Infant Mortality by Age at Death in the United States, 2016

November 16, 2018

Questions for Danielle Ely, Ph.D., Health Statistician and Author of “Infant Mortality by Age at Death in the United States, 2016

Q:  What made you decide to focus on the age when infants die in this new analysis of infant mortality in the United States?

DE:  We focused this study on the age when infants die for a number for reasons. Age at death is an important factor in the risk of infant mortality. One important statistic is that infants are more likely to die before 28 days of age (neonatal deaths) than infants who live to 28 days and older (postneonatal deaths.) By presenting infant mortality rates by age at death, we show the differences in the likelihood of death between these two infant groups — information that can help inform the U.S. Public Health Community, families, and physicians on this critical age factor in infant lives and deaths.


Q:  What sort of trend data do you have for the demographics and the cause of death data in your new study on infant mortality at the age of death?

DE:  We have interesting trend data here in this report, as well as other public-use resources that are available for further research and data. Our new report looks at the overall trends in infant, neonatal and postneonatal mortality rates from 2007 (the most recent peak in infant mortality) through 2016. For 2016, we looked at infant mortality rates by mother’s race and Hispanic origin and age and cause of death.


Q:  Was there a result in your study’s analysis of infant mortality at the age of death that you hadn’t expected and that really surprised you?

DE:  An important finding in this study is the lack of improvements to infant mortality. Since infant mortality had been on the decline in the United States for much of the last two decades, it was surprising that the infant mortality rate did not show significant declines from 2011-2016. Another recent report also showed a similar lack of improvement in fetal/perinatal mortality rates from 2014 through 2016.


Q:  What differences, if any, did you see in infant mortality among race and ethnic groups, or any other demographics?

DE:  The sometimes substantial differences among race and Hispanic origin groups in this report on infant mortality are noteworthy. We found that infants of non-Hispanic black mothers continue to have total, neonatal, and postneonatal mortality rates that were more than two times as high as infants of non-Hispanic white, Asian or Pacific Islander, or Hispanic mothers. Infants of American Indian or Alaska Native mothers had the next highest rates and had postneonatal mortality rates that were similar to infants of non-Hispanic black mothers.


Q:  What would you say is the take-home message of this report?

DE:  The most important message from this data brief is the lack of improvement in total infant mortality rates since 2011. Neonatal infants of all race and Hispanic origin groups we examined have higher mortality rates than postneonatal infants. Further, infants of non-Hispanic black women continue to have a higher risk of mortality than infants of non-Hispanic white, Asian or Pacific Islander, American Indian or Alaska Native, or Hispanic mothers. This information can further our understanding of current infant mortality trends and provide information on where improvements can be made.

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QuickStats: Infant Mortality Rate, by State — United States, 2016

August 27, 2018

In 2016, the infant mortality rate in the United States was 5.87 infant deaths per 1,000 live births.

The rate ranged from 3.47 in Vermont to 9.03 in Alabama. Rates in two other states were <4.00 (New Hampshire [3.67] and Massachusetts [3.94]).

Higher rates were primarily in the southern states. In addition to Alabama, two other states had rates >8.00 (Arkansas [8.20] and Mississippi [8.67]).

SOURCE: National Vital Statistics System. Linked birth/infant death period files, 2016. https://www.cdc.gov/nchs/nvss/linked-birth.htm.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6733a7.htm


Differences Between Rural and Urban Areas in Mortality Rates for the Leading Causes of Infant Death: United States, 2013–2015

February 15, 2018

Questions for Danielle Ely, Ph.D., “Differences Between Rural and Urban Areas in Mortality Rates for the Leading Causes of Infant Death: United States, 2013–2015

Q: Why did you decide to examine differences in mortality rates for the leading causes of infant death between rural and urban areas in the United States?

DE: After finding differences in infant mortality rates between rural and urban places in previous work, we thought causes of death might also differ by urbanization level. Although previous research looked at infant mortality rates by age of death and residence, there had not been research on leading causes of infant death by rural-urban status.


