PODCAST: The 2020 Decline in Life Expectancy

July 21, 2021

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210721/20210721.htm

podcast-iconHOST:  In February, we had a discussion with Elizabeth Arias with the NCHS Division of Vital Statistics about life expectancy in the United States during the first half of 2020, right as the pandemic was taking hold.  Americans lost a full year of life expectancy during that first part of 2020.  Today we feature the sequel to that conversation, as this week NCHS is releasing full-year life expectancy estimates for 2020.

HOST:  Can you tell us if life expectancy dropped more in the second half of 2020 than in the first half?

ELIZABETH ARIAS: Yes it did – life expectancy declined an additional amount during the second half of 2020 and it did so more for some groups than for other groups.  For example, for the Hispanic population it declined an additional 1.1 years.  For the non- Hispanic white population it declined an additional .4 years and for the non-Hispanic black population it declined an additional .2 years.

HOST:  So overall what was the total decline in life expectancy for 2020?

ELIZABETH ARIAS: It was 1 1/2 years.

HOST: So it’s another half year of decline from the first half then?

ELIZABETH ARIAS: That’s right.

HOST:  Were you surprised it didn’t drop more than 1.5 years given how bad the pandemic became near the end of 2020?

ELIZABETH ARIAS:  No. I was not surprised because the number of excess deaths would have had to be even larger than they were for the decline to have been greater.  And in addition half a year is a substantial amount – it sounds like a small change, but in terms of the way that mortality changes over time which is rather gradual, and it has been gradual and consistent ever since the 1940s, for example.  We have seen an increase gradually increase in life expectancy year to year, and of course a gradual decrease in mortality year to year.  So a half a year is substantial, so if we would have added another year of decline that would have meant that the number of deaths were even greater than what we saw.

HOST: OK so you mentioned some of the declines among race Hispanic groups- what about declines among men versus women?

ELIZABETH ARIAS:  We have seen the gap in life expectancy between men and women decline over the decades.  It started out rather large at the beginning of the 20th century, with women having higher mortality and lower life expectancy than men – that was mainly due to high rates of maternal mortality.  And then we saw over time men having higher mortality and women having greater advantage in terms of life expectancy.  Over time we’ve seen that this change and particularly during the latter part of the 20th century and early part of the 21st century.  The main reason for the decline in the gap, in the difference between the two, has been that life expectancy has been increasing at a faster pace or rate for men.  In other words, men had been catching up to women, and what happened in 2020 with the pandemic is that men experienced higher mortality than women did, and so they basically lost some of what they had achieved during the previous decades.

HOST: Now are you planning to release mid-year 2021 estimates like you did with 2020?

ELIZABETH ARIAS: That’s a good question and I believe we are. I don’t know definitively.

HOST: With 200,000 plus deaths from COVID-19 so far in 2021, would we expect to see another drop in life expectancy?

ELIZABETH ARIAS: No actually, I think what we would see is a small increase in life expectancy in comparison to what we saw in 2020.  In order for us to see another decline in life expectancy we would have to have a greater number of excess deaths than what we have seen so far.  So I would say that we would probably see life expectancy go up but it won’t return to what it was in 2019.

HOST: Now the drop in life expectancy for 2020 was 1.5 years, and yet way back 100 years ago plus, the Spanish flu pandemic resulted in an 11.8 year decline in 1918.  Why the huge difference?

ELIZABETH ARIAS:  Well, you have to think about number of deaths during the Spanish influenza.  So there were over 600,000 deaths, and also you have to think about the size of the population then.  It was a significantly smaller population than what we have today. So you know in 2020 we had 385,000 deaths and a population of over 330 million and back in 1918 we had over 600,000 deaths and – I don’t remember the number of the population at the time – but it was a lot smaller than it is so that translates into much larger death rates and as a result a greater decline in life expectancy.

HOST:  Are there any plans to down the road look at vaccination and deaths from COVID or vaccination and life expectancy?  Anything planned along those lines?

ELIZABETH ARIAS:  That would be really interesting and I don’t know if we would have the data for that. I think if the National Health Interview Survey asks that question – if people, you know, were vaccinated – or the NHANES… And since we link those surveys to our mortality data, we may be able to look at mortality by vaccination status.  But from our data, from vital statistics – in other words from the death certificate – we would not be able to see that.  We would have to have some sort of data that’s linked to our mortality data.

HOST:  OK well thanks for talking to us again Elizabeth.

ELIZABETH ARIAS:   You’re welcome.  Thank you.

