PODCAST: The Toll of COVID-19 on Physician Practices

September 30, 2022


HOST:  The COVID-19 pandemic took a major toll on the U.S. health care system.  In a new report released on September 28, data from the National Ambulatory Medical Care Survey were used to examine how COVID-19 impacted physician practices around the country.

Joining us to discuss that new study is Zach Peters, a health statistician with the NCHS Division of Health Care Statistics.

HOST:  What did you hope to achieve with this study?

ZACK PETERS:  This study was intended to produce nationally representative estimates of experiences at physician offices.  So it’s a physician level study and we really wanted to highlight some of the important experiences physicians had due to the pandemic, such as shortages of personal protective equipment.  And it highlights whether testing was common in physician, whether physicians were testing positive or people in their office were testing positive for COVID-19 given that they were on the front lines of helping to treat patients.  So we really wanted to touch on a broad set of experiences faced by physicians.  This certainly isn’t the first study to assess experiences and challenges faced by health care providers during the pandemic but often times those other studies are limited to specific facilities or locations or cohorts and can’t be generalized more broadly.  So a big benefit of a lot of the NCHS surveys is that we can produce nationally representative estimates and this study is an example of that.

HOST:  And what kind of impact has the pandemic had on physicians and their practices?

ZACH PETERS:  In having done quite a bit of literature review for this project it became pretty clear – and I think just listening to the news you sort of understood a lot of the impact.  A lot of research has shown that that health care providers experienced a lot of burnout or fatigue.  There was a lot of exposure and what not to COVID-19.  Long hours… So there’s a lot out there in in the literature that sort of cites some of the challenges.  What we really, what this study highlighted was it was the level of shortages of personal protective equipment that were faced.  About one in three physicians said that they had they had experienced personal protective equipment shortages due specifically to the pandemic .  The study highlighted that a large portion of physicians had to turn away patients who were either COVID confirmed or suspected COVID-19 patients.  And I think the last thing this really helped to show was the shift in the use of telemedicine due to the pandemic.  So prior to March of 2020 there were less than half of physicians at physician offices who were using telemedicine for patient care and that number, that percentage jumped to nearly 90% of office based physicians using telemedicine after March of 2020.  So this is sort of adding to the broader literature with some nationally representative estimates of experiences that providers had due to and during the pandemic.

HOST:  So what sort of personal protective equipment was most affected during this study?

ZACH PETERS:  It’s a good question.  The way in which we asked the questions about shortages of “PPE” – I’ll call it I guess – don’t allow us from really untangling that question.  We asked about face mask shortages, N-95 respirator shortages specifically, but then the second question we asked sort of grouped isolation gowns, gloves, and eye protection into one question.  So physicians didn’t really have the chance to check off specifically what they had shortages of other than face masks.  So it’s somewhat hard to untangle that but these results show that about one in five physicians faced N-95 respirator, face mask shortages due to the pandemic and a slightly higher – though we didn’t test significance in this in this report – a slightly higher percentage, about 25% of physicians, had shortages of isolation gowns,  gloves, or eye protection or some combination of those three. 

HOST:  And you say that nearly four in 10 physicians had to turn away COVID patients.  Now, was this due to a high volume of patients or a lack of staff?

ZACH PETERS:  Again that’s another great question. I think unfortunately we weren’t able to ask a lot of these really interesting follow-ups to some of these experiences. We didn’t get to pry physicians on some of the reasons why they had these experiences, including why they had to turn away patients.  So unfortunately we’re not able to answer some of the “why” questions that we would like with these data.

HOST:  And do you have any data on where these patients were referred to, the ones that were turned away?  Do you have any information on that?

ZACH PETERS:  Again unfortunately this specific question wasn’t something that we asked in the set of new COVID questions introduced in the 2020 NAMCS we did ask a question about whether physicians who had to turn away patients had a location where they could refer COVID-19 patients.  So there are a few reasons – we haven’t assessed that measure in this work so far, but it’s certainly an area we can dig into more especially as we have additional data from the 2021 NAMCS and can try to combine over time.

HOST:  Does it look like the shift to telemedicine visits is here to stay?

