Explaining the Recent Decrease in US Infant Mortality Rate, 2007-2013

William M. Callaghan

doi:10.1097/01.ogx.0000516406.10268.4b

Explaining the Recent Decrease in US Infant Mortality Rate, 2007-2013

2017-05-01

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William M. Callaghan *

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Marian F. MacDorman

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Carrie K. Shapiro‐Mendoza

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Wanda D. Barfield

DOI：10.1097/01.ogx.0000516406.10268.4b

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The objective of this article is to examine infant mortality rates (IMRs) in the United States between 2007 and 2013 for the whole population and for infants born to non-Hispanic black, non-Hispanic white, and Hispanic women. The study was performed by identifying births and infant deaths between 2007 and 2013 from the Centers for Disease Control and Prevention National Vital Statistics System's period linked birth and infant death files and including all birth and death statistics with gestational age (GA) at birth on the birth certificate of 22 weeks or greater. Obstetric practices may have a significant effect on reducing IMR, particularly through changing the overall GA distribution. This analysis quantified relative contributions of changing GA during this time period and improving survival at any given GA. During the 2007-2013 period, IMR decreased, and improvements were noted in both the distribution of preterm births and survival after birth. Decreases in mortality at each week of preterm gestation among non-Hispanic black, non-Hispanic white, and Hispanic infants, with the exception of a small increased mortality at 33 weeks, contributed to the overall decrease in IMR. The decrease in IMR was disaggregated such that changes could be attributed to improvements in GA-specific IMRs and changes in the distribution of GA, by week of gestation. Birth certificates were referred for obtaining data about maternal race and ethnicity. Records where obstetric estimate of GAwas missing and deaths and births less than 22 weeks' gestation were taken into account using sensitivity analyses. The analyses results showed that IMRs after exclusions were 5.72 and 4.92 per 1000 live births for 2007 and 2013, respectively, with 14 % decrease and an absolute difference of -0.80. There was also a drop in IMR among non-Hispanic whites (11%), non-Hispanic blacks (19%), and Hispanics (14%) during the study period. Proportion of births across GA categories was lower in 2013 in comparison to 2007 except for 39 weeks' GA where it increased significantly (30.1% [ 2007] vs 37.5% [ 2013]). Gestational age-specific mortality was found to decrease across all GA categories during the study period, except 33 weeks and greater than 42 weeks. Changes in the GA distribution accounted for 31% decrease in IMR, and improvements in GA-specific survival were responsible for 69% decrease in IMR. Gestational age distribution during the study period (2007-2013) led to 48% of the improvement for non-Hispanic white women, whereas it was 31% in non-Hispanic black and 14% in Hispanic women. The results safely lead us to conclude that IMR showed marked improvement due to improvements in the distribution of GA age at birth and also due to improvements in survival after birth. The varying improvement rates across race/ethnicity indicate that antenatal health and health care are yet to reach all parts of population evenly.

Explaining the Recent Decrease in US Infant Mortality Rate, 2007-2013

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