fetal, perinatal, and infant mortality · infant mortality rate, by urbanization level*-national...
TRANSCRIPT
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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
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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
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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.
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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)
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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.
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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
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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.
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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
SOURCE: NCHS, National Vital Statistics System, Linked birth/ infant death data set.
Perinatal
Total infant
Neonatal
Postneonatal
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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
SOURCE: NCHS, National Vital Statistics System, Linked birth/ infant death data set.
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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.
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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
SOURCE: NCHS, National Vital Statistics System, Linked birth/ infant death data set.
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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
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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.
Source: NCHS, National Vital Statistics System
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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.
Source: NCHS, National Vital Statistics System
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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.
Source: NCHS, National Vital Statistics System
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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
SOURCE: NCHS, National Vital Statistics System, Linked birth/ infant death data set.
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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
SOURCE: NCHS, National Vital Statistics System, Linked birth/ infant death data set.
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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
SOURCE: NCHS, National Vital Statistics System, Linked birth/ infant death data set.
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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
SOURCE: NCHS, National Vital Statistics System, Linked birth/ infant death data set.
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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
SOURCE: NCHS, National Vital Statistics System, Linked birth/ infant death data set.
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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
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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.
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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.
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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
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.
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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
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.
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Infant mortality rates by urbanization level
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 Report (MMWR): 66(41), 1122. 2017.
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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
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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
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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
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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
SOURCE: NCHS, National Vital Statistics System, Linked birth/ infant death data set.
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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
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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
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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
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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
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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)
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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.
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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
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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
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Thank you!
Questions?