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.

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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.


State by State Health Data Source Updated on NCHS Web Site

April 19, 2017

CDC’s National Center for Health Statistics has updated its Stats of the States feature on the NCHS web site.  This resource features the latest state-by-state comparisons on key health indicators ranging from birth topics such as teen births and cesarean deliveries to leading causes of death and health insurance coverage.

Tabs have been added to the color-coded maps to compare trends on these topics between the most recent years (2015 and 2014) and going back a decade (2005) and in some cases further back.

To access the main “Stats of the States” page, use the following link:

https://www.cdc.gov/nchs/pressroom/stats_of_the_states.htm


Trends in Infant Mortality in the United States, 2005-2014

March 21, 2017

T.J. Mathews, M.S., Demographer, Statistician

Questions for T.J. Mathews, M.S., Demographer, Statistician, and Lead Author of “Trends in Infant Mortality in the United States, 2005-2014

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

TM:  Though not unexpected, the pervasive and large decrease in infant mortality that is documented in the report is quite striking. While we had been observing slight declines in the infant mortality rate, it’s very good news to see significant declines over the past decade.


Q:  Why did you conduct this study on a decade of infant mortality in the United States?

TM:  We produced this report because infant mortality is an important public health measure. The United States does not compare well with other developed countries. Measuring and understanding the changes in infant mortality rates over time — and identifying who has been impacted by those changes — is critical.


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

TM:  We did see a number of significant differences in infant mortality among race and Hispanic origin groups. Rates reached new lows for infants of Hispanic, non-Hispanic white, non-Hispanic black, and Asian or Pacific Islander women, though there was no decline among infants of American Indian or Alaska Native women. The largest decreases we saw were among infants of Asian or Pacific Islander women with a 21% drop over the decade, and among infants of non-Hispanic black women, with a 20% decrease.


Q:  What is the “period linked birth/infant death data set” that you reference as a source for the statistics in your report?

TM: The “period linked birth and infant death data set” is a very valuable tool for monitoring and exploring the complex inter-relationships between infant death and any risk factors present at birth. In the linked birth and infant death data set, the information from the death certificate is linked to the information from the birth certificate for each infant under 1 year of age who dies in the United States, Puerto Rico, the Virgin Islands, and Guam. The purpose of the linkage is to use the many additional variables available from the birth certificate to conduct more detailed analyses of infant mortality patterns. The linked files include information from the birth certificate such as: age, race, and Hispanic origin of the parents, birth weight, period of gestation, plurality, prenatal care, maternal education, live birth order, marital status, and maternal smoking – which is then linked to information from the death certificate such as age at death, and underlying and multiple cause of death.


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

TM: I think the take-home message of this report is that the U.S. infant mortality rate declined significantly for the years 2005 to 2014, however, there is still much work to do. While the majority of race and ethnic groups experienced declines in infant mortality rates–and two-thirds of states showed declines as well–the U.S. infant mortality rate is still higher than many other developed countries. Our statistics show we can do better.