Fetal, Perinatal, and Infant Mortality · Infant Mortality Rate, by Urbanization Level*-National Vital Statistics System, United States, 2007 and 2015. Morbidity and Mortality Weekly

Fetal, Perinatal, and Infant Mortality

Danielle Ely, Ph.D. Division of Vital Statistics

National Center for Health Statistics

Presented to the Secretary’s Advisory Committee on Infant Mortality December 4, 2018

Vital Statistics Data Files • National data files currently available:

• Birth (natality)

• 2017 final • Rapid Release provisional estimates through first quarter of 2018

• Mortality

• 2017 final • Rapid Release provisional estimates through first quarter of 2018

Fetal death data file and cause of death • Fetal availability:

• 2016 final (demographic only) • 2015 and 2016 COD anticipated early 2019 • 2017 (both demographic and COD) anticipated early 2019

• Starting with 2017 fetal death data, cause of death will be released

with the demographic file.

• NCHS has dramatically improved timing of COD coding for both general mortality and fetal death.

Vital Statistics Data Files continued • Linked birth/infant death

• 2016 period file; 2012 cohort file

• 2017 period file and 2013 cohort file anticipated early 2019

• Rapid Release provisional estimates through end of 2017 (quarter 4)

Infant mortality data • Links birth and death certificate data for infant deaths (i.e., deaths

within a year of birth). • Purpose: To use more detailed data from the birth certificate for infant mortality

analysis (e.g., maternal demographic characteristics and pregnancy risk factors). • More accurate information on maternal race and ethnicity than mortality (i.e.,

birth certificate = maternal self-report.) • Historically: 2 files- period (2 birth years and 1 death year) and cohort (1 birth

year and 2 death years). • Starting in 2017, users will be able to create their own cohort files by combining

2 period files.

• Improvements in timeliness of release of the infant mortality period file made possible by improvements in the timeliness of the mortality file.

Total fetal, early fetal, late fetal, and perinatal mortality rates: United States, 2000-2016

6.61 6.02

3.31 3.15 3.32

2.88

6.97

6.00

0

1

2

3

4

5

6

7

8

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Infa

nt d

eath

s per

1,0

00 li

ve b

irths

, fet

al d

eath

s per

1,

000

live

birth

s and

feta

l dea

ths

SOURCE: NCHS, National Vital Statistics System.

Perinatal

Fetal

Early Fetal

Late Fetal

Total infant, neonatal, and postneonatal mortality rates: United States, 2000-2016

6.89

5.87

4.62

3.88

2.27 1.99

0

1

2

3

4

5

6

7

8

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Infa

nt d

eath

s per

1,0

00 li

ve b

irths

, fet

al d

eath

s per

1,

000

live

birth

s and

feta

l dea

ths

Neonatal

Postneonatal

Total Infant

SOURCE: NCHS, National Vital Statistics System, Linked birth/ infant death data set.

Total infant, neonatal, postneonatal, and perinatal rates, United States 2011-2016

6.07 5.87

4.06 3.88

2.01 1.99

6.26 6.00

0

1

2

3

4

5

6

7

2011 2012 2013 2014 2015 2016

Infa

nt d

eath

s per

1,0

00 li

ve b

irths

or i

nfan

t de

aths

per

1,0

00 li

ve b

irths

and

feta

l dea

ths


Perinatal

Total infant

Neonatal

Postneonatal

DC

MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VA WV

OH

MI

NY

PA

MD

DE

NJ CT

RI

MA

ME

VT NH

AK

HI Significantly lower IMR than 2011 Significantly higher IMR than 2011 No significant difference between 2011 and 2016

Changes in infant mortality rates from 2011 to 2016, United States


Perinatal mortality rates, by race and Hispanic origin of mother: 49 states and the District of Columbia, 2014-2016

10.59

5.39 5.04

10.53

5.43 4.97

10.66

5.35 4.98

0

2

4

6

8

10

12

Non-Hispanic black Hispanic Non-Hispanic white

2014 2015 2016

Rat

e pe

r 1,0

00 li

ve b

irths

and

feta

l dea

ths i

n sp

ecifi

ed g

roup

NOTE: All years exclude data for Rhode Island, which did not report mother’s race or Hispanic origin for fetal deaths for 2015. SOURCE: NCHS, National Vital Statistics System.

