Infant Mortality Statistics Research Articles

Infant Mortality in the United States, 2022: Data From the Period Linked Birth/Infant Death File.

This report presents final 2022 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined. Descriptive tabulations of data are presented and interpreted for infant deaths and infant mortality rates using the 2022 period linked birth/infant death file. The linked birth/infant death file is based on birth and death certificates registered in all 50 states and the District of Columbia. A total of 20,577 infant deaths were reported in the United States in 2022, up 3% from 2021. The U.S. infant mortality rate was 5.61 infant deaths per 1,000 live births, a 3% increase from the rate of 5.44 in 2021. The neonatal mortality rate increased 3% from 3.49 in 2021 to 3.59 in 2022, and the postneonatal mortality rate increased 4% from 1.95 to 2.02. The overall infant mortality rate increased for infants of American Indian and Alaska Native non-Hispanic, White non-Hispanic, and Dominican women in 2022 compared with 2021; changes in rates for the other race and Hispanic-origin groups were not significant. Infants of Black non-Hispanic women had the highest mortality rate (10.90) in 2022, followed by infants of American Indian and Alaska Native non-Hispanic and Native Hawaiian or Other Pacific Islander non-Hispanic (9.06 and 8.50, respectively), Hispanic (4.89), White non-Hispanic (4.52), and Asian non-Hispanic (3.51) women. Mortality rates increased from 2021 to 2022 among preterm (less than 37 weeks of gestation) infants (33.59 to 34.78) and for infants born term (37 to 41 weeks of gestation) (2.08 to 2.18). The five leading causes of infant death in 2022 were the same as in 2021. Infant mortality rates by state for 2022 ranged from a low of 3.32 in Massachusetts to a high of 9.11 in Mississippi.

Saving newborns, defining livebirth: The struggle to reduce infant mortality in East-Central Europe in comparative and transnational perspectives, 1945-1965.

After World War II, infant mortality rates started dropping steeply. We show how this was accomplished in socialist countries in East-Central Europe. Focusing on the two postwar decades, we explore comparatively how medical experts in Poland, Hungary, Czechoslovakia, and East Germany saved fragile newborns. Based on an analysis of medical journals, we argue that the Soviet Union and its medical practices had only a marginal influence; the four countries followed the recommendations of the World Health Organization instead, despite not being members. Importantly, we analyze the expert clashes over definitions of livebirth, which impact infant mortality statistics. We analyze the divergent practices and negotiations between countries: since the infant mortality rate came to represent the level of socioeconomic advancement, its political significance was paramount. Analyzing the struggle to reduce infant mortality thus helps us understand how socialist countries positioned themselves within the transnational framework while being members of the "socialist bloc."

Maternal, infant, and perinatal mortality statistics and trends in Korea between 2018 and 2020.

This study aimed to identify maternal, infant, and perinatal mortality using the nationalpopulation data of South Korea between 2018 and 2020, and to analyze mortality rates according tocharacteristics such as age, date of death, and cause of death in each group. This study updates themost recent study using 2009 to 2017 data. Analyses of maternal, infant, and perinatal mortality were done with data identifiedthrough the supplementary investigation system for cases of death from the Census of PopulationDynamics data provided by Statistics Korea from 2018 to 2020. Between 2018 and 2020, a total of 99 maternal deaths, 2,427 infant deaths, and 2,408 perinatal deaths were identified from 901,835 live births. The maternal mortality ratio was 11.3 deathsper 100,000 live births in 2018; it decreased to 9.9 in 2019 but increased again to 11.8 in 2020. Thematernal mortality ratio increased steeply in women over the age of 40 years. An increasing trend inthe maternal mortality ratio was found for complications related to the puerperium and hypertensive disorders. Both infant and perinatal mortality continued to decrease, from 2.8 deaths per 1,000live births in 2018 to 2.5 in 2020 and from 2.8 in 2018 to 2.5 in 2020, respectively. Overall, the maternal, infant, and perinatal mortality statistics showed improvements.However, more attention should be paid to women over 40 years of age and specific causes of maternal deaths, which should be taken into account in Korea's maternal and child health policies.

