Recent Declines in Infant Mortality in the United States
description
Transcript of Recent Declines in Infant Mortality in the United States
![Page 1: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/1.jpg)
Recent Declines in Infant Mortality in the United States
Marian MacDorman, PhD and T.J. Mathews, MSDivision of Vital Statistics
National Center for Health Statistics
![Page 2: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/2.jpg)
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
![Page 3: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/3.jpg)
2000 2002 2004 2006 2008 2010 20110
1
2
3
4
5
6
7
8
4.62 4.54 4.67 4.63 4.52 4.54 4.46 4.42 4.29 4.18 4.05 4.04
2.27 2.30 2.28 2.22 2.25 2.32 2.22 2.33 2.32 2.21 2.10 2.01
Neonatal Postneonatal
Rate
per
1,0
00 li
ve b
irths
6.89 6.84
6.056.39
6.15
6.68 6.75 6.84 6.78 6.866.61
6.95
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.
![Page 4: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/4.jpg)
Percentage of preterm births: United States, 2000-2011
2000 2002 2004 2006 2008 2010 20110
2
4
6
8
10
12
14
3.4 3.4 3.5 3.5 3.6 3.6 3.7 3.6 3.6 3.5 3.5 3.4
8.1 8.4 8.6 8.8 8.9 9.1 9.1 9 8.8 8.66 8.49 8.3
<34 weeks 34-36 weeks
Per
cent
pre
term
12.3 12.211.6
12.3 12.5 12.7 12.8 12.711.6 11.9 12.1
Source: Births: Final data for 2010; Births, preliminary data for 2011.
11.9
![Page 5: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/5.jpg)
Percent distribution of births by gestational age, US, 2006 and 2010
<34 34-36 37-38 39-41 42+0
10
20
30
40
50
60
70
3.79.1
28.9
52.6
5.73.5
8.5
26.9
55.6
5.7
2006 2010
Pe
rce
nt
SOURCE: National Vital Statistics System, NCHS, CDC.
Completed weeks of gestation
![Page 6: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/6.jpg)
Infant mortality rate and percent of preterm births, US, 2000-2011
2000 2002 2004 2006 2008 2010 20110
1
2
3
4
5
6
7
8
0
2
4
6
8
10
12
6.89 6.84 6.95 6.84 6.78 6.86 6.68 6.75 6.61 6.39 6.15 6.05
Infant mortality rate % preterm
Infa
nt m
ort
alit
y ra
te p
er
1,0
00
live
birt
hs
Per
cen
t of
pre
term
bir
ths
Source: CDC/NCHS; national vital statistics system
![Page 7: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/7.jpg)
Infant mortality rates by gestational age, US, 2008
Total <32 32-33 34-36 37-38 39-41 42+ 0
20
40
60
80
100
120
140
160
180
200
6.61
175.45
17.587.40 3.13 2.08 2.69
Ra
te p
er
1,0
00
live
birt
hs
Source: NCHS, linked birth/infant death data set.
Completed weeks of gestation
![Page 8: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/8.jpg)
Percent of births and infant deaths by gestational age (weeks), US, 2008
<32Se-
ries153%
32-33Series1
4%
34-36Se-
ries110%
37+Se-
ries133%
Infant DeathsBirths 34-36
9%
37+87%
<322%
32-332%
Source: CDC/NCHS Linked birth/infant death data set, 2008
![Page 9: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/9.jpg)
Components of infant mortalityThe 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
![Page 10: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/10.jpg)
Race/Ethnic Differences
![Page 11: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/11.jpg)
0
2
4
6
8
10
12
1412.67
8.42
7.296.61
5.58 5.524.9 4.76 4.51
Ra
te p
er
1,0
00
live
bir
ths
Infant mortality rates by maternal race/ethnicity, US, 2008
Source: CDC/NCHS linked birth/infant death data set, 2008.
Non- American Puerto Total Mexican Non- Cuban Central Asian orHispanic Indian Rican Hispanic or South Pacific black white American Islander
![Page 12: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/12.jpg)
Percent contribution of two components to race and ethnic differences in infant mortality rates, 2007
NHB/NHW infant mortality gap
PR/NHW infant mortality gap
AI/NHW infant mortality gap
0%
20%
40%
60%
80%
100%
78
100
24
22
0
76
Gestational age-specific infant mor-tality ratesDistribution of births by gestational age
Note: NHB=non-Hispanic black; NHW=non-Hispanic white; PR=Puerto Rican; AI=American IndianSource: CDC/NCHS; linked birth/infant death data set
![Page 13: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/13.jpg)
Infant mortality rates by race/ethnicity, US, 2000, 2005 and 2011
Total Non-Hispanic white
Non-Hispanic black
Hispanic0.00
2.00
4.00
6.00
8.00
10.00
12.00
14.00
16.00
6.915.71
14.11
5.646.87
5.73
14.28
5.806.055.05
11.96
5.27
2000 2005 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.