MUSIC BRIDGE

HOST:  Through the week ending on July 14, there have been 213,413 COVID-19 deaths recorded on death certificates in the United States during this year.  Deaths occurring in nursing homes or other long-term care facilities have declined from 22% of all COVID deaths in 2020 to 13% of the total so far in 2021.  81% of deaths in 2020 were among people age 65 and up; that percentage has dropped slightly in 2021 to less than 77%.  Deaths in the 45-64 year age group have risen from 16.6% of all deaths in 2020 to over 20% in 2021.  Total excess deaths in the U.S. since February 1, 2020 have topped 663,000, with approximately 80% or more of those deaths due to COVID-19.


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: Drowning Deaths Among U.S. Children

July 16, 2021

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210716/20210716.htm

podcast-iconHOST:  We’re joined today by Merianne Spencer, the author of a new study on accidental drowning deaths among children in the United States.

HOST:  So briefly describe to us the scope of the problem.

MERIANNE SPENCER:  Sure.  So unintentional drowning deaths are the second leading cause of injury death among children, those aged zero to 17, and is also the leading cause of unintentional injury deaths for those ages one to four, so for this study we wanted to look at national trends from 1999 to 2019 by demographic characteristics and also by urban-rural status to see what the patterns were over the past two decades among children.

HOST:  So you say that drowning deaths are the second leading cause of unintentional death among kids – what was the leading cause of unintentional injury deaths in that age group?

MERIANNE SPENCER:   The leading cause of death for unintentional injuries is motor vehicle traffic deaths, followed by drowning and then poisoning and then suffocation.  But it’s important to note that motor vehicle traffic deaths are much higher.  In 2019, there were almost 2000 deaths whereas for drowning there were pretty much half the amount.  Motor vehicle traffic deaths is much higher.

HOST:  How has this problem changed over time?

MERIANNE SPENCER:   So over the past two decades drowning deaths have decreased – roughly a 38 percent decline over the past two decades.

HOST:  Do we have any idea why drowning deaths have declined over the past two decades?  Are there any CDC programs that are targeting this problem?

MERIANNE SPENCER:  Looking at prevention programs, the National Center for Injury Prevention and Control – they provide a lot of information about the prevention of drowning, including pool safety, swimming safety tips and other considerations for water safety within the home. I would also look to prevention resources such as “Safe Kids Worldwide” and the “World Safety USA Network” but there are various programs that have been looking at improving safety for drowning among children and targeting that public health issue.

HOST:  Now one would assume that drowning deaths tend to spike during the summer months – is that an accurate assumption?  What did the data tell us about seasonality?

MERIANNE SPENCER:  There’s definitely a seasonality with respect to driving death.  So typically, the number of unintentional drowning deaths are lowest during colder months such as January or December, as well as in the Fall.  The number of deaths tend to rise sometime in April and they peak around June and July and decrease as it goes towards September.  So yes, it is an accurate assumption that there is a spike in around the warmer months when children might be swimming or going to the pool.

HOST: So which groups are more at risk for drowning deaths?

MERIANNE SPENCER:   Our study found that males are definitely at greater risk for unintentional drownings – they had higher rates of unintentional drowning deaths over the past two decades compared to females.  We also saw that those aged one to four had the highest rates of drowning compared to other age groups.  So much higher among those aged one to four years of age.  We also saw that rates were higher among non-Hispanic black children compared to non-Hispanic white children and Hispanics over the study period. And also we saw children were at higher risk for unintentional drownings in rural areas compared to urban areas.

HOST:  And what did the data tell us about places that are most risky for kids in terms of being a potential drowning risk?

MERIANNE SPENCER:  Our study found that death varied by age groups.  So those that were less than a year of age had a higher percentage that died in a bathtub, whereas those that at age 1 to four or five to 13 had the greatest percentage of deaths in swimming pools and those aged 14 to 17 were more likely to die in natural water such as lakes, rivers, streams, or oceans.  So there is definitely a difference by age group in the places where drowning deaths occurred.

HOST:  Are there any plans for further studies on this topic?

MERIANNE SPENCER: We are interested in looking at those places of drowning by looking at the literal text or the written information on the death certificate records to see if we can get a little bit more information.  Currently the study is focused on using the ICD-10 codes to look at places of drowning but maybe we can get some more insight about this finding in a future study.

HOST:  You mentioned the literal text – that’s the same kind of technique that’s been used on some studies looking at the types of drugs involved in overdose deaths is that correct?