ZACH PETERS:  The broader literature sort of highlights that these changes are broad and likely indicate that physician offices and different health care settings have built up the infrastructure to allow for telemedicine use in the future.  And so it’ll be interesting to see if, as waves of COVID or other infections ebb and flow, if we see that the use of telemedicine kind of ebbs and flows along with that.  But I think the option for telemedicine is something that health care settings won’t get rid of now that they have them. 

HOST:  Sticking with the topic of telemedicine – did physicians list any benefits to telemedicine visits other than limiting exposure to COVID-19?

ZACH PETERS:  The set of questions that we asked physicians were limited in scope and we didn’t really have that level of follow-up.  There are some additional questions about telemedicine use that we asked and hope to be able to dig into further.  We asked physicians what percentage of their visits they had used telemedicine and some other questions about just kind of the scope of use, but not necessarily the benefits that they felt they received due to using telemedicine.

HOST:  Is it possible that you might be getting some data on these questions in the future?

ZACH PETERS:  These questions were introduced part way through the 2020 survey year, so we were only able to ask half of our physician sample about these experiences in the 2020 survey.  But we kept the exact same set of COVID related questions in the 2021 NAMCS survey year and so we’re working to finalize the 2021 data and hope to be able to look into some of the more nuanced aspects of this that we might be interested in, such as trends over time if we combine years.  So we might be able to assess differences in experiences based on the characteristics of physicians.  So yeah, we asked these specific questions in the 2021 survey year so hope to have some additional information to put out for folks.

HOST:  You were talking a little bit about the fact that you made changes to the National Ambulatory Medical Care Survey, which this study is based on, which allowed you to collect more complete data during this period. Could you again sort of go over what sort of changes you made?

ZACH PETERS:  Yes the NAMCS team with the Division of Health Care Statistics, we made changes to a few of our surveys partway through the 2020 survey year.  Partly out of necessity and partly out of just interest in an unfolding public health crisis.  So for NAMCS two big changes were made. The first was that we had to cancel visit record abstraction at physician offices.  So historically we have collected a sample of visit records or encounter records from physicians to be able to publish estimates on health care utilization at physician offices due to sort of wanting to keep our participants safe, our data collectors safe, and patients safe.  We cancelled abstraction partly into the 2020 survey year so that was an important change in that we won’t be able to produce visit estimates from the survey year.  But the other change that we made – I think I alluded to it earlier – was that partway through the survey year we introduced a series of COVID-19 related questions, which is what this report summarizes.  And the reason it came partway through the survey year is simply due to the fact that adding a series of new questions to a national survey takes a lot of planning and a lot of levels of review and approval.  So this is partly why we were only able to ask these questions of half of our survey sample.

HOST:  Are there any other changes forthcoming in the NAMCS or for that matter any of your other health care surveys?

ZACH PETERS:  Historically there have been a few different types of providers that have been excluded from our sample frame.  We didn’t include anesthesiologists working in office-based settings, radiologists working in office-based settings.  So we had a few different types of promoting specialties that we couldn’t speak to in terms of their office characteristics and their care that they provided.  In future years we are hoping to expand to include other provider types that we haven’t in the past so I think that’s the big change going forward for the traditional NAMCS.  We also have a kind of a second half of NAMCS that looks at health centers in the U.S., and the big change for that survey in the 2021 survey years that we are in is instead of abstracting a sample of visit records, are we are starting to collect electronic health record data from health centers.  So that’s another a different portion of NAMCS but those are a couple of the big changes at high level that are implementing in NAMCS. 

HOST:  What would you say is the main take-home message you’d like people to know about this study?

ZACH PETERS:  I think the main strength of using data from NCHS in general is that many of our surveys allow for nationally representative estimates and NAMCS is the same in that regard.  We sampled physicians in a way that allows us to produce nationally representative estimates.  And so I think this study highlights how we’re able to leverage our surveys in a way that other studies that you might see in the literature can’t in that they’re more cohort-based.  So I think another important aspect of this is just that it highlights an example of some of the adaptations that DHCS end and NCHS more broadly, some of the adaptations that we made during the pandemic to better collect data and disseminate data.  And so outside of the topic being hopefully important to understand how physicians nationally experienced various things related to the pandemic, this highlights some of the ways in which NCHS was able to remain nimble during a public health crisis.


