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National VitalStatistics ReportsVolume58,Number17 April30,2010
Infant Mortality Statistics From the 2006 PeriodLinkedBirth/InfantDeathDataSetbyT.J.Mathews,M.S.,andMarianF.MacDorman,Ph.D.,DivisionofVitalStatistics
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and Prevention
National Center for Health StatisticsNational Vital Statistics System
MT
WY
ID
WA
OR
NV
UT
CA
AZ
ND
SD
NE
CO
NM
TX
OK
KS
AR
LA
MO
IA
MN
WI
IL IN
KY
TN
MSAL GA
FL
SC
NC
VAWV
OH
MI
NY
PA
MD
DE
NJ
CT RI
MA
ME
VTNH
DC
Not significantly different from U.S.
Significantly lower than U.S.
10 lowest
HI
AK
Significantly higher than the U.S.10 highestSOURCE: CDC/NCHS, National Vital Statistics System.
Figure1. Infantmortalityratesbystate:UnitedStates,20042006
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2 NationalVitalStatisticsReports,Volume58,Number17,April30,2010Abstract
ObjectivesThis report presents 2006 period infant mortalitystatistics from the linkedbirth/infantdeathdataset (linked file)byavariety of maternal and infant characteristics. The linked file differsfrom the mortality file, which is based entirely on death certificatedata.
MethodsDescriptivetabulationsofdataarepresentedandinterpreted.
ResultsTheU.S.infantmortalityratewas6.68infantdeathsper1,000livebirthsin2006,a3percentdeclinefrom6.86in2005.Infantmortalityratesrangedfrom4.52per1,000livebirthsforCentralandSouth American mothers to 13.35 for non-Hispanic black mothers.Infantmortalityrateswerehigherforthoseinfantswhosemotherswereborn inthe50statesortheDistrictofColumbia,wereunmarried,orwereborn inmultipledeliveries. Infantmortalitywas also higher formale infants and infants born preterm or at low birthweight. Theneonatalmortalityratewasessentiallyunchangedin2006(4.46)from2005(4.54).Thepostneonatalmortalityratedecreased4percent,from2.32in2005to2.22in2006.Infantsbornatthelowestgestationalagesand
birthweights
have
alarge
impact
on
overall
U.S.
infant
mortality.
Forexample,morethanhalfofall infantdeaths intheUnitedStatesin 2006 (54percent) occurred to the 2percent of infants born verypreterm(lessthan32weeksofgestation).Still, infantmortalityratesfor latepreterm infants(3436weeksofgestation)were three timesthoseforterminfants(3741weeks).Thethreeleadingcausesofinfantdeathcongenitalmalformations, lowbirthweight,andsudden infantdeathsyndrometakentogetheraccountedfor46percentofallinfantdeaths.Thepercentageof infantdeaths thatwere preterm-relatedwas36.1percentin2006.Thepreterm-relatedinfantmortalityratefornon-Hispanic black mothers was 3.4 times higher and the rate forPuerto Rican mothers was 84percent higher than for non-Hispanicwhitemothers.Keywords: infanthealthcbirthweightcgestationalagecmaternalcharacteristics
IntroductionThis report presents infantmortality data from the 2006 period
linked file.The linked file contains a numerator file consisting of allinfant deaths occurring in 2006 that have been linked to theircorrespondingbirthcertificates,whetherthebirthoccurredin2005orin2006.
Inthelinkedfile,informationfromthedeathcertificateislinkedtoinformationfromthebirthcertificateforeachinfantunder1yearofagewhodied in the50states, theDistrictofColumbia,PuertoRico, theVirginIslands,orGuamduring2006(1).Linkedbirth/infantdeathdataarenotavailableforAmericanSamoaandtheCommonwealthoftheNorthern Marianas. The purpose of the linkage is to use the manyadditionalvariablesavailablefromthebirthcertificatetoconductmoredetailedanalysesofinfantmortalitypatterns(2).ThisreportpresentsinfantmortalitydatabyraceandHispanicoriginofthemother,birth-weight, period of gestation, sex of infant, plurality, maternal age,live-birthorder,mothersmaritalstatus,mothersplaceofbirth,ageatdeath, and underlying cause of death (Tables18 and AE; Figures16).Othervariablesavailable in the linked file(1)butnotdiscussed in this report include fathersage, race,andHispanicorigin;
birth attendant; place of delivery; mothers weight gain during pregnancy;andmanymedicalandhealthmeasurements.
Anotherreport,basedondataexclusivelyfromthevitalstatisticsmortalityfile,providesfurtherinformationontrendsininfantmortalityandcausesofinfantdeath(3).Thelinkedfileisusedforanalysisandforcalculating infantmortality ratesby raceandethnicity,whicharemoreaccuratelymeasuredfromthebirthcertificate.Someratescalculated from the mortality file differ from those published using thelinkedfile.Amoredetaileddiscussionofthedifferencesinthenumberofinfantdeathsandinfantmortalityratesbetweenthelinkedfileandthemortality file ispresented in TechnicalNotes.
MethodsData shown in this report are based on birth and infant death
certificates registered in all states, the District of Columbia, PuertoRico, the Virgin Islands, and Guam. As part of the Vital StatisticsCooperativeProgram,eachstateprovidedtotheCentersforDiseaseControlandPreventions(CDC)NationalCenter forHealthStatistics(NCHS)matchingbirthanddeathcertificatenumbersforeach infantunder 1 year of age who died in the state during 2006. When thebirth and death occurred in different states, the state of death wasresponsible for contacting the state of birth identified on the deathcertificate toobtain theoriginalbirthcertificatenumber.NCHSusedthe matching birth and death certificate numbers provided by thestates to extract final edited data from the NCHS natality andmortality statistical files. These data were linked to form a singlestatistical record, therebyestablishinganational linkedrecord file.
After the initial linkage, NCHS returned lists of unlinked infantdeathrecordsandrecordswithinconsistentdatabetweenthebirthanddeathcertificatestoeachstate.Stateadditionsandcorrectionswereincorporated,anda finalnational linked filewasproduced. In2006,98.7percent of all infant death records were successfully linked ormatchedtotheircorrespondingbirthrecords.Recordswereweightedtoadjustforthe1.3percentofinfantdeathrecordsthatwerenotlinkedto theircorrespondingbirthcertificates;see TechnicalNotes.
Informationonbirthsbyage,race,ormaritalstatusofmotherisimputedifitisnotreportedonthebirthcertificate.Theseitemswerenot reported for less than1percentofU.S.births in2006(2).
RaceandHispanicoriginarereportedindependentlyonthebirthcertificate.IntabulationsofbirthdatabyraceandHispanicorigin,dataforHispanicpersonsarenotfurtherclassifiedbyracebecausethevastmajorityofwomenofHispanicoriginarereportedaswhite.Data forAmericanIndianorAlaskaNative(AIAN)andAsianorPacificIslander(API)
births
are
not
shown
separately
by
Hispanic
origin
because
the
vastmajorityof thesepopulationsarenon-Hispanic.
Cause-of-deathstatisticsinthispublicationareclassifiedinaccordancewiththeInternationalStatisticalClassificationofDiseasesandRelatedHealthProblems,TenthRevision(ICD10)(4);seeTechnicalNotes.
Thisreportincludesdatabasedonthe1989and2003revisionsofthebirthcertificate.NineteenstatesandPuertoRicoimplementedthe2003revisionoftheU.S.StandardCertificateofLiveBirthonorbefore January 1, 2006 (revised). The remaining reporting areasincludedatawhicharebasedonthe1989revisionoftheU.S.StandardCertificateofLiveBirth(unrevised).Revisedandunreviseddataare
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3NationalVitalStatisticsReports,Volume58,Number17,April30,2010combinedwhencomparable.Formoreinformation,seeNationalVitalStatisticsReports,Volume57Number7,Births:FinalDatafor2006(2).
Threekeydataitemsareconsiderednoncomparablebetweenthe1989and2003revisions:trimesterofpregnancyinwhichprenatalcarebegan,maternaleducationalattainment,andmaternalsmokingduringpregnancy (2).Because infantswhodied in2006wereborn inboth2005and2006,thisreportincludesdataonthesethreetopicsfromthe12states that implemented the2003revisionasofJanuary1,2005(seerespectivetextsectionsandTechnicalNotes).The12statesareFlorida, Idaho, Kansas, Kentucky, Nebraska, New Hampshire, NewYork (excluding NewYork City),Pennsylvania, SouthCarolina,Tennessee,Texas,andWashington.Resultsforthesethreeitemsfromthelimitedreportingareaarenotgeneralizabletothecountryasawhole(2).Databymaternaland infantcharacteristics
This report presents descriptive tabulations of infant mortalitydata by a variety of maternal and infant characteristics. Thesetabulations are useful for understanding the basic relationshipsbetweenrisk factorsand infantmortality,unadjusted for thepossibleeffectsofothervariables.Inreality,womenwithoneriskfactoroftenhave other risk factors as well. For example, teenage mothers aremore likely to also be unmarried and of a low-income status, andmotherswhodonotreceiveprenatalcarearemore likely tobeofalow-incomestatusanduninsured.Thepreferredmethodfordisentangling themultiple interrelationshipsamongrisk factors ismultivariateanalysis; however, an understanding of the basic relationshipsbetweenrisk factorsand infantmortality isanecessaryprecursor tomore sophisticated types of analyses and is the aim of thispublication.