Infant mortality rates by race and Hispanic origin of mother: United States, 2007-2016

5.76

4.87

13.63

11.21

8.06 8.61

4.89

3.97

5.62 4.96

0

2

4

6

8

10

12

14

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Non-Hispanic Black

American Indian/Alaska Native

Hispanic

Asian or Pacific Islander

Non-Hispanic White

Infa

nt d

eath

s per

1,0

00 li

ve b

irths


MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL

IN

KY

TN

MS

AL

GA

FL

SC

NC

VA WV

OH

MI

NY

PA

MD

DE

NJ

CT

.

RI

MA

ME VT

NH

AK

HI

DC

U.S. rate is 5.87

Less than 4.00 8.00-8.99

5.00-5.99

7.00-7.99

4.00-4.99

6.00-6.99

9.00-9.99

Infant mortality rates by state: United States, 2016

NOTE: The range of rates is 3.47 in Vermont to 9.03 in Alabama per 1,000 live births.

Source: NCHS, National Vital Statistics System

MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VA WV

OH

MI

NY

PA

MD

DE

NJ CT RI

MA

ME VT NH

AK

HI

DC

2013-2015 U.S. Infant mortality rate for infants of non-Hispanic white women is 4.95.

4.00-4.99 Less than 4.00

5.00-5.99

7.00-7.99 6.00-6.99

Infant mortality rates by state for infants of non-Hispanic white women: United States, 2013-2015

NOTE: The range of rates is 2.52 in the District of Columbia to 7.04 in Arkansas per 1,000 live births.


MT

WY

ID

WA

OR

NV

UT

CA

ND

SD

NE

CO

AZ NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VA WV

OH

MI

NY

PA

MD

DE

NJ CT

RI

MA

ME

VT NH

AK

HI

DC

2013-2015 U.S. Infant mortality rate for infants of

Unreliable, fewer than 20 infant deaths

Hispanic women is 4.99.

4.00-4.99 Less than 4.00

5.00-5.99

7.00-7.99 6.00-6.99

Infant mortality rates by state for infants of Hispanic women: United States, 2013-2015

NOTE: The range of rates is 3.94 in Iowa to 7.28 in Michigan per 1,000 live births.


MT

WY

ID

WA

OR

NV

UT

CA

AZ

ND

SD

NE

CO

NM

TX

OK

KS

AR

LA

MO

IA

MN

WI

IL IN

KY

TN

MS AL GA

FL

SC

NC

VA WV

OH

MI

NY

PA

MD

DE

NJ CT

RI

MA

ME

VT NH

AK

HI

DC

2013-2015 U.S. Infant mortality rate for infants of non-Hispanic black womenis 11.10.

8.00-8.99 9.00-9.99 10.00-10.99

Unreliable, fewer than 20 infant deaths

11.00-11.99 12.00 or more

Infant mortality rates by state for infants of non-Hispanic black women: United States, 2013-2015

NOTE: The range of rates is 8.27 in Massachusetts to 14.28 in Wisconsin per 1,000 live births.


Non-Hispanic white, Hispanic, and non-Hispanic black 2013-2015 infant mortality rates

Non-Hispanic White Hispanic Non-Hispanic Black

00 UnrL s ha 00 8. eliable, fewer e s t n 4. -8.99 4.00-4.99 9.00-9.99 than 20 infant

deaths 5.00-5.99 10.00-10.99 6.00-6.99 11.00-11.99 7.00-7.99 12.00 or more


Mortality rates for five leading causes of infant death: United States, 2007, 2015, and 2016

134.9

112.7

41.1

57.0

29.7

121.8

102.7

38.4 39.4 32.4

122.2

99.5

35.7 38.0 30.8

0

20

40

60

80

100

120

140

160

Congenital Malformations Low Birthweight Maternal Complications Sudden Infant deathSyndrome

Unintentional injuries

Infa

nt d

eath

s per

100

,000

live

birt

hs

2007 2015 2016


Mortality rates for five leading causes of neonatal and postneonatal death: United States, 2016

35.8 34.9 27.4

9.1 6.4

97.7

86.4

35.3

21.0 14.0

0

10

20

30

40

50

60

70

80

90

100

Lowbirthweight

CongenitalMalformations

MaternalComplications

Placenta,cord, andmembrane

complications

BacterialSepsis

CongenitalMalformations

SIDS Unintentionalinjury

Diseasesof the

circulatory system

Homicide

Infa

nt d

eath

s per

100

,000

live

birt

hs

Postneonatal Neonatal


Five leading causes of neonatal death by race and Hispanic origin of mother: United States, 2016

