The Challenge of Infant Mortality: Have We Reached a Plateau?
Infant mortality is a complex and multifactorial problem that has shown little improvement in the past several years, despite programmatic efforts," write the authors of an article published in the September-October 2009 issue of Public Health Reports. Infant mortality is an important indicator of the health of a nation, as it is associated with a variety of factors such as maternal health, quality of and access to medical care, socioeconomic conditions, and public health practices. The U.S. infant mortality rate generally declined throughout the 20th century, but recent data suggest at least a temporary halt in this decline in the first few years of the 21st century. This article analyzes patterns and trends in U.S. infant mortality.
Data discussed in this article are based primarily on the linked birth/infant death datasets produced by the Centers for Disease Control and Prevention's National Center for Health Statistics. The authors computed infant mortality rates per 100,000 live births by cause of death (COD) and per 1,000 live births for all other variables. Infant mortality rates and other measures of infant health were analyzed and compared. Leading and preterm-related CODs and international comparisons of infant mortality rates were also examined.
The authors found that:
The infant mortality rate declined by 93 percent during the 20th century, from approximately 100 infant deaths per 1,000 live births in 1900 to 6.89 in 2000.
The infant mortality rate was 6.86 in 2005, not significantly different from the rate of 6.89 in 2000.
Large variations in infant mortality rates among racial and ethnic groups remain. Non-Hispanic black mothers had the highest infant mortality rate (13.63), followed by Puerto Rican (8.30) and American Indian (8.06) mothers.
The percentage of low-birthweight (less than 2,500 g) births increased from a low of 6.8 percent in 1985 to 7.6 percent in 2000 and 8.2 percent in 2005. However, from 1985 to 2000, birthweight-specific infant mortality rates declined for all birthweight categories.
The infant mortality rate from congenital malformations decreased by 5 percent from 2000 to 2005, and the sudden infant death syndrome (SIDS) rate decreased by 13 percent, although this change may be due in part to changes in the way SIDS is diagnosed. However, for CODs with a high percentage of deaths to low-birthweight infants, infant mortality rates either plateaued or increased from 2000 to 2005.
In 2005, 10,364 out of a total of 28,384 infant deaths in the United States were due to preterm-related CODs. The percentage of infant deaths that were preterm-related increased from 35 percent in 2000 to 37 percent in 2005.
The United States' international ranking in infant mortality fell from 12th lowest in 1960 to 23rd lowest in 1990.
The authors conclude that "further efforts to lower the U.S. infant mortality rate should focus on preventing preterm and low birthweight deliveries and on reducing the large and persistent differences in infant mortality rates by race and ethnicity."