MERIANNE SPENCER:  Yes that’s correct.  So by looking at the written information by medical examiners and coroners we might be able to tease out some information beyond the coding on ICD-10 codes or get more specificity on the place of drowning or some context around the drowning deaths so that’s something we might be looking into for a future study for this topic.

MUSICAL BRIDGE

HOST:  This week, NCHS released the first, full-year provisional data from 2020 on drug overdose deaths in America.  The new release shows a nearly 30% increase in deaths, from over 72,000 estimated deaths in 2019 to more than 93,000 deaths in 2020.

Three-quarters of all overdose deaths involve opioids – or nearly 70,000 deaths.  Much of the 2020 spike was the result of increases in deaths from synthetic opioids, primarily fentanyl.  Deaths from psychostimulants such as methamphetamine also continued to increase in 2020, as did deaths from cocaine and from natural and semi-synthetic opioids such as prescription pain medication.

The first 2021 data on overdose deaths will be released in August of this year.


Drug Overdose Deaths in the U.S. Up Nearly 30% in 2020

July 14, 2021

drug_OD_2020The CDC’s National Center for Health Statistics has released full-year 2020 provisional drug overdose death data that estimates 93,331 drug overdose deaths in the United States during 2020, an increase of 29.4% from the 72,151 deaths predicted in 2019.

The data featured in an interactive web data visualization estimates overdose deaths from opioids increased from 50,963 in 2019 to 69,710 in 2020. Overdose deaths from synthetic opioids (primarily fentanyl) and psychostimulants such as methamphetamine also increased in 2020 compared to 2019. Cocaine deaths also increased in 2020, as did deaths from natural and semi-synthetic opioids (such as prescription pain medication).


Declines in Births by Month: United States, 2020

June 23, 2021

NCHS released a report that presents provisional 2020 and final 2019 and 2018 data on changes in the number of U.S. births by race and Hispanic origin of mother and by month of birth and state.

Findings:

  • From 2019 to 2020, the number of births for the United States declined for each month, with the largest declines occurring in December (8%), August (7%), and October and November (6%).
  • Larger declines in births were seen in the second half of 2020 (down 6%) compared with the first half (down 2%) of 2020.
  • The number of births declined in both the first and second 6 months of 2020 compared with 2019 for nearly all race and Hispanic-origin groups, with larger declines in the second half of 2020 compared with the first half of the year.
  • Births declined in 20 states in the first half of 2020, and in all states in the second half of 2020 (declines in 7 states were not significant).
  • Changes in births by race and Hispanic origin and by state were less pronounced from 2018 to 2019; the number of births declined for 9 months by 1%–3%.

 


PODCAST: NHANES Updates, Drug Overdose Deaths, and ER Visits From Motor Vehicle Crashes

June 18, 2021

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210618/20210618.htm

podcast-iconHOST:  In March of 2020, field operations for the National Health and Nutrition Examination Survey – or NHANES – were halted due to the COVID-19 pandemic. Field operations are scheduled to restart later this summer.  But the halt in operations presented a problem, since NHANES data traditionally is released in two-year cycles in order to have a large enough sample size to be nationally representative.  Because the data collected in the cycle from 2019 thru March 2020 are ­not nationally representative, NCHS took steps to combine these “partial-cycle” data with previously released 2017–2018 data in order to produce nationally representative estimates.

This effort resulted in a new report this week that explains these “prepandemic NHANES data files,” from the period January 2017 thru March 2020, and outlines recommendations as well as limitations related to using the files.  The new report also presents prevalence estimates for selected health outcomes based on these files.

One of the health topics selected was obesity.  From January 2017 to March 2020, the data show that 1 in 5 children and adolescents in the U.S. were obese, or 19.7% of the age 2-19 population.  The report also shows that nearly half of children and adolescents – or 46% – had untreated or restored cavities in one or more of their primary or permanent teeth.

Among adults age 20 and up, the age-adjusted prevalence of obesity was more than 4 in 10, or 42%, and nearly 1 in 10 were severely obese. In addition to obesity, the new data show that diabetes prevalence among adults was nearly 15% and that nearly half of adults age 18 and over – or 45% — had hypertension.  Also, among older adults age 65 and up, complete tooth loss was present in nearly 14% of that population.

Ultimately, these new estimates are similar to those reported during the 2017-2018 cycle, but the additional year and two plus months-worth of data provide a larger sample size and thus more precise estimates.  And the release of these data mark another important milestone, in that they are the last NHANES data collected before widespread transmission of COVID-19 began in 2020.