Continuous perinatal health monitoring and analysis in Europe based on a federated analytic approach: a proof of concept study

Abstract Background International comparisons of population indicators of maternal and newborn health are valuable for guiding health policy and practice. The Covid-19 pandemic revealed the difficulties of compiling comparable, timely data in Europe. As part of the PHIRI (Population Health Information Research Infrastructure) project, we developed a protocol to facilitate the exchange and analysis of population birth data in Europe. Methods The Euro-Peristat network, which includes experts from 31 European countries, developed a common data model and R scripts to facilitate rapid exchange of anonymised aggregate tables (https://zenodo.org/record/5148032#.YmlUttpBxPY). These tables were used to compile comparable perinatal health indicators from routine population-based sources for the years 2015 to 2020. We assessed the feasibility of this approach and the availability, quality and comparability of the data. Results Building on previous Euro-Peristat recommendations and a structured consensus process, the network defined a common data model including 22 variables for the testing phase. 17 additional variables were considered important and feasible for a second phase. 25 countries created patient-level data files. Most countries had 20 or more of the data items, whereas 1 had 18, 3 had 16 and 2 had 15 variables. Limiting factors included not having all data in a single database, most often the case for neonatal and infant mortality or vital statistics versus healthcare data, and the diversity or absence of data on socioeconomic status. Setting up the model was time consuming, but once established, running the R scripts was easy and quick (<15 min). The protocol requires the active participation of each country to ensure it is correctly applied. Conclusions We illustrated the feasibility of using a common data model with open source scripts to facilitate rapid production of data and analysis on key perinatal health indicators in European countries

Social factors and public policies associated with state infant mortality rates

ABSTRACT Despite mounting evidence that social factors and public policies affect state infant mortality rates (IMRs), few researchers have examined variation in IMRs associated with those factors and policies. We quantified disparities in infant mortality by state social factors and public policy characteristics. We hypothesized that some social factors and public policies would be more strongly associated with infant mortality than others, and that states with similar factors and policies would form clusters with varying levels of infant mortality. We examined associations of women’s economic empowerment, health and well-being, political participation, reproductive rights, and work and family-related policies with state IMRs in 2012 and 2015, using indicators created by the Institute for Women’s Policy Research. Methods included generalized linear models, principal component analysis, and cluster analysis. Health and well-being predicted IMRs (2012, 2015, both p < .05), as did poverty and opportunity, and reproductive rights (2012, p < .10). Consistent with our hypothesis, states formed clusters, with the states in each cluster having similar social factors and public policies, and similar IMRs. Women’s health status and insurance coverage were more predictive of state IMRs than other social factors. Improving health and insurance coverage may be an effective way to reduce state IMRs.

Valuing Infant Health in the United States.

In this issue of Pediatrics , Goldstein et al1 present new findings on state and local government expenditures and infant mortality in the United States. How much a society and/or individuals are willing to pay for something reflects its importance and monetizes its value.2 Nevertheless, investing wisely (eg, assessing the “return on investment” and domains of investing in medicine versus health) has been and continues to be challenging. Infant mortality statistics, like all vital statistics, are concerned with real people. They describe events and provide information about characteristics related to individuals entering or leaving life or changing their civil status.3 It is important to go behind those numbers and remember that each one represents a significant moment in life. The first recorded “vital statistics concerned with people” indicated that, in 1915, for every 1000 live births, ∼100 infants died before their first birthday.3–7 In 2018, the US infant mortality rate declined to 5.67 deaths per 1000 live births, making that year’s infant mortality rate the lowest reported in … Address correspondence to Michele Kiely, DrPH, Graduate School of Public Health and Health Policy, The City University of New York, 55 W 125th St, Room 714, New York, NY 10027. E-mail: michele.kiely{at}sph.cuny.edu

Maternal, infant, and perinatal mortality statistics and trends in Korea between 2009 and 2017.