Race and Hispanic origin dataInfant mortality rates are presentedherebyraceanddetailedHispanicoriginofmother.Thelinkedfile isparticularlyusefulforcomputingaccurate infantmortalityratesfor thispurposebecause theraceandHispanicoriginof themotherfromthebirthcertificateareusedinboththenumeratoranddenominator of the infant mortality rate. In contrast, for the vital statisticsmortality file, race information for thedenominator is the raceof themotherasreportedonthebirthcertificateandthatforthenumeratoristheraceofthedecedentasreportedonthedeathcertificate(2,3,5).Thus,standardinfantmortalityratescanbebasedoninconsistentrace
information. In addition, race information from the birth certificatereportedbythemotherisconsideredtobemorereliablethanthatfromthedeathcertificate,wheretheraceandethnicityofthedeceasedinfantarereportedbythefuneraldirectorbasedoninformationprovidedbyaninformantorbyobservation.Thesedifferentreportingmethodscanleadtodifferencesinrace- andethnicity-specificinfantmortalityratesbetween the twodata files(3,5).
The2003revisionof theU.S.StandardCertificateofLiveBirthallows the reportingofmore thanonerace (multipleraces) foreachparent(6,7).Informationonthischangeispresentedinarecentreport(2).Twenty-threestatesreportedmultipleraceontheirbirthcertificatesforeitherpartorallof2006.Toprovideuniformityandcomparabilityof data, multiple race is imputed to a single race (see TechnicalNotes).
Statistical significanceText statements have been tested forstatisticalsignificance,andastatementthatagiveninfantmortalityrateis higher or lower than another rate indicates that the rates aresignificantly different. Information on the methods used to test forstatisticalsignificance,aswellasinformationondifferencesbetweenperiod andcohortdata, theweightingof the linked file,andacomparison of infant mortality data between the linked file and the vitalstatisticsmortality filearepresented in TechnicalNotes.Additionalinformationonmaternalage,maritalstatus,periodofgestation,birth-weight,andcause-of-deathclassification isalsopresented in TechnicalNotes.ResultsandDiscussionTrends in infantmortality
The overall 2006 infant mortality rate from the linked file was6.68infantdeathsper1,000livebirths,3percentlowerthanthe2005rate
of
6.86
(Table
C);
the
2006
rate
from
the
mortality
file
was
6.69
(3).Theneonatalmortality rate for2006 (4.46)wasnotsignificantlydifferentfrom2005(4.54).Thepostneonatalmortalityratedecreasedfrom2.32 in2005 to2.22 in2006(TablesAandB for2006data).
Whiletheinfantmortalityratewas9percentlowerin2000(6.89)than in1995(7.57),theratehasdeclinedonly3percentsince2000(Figure2andTableC).Significantdeclines in2006 from2005wereobservedforinfantsofnon-Hispanicwhitemothers(3percent)andthetotalofHispanicmothers (4percent) (TableC).
TableA. Infant,neonatal,andpostneonataldeathsandmortalityrates,byraceofmother:UnitedStates,2006 linkedfile
Live Numberofdeaths Mortalityrateper1,000 livebirthsRaceofmother births Infant Neonatal Postneonatal Infant Neonatal Postneonatal
All races. . . . . . . . . . . . . . . . . . . 4,265,593 28,509 19,041 9,468 6.68 4.46 2.22White. . . . . . . . . . . . . . . . . . . . . 3,310,331 18,422 12,292 6,130 5.57 3.71 1.85Black. . . . . . . . . . . . . . . . . . . . . 666,494 8,595 5,778 2,818 12.90 8.67 4.23American IndianorAlaskaNative . . . . 47,720 395 205 190 8.28 4.30 3.98AsianorPacific Islander. . . . . . . . . . 241,048 1,097 766 331 4.55 3.18 1.37NOTES: Infantdeathsareweightedsonumbersmaynotexactlyadd to totalsdue torounding.Neonatal is less than28daysandpostneonatal is28days tounder1year.Twenty-threestatesreportedmultiple-racedataon thebirthcertificate for2006.Themultiple-racedata for thesestateswerebridged to thesingle-racecategoriesof the1977standards forcomparabilitywithotherstates;seereference2 in thisreport.
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. . . Categorynotapplicable.1Originofmothernotstated included in Alloriginsbutnotdistributedamongorigins.2Includesracesother thanwhiteorblack.NOTES: Infantdeathsareweightedsonumbersmaynotexactlyadd to totalsdue torounding.Neonatal is less than28daysandpostneonatal is28days tounder1year.PersonsofHispanicoriginmaybeofany race. In this table,Hispanicwomenareclassifiedonlybyplaceoforigin;non-Hispanicwomenareclassifiedbyrace.Seereference2 in thisreport.Twenty-threestatesreportedmultiple-racedataon thebirthcertificate for2006.Themultiple-racedata for thesestateswerebridged to thesingle-racecategoriesof the1977standards forcomparabilitywithotherstates;seereference2 in thisreport.
InfantmortalitybyraceandHispanicoriginofmother
As inpastyears, infantmortality rates in2006variedconsiderably by race and Hispanic origin of mother (8,9). The highest rate,13.35 per 1,000 live births, was for infants of non-Hispanic blackmothers, nearly three times greater than the lowest rateof 4.52 forinfants of Central and South American mothers and 4.55 for APImothers. Rates were also fairly high for infants ofAIAN (8.28) andPuertoRican(8.01)mothers.Rateswere intermediate,butallbelowthe U.S. rate, for infants of non-Hispanic white (5.58) and Mexican(5.34)mothers.Cubanmothers(5.08)alsohada lowrate(Figure2;TablesAC).Infantmortalitybystate
In2006,compared with2005, only threestates had significantchanges in infant mortality rates. Rates declined in South Carolina
(12percent), California (5percent), andTexas (5percent) (TableD).ToobtainstatisticallyreliableratesbyraceandHispanicorigin,threeyears of data were combined (Table3). Across the United States,rates are generally higher in the South and Midwest and lowerelsewhere (Figure1). For 20042006, infant mortality rates rangedfrom10.63forMississippito4.93forMassachusetts.Thehighestratenoted, 12.57, was for the District of Columbia (D.C.); however, theD.C. rate is more appropriately compared with rates for other largeU.S.citiesbecauseofthehighconcentrationofwomenathighriskintheseareas.
Forinfantsofnon-Hispanicblackmothers,mortalityratesrangedfrom20.85inHawaiito8.12inWashington.Forinfantsofnon-Hispanicwhitemothers,Oklahomahad thehighest infantmortalityrate(7.68)andHawaiihad the lowest rate (3.66)amongstates.Among the41states where infant mortality rates could be reliably computed forHispanic mothers, Rhode Island had the highest rate (7.95) andMinnesotahad the lowest(4.27).
TableB. Infant,neonatal,andpostneonataldeathsandmortalityrates,byHispanicoriginofmotherandbyraceofmother formothersofnon-Hispanicorigin:UnitedStates,2006 linked file
Live Numberofdeaths Mortality rateper1,000 livebirthsHispanicoriginand raceofmother births Infant Neonatal Postneonatal Infant Neonatal Postneonatal
Allorigins1. . . . . . . . . . . . . . . . . . 4,265,593 28,509 19,041 9,468 6.68 4.46 2.22TotalHispanic. . . . . . . . . . . . . . . . 1,039,079 5,622 3,883 1,739 5.41 3.74 1.67
Mexican. . . . . . . . . . . . . . . . . . 718,148 3,837 2,679 1,158 5.34 3.73 1.61PuertoRican. . . . . . . . . . . . . . . 66,932 536 364 172 8.01 5.44 2.57Cuban. . . . . . . . . . . . . . . . . . . 16,936 86 61 24 5.08 3.60 1.42CentralandSouthAmerican. . . . . . 165,321 748 515 233 4.52 3.12 1.41OtherandunknownHispanic . . . . . 71,742 415 264 151 5.78 3.68 2.10
Non-Hispanic total2. . . . . . . . . . . . . 3,196,111 22,493 14,820 7,673 7.04 4.64 2.40Non-Hispanicwhite . . . . . . . . . . . 2,308,654 12,884 8,410 4,474 5.58 3.64 1.94Non-Hispanicblack . . . . . . . . . . . 617,260 8,241 5,525 2,716 13.35 8.95 4.40
Notstated. . . . . . . . . . . . . . . . . . 30,403 395 338 57 ... ... ...