(MUSIC BRIDGE)

HOST:  This week, the monthly provisional numbers for drug overdose deaths in the U.S. were released.  The latest round of data cover the one-year period ending in November of 2020, and show that the number of drug overdose deaths increased nearly 30% from the one-year period ending in November 2019.  Over 92,000 Americans died of drug overdoses in the year ending in November 2020, up from less than 72,000 the year before.

Three out of every four of these overdose deaths involved opioids, as the number of opioid-involved deaths topped 69,000 in this one-year period ending in November 2020, a major increase from 50,504 deaths the year before.  It’s important to note that recent trends may still be at least partially due to incomplete data.

A big factor behind the increase in overdose deaths is the continued increase in deaths involving synthetic opioids, primarily fentanyl.  But increases in deaths from other drugs are playing a major role as well.  Overdose deaths from cocaine as well as psychostimulants such as methamphetamine have shown significant increases compared to the previous year.

The next release of provisional numbers will feature full-year 2020 data for the first time.

(MUSIC BRIDGE)

HOST:  An average of 3.4 million emergency department visits occur each year due to injuries from motor vehicle crashes.  Most people who are injured or killed in motor vehicle crashes are occupants.  Studies have shown that medical care costs and productivity losses associated with motor vehicle injuries and deaths exceeded $75 billion in 2017.

Today, NCHS released a new report that presents emergency department visit rates per 1,000 for motor vehicle crashes by age, race and ethnicity, health insurance status, and census region. The data come from the National Hospital Ambulatory Medical Care Survey, an annual, nationally representative survey of nonfederal, general, and short-stay hospitals in the United States.

The report shows that in 2017–2018, the overall ER visit rate for motor vehicle crash injuries was 5.3 visits per 1,000, and was highest among patients between ages 15 and 24.  The ER visit rate for non-Hispanic black patients was several times higher than for non-Hispanic white or Hispanic patients.

Emergency department visit rates were higher for patients who had Medicaid, no insurance, or workers’ compensation insurance as their primary expected source of payment compared with patients who had private insurance or Medicare.  The ER visit rate for motor vehicle crashes at hospitals located in the South was higher than the rates at hospitals in all other census regions of the United States.


NCHS Releases Latest Provisional Drug Overdose Data

June 16, 2021

NOV2020_Overdose

NCHS released the latest monthly preliminary counts of drug overdose deaths in the United States, covering the one-year period ending in November of 2020.  The data is now available in a web-based interactive dashboard at:  https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.

Provisional data show that the reported number of drug overdose deaths occurring in the United States increased by 28.9% from the 12 months ending in November 2019 to the 12 months ending in November 2020, from 70,357 to 90,722. After adjustments for delayed reporting, the predicted number of drug overdose deaths showed an increase of 29.4% from the 12 months ending in November 2019 to the 12 months ending in November 2020, from 71,672 to 92,751.

The reported number of opioid-involved drug overdose deaths in the United States for the 12-month period ending in November 2020 (67,574) increased from 49,488 in the previous year. The predicted number of opioid-involved drug overdose deaths in the United States for the 12-month period ending in November 2020 (69,287) increased from 50,504 in the previous year.


PODCAST: The 2020 Increase in Death Rates Were The Highest Ever Recorded

June 11, 2021

STATCAST, JUNE 2021: DISCUSSION WITH FARIDA AHMAD, STATISTICIAN, ABOUT LATEST PROVISIONAL QUARTERLY MORTALITY DATA.

https://www.cdc.gov/nchs/pressroom/podcasts/2021/20210611/20210611.htm

podcast-iconHOST:  Each quarter NCHS releases provisional data on mortality from leading causes of death in the U.S. on an interactive web-based dashboard.   This week the dashboard was updated to include Quarter 4 data from 2020 and gives a complete account of provisional death rates in the U.S. for the year.  Joining us to discuss some of the key findings is Farida Ahmad of the Division of Vital Statistics.

HOST: First question: how much did the death rate in the U.S. increase in 2020?

FARIDA AHMAD:  The death rate for the U.S. increased by about 16% in 2020 compared to 2019-

HOST:  Now is it safe to say that almost all of the increase can be attributed to COVID-19.

FARIDA AHMAD:  A large part of it, yes, but we also saw increases in other causes of death like heart disease, Alzheimer’s disease, and diabetes.  Unintentional injuries like drug overdose also increased throughout 2020.  This report only includes drug overdose rates for the first half of the year but you do see very large increases in the second quarter of 2020.