Rank Non-Hispanic White Non-Hispanic Black Hispanic

1 Congenital Malformations Low Birthweight Congenital Malformations

2 Low Birthweight

Congenital Malformations

Low Birthweight

3 Maternal Complications Maternal Complications Maternal Complications

4 Placenta, Cord, and Membrane Complications

Placenta, Cord, and Membrane Complications

Placenta, Cord, and Membrane Complications

5 Bacterial Sepsis Bacterial Sepsis Bacterial Sepsis


Five leading causes of postneonatal death by race and Hispanic origin of mother: United States, 2016

Rank Non-Hispanic White Non-Hispanic Black Hispanic

1 SIDS

SIDS

Congenital Malformations

2 Congenital Malformations

Unintentional Injuries

SIDS

3 Unintentional Injuries Congenital Malformations

Unintentional Injuries

4 Diseases of the Circulatory System

Diseases of the Circulatory System

Diseases of the Circulatory System

5 Homicide Homicide Septicemia/Homicide


SIDS and SUID mortality rates: United States, 1999-2016

66.75

54.55 57.02

37.99

92.24 91.08 95.89

88.80

0

20

40

60

80

100

120

1999 2001 2003 2005 2007 2009 2011 2013 2015

Infa

nt d

eath

s per

100

,000

live

birt

hs

SIDS SUID

*

*

SOURCE: NCHS, National Vital Statistics System, Linked birth/ infant death data set. NOTE: *New SUID reporting guide released in 2006, may have contributed to increase between 2006-2007

Percentage of preterm births by maternal race and Hispanic origin: United States, 2016

9.85 9.06

13.64

9.45

0

2

4

6

8

10

12

14

16

Total Non-Hispanic White Non-Hispanic Black Hispanic

Perc

ent

NOTE: Gestational age is expressed in completed weeks based on the obstetric estimate of gestation. SOURCE: NCHS, National Vital Statistics System, Natality.

5.87

190.15

20.12 8.65 3.26 1.72 1.49 4.31

0

20

40

60

80

100

120

140

160

180

200

Total <32 32-33 34-36 37-38 39-40 41 42+

Infa

nt d

eath

s per

1,0

00 li

ve b

irths

Preterm

Infant mortality rates by gestational age, United States, 2016

NOTE: Gestational age is expressed in completed weeks based on the obstetric estimate of gestation. SOURCE: NCHS, National Vital Statistics System, Linked birth/ infant death data set.

Infant mortality rates for preterm births (less than 37 weeks) by maternal race and Hispanic origin: United States, 2016

173.62

215.62

181.54

19.63 19.42 22.06 8.77 11.13 7.42

0

50

100

150

200

250

Non-Hispanic White Non-Hispanic Black Hispanic

Infa

nt d

eath

s per

1,0

00 li

ve b

irths

<32 weeks 32-33 weeks 34-36


Percent of preterm-related infant mortality by maternal race and Hispanic origin: United States, 2016

35.8

29.8

44.1

36.1

0

10

20

30

40

50

Total Non-Hispanic White Non-Hispanic Black Hispanic

Perc

ent o

f inf

ant d

eath

s due

to p

rete

rm

rela

ted

caus

es


Infant mortality rates by urbanization level


SOURCE: Ely DM. Infant Mortality Rate, by Urbanization Level*-National Vital Statistics System, United States, 2007 and 2015. Morbidity and Mortality Weekly Report (MMWR): 66(41), 1122. 2017.

6.38

7.09 7.45

5.44

6.36 6.78

0

1

2

3

4

5

6

7

8

9

Large urban counties Small and medium urban counties Rural counties

Infa

nt d

eath

s per

1,0

00 li

ve b

irths

Large urban counties Small or Medium urban counties Rural counties

Infant mortality rates by urbanization level: United States, 2007 and 2015

SOURCE: Ely DM. Infant Mortality Rate, by Urbanization Level*-National Vital Statistics System, United States, 2007 and 2015. Morbidity and Mortality Weekly

Small or Medium urban counties Rural counties

7.09 7.45

6.36 6.78

0

1

2

3

4

5

6

7

8

9

Small and medium urban counties Rural counties

Infa

nt d

eath

s per

1,0

00 li

ve b

irths

Rural 5% higher

Rural 7% higher

SOURCE: NCHS, National Vital Statistics System, Linked birth/infant death data set.