HOST:  On September 1, NCHS released a new report looking at emergency department visits for chronic conditions associated with severe COVID illness.  The data, collected through the National Hospital Ambulatory Medical Care Survey, were collected during the pre-pandemic period of 2017-2019 and serve as a useful baseline, since it is well established that chronic conditions increase the risk of hospitalization among COVID patients.  The report showed that during this pre-pandemic period, hypertension was present in one-third of all emergency department visits by adults, and diabetes and hypertension were also present together in one-third of these visits.

On the 7th of September, NCHS released a study focusing on mental health treatment among adults during both the pre-pandemic and pandemic period, 2019 to 2021.  It has been documented by the Household Pulse Survey and other studies that anxiety and depression increased during 2020 and the beginning of 2021, and this new study focuses on the use of counseling or therapy, and/or the use of medication for mental health during this period.   The study found there was a small increase in the use of mental health treatment among adults from 2019 to 2021, with slightly larger increases among non-Hispanic white and Asian people.

Also this month, NCHS updated two of its interactive web dashboards, featuring data from the revamped National Hospital Care Survey.  On September 12, the dashboard on COVID-19 data from selected hospitals in the United States was updated, and two days later the dashboard featuring data on hospital encounters associated with drug use was updated. 

On the same day, September 14, NCHS released the latest monthly estimates of deaths from drug overdoses in the country, through April of this year, showing 108,174 people died from overdoses in the one-year period ending in April.  This death total was a 7% increase from the year before.  Over two-thirds of these overdose deaths were from fentanyl or other synthetic opioids. 

On September 29, the latest infant mortality data for the U.S. was released, based on the 2020 linked birth and infant death file, which is based on birth and death certificates registered in all 50 states and DC. 

Finally, September is Suicide Prevention Month, and on the final day of the month, NCHS released its first full-year 2021 data on suicides in the country.  For the first time in three years, suicide in the United States increased.  A total of 47,646 suicides took place in 2021, according to the provisional data used in the report.  The rate of suicide was 14 suicides per 100,000 people.


QuickStats: Infant Mortality Rates for Metropolitan and Nonmetropolitan Counties by Single Race and Hispanic Origin — National Vital Statistics System, United States, 2019

November 5, 2021

In metropolitan counties, infant mortality rates were highest for infants of non-Hispanic Black mothers (10.60 infant deaths per 1,000 live births), followed by infants of non-Hispanic American Indian or Alaska Native (5.95), Hispanic (4.96), non-Hispanic White (4.22), and non-Hispanic Asian (3.34) mothers.

In nonmetropolitan counties, the mortality rate was also highest for infants of non-Hispanic Black mothers (10.85), followed by infants of non-Hispanic American Indian or Alaska Native (9.78), Hispanic (5.97), non-Hispanic White (5.63), and non-Hispanic Asian (4.85) mothers.

The infant mortality rate was significantly lower for infants of non-Hispanic White, non-Hispanic American Indian or Alaska Native, and Hispanic mothers in metropolitan counties compared with nonmetropolitan counties; differences in rates between metropolitan and nonmetropolitan counties for infants of non-Hispanic Black and non-Hispanic Asian mothers were not statistically significant.

Source: National Vital Statistics System. Linked Birth and Infant Death Data. https://www.cdc.gov/nchs/nvss/linked-birth.htm

Latest Quarterly Infant Mortality Rate Estimates

July 20, 2021

NCHS released the latest quarterly estimates of infant mortality rates in the U.S.

The data shows infant mortality rate in the United States was 5.43 infant deaths per 1,000 live births in the one-year period ending in September 2020, no significant change from the year before.

The data is featured in a web-based interactive dashboard at: https://www.cdc.gov/nchs/nvss/vsrr/infant-mortality-dashboard.htm

PODCAST: Infant Mortality Trends in Appalachia and the Delta

May 28, 2021


podcast-iconHOST:  This week NCHS has released a new report looking at infant mortality trends in two distinct regions of the country: Appalachia and the Delta.  Joining us is the lead author of that report, Anne Driscoll, of the Reproductive Statistics Branch at NCHS.