Q: Can you describe the differences in infant, neonatal, and postneonatal mortality rates?

DE: Infant mortality rates are based on all infant deaths. Neonatal mortality specifies the infant was less than 28 days of age at time of death and postneonatal mortality rates are those infant deaths that occurred between 28 days and 11 months of age. In this data brief, as in previous research, we see higher neonatal mortality rates than postneonatal mortality rates. Indeed, neonatal mortality rates were nearly twice as high as postneonatal mortality rates across urbanization levels. Further, there are distinct differences in the leading causes of death for neonatal and postneonatal mortality. Although both include congenital malformations, neonatal deaths are generally associated with more birth related medical issues whereas postneonatal deaths are generally associated with more causes external from the infant.


Q: Overall, how did the mortality rate for the five leading causes of infant death vary by urbanization level?

DE: Rural areas have higher infant, neonatal, and postneonatal mortality rates than urban areas. However, when we drill down by the leading causes of death by age of death, there are specific causes of death where infants in rural areas do experience lower mortality rates, such as mortality from low birthweight and from maternal complications. However, there are markedly higher mortality rates for both neonatal and postneonatal infants from congenital malformations, sudden infant death syndrome, and unintentional injuries in rural places than in urban.


Q: Were there any surprises in the findings from this report?

DE: Although we expected differences in mortality rates by the leading causes of death, I think we were surprised by the marked differences for some causes; particularly SIDS mortality rates being twice as high in rural places than in large urban counties. I also think some of the most interesting findings in the report are related to how rural infant mortality rates are generally higher than rates in urban areas, but there are some causes for which rural places have similar or even lower rates compared to urban places.


Q: What is the take home message in this report?

DE: The message that should be taken from this report is that different types of places– rural and urban– have different issues when it comes to the leading causes of infant death. Although the leading causes are generally the same across areas, there are substantial differences in rates, meaning different public health interventions may be needed for people in rural areas compared to people in urban areas to address these issues.


QuickStats: Infant Mortality Rate, by Urbanization Level — National Vital Statistics System, United States, 2007 and 2015

October 20, 2017

In both 2007 and 2015, infant mortality rates were highest in rural counties (7.5 infant deaths per 1,000 live births and 6.8, respectively).

Rates were lower in small and medium urban counties (7.1 in 2007 and 6.4 in 2015) and lowest in large urban counties (6.4 in 2007 and 5.4 in 2015).

For all three urbanization levels, infant mortality rates were significantly lower in 2015, compared with rates in 2007.

Source: National Vital Statistics System, linked birth/infant death period files, 2007 and 2015.

https://www.cdc.gov/mmwr/volumes/66/wr/mm6641a8.htm


Infant Mortality Rates in Rural and Urban Areas in the United States, 2014

September 6, 2017

Questions for Danielle Ely, Ph.D., Statistician and Lead Author of “Infant Mortality Rates in Rural and Urban Areas in the United States, 2014

Q: What is the most significant finding in your study?

DE: The most significant finding in this study was the consistency with which infants in rural areas have significantly higher mortality rates than infants in urban places. Higher rural infant mortality was generally observed by race and Hispanic origin, mother’s age, and by infant age at death.


Q: Why are infant mortality rates higher in rural areas vs urban areas?

DE: Generally, previous research shows that health outcomes are poorer in rural places compared with urban places and this study is consistent with those findings. This study did not examine the factors that might be influencing the higher rural infant mortality in comparison with urban infant mortality.


Q: Is this surprising, or are problems with poverty, substance abuse, and health care that much worse in rural areas?

DE: Higher infant mortality in rural places compared with urban places is not necessarily surprising based on the number of other poor health outcomes (such as higher overall mortality rates, higher rates of disability) that rural residents have in comparison to urban residents.


Q: Are there any theories in the literature as to why this infant mortality disparity exists between rural and urban?

DE: Given there are some poorer health outcomes in rural areas, it is possible more pregnant women in rural areas have poorer general health than pregnant women in urban areas that can lead to poor infant outcomes. Further, there is generally less access to health care due to distance and number of providers available in rural areas, which can impact health outcomes.


