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Surveillance of postneonatal mortality, United States, 1980-1987
Insights
Postneonatal mortality (PNM) rates declined in the 1980s, particularly for black infants, due to fewer deaths from infections, injuries, and sudden infant death syndrome (SIDS). However, significant racial disparities persist, requiring further prevention efforts.
Area of Science:
- Public Health
- Epidemiology
- Pediatrics
Background:
- Postneonatal mortality (PNM) accounts for one-third of US infant deaths.
- A significant portion of PNM is potentially preventable.
- Understanding trends is crucial for targeted interventions.
Purpose of the Study:
- To analyze trends in postneonatal mortality (PNM) in the United States from 1980-1987.
- To identify factors contributing to changes in PNM rates.
- To examine racial disparities in PNM.
Main Methods:
- Analysis of US birth and death certificate data for resident infants (1980-1987).
- Calculation of PNM rates per 1,000 live births.
- Comparison of rates between white and black infants.
Main Results:
- Overall PNM rates declined for both white (11%) and black (16%) infants.
- Reductions were primarily driven by decreased mortality from infectious diseases and injuries.
- Sudden infant death syndrome (SIDS) also contributed to the decline among black infants.
- Racial disparities in PNM persisted, with black infants having double the rate of white infants.
- Black infants faced higher mortality risks from infections (2.7x) and injuries (2.3x).
Conclusions:
- While PNM rates decreased in the 1980s, further reductions are needed to meet public health objectives, especially for black infants.
- Improved access to comprehensive pediatric care and community-based prevention programs are essential.
- Further research into the causes of SIDS and birth defects is critical for preventing postneonatal deaths.
Abstract:
In the United States, one-third of all infant deaths (deaths of infants ages 0-364 days) occurs in the postneonatal period (28-364 days). A substantial proportion of these deaths potentially could be prevented. To examine recent trends in postneonatal mortality (PNM) in the United States, the investigators analyzed birth and death certificate data for resident infants for the period from 1980 through 1987. Rates of PNM declined 11% from 3.5 to 3.1/1,000 live births among white infants and declined 16% from 7.3 to 6.1/1,000 live births among black infants. Most of the decline resulted from reduced mortality from infectious diseases and injuries. A decreased mortality attributable to sudden infant death syndrome (SIDS) among black infants additionally accounted for the decline. Autopsy rates for SIDS increased from 82% to 92% but did not differ for black infants and white infants. Birth defects-related PNM declined more among white infants than among black infants. The racial gap in PNM (rate ratio (RR) = approximately 2.0) persisted. However, the largest black/white gap occurred in the Northeast (RR = 2.5), the region with the lowest PNM. Black infants were 2.7 and 2.3 times more likely to die of infections and injuries, respectively, than were white infants. Although PNM rates declined during the 1980s, a greater rate of reduction is needed to achieve the Year 2000 objectives, especially among black infants. Such reductions are possible through improved access to comprehensive pediatric care as well as education and community-oriented prevention programs designed to reduce deaths due to infections and injuries. A better understanding of the etiology of SIDS and birth defects is critical for preventing postneonatal deaths.