HOST:  Why did you decide to focus on these regions of the country?

ANNE DRISCOLL:  Well both of these regions, at least the names, people are familiar with and the general locations.  And they have very distinct cultures and histories compared to other regions of the country.  And in addition, both are historically disadvantaged but also very different in terms of their histories, their populations, their geography, their economies.  And a key factor for doing the analysis was that there are official, congressionally-mandated definitions of which counties belong to each region, so that made it possible to be very precise in our definition of each region when we’re doing the analysis itself.

HOST:  When you say “Appalachia,” specifically what areas are you talking about?

ANNE DRISCOLL:  So like I said Appalachia is a official region and Congress established the Appalachian Regional Commission in 1965.  And it includes 420 counties in 12 states – it runs from southern and western New York state, all the way down to northeastern Mississippi.  It includes much of Pennsylvania, every single county in West Virginia, and parts of Virginia, North Carolina, South Carolina, Kentucky, Tennessee, Georgia and Alabama.

HOST:  And so the same question goes for the Delta – what do you mean exactly when you say “the Delta region?”

ANNE DRISCOLL:  Right, so it is also an official region and it was designated by Congress in 2000.  It’s a smaller area – it includes 252 counties spread across eight states, and it basically runs from southern Illinois, a few counties in southern Illinois, along the Mississippi River south and includes parts of Missouri, Kentucky, Tennessee, Arkansas, Mississippi, Alabama and Louisiana.

HOST:  So before we go into the results of your new report, do we have any insight about why infant mortality rates have traditionally been so much higher in these parts of the country?

ANNE DRISCOLL:   Both of these regions have been historically very rural -different kinds of rural but very rural – with high rates of poverty.  Overall, there are lower levels of educational attainment, less access to decent paying jobs and other economic opportunities, less access to health care of all kinds.  So generally there are worse outcomes – health outcomes – across a host of measures, not just infant mortality but including infant mortality.  But also higher rates of disease and disability overall. such as heart disease, cancer, diabetes, obesity, an overall lower life expectancy.  So usually all these health measures move in one direction or the other, so when you have poor health in general you’re going to have in general an area that is going to have higher infant mortality.

HOST:  So would access to prenatal care, for example, be an issue that might be contributing to that?

ANNE DRISCOLL:  Right, and particularly in rural areas that are also poor areas.  A lot of times it might be a long way to a, to drive to a doctor’s office or a hospital, and lower income people might not have access to transportation to receive prenatal care.  Rural hospitals often do not have the incomes they need to sustain themselves so you know some hospitals have gone out of business in rural areas in recent years.  So yeah, so less access to actual health care while you’re pregnant as well as all these other factors that come out of being in low-density populations and poor populations.

HOST:  So your report shows that over the past couple decades rates are dropping fairly significantly in these regions.  Do we have an understanding why that’s happening?

ANNE DRISCOLL:   That’s a general trend in the United States in general that both regions have followed in terms of infant mortality.  So yes, it’s declined in the country in general, it’s declined in Appalachia, it’s declined in the Delta and in the parts of the country that are not either.  And there are various other trends that have also affected the nation in general that affect infant mortality trends, such as lower teen birth rates… generally better treatment and care for at risk infants so for pre term infants we’ve gotten better at saving their lives over time as a society …educational attainment has risen somewhat across the country and that is associated with better outcomes for infants… there’s also been wider access to Medicaid for pregnant women in recent decades and that’s allowed more to access prenatal care.  One factor that we measured directly in this study was the decline in percentage of birth to teens.  And so again infants of teens have a much higher risk of dying, and so when that percentage went down that affected the overall infant mortality rate and accounted for about a fifth of decline in mortality rates in our study.  But that was true across all three regions – across Appalachia, across the Delta, and across the rest of the United States.

HOST:  So the national rates are falling, but is there any indication that the disparity between the U.S. as a whole and these two regions are narrowing at all?

