Infant Mortality in the US: An introductory exploration. Amy M. Branum National Center for Health Statistics Infant and Child Health Studies Branch

Transcription

1 Infant Mortality in the US: An introductory exploration Amy M. Branum National Center for Health Statistics Infant and Child Health Studies Branch

2 Infant Mortality Infant deaths = deaths between birth and 1 year of age In 2000 infant deaths accounted for: 85% of deaths among children younger than 5 years 69% of deaths among children younger than 15 years Infant deaths per year in U.S. Approximately 28,000 in 2000 Total births per year in U.S. Approximately 4 million in 2000

3 Infant Mortality Rate Infant Mortality Rate = infant deaths during a period X 1,000 live births during same period 2000 US Infant Mortality Rate = 6.9 per 1,000 Out of 1,000 infants born alive, 7 died before reaching first birthday 0.7% of infants died in 2000

4 Trend in US Infant Mortality Year Infant Mortality Rate 1920

5 Infant Mortality Data Sources Vital statistics mortality file Information from all death certificates filed in the 50 states and DC Period linked birth/infant death file Based on matching birth and death certificates for each infant who died in 2000

6 Infant Mortality by Race/Ethnicity US, 2000 Deaths per 1,000 births All US NH White NH Black Am. Indian Asian Hispanic

7 Deaths per 1,000 births Infant Mortality by Ethnicity US, 2000 Chinese Filipino Hawaiian Japanese Cuban Mexican Puerto Rican Asian Hispanic

8 Infant Mortality by Sex US, 2000 Deaths per 1,000 births Male Female

9 Infant Mortality by Plurality US, Deaths per 1,000 births Singletons Multiples

10 Infant Mortality by Maternal Education US, 2000 Deaths per 1,000 births < years

11 Infant Mortality Three important aspects Timing (age at death) Cause of death Birth weight

12 Components of Infant Mortality Neonatal (birth through first 27 days) Early neonatal (birth-6 days) Late neonatal (7-27 days) Postneonatal (28 days through 365 days)

13 Percentage Distribution of Deaths by Time US, <1 day 1-6 days 7-27 days > 1 month Neonatal Postneonatal

14 Causes of Infant Mortality Vary according to time of death Vary according to race, sex, other factors Change with intervention

15 5 Leading Causes of Infant Mortality US, 2000 Congenital anomalies Preterm birth/lbw SIDS Maternal complications Pregnancy complications Infant deaths per 100,000

16 5 Leading Causes of Neonatal Mortality US, 2000 Preterm birth/lbw Congenital anomalies Maternal complications Pregnancy complications RDS Infant deaths per 100,000

17 5 Leading Causes of Postneonatal Mortality US, 2000 SIDS Congenital anomalies Accidents Circulatory Assault Infant deaths per 100,000

18 Causes of Infectious Origin Septicemia Flu/Pnemo Infant deaths per 100,000

19 Selected Factors Influencing Infant Mortality Medical interventions Surfactant Immunizations and antibiotics Environmental factors Sleep position Child-proofing of residence

20 Deaths per 100,000 Trends in RDS Mortality Rates US,

21 Selected Factors Influencing Infant Mortality Medical interventions Surfactant Immunizations and antibiotics Environmental factors Sleep position Child-proofing of residence

22 SIDS Intervention April, 1992: American Academy of Pediatrics recommends healthy infants should sleep on their backs or sides June, 1994: Back to Sleep campaign initiated

23 Deaths per 100,000 live births Trends in SIDS Rates US,

24 Is it gestational age or birth weight??

25 Birthweight-Specific Infant Mortality US, Infant mortality rate Birthweight (grams)

26 Percentage Birthweight Distribution US, VLBW (<1500g) MLBW ( g) NBW (>=2500g)

27 Birthweight-specific Infant Mortality US, Deaths per 1,000 live births VLBW MLBW NBW All infants

28 Percentage Birth and Infant Mortality Distribution US, VLBW MLBW NBW Births Infant deaths

29 Selected Factors Influencing Low Birthweight or Preterm Birth Maternal nutrition or weight gain Smoking Prenatal care Medical interventions -Tocolysis -Vaginal and cervical infection treatment -Management of maternal diabetes

30 Summing it all up Differences in infant mortality among different groups defined different ways (sex, education, race, etc.) Majority of infant deaths occur very early in infancy and likely related to conditions intrinsic to pregnancy, etc. Causes of death vary by timing

31 Summing it all up Crude evidence supports that some interventions may beneficially influence mortality rates PT and LBW are large contributors to infant mortality

32 Further Information CDC Birth defects, injury, immunizations, MMWR NCHS Annual mortality reports, public use data Questions?