TableC. Infantmortalityrates,byraceandHispanicoriginofmother:UnitedStates,1995,20002006 linked filesPercentchange
RaceandHispanicoriginofmother 1995 2000 2001 2002 2003 2004 2005 2006 20002006 20052006All races. . . . . . . . . . . . . . . . . . . 7.57 6.89 6.84 6.95 6.84 6.78 6.86 6.68 **3.0 **2.6White. . . . . . . . . . . . . . . . . . . . . 6.30 5.71 5.69 5.79 5.72 5.66 5.73 5.57 **2.5 **2.8Black. . . . . . . . . . . . . . . . . . . . . 14.58 13.48 13.34 13.81 13.50 13.25 13.26 12.90 **4.3 2.7American IndianorAlaskaNative . . . . 9.04 8.30 9.65 8.64 8.73 8.45 8.06 8.28 0.2 2.7AsianorPacific Islander. . . . . . . . . . 5.27 4.87 4.73 4.77 4.83 4.67 4.89 4.55 6.6 7.0Hispanic . . . . . . . . . . . . . . . . . . . 6.27 5.59 5.44 5.62 5.65 5.55 5.62 5.41 3.2 **3.7
Mexican. . . . . . . . . . . . . . . . . . 6.03 5.43 5.22 5.42 5.49 5.47 5.53 5.34 1.7 3.4PuertoRican. . . . . . . . . . . . . . . 8.88 8.21 8.53 8.20 8.18 7.82 8.30 8.01 2.4 3.5Cuban. . . . . . . . . . . . . . . . . . . 5.29 4.54 4.28 3.72 4.57 4.55 4.42 5.08 11.9 14.9CentralandSouthAmerican. . . . . . 5.52 4.64 4.98 5.06 5.04 4.65 4.68 4.52 2.6 3.4
Non-Hispanicwhite. . . . . . . . . . . . . 6.28 5.70 5.72 5.80 5.70 5.66 5.76 5.58 2.1 **3.1Non-Hispanicblack. . . . . . . . . . . . . 14.65 13.59 13.46 13.89 13.60 13.60 13.63 13.35 1.8 2.1** Significantatp
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Mortalityratescouldbereliablycomputed foronly13statesforinfantsofAIANmothersandfor31statesforinfantsofAPImothers.ForinfantsofAIANmothers,mortalityratesrangedfrom12.28inSouthDakotato6.30inCalifornia.MortalityratesforinfantsofAPImothersranged from8.64 in Iowa to3.19 inConnecticut.Sex of infant
In2006,theoverallmortalityrateformale infantswas7.31per1,000 live births, 21percent higher than the rate for female infants(6.02).InfantmortalityrateswerehigherformalethanfemaleinfantsineachraceandHispanic-origingroup(Tables1and2),althoughthedifference was not significant for infants of Cuban and Central andSouthAmericanmothers.Multiplebirths
Formultiplebirths,theinfantmortalityratewas30.07,morethanfivetimestherateof5.87forsingletonbirths(Tables1and2).Infantmortality rates for multiple births were higher than the rates forsingletonbirths forall raceandHispanic-origingroups.
Theriskofinfantdeathincreaseswiththeincreasingnumberofinfants in the pregnancy. In 2006, the infant mortality rate for twins(27.92)wasnearlyfivetimestherateforsingletonbirths(5.87).Theratefortriplets(69.63)wasnearly12timesandtherateforquadruplets(146.48)was25 timeshigher than the rate forsingletonbirths (Figure3).Areliable infantmortality rate forquintupletandhigherorderbirthscouldnotbecomputeddue tosmallnumbersof infantdeathsforthatcategory.Infantmortalityratesforsingletonandtwinbirthsweresignificantlylowerin2006thanin2005,whiletheinfantmortalityratefor tripletswassignificantlyhigher in2006comparedwith2005.
Multiplepregnancycanleadtoanaccentuationofmaternalrisksandcomplicationsassociatedwithpregnancy(2,1012).Forexample,multiplebirthsaremuchmorelikelytobepretermandoflowbirthweightthansingletonbirths(2,1012).Thehigherriskprofileofmultiplebirths
has a substantial impact on overall infant mortality (10,1315). Forexample,in2006multiplesaccountedfor3percentofalllivebirths,but15percentofall infantdeaths in theUnitedStates (Table1).Ageatdeath
In 2006, two-thirds of all infant deaths (19,041 out of 28,509)occurred during the neonatal period (from birth through 27 days of
TableD. Infantmortalityrates,bystate:2000,2005,and2006 linked files[Byplaceof residence]
Infantmortality rateper1,000 livebirths Percent
changeState 2000 2005 2006 20052006
Total
. . . . . . . . . . . . . . . . . . . . .
6.89
6.86
6.68
**2.6
Alabama. . . . . . . . . . . . . . . . . . . 9.51 9.53 8.98 5.7Alaska . . . . . . . . . . . . . . . . . . . . 6.92 5.93 7.00 18.1Arizona. . . . . . . . . . . . . . . . . . . . 6.75 6.85 6.36 7.2Arkansas. . . . . . . . . . . . . . . . . . . 8.23 7.83 8.45 7.9California. . . . . . . . . . . . . . . . . . . 5.42 5.32 5.04 **5.2Colorado. . . . . . . . . . . . . . . . . . . 6.14 6.44 5.77 10.5Connecticut . . . . . . . . . . . . . . . . . 6.51 5.85 6.17 5.5Delaware. . . . . . . . . . . . . . . . . . . 9.59 9.02 8.09 10.3DistrictofColumbia . . . . . . . . . . . . 12.13 13.67 11.85 13.3Florida . . . . . . . . . . . . . . . . . . . . 6.91 7.24 7.26 0.3Georgia . . . . . . . . . . . . . . . . . . . 8.45 8.07 8.07 0.0Hawaii . . . . . . . . . . . . . . . . . . . . 8.09 6.58 5.85 11.2Idaho. . . . . . . . . . . . . . . . . . . . . 7.56 5.98 6.82 14.0Illinois . . . . . . . . . . . . . . . . . . . . 8.48 7.38 7.29 1.2Indiana. . . . . . . . . . . . . . . . . . . . 7.79 8.04 7.91 1.6Iowa . . . . . . . . . . . . . . . . . . . . . 6.43 5.44 5.12 5.9Kansas. . . . . . . . . . . . . . . . . . . . 6.55 7.37 7.15 3.0Kentucky. . . . . . . . . . . . . . . . . . . 7.10 6.73 7.50 11.4Louisiana. . . . . . . . . . . . . . . . . . . 9.03 9.85 9.96 1.1Maine. . . . . . . . . . . . . . . . . . . . . 4.85 6.87 6.29 8.5Maryland. . . . . . . . . . . . . . . . . . . 7.51 7.30 7.95 9.0Massachusetts . . . . . . . . . . . . . . . 4.61 5.13 4.85 5.3Michigan. . . . . . . . . . . . . . . . . . . 8.19 7.89 7.33 7.0Minnesota . . . . . . . . . . . . . . . . . . 5.62 5.09 5.18 1.8Mississippi. . . . . . . . . . . . . . . . . . 10.64 11.46 10.53 8.1Missouri . . . . . . . . . . . . . . . . . . . 7.19 7.52 7.45 1.0Montana . . . . . . . . . . . . . . . . . . . 6.02 7.25 6.00 17.3Nebraska. . . . . . . . . . . . . . . . . . . 7.18 5.66 5.54 2.2Nevada. . . . . . . . . . . . . . . . . . . . 6.45 5.66 6.62 16.9NewHampshire. . . . . . . . . . . . . . . 5.82 5.27 5.91 12.2NewJersey . . . . . . . . . . . . . . . . . 6.26 5.17 5.44 5.3NewMexico. . . . . . . . . . . . . . . . . 6.72 6.17 5.71 7.5New York . . . . . . . . . . . . . . . . . . 6.40 5.82 5.64 3.0NorthCarolina. . . . . . . . . . . . . . . . 8.60 8.81 8.09 8.2NorthDakota . . . . . . . . . . . . . . . . 8.34 5.96 5.92 0.7Ohio . . . . . . . . . . . . . . . . . . . . . 7.66 8.17 7.76 5.1Oklahoma . . . . . . . . . . . . . . . . . . 8.40 7.95 7.96 0.1Oregon. . . . . . . . . . . . . . . . . . . . 5.57 5.99 5.38 10.1Pennsylvania . . . . . . . . . . . . . . . . 7.10 7.29 7.65 5.0Rhode Island . . . . . . . . . . . . . . . . 6.24 6.46 6.22 3.6SouthCarolina . . . . . . . . . . . . . . . 8.77 9.46 8.32 **12.1SouthDakota . . . . . . . . . . . . . . . . 5.22 6.98 6.88 1.4Tennessee. . . . . . . . . . . . . . . . . . 9.11 8.77 8.65 1.3Texas. . . . . . . . . . . . . . . . . . . . . 5.60 6.55 6.19 **5.4Utah . . . . . . . . . . . . . . . . . . . . . 5.32 4.52 5.12 13.3Vermont . . . . . . . . . . . . . . . . . . . 6.46 6.49 5.68 12.4Virginia. . . . . . . . . . . . . . . . . . . . 6.91 7.47 7.10 5.0Washington . . . . . . . . . . . . . . . . . 5.20 5.07 4.70 7.3WestVirginia . . . . . . . . . . . . . . . . 7.38 8.16 7.07 13.3Wisconsin . . . . . . . . . . . . . . . . . . 6.64 6.54 6.37 2.5Wyoming. . . . . . . . . . . . . . . . . . . 6.72 6.63 6.78 2.2** Significantatp
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age)(TablesAandB).In2006,theneonatalmortalityratewas4.46deathsper1,000livebirths,essentiallyunchangedfromthepreviousyear (4.54). The 2006 postneonatal (28 days to under 1 year)mortality rateof2.22was4percent lower than the2005 rate (2.32)butwasnotsignificantlydifferentfromthe2004rate(2.25)(2004and2005datanotshown).