ANNE DRISCOLL:  That is exactly the main question we wanted to address for this study.  We know that these regions have lagged behind the rest of the country on a multitude of health measures.  And we know that the infant mortality rates have gone down in these regions as they have in the rest of the United States.  But that is exactly what we wanted to examine: whether the gap between either of these regions and the rest of the country has been, you know, closing or getting wider or staying the same.  And our results support the conclusion that there has been some narrowing in the gap between the Delta and the rest of United States.  In 1995 -96 which is the first year of our trend analysis, first years, the gap was 2.9 deaths per 1000 births – was that much higher in the Delta than the rest of United States.  And by 2017-2018 that had gone on to 2.2.  So another way to think of these numbers is that the gap between the Delta and the rest of the United States was about one quarter smaller in 2017-2018 then it was in 1995-96.  And incidentally, when we track the trend line over that period, most of the decline in infant mortality rates in the Delta occur after 2004.  So it was basically stable from 1995-96 through 2003-2004, and then started declining.  But the gap between Appalachia and the rest of United States hasn’t narrowed.  The infant mortality rates in both regions have declined over the past twenty-some years, but they declined at about the same rate. So the gap between them didn’t close and in both our first year of analysis and our last year – 1995-96 and then 2017-2018 – the infant mortality rates in Appalachia were 0.9 deaths per 1000 births higher than the rest of the country.  So during this time the gap between Appalachia and the rest of the country has been always been smaller than that between the Delta and the rest of the country, but it hasn’t changed.

HOST:  What about movement within the country?  We’ve had the big growth in the “Sun Belt” that may include parts of these regions – a lot of people from the Northeast and Midwest have relocated.  Has the role of migration to these areas played any part in reducing infant mortality?

ANNE DRISCOLL:   Yes I mean it’s true that we know that there’s been this net migration from the northeast and the “Rust Belt” down to the South and the West. And this is not from our data but from Census data we know this, but if you look at the counties that encompass there that are parts of either the Appalachia or the Delta, this is not where most of the migration to those areas tends to go.  It tends to go to more urban areas such as Charlotte or the Raleigh-Durham, the Research Triangle in North Carolina, or to Atlanta in Georgia.  But much of the area that includes Appalachia and the Delta do not include large cities or have other economic opportunities that tend to draw new migrants from other regions of the country.  So for instance Appalachia encompasses the Appalachian and the Great Smoky Mountain chains, where coal mining has been the main economic activity or a main economic activity, but there haven’t been many robust economic areas that have attracted newcomers, so people are moving South but they’re not moving to that part of the South and Southeast.  The Delta is along the Mississippi Delta as I mentioned, but it includes mostly rural agriculture areas, and they’ve always suffered from lack of services and investment.  So again in those States and regions people are not going to those parts of the South but to the bigger economic draws so we can’t say directly but it doesn’t appear that migration has played a role in changing infant mortality rates in these particular regions.

Declines in Infant Mortality in Appalachia and the Delta: 1995–1996 Through 2017–2018

May 26, 2021

Questions for Anne Driscoll, Health Statistician and Lead Author of “Declines in Infant Mortality in Appalachia and the Delta: 1995–1996 Through 2017–2018.”

Q: Why did you decide to focus on infant mortality rates in the Appalachia and Delta region?

AD: These two regions are interesting to me because although they are very different in terms of history, geography and population but they are similar in that both have higher poverty rates and worse health outcomes including infant mortality rates (IMRs). In addition, there are official, congressionally-mandated definitions of which counties belong to each region which made it possible to be precise in our definition of each region for the analyses.

Q: Can you summarize how the infant mortality data varied by age and race?

AD: Infants of women in the youngest and oldest age groups (under age 20 and age 40 and over) had the highest mortality rates in all three regions (Appalachia, the Delta and the rest of the US). Infants born to women in their early thirties had the lowest mortality rates. In all three regions, infants of non-Hispanic black women had the highest mortality rates.

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

AD: The main question we asked in this report was whether the gap in infant mortality rates between these two regions and the rest of the U.S. changed over the last two decades. Our results support the conclusion that there has been some narrowing in the gap between the Delta and the rest of the US; the gap decreased from 2.9 deaths per 1,000 births to 2.2. Another way to think of this is that the gap was about one quarter smaller in 2017-2018 than it was in 1995-1996. During the study period, rates did not start declining in the Delta until 2005-2006.

