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Explaining the recent decrease in US infant mortality rate, 2007-2013.

William M Callaghan1, Marian F MacDorman2, Carrie K Shapiro-Mendoza1

  • 1Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, GA.

American Journal of Obstetrics and Gynecology
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PubMed
Summary
This summary is machine-generated.

US infant mortality declined 14% from 2007-2013, driven by improved survival rates and a shift towards later preterm births. These gains varied by race and ethnicity, highlighting disparities in prenatal care access.

Keywords:
Kitagawa analysisinfant mortalitypreterm birth

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Area of Science:

  • Public Health
  • Neonatalogy
  • Demography

Background:

  • The US infant mortality rate (IMR) and preterm birth rate have declined.
  • Preterm birth is a significant risk factor for infant mortality.
  • Clarification is needed on the contributions of gestational age-specific mortality and birth distribution changes to the IMR decline.

Purpose of the Study:

  • To analyze the factors contributing to the 2007-2013 infant mortality decline.
  • To examine these factors across the total population and specific racial/ethnic groups (non-Hispanic black, non-Hispanic white, Hispanic).

Main Methods:

  • Utilized 2007 and 2013 National Vital Statistics System period linked birth and infant death files.
  • Included births and deaths with gestational age ≥22 weeks.
  • Applied the Kitagawa method to disaggregate IMR decline into gestational age-specific mortality and birth distribution changes.
  • Conducted sensitivity analyses for missing gestational age data and births/deaths <22 weeks gestation.

Main Results:

  • The US IMR decreased by 14% (5.72 to 4.92 per 1000 live births) between 2007 and 2013.
  • Gestational age distribution changes accounted for 31% of the decline, while improved gestational age-specific survival accounted for 69%.
  • Improvements in gestational age distribution disproportionately benefited non-Hispanic white infants (48%), followed by non-Hispanic black (31%) and Hispanic (14%) infants.

Conclusions:

  • Infant mortality reduction resulted from both improved gestational age distribution and enhanced post-birth survival.
  • Disparities in the contribution of gestational age distribution suggest unequal access to preconception and antenatal care.
  • Targeted interventions are needed to address these disparities and further reduce infant mortality.