ObjectiveTo provide updates on maternal, infant, and perinatal mortality using the national population data of South Korea between 2009 and 2017 and describe the mortality rate by target groups, timing, or causes of events to provide a basis for detecting vulnerable populations and ensuring timely medical and political interventions.MethodsPregnancy-related mortality in women, as well as deaths of infants, in South Korea was identified using population data from Statistics Korea. Records from death certificates, cremation reports on infant and fetal deaths, and the complementary cause-of-death investigation system were reviewed for the 2009–2017 period.ResultsA total of 461 maternal deaths, 11,717 infant deaths, and 12,249 perinatal deaths, including fetal deaths over 28 gestational weeks, were identified from 3,945,159 live births between 2009 and 2017. The maternal mortality ratio was 13.5 deaths per 100,000 live births in 2009 and decreased to 7.8 in 2017. Only the rate of deaths related to hypertensive disorders showed an increasing tendency. Both the infant and perinatal mortality rates improved (from 3.2 deaths per 1,000 live births in 2009 to 2.8 in 2017 and from 3.5 to 2.7, respectively). Among the external causes of infant mortality, assaults including homicides accounted for 25% (n=150), and this proportion was constant throughout the study period.ConclusionOverall improvements were observed in all maternal, infant, and perinatal mortality measures. In-depth analysis and interventions with respect to certain causes, such as hypertensive disorders in mothers or assaults in infants, should be considered priority issues.

State Infant Mortality Rate Calculations Vary by Classification of Pre-Viable Infants

Ohio birth records and death records from Ohio Vital Statistics were used to examine deaths within Ohio. Records were linked using birth certificate numbers. Due to data availability and the scope of the original evaluation these analyses were completed for, only data for years 2008-2015 are used from these Ohio datasets. National data for all states and Washington DC from 2007 to 2017 were acquired from the CDC Wonder database. Variables used included number of live births, number of infant deaths, and gestational age at birth. Descriptive statistics including counts, percentages, birth rates, and infant mortality rates were calculated.

Birth in High Infant Mortality States and Dementia Risk in a Cohort of Elderly African American and White Health Care Members.

Birth in areas with high infant mortality rates (IMRs) has been linked to worse long-term health outcomes, yet it is completely unknown if it impacts dementia risk. In total 6268 health care members were followed for dementia diagnosis from 1996 to 2015. Birth state IMRs from 1928 were ranked into quartile (worst IMRs quartile range, whites: 69 to 129 deaths/1000 live births, Non-whites: 129 to 277 deaths/1000 live births). Cox proportional hazard models estimated the dementia risk associated with birth state IMR quartile adjusting for demographics and lifecourse health indicators. Compared with whites born outside of states in the worst IMR quartile, African Americans born in states in the worst IMR quartile had 92% increased dementia risk (HR=1.92; 95% CI: 1.42, 2.59), and African Americans born outside those states had 36% increased risk (HR=1.36; 95% CI: 1.20, 1.53). There was no association between birth state IMR and dementia risk among whites. Birth in states with the highest rates of infant mortality was associated with elevated dementia risk among African Americans but not whites. The large absolute difference in IMRs likely reflects harsher early childhood conditions experienced by African Americans. These findings suggest that childhood conditions may play a role in racial disparities in dementia rates.

Addressing Decision Making in Progesterone Treatment for History of Preterm Delivery [27C

INTRODUCTION: The United States infant mortality rate of 6.1 deaths per 1000 live births ranks 27th worldwide. The majority of perinatal morbidity and mortality is related to preterm birth, whose only FDA approved preventive treatment is intramuscular 17-hydroxyprogesterone (17-OH-P) from 16-36 weeks of gestation. Unfortunately, many patients refuse this treatment. METHODS: This 12 month prospective study utilized a short survey, in combination with focus groups, to identify social, cultural, and personal reasoning that influences patients’ decisions to accept or reject 17-OH-P treatment. We hypothesized that treatment refusal is multifactorial for any given patient. RESULTS: Acceptors (n=43) and refusals (n=7) were unable to generate sufficient power to identify statistically significant intragroup differences. However, utilizing these surveys and resultant focus groups, this study was able to identify trends within these populations which may guide future approaches to them. Patients refusing 17-OH-P often cited pain with injection, exhibited fatalistic beliefs regarding their care, and/or had personal concerns related to full term pregnancy. Acceptors were identified as candidates at the time of their previous preterm birth, coped better with treatment side effects, and/or had traumatic emotional reactions regarding their premature birth outcomes. Both groups cited barriers to their care–specifically including access and disparities within their care. CONCLUSION: Identifying these differences between women accepting and rejecting 17-OH-P may help to develop new approaches to improve patient acceptance of 17-OH-P therapy.