The neonatal mortality rate for infants of non-Hispanic blackmothers(8.95)wasmorethantwicethoseforinfantsofAIAN(4.30),non-Hispanic white (3.64), API (3.18), Mexican (3.73), Central andSouth American (3.12), and Cuban women (3.60) (Figure4). TheneonatalmortalityrateforPuertoRicanwomen(5.44)wasthesecondhighest after that for non-Hispanic black women. Neonatal mortalityratesdidnotdeclinesignificantlyforanyraceorethnicgroupin2006from2005 (datanotshown).
Infantsofnon-Hispanicblack(4.40)andAIAN(3.98)mothershadthehighestpostneonatalmortalityratesofanygroupmorethantwicethatfornon-Hispanicwhitewomen(1.94)(Figure4).Thepostneonatalmortality rate forPuertoRicanwomen (2.57)was32percenthigherthanfornon-Hispanicwhitewomen.Incontrast,postneonatalmortalityratesforMexican(1.61),API(1.37),andCentralandSouthAmericanwomen(1.41)were1729percent lowerthanfornon-Hispanicwhitewomen (Figure4; TablesA and B). Postneonatal mortality ratesdeclined in 2006 from 2005 for non-Hispanic white (2.05 to 1.94,respectively)andMexican(1.75to1.61,respectively)women;ratesforother race and Hispanic origin groups were essentially unchanged(2005datanotshown).Periodofgestation
Thegestationalageofan infant isperhaps themost importantpredictor of his or her subsequent health and survival. Infants borntoosmalland toosoonhaveamuchgreaterriskofdeathandbothshort- andlong-termdisabilitythanthosebornatterm(3741weeksofgestation),andthepercentageofpretermbirthshasbeenlinkedtovariations in infant mortality rates betweencountries (1621). Infant
0
30
60
90
120
150
QuadrupletTripletTwinSingletonAllpluralities
Rateper1,0
00livebirths
6.86 5.87
27.92
69.63
146.48
Includes quintuplet and higher order births not shown separately.
SOURCE: CDC/NCHS, National Vital Statistics System.
Figure3. Infantmortalityrates,byplurality:UnitedStates,2006
0
2
4
6
8
10 Neonatal
Centraland
SouthAmerican
CubanMexicanAmericanIndian orAlaskaNative
TotalPuertoRican
NonHispanic
black
Rateper1,0
00livebirths
NonHispanic
white
Asian orPacific
Islander
Postneonatal
Includes persons of Hispanic and nonHispanic origin.
SOURCE: CDC/NCHS, National Vital Statistics System.
Difference between neonatal and postneonatal is not significant.
8.95
4.40
5.44
2.57
4.46
2.22
4.303.98
3.73
1.61
3.64
1.94
3.60
1.42
3.18
1.37
3.12
1.41
NS
Figure4.Neonatalandpostneonatalmortalityrates,byraceandethnicityofmother:UnitedStates,2006
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7NationalVitalStatisticsReports,Volume58,Number17,April30,2010mortality rates are highest for very preterm (less than 32 weeks)infants, and the risk decreases sharply with increasing gestationalage(1620).In2006,theinfantmortalityrateforverypreterminfants(175.94)was74timestherateof2.39forterminfants(TableE).Themortalityrateforinfantsbornat3233weeksofgestationwas16.19,nearlyseven times the rate for term infants.Althoughmortality fallswith increasinggestationalage,even infantsbornonlya fewweeksearly have a substantially increased risk of death when comparedwith term infants (2224). In 2006, the infant mortality rate for latepreterm infants (3436weeksofgestation)was7.08, 2.9 times therate for term infants. Even within the term period, infants born at3739 weeks of gestation had mortality rates that were 28percenthigher than those for infants born at 4041 weeks of gestation(Tables1and2).
Becauseof theirmuchgreaterriskofdeath, infantsbornatthelowest gestational ages have a large impact on overall U.S. infantmortality.Forexample, infantsbornverypretermaccounted foronly2percentofbirthsbutmorethanone-halfofallinfantdeaths(54percent)intheUnitedStatesin2006(TableE).Conversely,infantsbornat37weeksofgestationormoreaccountedfor87percentofbirthsbut32percentof infantdeaths.Afteraplateaufrom2000to2005,theinfantmortalityrateforverypreterminfantsdeclinedby4percentin2006from2005.In2006,theinfantmortalityrateforverypreterminfantswas175.94,comparedwith
183.24in2005and180.95in2000(TableE).Changesin2006from2005forotherspecificgestationalagecategorieswerenotstatisticallysignificant.
Therewerelargedifferencesinthepercentageofpretermbirthsby raceandethnicity,and thesedifferenceshavea large impactoninfantmortalityrates(15,25).In2006,thepercentageofpretermbirthsranged from10.9percentofbirths toAPImothersto18.5percentofbirthstonon-Hispanicblackmothers(Tables4and5).Thepercentageofpretermbirths in theUnitedStateshasbeen increasingsince themid-1980s(2).Aportionoftheincreaseisrelatedtoariseinmultiplebirths (in part due to growth in the use of assisted reproductivetechnologies),althoughthepercentageofpretermbirthshasalsorisenforsingletons(2).Changesinthemedicalmanagementofpregnancy(i.e.,increasesincesareansectionandinductionoflaborforpreterminfants)mayhavealsohadan impact(2,12,22,2628).
Somedifferencesoccurredingestationalage-specificinfantmortalityratesbyraceandethnicity(Tables1and2).Infantmortalityratesweresignificantlyhigherfornon-Hispanicblackthanfornon-Hispanicwhitemothersforthegestationalagecategorieslessthan32weeks,3436weeks,3741weeks,and42weeksormore.Whencomparedwithnon-Hispanicwhitemothers,infantmortalityrateswerehigherforAIANmothersat3436weeksand3741weeksofgestation,whileinfantmortalityrateswerehigherforPuertoRicanmothersatlessthan32weeksofgestation. Comparedwith non-Hispanicwhitemothers,
TableE. Infantmortalityrates,andpercentdistributionof livebirthsand infantdeaths,byperiodofgestation:UnitedStates,20002006 linked files
Preterm (less than37weeks)Very Late
All preterm preterm Term Post-termgestational Total (less than 3233 (3436 (3741 (42weeks
Year ages1 preterm 32weeks) weeks weeks) weeks) ormore)Infantmortality rate1
2006 . . . . . . . . . . . . . . . . . . . . . 6.68 35.15 175.94 16.19 7.08 2.39 2.802005 . . . . . . . . . . . . . . . . . . . . . 6.86 36.55 183.24 16.69 7.30 2.43 2.662004 . . . . . . . . . . . . . . . . . . . . . 6.78 36.56 182.47 16.06 7.32 2.39 2.872003 . . . . . . . . . . . . . . . . . . . . . 6.84 37.21 188.24 16.42 7.12 2.42 2.882002 . . . . . . . . . . . . . . . . . . . . . 6.95 37.86 186.39 17.63 7.66 2.48 3.072001 . . . . . . . . . . . . . . . . . . . . . 6.84 36.94 181.00 17.62 7.32 2.54 2.952000 . . . . . . . . . . . . . . . . . . . . . 6.89 37.88 180.95 17.37 7.96 2.59 2.91
Percentdistributionof infantdeaths22006 . . . . . . . . . . . . . . . . . . . . . 100.0 68.1 54.3 4.0 9.8 29.5 2.42005 . . . . . . . . . . . . . . . . . . . . . 100.0 68.6 54.9 3.9 9.8 29.1 2.32004 . . . . . . . . . . . . . . . . . . . . . 100.0 68.3 54.7 3.8 9.7 29.1 2.72003 . . . . . . . . . . . . . . . . . . . . . 100.0 68.1 55.0 3.8 9.3 29.2 2.72002 . . . . . . . . . . . . . . . . . . . . . 100.0 67.3 53.7 4.0 9.7 29.6 3.02001
. . . . . . . . . . . . . . . . . . . . .