HOST:  Some say that certain causes of death like influenza and pneumonia declined in 2020 due to COVID – is that true?

FARIDA AHMAD:  No, not really – that’s due to influenza and pneumonia were actually higher in 2020 than in 2019.  That’s likely driven by the pneumonia more so than influenza though.

HOST:  Is there any sense whether some of those pneumonia deaths are miscategorized, that maybe they should be in the COVID category?

FARIDA AHMAD:  Yes, you know it’s definitely possible.  We don’t have hard numbers on that and to account for maybe miscategorized COVID deaths we would we would look at excess mortality.  So a different kind of measure to look at that.

HOST:  I guess then the same would be true for other causes of death, particularly those that occur at the very beginning of 2020.  Is there any chance there will be more COVID deaths added to the tally?

FARIDA AHMAD:  It’s certainly possible but we haven’t closed out the 2020 data year.  So we could still get additional changes but we don’t anticipate a significant number of deaths data will change.

HOST:  So the data aren’t final yet is that correct?

FARIDA AHMAD:   Yes that’s correct.

HOST:   So what are some of the more striking changes you saw in the death rates from 2019 to 2020 as far as certain leading causes go?

FARIDA AHMAD:  Diabetes deaths increased by almost 14%… Chronic liver disease increased by 17% … and then hypertension and Parkinson disease those increased by 12% and 11% respectively.

HOST:  So in a normal year those would be considered very large increases is that correct?

FARIDA AHMAD:  Yes, yeah shifts that large would be notable.

HOST: But there’s no way to sort of link that back to the pandemic, either directly or indirectly?

FARIDA AHMAD:   Not with the death certificate data that we have, unless these deaths – you know these deaths which were the underlying cause is what we’re looking at.  For these deaths COVID-19 might also be listed on the death certificate, in which case you could say that COVID-19 played a role in that death but otherwise we wouldn’t necessarily know if it was a direct or indirect cause of the pandemic in terms of disrupted access to healthcare or other contributing factors.  The death certificate data wouldn’t necessarily tell us that.

HOST: So in general 2020 was a very rough year for mortality but were there any declines in leading causes of death in 2020?

FARIDA AHMAD:  There were a few – there were declines in cancer, in chronic lower respiratory diseases, and pneumonitis due to solids and liquids>

HOST: Did the pandemic – did COVID-19 — have any impact on death rates at the state level?  Were there any unusual changes in 2020?

FARIDA AHMAD:  West Virginia and Mississippi had the highest death rates overall, but the largest increases in death rates were actually seen in New York and New Jersey.

HOST:  Is there anything else in this new data that you’d like to note?

FARIDA AHMAD: What this report allows us to look at is not just the deaths due to COVID-19, which have been understandably a huge focus of public health surveillance in last year, but with this report we get to look at some of the other leading causes of death that might not be in the top five, or the top ten, but these are issues of public health importance and concern.  To look at these various diseases and causes of death, so I think that’s really what this report adds is to be able to take a broader look.

MUSICAL BRIDGE:

HOST: Our thanks to Farida Ahmad for joining us on this edition of “Statcast.”

HOST:  On Wednesday of this week, NCHS also released a new report on screening for breast, cervical and colorectal cancer.  The study featured data on women age 45 and over from the National Health Interview Survey, and concluded that regular cancer screening is much more likely among women of higher socio-economic status, as well as women who are married or living with a partner, and women who engage in healthy behaviors — such as not smoking, regularly exercising, and getting a flu shot.


NCHS Releases Latest Quarterly Provisional Mortality Data Through Full-Year 2020

June 8, 2021

NCHS has released the latest quarterly provisional mortality rates for the U.S., through full-year 2020 for most causes of death. 

Estimates are presented for 15 leading causes of death plus estimates for deaths attributed to coronavirus disease 2019 (COVID-19), drug overdose, falls for persons aged 65 and over, firearm-related injuries, human immunodeficiency virus (HIV) disease, and homicide. 

The data is featured on an interactive web site dashboard at: https://www.cdc.gov/nchs/nvss/vsrr/mortality-dashboard.htm.

NCHS has also released state maps showing COVID-19 death rates for provisional quarter 4 mortality data. You can access the 12-month ending map here and quarterly map here.


PODCAST: Infant Mortality Trends in Appalachia and the Delta

May 28, 2021

STATCAST, MAY 2021: DISCUSSION WITH ANNE DRISCOLL, STATISTICIAN, ABOUT INFANT MORTALITY TRENDS IN APPALANCHIA AND THE DELTA.

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.