Medicaid Expansion and Infant Mortality in the United States.

To explore the effect of Medicaid expansion on US infant mortality rate. We examined data from 2010 to 2016 and 2014 to 2016 to compare infant mortality rates in states and Washington, DC, that accepted the Affordable Care Act Medicaid expansion (Medicaid expansion states) and states that did not (non-Medicaid expansion states), stratifying data by race/ethnicity. Mean infant mortality rate in non-Medicaid expansion states rose (6.4 to 6.5) from 2014 to 2016 but declined in Medicaid expansion states (5.9 to 5.6). Mean difference in infant mortality rate in Medicaid expansion versus non-Medicaid expansion states increased from 0.573 (P = .08) in 2014 to 0.838 in 2016 (P = .006) because of smaller declines in non-Medicaid expansion (11.0%) than in Medicaid expansion (15.2%) states. The 14.5% infant mortality rate decline from 11.7 to 10.0 in African American infants in Medicaid expansion states was more than twice that in non-Medicaid expansion states (6.6%: 12.2 to 11.4; P = .012). Infant mortality rate decline was greater in Medicaid expansion states, with greater declines among African American infants. Future research should explore what aspects of Medicaid expansion may improve infant survival.

Political gender inequality and infant mortality in the United States, 1990–2012

Although gender inequality has been recognized as a crucial factor influencing population health in the developing world, research has not yet thoroughly documented the role it may play in shaping U.S. infant mortality rates (IMRs). This study uses administrative data with fixed-effects and random-effects models to (1) investigate the relationship between political gender inequality in state legislatures and state infant mortality rates in the United States from 1990 to 2012, and (2) project the population level costs associated with women's underrepresentation in 2012. Results indicate that higher percentages of women in state legislatures are associated with reduced IMRs, both between states and within-states over time. According to model predictions, if women were at parity with men in state legislatures, the expected number of infant deaths in the U.S. in 2012 would have been lower by approximately 14.6% (3,478 infant deaths). These findings underscore the importance of women's political representation for population health.

"The dangers that surround the child": Gender, Science, and Infant Mortality in Postindependence Havana

In early July 1914, Cuban president Mario Menocal and his wife toured the recently inaugurated Colonia de Defensa Sanitaria Infantil, or Colony for Children's Sanitary Defense. As they made their way through a dense crowd of children and parents, photographers and reporters, the president and his wife inspected the dining rooms, grounds, and dormitories where almost four hundred poor children would spend their summer months away from the insalubrious environment of the Cuban capital. Later that day, the president and his wife handed out toys and watched as children performed calisthenic exercises and participated in road races.1 Envisioned as a temporary summer health resort during the scorching summer months of July and August, the Colony for Children's Sanitary Defense was meant to provide a cool and healthy environment for Havana's poor and sickly children. 2 In sharp contrast to the overcrowded and run-down solares where many of the city's poor lived, the colony would offer all the elements necessary for [the children's] physical development, and . . . accustom them to advantageous sanitary practices.3The event marked a new step in the Cuban government's campaign to reduce infant and child mortality rates in the capital, which began the previous summer with the creation of the Ministry of Health's Servicio de Higiene Infantil, which one American observer would describe as nothing less than a complete state department of child welfare.4 Responding to years of alarming infant mortality statistics and accusations of government indifference, the new Children's Hygiene Service represented an aggressive new campaign for the protection of infants, children, and pregnant women. But like many other Cuban public health campaigns, the campaign against infant mortality was inaugurated only after years of outcry from medical reformers, welfare activists, and health officials who decried a lack of government action in the face of the crisis of infant mortality.In the years after independence, reformers and physicians routinely decried Havana's exorbitant annual infant mortality statistics, which represented thousands of preventable deaths of the city's youngest residents. In the Cuban capital alone, more than twelve thousand children under the age of one died between 1904 and 1913, an average of over one hundred infants dying per month in a city of less than three hundred thousand people. Of these, the majority of the deaths were the result of infantile enteritis.5 As Cuban physicians regularly noted, enteritis was could be extremely dangerous, but it should have been easy to control. Enteritis and gastroenteritis are gastrointestinal ailments often caused by bacteria-laden water, milk, and food, and they can be particularly deadly for young children with still-developing immune and digestive systems.6 Afflicted children can develop acute diarrhea, and without the antibiotics and intravenous fluids that are today the common therapeutic response, many died quickly of dehydration. In a grimly regular cycle, the city's death rate for young children would spike every summer as a result of the sharp increase in gastrointestinal disorders during the hot summer months.7 Years after the island's successful battle against yellow fever, when overall health statistics on the island were improving and Cuban public health officials boasted of the island's newfound salubrity, the persistence of these high infant and child mortality rates was galling.8 As physician Domingo F. Ramos wrote, There is no reason why Cuba, which is at present such a healthy country for inhabitants over five years of age, both native and foreign, should prove so unfavorable to children under this age.9This article explores the expansion in infant and child health work in early twentieth-century Havana, tracing the local, national, and transnational webs of influence that shaped the development of health institutions in the streets of the capital. …