In contrast, the gap between Appalachia and the rest of the US hasn’t narrowed. That is, IMRs have declined in both regions over the last 20 years but since they declined at about the same rate the gap between them didn’t close. In both 1995-96 and 2017-18, IMRs in Appalachia were 0.9 deaths per 1,000 births higher than in the rest of the country. Thus, while the gap between Appalachia and the rest of the US has been smaller than that between the Delta and the rest of the country, it hasn’t narrowed.

Q: Why do you think infant mortality rates have dropped in the Appalachia, Delta, and rest of U.S.?

AD: IMRs have declined for a variety of reasons. Other research has shown that more advanced and effective medical interventions for at-risk infants, particularly for premature infants, have helped lower the mortality rate. In addition, Medicaid is more widely available for pregnant women which allows low-income women to access timely and adequate prenatal care.

Another change which we show in our report is the decline in births to teens. Infants born to teens are at higher risk of poor outcomes, including death. Our analysis shows that the percent of births to teens declined in all three regions and that this accounted for about a fifth of the decline in IMRs in each region.

Q: Do you have infant mortality data on other regions of the United States during the same time-period?

AD: We calculate and publish IMRs for each state every year. But in terms of regions, the key is to have an ‘official’ definition of the region. One of the factors that made this research project possible was that there is an official definition of each of the two regions we studied. That is, we were able to categorize each county as part of Appalachia, the Delta, or the rest of the US.


March 26, 2021


The CDC National Center for Health Statistics web page “Stats of the States” has been updated to include the latest state-based final data on selected vital statistics topics, including:

  • General fertility rates
  • Teen birth rates
  • Selected other maternal and infant health measures
  • Marriage & divorce rates
  • Leading causes of death
  • Other high profile causes of death.

The site’s map pages allow users to rank states from highest to lowest or vice versa.  This latest version of “Stats of the States” also includes two new topics:  Life expectancy by state and COVID-19 death rates by state (provisional data on a quarterly basis, through Q3 of 2020).  All death rates are adjusted for age.  Rates are featured in the maps because they best illustrate the impact of a specific measure on a particular state.

The main “Stats of the States” page can be accessed at:  https://www.cdc.gov/nchs/pressroom/stats_of_the_states.htm

World Statistics Day 2020

October 20, 2020

Happy World Statistics Day!  Here are some charts from the Organisation for Economic Co-operation and Development (OECD) that rank the OECD countries by life expectancy, percentage of daily smokers and infant mortality.

NCHS will also be holding an informational webinar TODAY highlighting the NCHS Data Linkage Program.  More information can be found in the following link: https://www.cdc.gov/nchs/data-linkage/datalinkage-webinar.htm

For more information on World Statistics Day: https://worldstatisticsday.org/ 

Provisional Infant Mortality Rates from 2017 to Quarter 3, 2019

October 6, 2020

No significant change was seen when comparing rate(s) for the 12-month period ending with 2018 Q3 with rate(s) for the 12-month period ending with 2019 Q3.



Racial and Ethnic Differences in Mortality Rate of Infants Born to Teen Mothers: United States, 2017–2018

July 31, 2020

Questions for Ashley Woodall, Health Statistician and Lead Author of “Racial and Ethnic Differences in Mortality Rate of Infants Born to Teen Mothers: United States, 2017–2018.”

Q: Why did you decide to focus on teenagers for this report?

AW: There has not been much research on infant mortality using national data that focuses on specific maternal age groups. Teenagers are an age group of particular interest because infants born to teenagers have higher infant mortality rates compared with infants born to women in older age groups. Consequently, we wanted to explore the recent patterns in infant mortality for teenagers in the United States.

Q: Can you summarize some of the findings?