![Page 14: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/14.jpg)
Percent of preterm births by maternal race/ethnicity, US, 2000, 2006, 2011
Total Non-Hispanic white
non-Hispanic black Hispanic0
2
4
6
8
10
12
14
16
18
20
11.610.4
17.4
11.2
12.811.7
18.5
12.211.710.5
16.8
11.7
2000 2006 2011
![Page 15: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/15.jpg)
Trends in Leading Causes
Of Infant Death
![Page 16: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/16.jpg)
Infant mortality rates for the five leading causes of infant death in 2011: US, 2000, 2005, and 2011
0
20
40
60
80
100
120
140
160141.5
108.3
62.2
34.6
21.7
134.2
113.9
53.942.9
26.2
126.1
104.1
43.3 39.9
27.5
2000 2005 2011
Rate
per
100
,000
live
birt
hs
Source: NCHS, mortality data set. 2011 data are ore preliminary.
![Page 17: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/17.jpg)
State Differences
![Page 18: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/18.jpg)
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
MS AL GA
FL
SC
NC
VAWV
OH
MI
NY
PA
MD
DE
NJ
CT RI
MA
ME
VT
NH
AK
HI
DC
Infant mortality rates by State, 2010
Source: National Vital Statistics System, NCHS, CDC
5.00 to 5.99
Less than 5.00
6.00 to 6.99
7.00 to 7.99
More than 8.00
U.S. rate = 6.15
![Page 19: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/19.jpg)
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
MS AL GA
FL
SC
NC
VAWV
OH
MI
NY
PA
MD
DE
NJ
CT RI
MA
ME
VT
NH
AK
HI
DC
Decline in infant mortality rates by state, 2005-2010
Source: National Vital Statistics System, NCHS, CDC
No significant change
Statistically significant decline of <20%
Statistically significant decline of 20% or more
U.S. change = -10.5
![Page 20: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/20.jpg)
Understanding the Recent Decline in Preterm Birth
![Page 21: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/21.jpg)
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
![Page 22: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/22.jpg)
Components of preterm birth
“Indicated” preterm birth30-35%
PROM 25-30%
Spontaneous preterm labor40-45%
Source: Goldenberg et al. Lancet, 2008.
![Page 23: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/23.jpg)
![Page 24: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/24.jpg)
Percent preterm for cesarean, induced vaginal, and non-induced vaginal births: US, 2000, 2006, and 2010
Cesarean births Induced Noninduced0
2
4
6
8
10
12
14
16
18
20
17.1
7.7
10.6
17.8
7.7
11.6
16.7
6.8
10.7
2000 2006 2010
Vaginal births
![Page 25: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/25.jpg)
International Comparisons
![Page 26: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/26.jpg)
Infant mortality rates, OECD countries, 2009
United StatesSlovak Republic
PolandNew Zealand
HungaryUnited Kingdom
AustraliaSwitzerland
FranceItaly
AustriaIsrael
NetherlandsPortugal
GermanyBelgium
IrelandRepublic of Korea
SpainDenmark
GreeceNorway
Czech RepublicFinlandSweden
JapanIceland
0 1 2 3 4 5 6 7
6.45.7
5.65.2
5.14.6
4.34.3
3.93.9
3.83.83.8
3.63.5
3.43.23.23.2
3.13.13.1
2.92.6
2.52.4
1.8
Rate per 1,000 live birthsSource: Health, United States, 2012. OECD=Organization for Economic Cooperation and Development.
![Page 27: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/27.jpg)
Percentage of preterm births, United States and selected European countries, 2004
United StatesAustria
GermanyHungary
SpainScotland
England and WalesNetherlands
NorwayCzech Republic
DenmarkItaly
PolandPortugal
Northern IrelandFrance
SlovakiaSwedenGreeceFinlandIreland
0 2 4 6 8 10 12 14
12.411.4
8.98.6
8.07.67.57.4
7.17.06.96.86.86.8
6.66.36.36.3
6.05.65.5
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).
![Page 28: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/28.jpg)
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.
![Page 29: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/29.jpg)
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
![Page 30: Recent Declines in Infant Mortality in the United States](https://reader035.fdocuments.us/reader035/viewer/2022062723/56813c39550346895da5b831/html5/thumbnails/30.jpg)
Contact information
Marian MacDorman 301-458-4356 [email protected]
T.J. [email protected]
Any questions?