Infant, maternal, and perinatal mortality statistics in the Republic of Korea, 2014

Infant, maternal, and perinatal mortality statistics in the Republic of Korea, 2014

Do racial inequities in infant mortality correspond to variations in societal conditions? A study of state-level income inequality in the U.S., 1992–2007

BackgroundPrior studies have examined the association between income inequality and overall infant mortality rates (IMR). We examine effects of income inequality on racial inequities in IMR over the period 1992–2007 in the U.S. MethodsRace-specific state IMR data were obtained from 1992 to 2007, from which absolute and relative IMR inequities were calculated. Fixed and random effects models, adjusted for state-level median income, percent poverty, percent high school graduates, and unemployment rate, were used to determine contemporaneous and lagged state-level associations between income inequality and racial IMR inequities. ResultsRacial IMR inequities varied significantly across the U.S. Contemporaneous income inequality was negatively associated with white IMR only. Two-year lagged income inequality was negatively associated with black IMR and had the most pronounced effect on racial inequities in IMR. DiscussionFuture studies should consider lagged effects of income inequality on IMR and other health outcomes, and should examine other potential societal conditions that may account for state-level variations in racial IMR inequities.

Cigarette Tax Increase and Infant Mortality.

Maternal smoking increases the risk for preterm birth, low birth weight, and sudden infant death syndrome, which are all causes of infant mortality. Our objective was to evaluate if changes in cigarette taxes and prices over time in the United States were associated with a decrease in infant mortality. We compiled data for all states from 1999 to 2010. Time-series models were constructed by infant race for cigarette tax and price with infant mortality as the outcome, controlling for state per-capita income, educational attainment, time trend, and state random effects. From 1999 through 2010, the mean overall state infant mortality rate in the United States decreased from 7.3 to 6.2 per 1000 live births, with decreases of 6.0 to 5.3 for non-Hispanic white and 14.3 to 11.3 for non-Hispanic African American infants (P < .001). Mean inflation-adjusted state and federal cigarette taxes increased from $0.84 to $2.37 per pack (P < .001). In multivariable regression models, we found that every $1 increase per pack in cigarette tax was associated with a change in infant deaths of -0.19 (95% confidence interval -0.33 to -0.05) per 1000 live births overall, including changes of -0.21 (-0.33 to -0.08) for non-Hispanic white infants and -0.46 (-0.90 to -0.01) for non-Hispanic African American infants. Models for cigarette price yielded similar findings. Increases in cigarette taxes and prices are associated with decreases in infant mortality rates, with stronger impact for African American infants. Federal and state policymakers may consider increases in cigarette taxes as a primary prevention strategy for infant mortality.

Role of the nurse in returning birth to the North

With the colonization of the Americas came the eventual stigmatization of Aboriginal women and their traditional birthing methods. Gradual introduction of Western ideology and medicine led to government pressure to medicalize birth. Women were eventually flown to southern hospitals with immediate medical and surgical services available to ensure 'safer' deliveries and thereby improve serious maternal and infant morbidity and mortality statistics that were becoming too obvious to ignore. This process led to devastating consequences for women and families, which are still being felt today. The history of colonization of birth for Aboriginal families is discussed, with current strategies to alleviate this suffering in the north. Proposals for change from the Society of Obstetricians and Gynecologists of Canada (SOGC) are discussed. The role of the nurse is described, including being culturally competent, fostering an environment of respect, dispelling myths and stereotypes, ensuring research involving Aboriginal peoples is done ethically, and promoting pursuing a career in health care.