100.0
66.1
52.8
3.8
9.0
30.9
3.0
2000 . . . . . . . . . . . . . . . . . . . . . 100.0 65.6 52.0 3.7 9.4 31.2 3.2
Percentdistributionof livebirths22006 . . . . . . . . . . . . . . . . . . . . . 100.0 12.8 2.0 1.6 9.1 81.5 5.72005 . . . . . . . . . . . . . . . . . . . . . 100.0 12.7 2.0 1.6 9.1 81.4 5.82004 . . . . . . . . . . . . . . . . . . . . . 100.0 12.5 2.0 1.6 8.9 81.3 6.22003 . . . . . . . . . . . . . . . . . . . . . 100.0 12.3 2.0 1.6 8.8 81.3 6.42002 . . . . . . . . . . . . . . . . . . . . . 100.0 12.1 2.0 1.5 8.6 81.2 6.72001 . . . . . . . . . . . . . . . . . . . . . 100.0 11.9 1.9 1.5 8.4 81.2 6.92000 . . . . . . . . . . . . . . . . . . . . . 100.0 11.6 1.9 1.5 8.1 81.1 7.31Infantmortalityratesaredeaths less than1yearper1,000 livebirths inspecifiedgroup.2Infantdeathsandbirthswithnotstatedgestationalagearesubtracted from the totalnumberofeventsusedasdenominators forpercentagecomputations.
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8 NationalVitalStatisticsReports,Volume58,Number17,April30,2010infantmortalityrates forAPImotherswere lowerat3436weeksofgestation; for Mexican mothers, infant mortality rates were lower at3741 weeks of gestation; and for Central and South Americanmothers,infantmortalityrateswereloweratbothlessthan32weeksand3741weeksofgestation.Birthweight
Birthweight is another important predictor of infant health. It iscloselyassociatedbutdoesnotexactlycorrespondwiththeperiodofgestation. Infant mortality rates are highest for the smallest infantsand decrease sharply as birthweight increases. In 2006, infantmortalityratesweremuchhigherforlowbirthweight(lessthan2,500grams) infants(55.38per1,000)thanfor infantswithbirthweightsof2,500 grams or more (2.24) (Table1). The infant mortality rate forvery low birthweight (less than 1,500 grams) infants was 240.44,more than 100 times the rate for infants with birthweights of 2,500grams ormore. When detailed birthweight categoriesareexamined(Table6), 85percent of infants with birthweights of less than 500grams(1 lb.1oz.or less)diedwithinthefirstyearof life.Reportingofdeathsamongtheseverysmallinfantsmaybeincomplete(29).Aninfants chances of survival increases rapidly with increasing birth-weight: Infant mortality rates were lowest at birthweights of3,0004,999grams.
Becauseoftheirmuchhighermortalityrates,infantsbornatthelowestbirthweightshaveasubstantialimpactonoverallinfantmortalityrates. For example, infants born weighing less than 1,000 gramsaccountedforonly0.7percentofbirthsbutnearlyone-halfofallinfantdeaths (48.0percent) in theUnitedStates in2006 (tabulardatanotshown).Conversely,91.7percentofinfantsbornintheUnitedStatesin2006weighed2,500gramsormore,buttheseinfantsaccountedforlessthanone-thirdofinfantdeaths(31.0percent).ThelargeraceandHispanic-originvariationsinthepercentageofbirthsatlowbirthweight(less than 2,500 grams)from 6.6percent for Mexican mothers to14.0percentfornon-Hispanicblackmothersmeanthatsomeraceorethnicgroupsaredisproportionatelyimpactedbythehighinfantmortality rates for lowbirthweight infants (Tables4and5).
From2000to2006,infantmortalityratesforthetotalpopulationdeclinedby10percentforinfantsweighing1,0001,249gramsandby814percentforinfantsweighing1,5003,999gramsatbirth(Table6).Changesforotherdetailedbirthweightcategorieswerenotstatisticallysignificant.
Fornon-Hispanicwhitewomen from2000 to2006,birthweightspecificinfantmortalityratesdeclinedforspecificbirthweightcategories(1,0001,249gramsand2,0003,499grams),whilefornon-HispanicblackandHispanicwomen,declinesweresignificant for infantswithbirthweights of 2,5003,999 grams. No significant changes for anydetailedbirthweightcategorywereobservedforAIANandAPIwomen.TheinfantmortalityratesforseveralraceandHispanicorigingroupsdeclined foroneorbothof thesummarycategories less than2,500gramsor2,500gramsormore(Table6).Prenatalcare
This report includes data on the timing of prenatal care basedonlyonthe12statesthathadimplementedthe2003RevisiontotheU.S.StandardCertificateofLiveBirthasofJanuary1,2005(2).The2003revisionof thebirthcertificate introducedsubstantivechanges
in item wording and to the sources of prenatal information (seeMethods and Technical Notes). Accordingly, prenatal care databasedon the2003and1989 revisionsarenotdirectlycomparable.Only ratesbasedon the2003 reviseddataareshown in thisreport(seeTableII, TechnicalNotes).
The timingandqualityofprenatalcare receivedby themotherduringpregnancy is important to the infantssubsequenthealthandsurvival (3033). Early comprehensive prenatal care can promotehealthierpregnanciesbyprovidinghealthbehavioradviceaswellasearlydetectionandtreatmentofriskfactorsandsymptoms(30,31).Theinitiationandsubsequentutilizationofprenatalcareisalsoviewedasan indicator foraccess tocare(33).Maternalage
Infantmortalityratesvarywithmaternalage:Infantsofteenagemothers(9.78)andmothersaged40yearsandover(8.01)havethehighestrates.Thelowestratesareforinfantsofmothersintheirlatetwentiesandearly thirties(Tables1and2).
In 2006, among births to teenagers, infants of the youngestmothers(under15years)hadthehighestmortalityrate(18.14).Therateforinfantsofmothersaged1517was10.42,a9-percentdecreasefrom2005(11.40);therateforinfantsofmothersaged1819was9.30in2006comparedwith9.60in2005(tabulardatanotshown);andtherateforinfantsofmothersaged2024decreased4percentfrom7.86in2005 to7.55 in2006.
Withinracialandethnicsubgroups,amonggroupsforwhichratescould be reliably computed, infant mortality rates for births to non-Hispanic white mothers under age 20 years were higher than formothersaged40andover.Incontrast,forMexicanmothers,ratesforbirths to the oldest women were higher than rates for infants ofteenagers.Maternaleducation
Information on educational attainment in this report is drawnfrom the 12 states that had implemented the 2003 U.S. StandardCertificateofLiveBirthasofJanuary1,2005(2).The formatof theeducation item on the 2003 revised birth certificate substantivelydiffers from that of the unrevised (1989) standard certificate (seeMethods and Technical Notes). Only rates based on the 2003revised data are shown in this report (see TableII, TechnicalNotes).
Infant mortality rates are known to decrease with increasingeducational levels, which may reflect socioeconomic differences;womenwithmoreeducationtendtohavehigherincomelevels(9,34).Livebirthorder
Infantmortalityratesweregenerallyhigherforfirstbirthsthanforsecondbirths,and thengenerally increasedasbirthorder increased(Tables1and2).Overall,theinfantmortalityrateforfirstbirths(6.69)was14percenthigherthanforsecondbirths(5.89).Therateforfifthandhigherorderbirths (10.13)was 72percenthigher than the rateforsecondbirths.Thehigherparitiesandthereforethehighest-orderbirths (fifth child and above) are more likely to be associated witholdermaternalage,multiple births,and lowersocioeconomic status(2,35).
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9NationalVitalStatisticsReports,Volume58,Number17,April30,2010Maritalstatus
Maritalstatusmaybeamarker for thepresenceorabsenceofsocial,emotional,andfinancialresources(36,37).Infantsofmotherswhoarenotmarriedhavebeenshown tobeathigher risk forpooroutcomes (38,39). In 2006, infants of unmarried mothers had aninfantmortalityrateof9.19per1,000,80percenthigherthantheratefor infants of married mothers (5.11) (Tables1 and 2). Within eachrace and Hispanic origin group, infants of unmarried mothers hadhigherratesofmortality,andwith theexceptionofAIANandCubaninfants, thesedifferencesweresignificant.Nativity
In 2006, the infant mortality rate for mothers born in the 50statesandtheDistrictofColumbia(7.03)was38percenthigherthantherateformothersbornelsewhere(5.09)(Figure5;Tables1and2).Among race and Hispanic origin groups for whom infant mortalityrates could be calculated, except for Puerto Rican, Cuban, andCentralandSouthAmericanmothers,mothersborn in the50statesand the District of Columbia had higher infant mortality rates thanmothersbornelsewhere(Tables1and2).
