puerto Rican; AI=American Indian Source: CDC/NCHS; linked birth/infant death data set

  13. Infant mortality rates by race/ethnicity, US, 2000, 2005 and 2011 Source: Data from the vital statistics mortality file. Note: Infant mortality rates by race and Hispanic origin are more accurate from the linked birth/infant death data set.

  14. Percent of preterm births by maternal race/ethnicity, US, 2000, 2006, 2011

  15. Trends in Leading Causes Of Infant Death

  16. Infant mortality rates for the five leading causes of infant death in 2011: US, 2000, 2005, and 2011 Source: NCHS, mortality data set. 2011 data are ore preliminary.

  17. State Differences

  18. WA ME MT ND MN VT OR NH MA ID WI NY SD CT WY MI RI PA IA NJ NE NV OH DE IN IL UT MD CO WV VA KS MO CA KY NC TN OK AZ AR SC NM GA AL MS TX LA FL AK More than 8.00 7.00 to 7.99 HI 6.00 to 6.99 5.00 to 5.99 Less than 5.00 Infant mortality rates by State, 2010 DC U.S. rate = 6.15 Source: National Vital Statistics System, NCHS, CDC

  19. WA ME MT ND MN VT OR NH MA ID WI NY SD CT WY MI RI PA IA NJ NE NV OH DE IN IL UT MD CO WV VA KS MO CA KY NC TN OK AZ AR SC NM GA AL MS TX LA FL AK HI Statistically significant decline of 20% or more Statistically significant decline of <20% No significant change Decline in infant mortality rates by state, 2005-2010 DC U.S. change = -10.5 Source: National Vital Statistics System, NCHS, CDC

  20. Understanding the Recent Decline in Preterm Birth

  21. Understanding the Recent Decline in Preterm Birth • Decline in preterm births from 2006-2010 appears to be widespread. Declines in preterm rates for most/all: • - maternal race/ethnic groups • - maternal age groups • - states • - among both single and multiple births • Some factors to consider in changes to overall rate: • Recent decline in teen births (who have higher • preterm rates) • Leveling out of multiple birth rates • Changes in obstetrical management of pregnancy

  22. Components of preterm birth Spontaneous preterm labor 40-45% Source: Goldenberg et al. Lancet, 2008.

  23. Percent preterm for cesarean, induced vaginal, and non-induced vaginal births: US, 2000, 2006, and 2010 Vaginal births

  24. International Comparisons

  25. Infant mortality rates, OECD countries, 2009 Source: Health, United States, 2012. OECD=Organization for Economic Cooperation and Development.

  26. Percentage of preterm births, United States and selected European countries, 2004 Note: Excludes births at <22 weeks of gestation to promote comparability between countries. Preterm births are those from 22 to 36 weeks of gestation. Source: NCHS linked birth/infant death data set (for US data), and European Perinatal Health Report (for European data).

  27. Conclusions • After a plateau from 2000-2005, the US infant mortality rate declined 12% from 2005 to 2011. • After more than two decades of increase, there was a 9% decrease in the preterm birth rate from 2006-2011. • From 2005-2011, infant mortality declined most rapidly for non-Hispanic black women (-16%), followed by non-Hispanic white (-12%) and Hispanic women (-9%), based on mortality file data. • Infant mortality declines were largest for states such as Louisiana, Georgia, the Carolinas and DC with large African-American populations and which previously had persistently high infant mortality rates. • Provisional data from July 2011-June 2012 show a US infant mortality rate of 5.9, suggesting a continued downward trend from the rate of 6.05 in 2011.

  28. Links to some recent reports Infant mortality statistics from the 2008 linked birth/infant death data set: http://www.cdc.gov/nchs/data/nvsr/nvsr60/nvsr60_05.pdf Deaths, preliminary data for 2011: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf Tables from Deaths, Final data for 2010: http://www.cdc.gov/nchs/data/dvs/deaths_2010_release.pdf Births, preliminary data for 2011: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_05.pdf Births: final data for 2010: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_01.pdf Provisional monthly and 12 month ending number of deaths, live births and infant deaths and rates: United States, January 2011 to June 2012. http://www.cdc.gov/nchs/data/dvs/provisional_tables/Provisional_Table01_2012Jun.pdf

  29. Contact information Marian MacDorman 301-458-4356 mfm1@cdc.gov T.J. Mathews 301-458-4363 tjm4@cdc.gov Any questions?

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