Infant Mortality in the United States, 2021: Data From the Period Linked Birth/Infant Death File

Objective-This report presents 2021 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined. Methods-Descriptive tabulations of data are presented and interpreted for infant deaths and infant mortality rates using the 2021 period linked birth/infant death file. The linked birth/infant death file is based on birth and death certificates registered in all 50 states and the District of Columbia. Results-A total of 19,928 infant deaths were reported in the United States in 2021, up 2% from 2020. The U.S. infant mortality rate was 5.44 infant deaths per 1,000 live births, essentially unchanged from the rate of 5.42 in 2020. The neonatal mortality rate was essentially unchanged from 3.56 in 2020 to 3.49 in 2021, but the postneonatal mortality rate increased from 1.86 to 1.95. The overall infant mortality rate increased for infants of Asian non-Hispanic women and declined for infants of Dominican women in 2021 compared with 2020; changes in rates for the other race and Hispanic-origin groups were not significant. Infants of Black non-Hispanic women had the highest mortality rate (10.55) in 2021, followed by infants of Native Hawaiian or Pacific Islander non-Hispanic and American Indian or Alaska Native non-Hispanic (7.76 and 7.46, respectively), Hispanic (4.79), White non-Hispanic (4.36), and Asian non-Hispanic (3.69) women. By gestational age, infants born very preterm (less than 28 weeks of gestation) had the highest mortality rate (353.76), 170 times as high as that for infants born at term (37-41 weeks of gestation) (2.08). The five leading causes of infant death in 2021 were the same as in 2020. Infant mortality rates by state for 2021 ranged from a low of 2.77 in North Dakota to a high of 9.39 in Mississippi.