AW: In 2017–2018, infants born to teenagers aged 15–19 had the highest rate of mortality (8.77 deaths per 1,000 live births) compared with infants born to women aged 20 and over. Among teenagers, infants of non-Hispanic black females had the highest infant mortality rate (12.54) compared with non-Hispanic white (8.43) and Hispanic (6.47) females. Among the five leading causes of infant death, the largest racial and ethnic difference in mortality rates was found for preterm- and low-birthweight-related causes, where rates were two to three times higher for infants of non-Hispanic black teenagers (284.31 per 100,000 live births) than infants of non-Hispanic white (119.18) and Hispanic (94.44) teenagers.

Q: Was there a specific finding in the data that surprised you from this report?

AW: We were surprised by the large racial and ethnic disparity in deaths for preterm- and low-birthweight-related causes. This finding suggests that preterm birth and low birthweight are significant contributing factors for death among infants born to non-Hispanic black teenagers.

Q: Can you explain the difference between total infant, neonatal, and postneonatal mortality rates?

AW: Infant mortality is the death of a baby before his or her first birthday. It is calculated by dividing the number of infant deaths during a calendar year by the number of live births reported in the same year. It is expressed as the number of infant deaths per 1,000 live births. Neonatal mortality rate is the death of a baby during the first 27 days after birth, per 1,000 live births. Postneonatal mortality rate is the death of a baby between 28 days to under 1 year after birth, per 1,000 live births.

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

AW: The different mortality patterns seen among infants born to teenage mothers illustrate the racial and ethnic disparities in infant mortality and suggest that preterm birth and low birthweight are major public health concerns for infants born to non-Hispanic black teenagers.

Infant Mortality in the United States, 2018: Data From the Period Linked Birth/Infant Death File

July 16, 2020

Questions for Danielle Ely, Health Statistician and Lead Author of “Infant Mortality in the United States, 2018: Data From the Period Linked Birth/Infant Death File.”

Q: Why does NCHS conduct studies on infant mortality?

DE: NCHS collects data from U.S. jurisdictions on infant deaths to provide national statistics on infant mortality. Infant mortality is considered a key public health indicator for a country.

Q: Can you explain what the Linked Birth/Infant Death File is?

DE: The linked file consists of infant death information linked with the birth certificate information for infants under 1 year of age. Individual birth and death records are selected from their respective files and linked into a single statistical record, thereby establishing a national linked record file. The linked birth/infant death data set is the preferred source for examining infant mortality by race and Hispanic origin. Infant mortality rates by race and Hispanic origin are more accurately measured from the birth certificate compared with the death certificate.

Q: Can you summarize how the infant mortality data varied?

DE: The U.S. infant mortality rate was 5.67 infant deaths per 1,000 live births, lower than the rate of 5.79 in 2017 and an historic low. The mortality rate declined in 2018 for infants of Hispanic women compared with the 2017 rate; changes in rates for other race and Hispanic-origin groups were not statistically significant. The 2018 infant mortality rate for infants of non-Hispanic black women (10.75) was more than twice as high as that for infants of non-Hispanic white (4.63), non-Hispanic Asian (3.63), and Hispanic women (4.86). Infants born very preterm (less than 28 weeks of gestation) had the highest mortality rate (382.20), 186 times as high as that for infants born at term (37–41 weeks of gestation) (2.05). Infant mortality rates by state for 2018 ranged from a low of 3.50 in New Hampshire to a high of 8.41 in Mississippi.

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

DE: Although the infant mortality rate continues to slowly decline, some groups have consistently higher rates than others (for example, by maternal race and Hispanic origin, infants of non-Hispanic black, American Indian or Alaska Native, and Native Hawaiian and Other Pacific Islander women have higher rates than infants of non-Hispanic white, non-Hispanic Asian, and Hispanic women). This information can further our understanding of current infant mortality trends and provide information on where improvements can be made.

Q: Any predictions for 2019 infant mortality data?

DE: We do not predict what will happen for the infant mortality rate in future years. Provisional estimates for each quarter can be found in the Vital Statistics Rapid Release Quarterly Provisional Estimates at https://www.cdc.gov/nchs/nvss/vsrr/infant-mortality-dashboard.htm. These data show a slight increase in the 2019 quarter 2 estimates to 5.69 infant deaths per 1,000 live births.  Note that this estimate may be revised when the 2018 quarter 3 estimate becomes available.