Infant mortality rates by urbanization level, 2007 and 2015

SOURCE: Ely DM. Infant Mortality Rate, by Urbanization Level*-National Vital Statistics System, United States, 2007 and 2015. Morbidity and Mortality Weekly R t (MMWR) 66(41) 1122 2017

Infant mortality rates by urbanization level: United States, 2007 and 2015

9 Large urban counties Rural counties

8 7.45

hs 7 6.78

rt 6.38 Rural 17% higher

bi

vei 6 5.44

000

l

5

r 1,

pe 4

hsta d

e 3

ntIn

fa 2 Rural 25% higher

1

0Large urban counties Rural counties

SOURCE: NCHS, National Vital Statistics System, Linked birth/infant death data set. SOURCE: Ely DM. Infant Mortality Rate, by Urbanization Level*-National Vital Statistics System, United States, 2007 and 2015. Morbidity and Mortality Weekly

Total infant, neonatal, and postneonatal mortality rates by urbanization level: United States, 2016

6.70

5.74

4.09 3.85

2.61

1.89

0

1

2

3

4

5

6

7

8

Rural Urban*

Infa

nt d

eath

s per

1,0

00 li

ve b

irths

Total infant Neonatal Postneonatal


Conclusions - trends • Fetal mortality was essentially unchanged from 2011-2016

• Infant mortality has also been essentially unchanged since 2011

• Accordingly, there have been no recent improvement in overall perinatal

mortality

• Only four states significantly improved infant mortality rates in 2016 compared with 2011

• Lower rate in 2016: California, New Jersey, New York, Virginia

Conclusions – infant mortality by race and Hispanic origin

• Non-Hispanic black infants continue to have infant mortality rates more than twice as high as those for non-Hispanic white, Asian or Pacific Islander, and Hispanic infants

• Native American or Alaska Native infants have the second highest infant mortality rates

• Compared with 2011, mortality rates for non-Hispanic white and Asian or Pacific Islander infants were lower in 2016; rates for the other 3 race and Hispanic origin groups were essentially unchanged

• The lowest mortality rates by state for infants of non-Hispanic black women

were higher than the highest mortality rates by state for infants of non-Hispanic white and Hispanic women

Conclusions – total infant leading causes of death

• The five leading causes of infant mortality for 2016 were:

• congenital malformations • low birthweight • maternal complications • SIDS • unintentional injuries

• Consistently the leading 5 causes of infant mortality since 2006

Conclusions – neonatal leading causes of death • The five leading causes of neonatal mortality for 2016 were:

• low birthweight • congenital malformations • maternal complications • placenta, cord, and membrane complications • bacterial sepsis.

• Consistently the leading 5 causes of neonatal mortality since 2007 (except in

2011 when bacterial sepsis was ranked 6th) • Same 5 leading causes of neonatal mortality for non-Hispanic white, non-

Hispanic black, and Hispanic infants

Conclusions – postneonatal leading causes of death

• The five leading causes of neonatal mortality were:

• congenital malformations • SIDS • unintentional injuries • diseases of the circulatory system • homicide

• Consistently the leading 5 causes of postneonatal mortality since 2010 (before

this, homicide/assault was ranked 6th or 7th for several years) • Same 5 leading causes of postneonatal mortality for non-Hispanic white, non-

Hispanic black, and Hispanic infants (Hispanic infants also have septicemia tied for 5th)

Conclusions – SIDS/SUID and preterm-related infant mortality

• Since 2007 (the year after new reporting guide released), SIDS rates declined 33% and SUID rates declined 7%

• Preterm-related causes of death accounted for more than 1/3 of infant deaths in 2016

• Large differences by race and Hispanic origin (e.g. 29.8% non-Hispanic white; 44.1%

non-Hispanic black.

Conclusions – urban / rural divide

• Total infant, neonatal, and postneonatal mortality rates are higher in rural counties than in urban counties

• Higher rural infant mortality has been consistent over time

• Differences between rural and urban counties have widened over time

Looking ahead

• 2017 linked file data will be based fully on the 2003 birth certificate revision

• Users will be able to make their own cohort files starting with the re-release of the 2017 data

• Will continue to make improvements to data timeliness

Thank you!

Questions?

Documents

Fetal, Perinatal, and Infant Mortality · Infant Mortality Rate, by Urbanization Level*-National Vital Statistics System, United States, 2007 and 2015. Morbidity and Mortality Weekly