Q: Any other findings of note that you find significant?

DE: These findings highlight the importance of place for infant survival and suggests the need for including place in research on health outcomes, as well as a need for further research on the greater risk of infant death in rural settings.


Quarterly Provisional Estimates for Selected Birth Indicators, 2015—Quarter 1, 2017 Quarterly Provisional Estimates of Infant Mortality, 2014—Quarter 3, 2016 Vital Statistics Rapid Release from the National Vital Statistics System

August 8, 2017

Lauren_RossenQuestions for Lauren Rossen, Ph.D., Health Statistician and Lead Author of “Quarterly Provisional Estimates for Selected Birth Indicators”and “Quarterly Provisional Estimates of Infant Mortality

Q: What findings in your new data analyses on births and infant mortality most surprised you and why?

LR:  These latest quarterly provisional estimates suggest that the steady decline in teen birth rates that we have seen over the past several years is continuing into 2017, which is good news. What is of concern is the recent uptick in preterm birth rates, a trend that emerged in 2015 and that has unfortunately continued into 2016 and early 2017.


Q: What is the difference between the Rapid Release provisional estimates on births released today and the report from your office released last month, “Births: Provisional Data for 2016”? And how are these two provisional data analyses different from your office’s “preliminary data” released in the recent past?

LR:  The most recent Quarterly Provisional Estimates provide an update to some of the data released in the recent report, Births: Provisional Data for 2016. That report is similar to previous “preliminary birth data” reports, but is redesigned and released under our Vital Statistics Rapid Release (VSRR) program. We hope that the VSRR program can be a one-stop-shop for our provisional vital statistics data. The Quarterly Provisional Estimates describe very recent trends in key indicators of maternal and infant health from the birth and mortality data the report, Births: Provisional Data for 2016, provides some critical context for understanding these recent trends.  report also describes some additional demographic and reproductive health indicators that aren’t yet available in the Quarterly Provisional Estimates, such as birth rates by race and Hispanic origin, as well as the timing of prenatal care.


Q: What in your data analyses can be attributed to no change in infant mortality in the last few quarters?

LR: is another surprising and concerning finding, because infant mortality rates have generally been declining over the past decade, at least through 2014. These declines seem to have leveled off more recently, according to our provisional estimates. We can’t speak to why infant mortality rates might no longer be declining, but we are planning future research to help us better understand this troubling trend.    


Q: What differences did you see among various age groups of mothers?

LR: There is a great deal of detail in the recent report, Births: Provisional Data for 2016, discussing how age-specific birth rates have changed recently. Generally, both that report and our recent Quarterly Provisional Estimates show that maternal age is increasing. Birth rates among younger women (under 30) are going down, while those among women 35 and up are increasing.


Q: What are seasonal fluctuations in the number of infant deaths and births, and what do you mean by accounting for seasonality as you described in your report’s preface?

LR: People may not think that there are seasonal patterns to births, but it turns out that there are more babies born in the third quarter of the year, from July-September, than during other parts of the year. There are seasonal patterns in other indicators as well. For example, preterm birth rates dip slightly in the third quarter compared with other quarters, while infant mortality rates tend to be a bit higher in the beginning of the year than toward the end of the year. So to ensure that any differences we find aren’t influenced by seasonal fluctuations, we only compare the most recent quarter with the same quarter from the previous year. We also present 12 month-ending estimates, which include all seasons of the year, and thus aren’t subject to seasonal ups and downs.


New Preliminary 2016 Data on Births and Deaths in U.S.

May 17, 2017

The Vital Statistics Rapid Release program provides access to the timeliest vital statistics for public health surveillance, through 1) releases of Quarterly Provisional Estimates and 2) Special Reports based on a current flow of vital statistics data from state vital records offices.

Using the provisional data, NCHS produces much more timely estimates of important health indicators for public health practitioners, researchers, and health policy-makers than would be possible using final annual data.