Avarietyofhypotheseshavebeenadvancedtoaccountforthelowerinfantmortalityrateamong infantsofmothersbornoutsidethe50statesandtheDistrictofColumbia, includingpossibledifferencesinmigrationselectivity,socialsupport,andriskbehaviors(40,41).Also,womenbornoutsidethe50statesandtheDistrictofColumbiahave
been shown to have different characteristics than their U.S.-borncounterpartswithregardtosocioeconomicandeducationalstatus(42).Maternalsmoking
Informationonsmokingduringpregnancyinthisreportisbasedonthe2003revisionofthebirthcertificate,whichdifferssubstantivelyfrom that of the unrevised (1989) standard certificate (2). For the2006linkedfile,reviseddataareavailablefor11ofthe12statesthatrevised their certificates as of January 1, 2005; Florida revised thecertificate but had a noncomparable question (see Methods andTechnical Notes). Only rates based on the 2003 revised data areshown in thisreport(seeTableII, TechnicalNotes).
Tobaccouseduringpregnancycausesthepassageofsubstancessuchasnicotine,hydrogencyanide,andcarbonmonoxide from theplacenta into the fetal blood supply. These substances restrict thegrowinginfantsaccesstooxygenandcanleadtoadversepregnancyandbirthoutcomessuchas lowbirthweight,pretermdelivery, intrauterine growth retardation, and infant mortality (43,44). Maternalsmoking has also been shown to increase the risk of respiratoryinfectionsand inhibitallergic immune responses in infants (45,46).Leadingcausesof infantdeath
Infantmortality rates for the five leadingcausesof infantdeatharepresented inTable7byraceandHispanicoriginofmother.Theleading cause of infant death in the United States in 2006 was
0
3
6
9
12
15 Born in the U.S.
Centraland
SouthAmerican
CubanMexicanAmericanIndian orAlaskaNative
TotalPuertoRican
NonHispanic
black
Rateper1,0
00livebirths
NonHispanic
white
Asian orPacific
Islander
Born elsewhere
13.54
10.01
8.35
NA
7.56
8.70
7.03
5.09
5.92
4.985.59
4.04
5.76
4.19
5.304.76
4.994.43
NS
NSNS
Includes persons of Hispanic and nonHispanic origin.
SOURCE: CDC/NCHS, National Vital Statistics System.
Difference between born in the U.S. and born elsewhere is not significant.Not applicable, for mothers born elsewhere there are fewer than 20 infant deaths.
Figure5. Infantmortalityrates,bymothersplaceofbirthandraceandethnicityofmother:UnitedStates,2006
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10 NationalVitalStatisticsReports,Volume58,Number17,April30,2010Congenitalmalformations,deformationsandchromosomalabnormalities(congenitalmalformations),accountingfor21percentofallinfantdeaths.Disordersrelatingtoshortgestationand lowbirthweight,notelsewhere classified (low birthweight) was second, accounting for17percent of all infant deaths, followed by Sudden infant deathsyndrome (SIDS) at 8percent of infant deaths. The fourth and fifthleading causesNewborn affected by maternal complications ofpregnancy (maternalcomplications), followedbyAccidents (unintentional injuries)accounted for 6percent and4percent, respectively,of all infant deaths in 2006. Together the five leading causesaccounted for56percentofall infantdeaths in theUnitedStates in2006.Theorderof the top four leadingcauseswas thesameas in2005. The fifth leading cause of death in 2006 was unintentionalinjuries, which was ranked sixth in 2005. Newborn affected bycomplicationsofplacenta,cordandmembranes(cordcomplications)was fifth in2005butdropped tosixth in2006. Infantmortality ratesfor the five leadingcausesdidnotchangesignificantly in2006 from2005,exceptformaternalcomplications,whichdeclinedby8percentin2006 fromayearearlier(2005datanotshown).
In2006,therankorderofleadingcausesof infantdeathvariedsubstantially by race and Hispanic origin of the mother. Congenitalmalformations was the leading cause of infant death for all groupsexceptfornon-HispanicblackandPuertoRicanwomen,forwhomlowbirthweightwas the leadingcause.
When differences between cause-specific infant mortality rateswereexaminedbyraceandethnicity,infantmortalityratesfromCongenitalmalformationswere38percenthigher fornon-Hispanicblackand20percenthigherforMexicanthanfornon-Hispanicwhitewomen.InfantmortalityratesfromCongenitalmalformationswere14percentlower forAPI than fornon-Hispanicwhitewomen.
Infantsofnon-Hispanicblackmothershad thehighestmortalityratesfromlowbirthweight.Theratefornon-Hispanicblackmotherswasnearlyfourtimestheratefornon-Hispanicwhitemothers.TherateforPuertoRicanmotherswasmorethantwicetheratefornon-Hispanicwhitemothers.
SIDS rates were highest for AIAN and non-Hispanic blackmothers2.1 and 1.9 times those for non-Hispanic white mothers,respectively. As most SIDS deaths occur during the postneonatalperiod,thehighSIDSratesforinfantsofnon-HispanicblackandAIANmothers accounted for much of their elevated risk of postneonatalmortality.Comparedwithnon-Hispanicwhitemothers,SIDSrateswere54percent lower for Mexican mothers, 59percent lower for APImothers, and 73percent lower for Central and South Americanmothers.
Formaternalcomplications(e.g., incompetentcervix,prematureruptureofmembranes,andmultiplepregnancy,amongothers),infantsof non-Hispanic black mothers had the highest mortality rates2.8times those fornon-Hispanicwhitemothers.Rates forPuertoRicanmotherswere74percenthigherthanfornon-Hispanicwhitemothers.Infantsofnon-HispanicblackandPuertoRicanwomenhaveamuchhigherpercentageoflowbirthweight(Tables4and5),whichmayhelptoexplain theirhigher infantmortality rates frommaternalcomplications, as this cause occurs predominantly among low birthweightinfants.Infantmortalityratesfrommaternalcomplicationswere26percentlowerforAPIand52percentlowerforCentralandSouthAmericanwomen than fornon-Hispanicwhitewomen.
ForAIANwomen,infantmortalityratesfromunintentionalinjurieswere triple those for non-Hispanic white women. For non-Hispanicblackwomen,ratesfromunintentional injuriesweredoublethosefornon-Hispanic white women. Infant mortality rates from unintentionalinjurieswere47percentlowerforMexicanand50percentlowerforAPIwomen than fornon-Hispanicwhitewomen.
An examination of cause-specific differences in infant mortalityratesamongraceandHispanicorigingroupscanhelpinunderstandingoveralldifferences in infantmortality ratesamong thesegroups.Forexample, 29percent of the elevated infant mortality rate for non-Hispanic black mothers, when compared with non-Hispanic whitemothers,canbeaccountedforbytheirhigherratefromlowbirthweight,and7percentbydifferencesinmaternalcomplications.Inotherwords,ifnon-Hispanicblackinfantmortalityratesforthesetwocausescouldbereducedtothelevelsfornon-Hispanicwhiteinfants,thedifferencein the infant mortality rate between non-Hispanic black and non-Hispanicwhitemotherswouldbereducedby36percent.
ForAIAN mothers, 24percent of their elevated infant mortalityrate, when compared with non-Hispanic white mothers, can beaccountedforbytheirhigherSIDSrateand19percentbydifferencesinunintentional injuries.Thus, ifAIAN infantmortalityrates forthesetwocausescouldbereducedtonon-Hispanicwhitelevels,thedifferenceintheinfantmortalityratebetweenAIANandnon-Hispanicwhitemotherswouldbe reducedby43percent.
Similarly,37percentofthedifferencebetweenPuertoRicanandnon-Hispanic white infant mortality rates can be accounted for bydifferencesinlowbirthweightand10percentbydifferencesinmaternalcomplications. Thus, if Puerto Rican infant mortality from these twocausescouldbereducedtonon-Hispanicwhitelevels,thedifferencein the infant mortality rate between Puerto Rican and non-Hispanicwhite infantswouldbereducedby47percent.Preterm-relatedcausesofdeath
In order to more fully assess the impact of preterm birth oninfant mortality, CDC researchers have developed a grouping ofpreterm-related causes of death. A cause of death is consideredpreterm related if75percentormore of infantswhose deathswereattributedtothatcausewerebornatlessthan37weeksofgestation,and the cause of death was a direct consequence of preterm birthbasedonaclinicalevaluationand reviewof the literature(47,48).
Thisgroupingwasdevelopedbecause it isdifficult,using traditionalanalysesof the leadingcausesof infantdeath, toassess theoverall impactofpreterm-related infantdeathson infantmortality. Inparticular,thecategoryofDisordersrelatedtoshortgestationandlowbirthweight, not elsewhere classified, includes the phrase not elsewhere classified, indicating that many other preterm-related infantdeathsareclassified toothercause-of-deathcategories.
The comprehensive list of preterm-related cause-of-death categories(ICD10codes)isshownintheTable8footnote.Notethateventhis more comprehensive listing probably underestimates the totalimpactofpreterm-related infantdeath,assomecause-of-deathcategories(notablythosebeginningwiththewordsotherandallother)hadahighpercentageofpreterm infantdeathsbut lackedsufficientspecificitytobeabletoestablishtheetiologicconnectiontoprematuritywithanydegreeofcertainty.