The pattern of association between U.S. economic indicators and infant mortality rates at the state level.

This cross-sectional ecological study examines the pattern of association of state income and income inequality (measured by Gini coefficient) with state infant mortality rates (IMRs) in the U.S. Scatter plots and correlation coefficients were used to examine bivariate associations and bubble plots to examine three-way relationships. Infant mortality rate was positively associated with Gini (R=0.397, p=.004) and negatively with income (R=-0.482, p &lt;.001). However using Black and White IMRs, the associations with Gini were non-significant, but with income remained significant. The bubble plot of Gini versus White IMR (income represented by bubble size) showed increasing IMR as Gini increases and income decreases, except for a subgroup of high-gini, high-income states with low IMRs. State income appears to be a stronger and more consistent predictor of U.S. IMRs for both Black and White races and can explain the pattern of association of White IMR with state Gini coefficient.

Has the Rate of Reduction in Infant Mortality Increased in India Since the Launch of National Rural Health Mission? Analysis of Time Trends 2000-2009 with Projection to 2015.

National Rural Health Mission (NRHM) - India was launched in 2005 to tackle urban-rural health inequalities, especially in maternal and child health. We examined national and state level trends in Infant Mortality Rates (IMR) from 2000 through 2009 to: 1) assess whether the NRHM had increased the average annual reduction rate (AARR) of IMR 2) evaluate state-wise progress towards Millennium Development Goals (MDG4) and estimate required AARRs for 'off track' states. Log-linear regression models were applied to national and state IMR data collated from the Sample Registration System (SRS)-India to estimate average annual reduction rates and compare AAARs before and after introduction of NRHM. The log-linear trend of infant mortality rates was also projected forward to 2015. The infant mortality rate in rural India declined from 74 to 55/1000 live births between 2000 and 2009, with AARR of 3.0% (95% CI=2.6%-3.4%) and the urban-rural gap in infant mortality narrowed (p =0.036). However there was no evidence (p=0.49) that AARR in rural India increased post NRHM (3.4%, 95% CI 2.0-4.7%) compared to pre NRHM (2.8%, 95% CI 2.1%-3.5%). States varied widely in rates of infant mortality reduction. Projections of infant mortality rates suggested that only eight states might be on track to help India achieve MDG4 by 2015. Despite a narrowing urban-rural gap and high AARRs in some states, there was no evidence that the rate of reduction in infant mortality has increased in rural India post NRHM introduction. India appears unlikely to achieve child survival-related NRHM and millennium development goals. Government should revisit the child survival related NRHM strategies and ensure equitable access to health services. More robust monitoring and evaluation mechanisms must be inbuilt for following years.

Developing a standard approach to examine infant mortality: findings from the State Infant Mortality Collaborative (SIMC).

States can improve pregnancy outcomes by using a standard approach to assess infant mortality. The State Infant Mortality Collaborative (SIMC) developed a series of analyses to describe infant mortality in states, identify contributing factors to infant death, and develop the evidence base for implementing new or modifying existing programs and policies addressing infant mortality. The SIMC was conducted between 2004 and 2006 among five states: Delaware, Hawaii, Louisiana, Missouri, and North Carolina. States used analytic strategies in an iterative process to investigate contributors to infant mortality. Analyses were conducted within three domains: data reporting (quality, reporting, definitional criteria, and timeliness), cause and timing of infant death (classification of cause and fetal, neonatal, and postneonatal timing), and maturity and weight at birth/maturity and birth weight-specific mortality. All states identified the SIMC analyses as useful for examining infant mortality trends. In each of the three domains, SIMC results were used to identify important direct contributors to infant mortality including disparities, design or implement interventions to reduce infant death, and identify foci for additional analyses. While each state has unique structural, political, and programmatic circumstances, the SIMC model provides a systematic approach to investigating increasing or static infant mortality rates that can be easily replicated in all other states and allows for cross-state comparison of results.