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NationalVitalStatisticsReports,Volume58,Number17,April30,2010 11Table8shows trends inpreterm-related infantmortalityby race
andHispanicoriginofmotherfrom2000to2006.Ofthetotal28,509infantdeathsintheUnitedStatesin2006,10,303werepretermrelated.In 2006, 36.1percentofall infantdeaths in the United Stateswerepreterm related, slightly lower than in 2005 (36.5percent), but still4percenthigher than in2000 (34.6percent).
The impactofpreterm-related infantdeathsvariedconsiderablybymaternalraceandethnicity.In2006,45percentofinfantdeathstonon-Hispanicblackwomenand41percentofinfantdeathstoPuertoRicanwomenwereduetopreterm-relatedcauses,whilepercentagesweresomewhat lower forother raceandethnicgroups (Table8).
Preterm-relatedinfantmortalityratesvariedconsiderablybyraceand ethnicity of the mother (Figure6 and Table8). Preterm-relatedinfant mortality rates were 3.4 times higher for non-Hispanic black(6.01)thanfornon-Hispanicwhitemothers(1.79).Infact,in2006thepreterm-related infant mortality rate for non-Hispanic black motherswashigherthanthetotalinfantmortalityratefornon-Hispanicwhite,Mexican,CentralandSouthAmerican,andAPIwomen.ThepretermrelatedinfantmortalityrateforPuertoRicanwomen(3.30)was84percenthigherthanfornon-Hispanicwhitewomen.Preterm-relatedinfantmortalityratesforAPI(1.49)andCentralandSouthAmerican(1.52)womenweresignificantly lower than fornon-Hispanicwhitewomen.Changes inpreterm-related infantmortality rates in2006 from2005were not statistically significant except for API women, who had a14percentdecline inpreterm-related infantmortality.
Aswiththeleadingcausesofdeath,itispossibletocomputethecontributionofpreterm-related infantmortality toraceandethnicdifferences in infant mortality rates.Thus,54percent of the difference
betweenthenon-Hispanicblackandnon-Hispanicwhiteinfantmortalityrates isduetopreterm-relatedcauses.Ifpreterm-related infantmortalityfornon-Hispanicblackwomencouldbereducedtonon-Hispanicwhite levels, thedifference in the infantmortality ratebetweennon-Hispanicblackandnon-Hispanicwhitemotherswouldbereducedby54percent.
Similarly,forPuertoRicanwomen,62percentofthedifferenceininfantmortalityratescomparedwithnon-Hispanicwhitewomenisdueto differences in preterm-related causes of death, and reducingpreterm-relatedinfantmortalityforPuertoRicanwomentothelevelsfor non-Hispanic white women would lower the difference in ratesbetweenthetwogroupsbythesamepercentage.Inadditiontohelpingtoexplaindifferencesininfantmortalityratesbetweenvariousgroups,comparisons such as these can be helpful in targeting preventionefforts.
References1. National Center for Health Statistics. Public-use data file documenta
tion:2006period linkedbirth/infantdeathdataset [online].Hyattsville,MD.Available from:http://www.cdc.gov/nchs/data_access/VitalStatsOnline.htm.
2. MartinJA,HamiltonBE,SuttonPD,etal.Births:Finaldata for2006.Nationalvital statistics reports;vol57 no 7. Hyattsville, MD: NationalCenter forHealthStatistics.2009.
3. Heron M, Hoyert DL, Murphy SL, et al. Deaths: Final data for 2006.Nationalvitalstatisticsreports;vol57no14.Hyattsville,MD:NationalCenter forHealthStatistics.2009.
0
3
6
9
12
15 Total
Centraland
SouthAmerican
MexicanAmericanIndian orAlaskaNative
TotalPuertoRican
NonHispanic
black
Rateper1,0
00livebirths
NonHispanic
white
Asian orPacific
Islander
Pretermrelated
13.35
6.01
8.28
2.10
8.01
3.30
6.68
2.42
5.58
1.79
5.34
1.71
4.55
1.49
4.52
1.52
Preterm-related deaths are those where the infant was born preterm (before 37 completed weeks of gestation) with the underlying cause of death assigned to one of the following
International Classification of Diseases, Tenth Revision catagories: K550, P000, P010, P011, P015, P020, P021, P027, P070P073, P102, P220P229, P250P279, P280, P281, P360P369,
P520P523, and P77; see Technical Notes.
Includes persons of Hispanic and Non-Hispanic origin.
SOURCE: CDC/NCHS, National Vital Statistics System.
Figure6.Totalandpreterm-related infantmortalityrates,byraceandethnicityofmother:UnitedStates,2006
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ListofDetailedTables1. Infant mortality rates, live births, and infant deaths, by selected
characteristics and race of mother: United States, 2006 linkedfile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
2. Infant mortality rates, live births, and infant deaths, by selectedcharacteristics and Hispanic origin of mother and by race ofmother for mothers of non-Hispanic origin: United States, 2006l inked file . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
3. Infant mortality rates, by race and Hispanic origin of mother:United States and each state, Puerto Rico, Virgin Islands, andGuam, 20042006 linked files . . . . . . . . . . . . . . . . . . . . . . . 20
4. Percentage of live births with selected maternal and infantcharacteristics, by race of mother: United States, 2006 linkedfile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
5.
Percentage
of
live
births
with
selected
maternal
and
infant
characteristics,byHispanicorigin ofmotherand raceofmotherfor mothers of non-Hispanic origin: United States, 2006 linkedfile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
6. Live births and infant, neonatal, and postneonatal deaths andmortality rates, by race and Hispanic origin of mother andbirthweight:UnitedStates,2006linkedfile,andpercentchangeinbirthweight-specific infantmortality,20002006 linked files. . . . . 22
7. Infant deaths and mortality rates for the five leading causes ofinfantdeath,byraceandHispanicoriginofmother:UnitedStates,2006 linked file . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
8. Number and percent of preterm-related infant deaths andpreterm-related infantmortalityrates,byraceandHispanicoriginofmother:UnitedStates,20002006 linked files. ... . ... . .. 26
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14 NationalVitalStatisticsReports,Volume58,Number17,April30,2010Table1. Infantmortalityrates, livebirths,and infantdeaths,byselectedcharacteristicsandraceofmother:UnitedStates,2006 linked file
RaceofmotherAmerican
All Indianor AsianorCharacteristic races White Black AlaskaNative Pacific Islander
Infantmortalityratesper1,000 livebirths inspecifiedgroupTotal . . . . . . . . . . . . . . . . . . . . . . . . . . 6.68 5.57 12.90 8.28 4.55
AgeatdeathTotal neonatal. . . . . . . . . . . . . . . . . . . . . 4.46 3.71 8.67 4.30 3.18
Earlyneonatal (less than7days). . . . . . . . 3.55 2.95 6.93 3.29 2.56Lateneonatal(727days). . . . . . . . . . . . 0.91 0.77 1.74 1.03 0.63
Postneonatal . . . . . . . . . . . . . . . . . . . . . 2.22 1.85 4.23 3.98 1.37Sex
Male . . . . . . . . . . . . . . . . . . . . . . . . . . 7.31 6.12 13.91 9.54 5.09Female. . . . . . . . . . . . . . . . . . . . . . . . . 6.02 4.98 11.84 6.96 3.98
PluralitySingle births. . . . . . . . . . . . . . . . . . . . . . 5.87 4.87 11.39 7.84 3.96Plural births . . . . . . . . . . . . . . . . . . . . . 30.07 25.57 52.18 26.38 24.32
BirthweightLess than 2,500 grams . . . . . . . . . . . . . . . 55.38 50.10 72.95 54.71 38.55
Less than1,500grams. . . . . . . . . . . . . . 240.44 228.21 269.15 227.56 206.821,5002,499grams . . . . . . . . . . . . . . . . 14.11 13.95 15.09 18.81 11.04
2,500 grams or more . . . . . . . . . . . . . . . . 2.24 2.06 3.33 4.49 1.50Periodofgestation
Less than32weeks . . . . . . . . . . . . . . . . . 175.94 162.26 208.41 139.88 160.223233 weeks . . . . . . . . . . . . . . . . . . . . . 16.19 15.83 17.11 * 16.913436 weeks . . . . . . . . . . . . . . . . . . . . . 7.08 6.61 9.11 9.69 5.273741 weeks . . . . . . . . . . . . . . . . . . . . . 2.39 2.17 3.68 4.85 1.65
3739 weeks . . . . . . . . . . . . . . . . . . . 2.58 2.34 3.96 4.79 1.744041 weeks . . . . . . . . . . . . . . . . . . . 2.02 1.84 3.06 5.05 1.46
42 weeks or more . . . . . . . . . . . . . . . . . . 2.80 2.65 3.83 * 2.09Ageofmother
Under 20 years. . . . . . . . . . . . . . . . . . . . 9.78 8.30 13.94 8.83 9.512024 years. . . . . . . . . . . . . . . . . . . . . . 7.55 6.26 12.72 8.45 5.402529 years. . . . . . . . . . . . . . . . . . . . . . 5.95 4.99 11.94 8.28 4.093034 years. . . . . . . . . . . . . . . . . . . . . . 5.32 4.46 12.96 7.67 3.393539 years. . . . . . . . . . . . . . . . . . . . . . 6.09 5.14 13.73 6.68 5.284054 years. . . . . . . . . . . . . . . . . . . . . . 8.01 6.92 14.88 * 7.80
Livebirthorder1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.69 5.61 13.15 7.82 4.252 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.89 5.08 11.14 6.87 4.213 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.39 5.24 12.33 7.79 5.004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.78 6.30 13.80 10.61 7.025 or more . . . . . . . . . . . . . . . . . . . . . . . 10.13 7.88 16.97 12.86 7.57
MaritalstatusMarried . . . . . . . . . . . . . . . . . . . . . . . . 5.11 4.68 10.71 7.28 4.17Unmarried . . . . . . . . . . . . . . . . . . . . . . .
9.19
7.33
13.82
8.82
6.48
Mothersplaceofbirth
Born in the50statesandD.C. . . . . . . . . . . 7.03 5.66 13.36 8.35 5.76Born elsewhere. . . . . . . . . . . . . . . . . . . . 5.09 4.82 8.65 * 4.19See footnotesatendof table.
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NationalVitalStatisticsReports,Volume58,Number17,April30,2010 15Table1. InfantUnitedStates, mortalityrates, livebirths,2006 linked fileCon. and infantdeaths,byselectedcharacteristicsandraceofmother:
Characteristic Allraces
Raceofmother
White BlackAmericanIndianor
AlaskaNative AsianorPacific Islander
Total . . . . . . . . . . . . . . . . . . . . . . . . . . Sex
Male . . . . . . . . . . . . . . . . . . . . . . . . . . Female . . . . . . . . . . . . . . . . . . . . . . . .
PluralitySinglebirths . . . . . . . . . . . . . . . . . . . . . Plural births . . . . . . . . . . . . . . . . . . . . . .
BirthweightLess than2,500grams . . . . . . . . . . . . . . .
Less than1,500grams . . . . . . . . . . . . . 1,5002,499grams . . . . . . . . . . . . . . . .
2,500gramsormore . . . . . . . . . . . . . . . . Not stated . . . . . . . . . . . . . . . . . . . . . .
PeriodofgestationLess than 32 weeks . . . . . . . . . . . . . . . . 3233 weeks . . . . . . . . . . . . . . . . . . . . . 3436 weeks . . . . . . . . . . . . . . . . . . . . . 3741 weeks . . . . . . . . . . . . . . . . . . . . .
3739weeks . . . . . . . . . . . . . . . . . . . 4041 weeks . . . . . . . . . . . . . . . . . . .
42 weeks or more . . . . . . . . . . . . . . . . . Not stated . . . . . . . . . . . . . . . . . . . . . .
AgeofmotherUnder 20 years . . . . . . . . . . . . . . . . . . . 2024 years . . . . . . . . . . . . . . . . . . . . . 2529 years . . . . . . . . . . . . . . . . . . . . . 3034 years . . . . . . . . . . . . . . . . . . . . . 3539 years
. . . . . . . . . . . . . . . . . . . . .
4054 years . . . . . . . . . . . . . . . . . . . . .
Livebirthorder1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 or more . . . . . . . . . . . . . . . . . . . . . . Not stated . . . . . . . . . . . . . . . . . . . . . .
MaritalstatusMarried . . . . . . . . . . . . . . . . . . . . . . . . Unmarried . . . . . . . . . . . . . . . . . . . . . .
MothersplaceofbirthBorn
in
the
50
states
and
D.C.
. . . . . . . . . .
Bornelsewhere . . . . . . . . . . . . . . . . . . . Not stated . . . . . . . . . . . . . . . . . . . . . . See footnotesatendof table.
4,265,5932,184,2602,081,333
4,121,964143,629
353,46064,456
289,0043,911,038
1,095
86,54768,579
387,7913,456,4242,303,0211,153,403
240,58925,663
441,8341,080,4511,181,909
950,267498,620
112,512
1,697,0001,354,418
716,673288,771185,022
23,709
2,623,6231,641,970
3,191,345
1,058,70715,541
3,310,3311,695,8861,614,445
3,199,491110,840
239,31040,366
198,9443,070,169
852
55,75648,264
285,8392,709,3291,792,662
916,667190,709
20,434
311,948818,260935,936756,478399,118
88,591
1,312,3471,067,145
563,322220,968131,031
15,518
2,206,7671,103,564
2,545,857
755,7138,761
Live666,494339,844326,650
641,86924,625
90,94020,71070,230
575,385169
26,29416,12977,746
508,501349,822158,679
34,9592,865
113,616213,884166,862104,123
53,964
14,045
257,537189,937115,040
53,64043,480
6,860
198,596467,898
555,151
105,6525,691
births47,72024,30823,412
46,5451,175
3,601624
2,97744,111
8
1,008874
4,84837,29224,41012,882
3,451247
8,38516,44712,197
6,7803,143
768
16,75412,947
8,7254,6184,431
245
16,89230,828
44,659
2,952109
241,048124,222116,826
234,0596,989
19,6092,756
16,853221,373
66
3,4893,312
19,358201,302136,127
65,17511,470
2,117
7,88531,86066,91482,88642,395
9,108
110,36284,38929,586
9,5456,0801,086
201,36839,680
45,678
194,390980
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16 NationalVitalStatisticsReports,Volume58,Number17,April30,2010Table1. Infantmortalityrates, livebirths,and infantdeaths,byselectedcharacteristicsandraceofmother:UnitedStates,2006 linked fileCon.
RaceofmotherAmerican
All Indianor AsianorCharacteristic races White Black AlaskaNative Pacific Islander
InfantdeathsTotal . . . . . . . . . . . . . . . . . . . . . . . . . . 28,509 18,422 8,595 395 1,097
AgeatdeathTotalneonatal . . . . . . . . . . . . . . . . . . . . 19,041 12,292 5,778 205 766
Earlyneonatal (less than7days) . . . . . . . 15,148 9,760 4,616 157 616Lateneonatal (727days) . . . . . . . . . . . 3,893 2,533 1,161 49 151
Postneonatal . . . . . . . . . . . . . . . . . . . . . 9,468 6,130 2,818 190 331Sex
Male . . . . . . . . . . . . . . . . . . . . . . . . . . 15,973 10,384 4,726 232 632Female . . . . . . . . . . . . . . . . . . . . . . . . 12,536 8,039 3,869 163 465
PluralitySinglebirths . . . . . . . . . . . . . . . . . . . . . 24,190 15,588 7,310 365 927Pluralbirths. . . . . . . . . . . . . . . . . . . . . . 4,319 2,834 1,285 31 170
BirthweightLess than2,500grams . . . . . . . . . . . . . . . 19,576 11,989 6,634 197 756
Less than1,500grams . . . . . . . . . . . . . 15,498 9,212 5,574 142 5701,5002,499grams . . . . . . . . . . . . . . . . 4,078 2,776 1,060 56 186
2,500gramsormore . . . . . . . . . . . . . . . . 8,779 6,331 1,918 198 333Notstated . . . . . . . . . . . . . . . . . . . . . . 154 103 44 8
PeriodofgestationLess than32weeks . . . . . . . . . . . . . . . . 15,227 9,047 5,480 141 5593233weeks . . . . . . . . . . . . . . . . . . . . . 1,110 764 276 14 56 3436weeks . . . . . . . . . . . . . . . . . . . . . 2,746 1,890 708 47 1023741weeks . . . . . . . . . . . . . . . . . . . . . 8,272 5,888 1,871 181 332
3739weeks . . . . . . . . . . . . . . . . . . . 5,937 4,198 1,385 117 2374041weeks . . . . . . . . . . . . . . . . . . . 2,335 1,690 485 65 95
42weeksormore . . . . . . . . . . . . . . . . . 674 505 134 11 24 Notstated . . . . . . . . . . . . . . . . . . . . . . 481 329 127 1 24
AgeofmotherUnder20years . . . . . . . . . . . . . . . . . . . 4,320 2,588 1,584 74 752024years . . . . . . . . . . . . . . . . . . . . . 8,156 5,124 2,721 139 1722529years . . . . . . . . . . . . . . . . . . . . . 7,036 4,669 1,992 101 2743034years . . . . . . . . . . . . . . . . . . . . . 5,058 3,376 1,349 52 2813539years . . . . . . . . . . . . . . . . . . . . . 3,039 2,053 741 21 2244054years . . . . . . . . . . . . . . . . . . . . . 901 613 209 8 71
Livebirthorder1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,345 7,359 3,387 131 4692 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,977 5,417 2,116 89 3553 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,583 2,949 1,418 68 1484 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,248 1,393 740 49 675 or more . . . . . . . . . . . . . . . . . . . . . . 1,874 1,033 738 57 46Notstated . . . . . . . . . . . . . . . . . . . . . . 482 271 197 2 12
MaritalstatusMarried . . . . . . . . . . . . . . . . . . . . . . . . 13,419 10,330 2,127 123