Advances in neonatology (the medical subspecialty concerned with the care of newborns, especially those at risk), which date back to the 1960s, have contributed to the huge drop in infant death rates. Infants born prematurely or with low birth weights, who were once likely to die, now can survive life-threatening conditions because of the development of neonatal intensive care units (NICUs). However, the improvements are not consistent for newborns of all races.
African-American infants are more than twice as likely as white and Hispanic infants to die before their first birthday. In 2002 the national death rate for African-American infants was 14.4 per one thousand live births, compared with 5.9 for non-Hispanic white infants per one thousand live births and 5.6 for Hispanic infants per one thousand live births. In 2003 the national death rate for African-American infants was 14.1 per one thousand live births, compared with 5.8 for non-Hispanic white infants per one thousand live births and 5.9 for Hispanic infants per one thousand live births. (See Table 5.2.) Additionally, the life expectancy at birth of African-American babies is less than that of white babies: African-American babies born in 2003 had a life expectancy of 72.7 years, while white babies born that same year had a life expectancy of seventy-eight years. (See Table 5.3.)
Leading Causes of Infant Mortality
Birth defects are the leading cause of infant mortality in the United States. Some of the more serious birth defects are anencephaly (a condition in which most of the brain and spinal cord are missing), spina bifida (a condition in which the spinal column does not close completely, leaving portions of the spinal cord exposed), and Down syndrome (a condition in which babies are born with an extra copy of chromosome 21 in their cells, which results in anatomical and developmental problems, along with cognitive deficits).
According to the CDC, one in every thirty-three babies born in the United States each year have birth defects. Babies born with birth defects have a greater chance of illness and long-term disability than babies without birth defects.
Birth defects, which are identified as "congenital malformations, deformations, and chromosomal abnormalities" by the International Classification of Diseases TABLE 5.1 Infant, neonatal, and postneonatal mortality rates, by race and Hispanic origin of mother, selected years 1983–2002(Tenth Revision, 1992), accounted for 20.1% of all infant deaths in 2003 (5,714 out of 28,422 total causes). (See Table 5.4.)
| TABLE 5.1 | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Infant, neonatal, and postneonatal mortality rates, by race and Hispanic origin of mother, selected years 1983–2002 | |||||||||
| [Data are based on linked birth and death certificates for infants] | |||||||||
| Race and Hispanic origin of mother | 1983a | 1985a | 1990a | 1995b | 1998b | 1999b | 2000b | 2001b | 2002b |
| Infantc deaths per 1,000 live births | |||||||||
| All mothers | 10.9 | 10.4 | 8.9 | 7.6 | 7.2 | 7.0 | 6.9 | 6.8 | 7.0 |
| White | 9.3 | 8.9 | 7.3 | 6.3 | 6.0 | 5.8 | 5.7 | 5.7 | 5.8 |
| Black or African American | 19.2 | 18.6 | 16.9 | 14.6 | 13.8 | 14.0 | 13.5 | 13.3 | 13.8 |
| American Indian or Alaska Native | 15.2 | 13.1 | 13.1 | 9.0 | 9.3 | 9.3 | 8.3 | 9.7 | 8.6 |
| Asian or Pacific Islander | 8.3 | 7.8 | 6.6 | 5.3 | 5.5 | 4.8 | 4.9 | 4.7 | 4.8 |
| Chinese | 9.5 | 5.8 | 4.3 | 3.8 | 4.0 | 2.9 | 3.5 | 3.2 | 3.0 |
| Japanese | 5.6* | 6.0* | 5.5* | 5.3* | 3.4* | 3.5* | 4.5* | 4.0* | 4.9* |
| Filipino | 8.4 | 7.7 | 6.0 | 5.6 | 6.2 | 5.8 | 5.7 | 5.5 | 5.7 |
| Hawaiian | 11.2 | 9.9* | 8.0* | 6.5* | 9.9 | 7.0* | 9.0 | 7.3* | 9.6 |
| Other Asian or Pacific Islander | 8.1 | 8.5 | 7.4 | 5.5 | 5.7 | 5.1 | 4.8 | 4.8 | 4.7 |
| Hispanic or Latinod, e | 9.5 | 8.8 | 7.5 | 6.3 | 5.8 | 5.7 | 5.6 | 5.4 | 5.6 |
| Mexican | 9.1 | 8.5 | 7.2 | 6.0 | 5.6 | 5.5 | 5.4 | 5.2 | 5.4 |
| Puerto Rican | 12.9 | 11.2 | 9.9 | 8.9 | 7.8 | 8.3 | 8.2 | 8.5 | 8.2 |
| Cuban | 7.5 | 8.5 | 7.2 | 5.3 | 3.7* | 4.6 | 4.6 | 4.2 | 3.7 |
| Central and South American | 8.5 | 8.0 | 6.8 | 5.5 | 5.3 | 4.7 | 4.6 | 5.0 | 5.1 |
| Other and unknown Hispanic or Latino | 10.6 | 9.5 | 8.0 | 7.4 | 6.5 | 7.2 | 6.9 | 6.0 | 7.1 |
| Not Hispanic or Latino: | |||||||||
| Whitee | 9.2 | 8.6 | 7.2 | 6.3 | 6.0 | 5.8 | 5.7 | 5.7 | 5.8 |
| Black or African Americane | 19.1 | 18.3 | 16.9 | 14.7 | 13.9 | 14.1 | 13.6 | 13.5 | 13.9 |
| Neonatalc deaths per 1,000 live births | |||||||||
| All mothers | 7.1 | 6.8 | 5.7 | 4.9 | 4.8 | 4.7 | 4.6 | 4.5 | 4.7 |
| White | 6.1 | 5.8 | 4.6 | 4.1 | 4.0 | 3.9 | 3.8 | 3.8 | 3.9 |
| Black or African American | 12.5 | 12.3 | 11.1 | 9.6 | 9.4 | 9.5 | 9.1 | 8.9 | 9.3 |
| American Indian or Alaska Native | 7.5 | 6.1 | 6.1 | 4.0 | 5.0 | 5.0 | 4.4 | 4.2 | 4.6 |
| Asian or Pacific Islander | 5.2 | 4.8 | 3.9 | 3.4 | 3.9 | 3.2 | 3.4 | 3.1 | 3.4 |
| Chinese | 5.5 | 3.3 | 2.3 | 2.3 | 2.7 | 1.8 | 2.5 | 1.9 | 2.4 |
| Japanese | 3.7* | 3.1* | 3.5* | 3.3* | 2.5* | 2.8* | 2.6* | 2.5* | 3.7* |
| Filipino | 5.6 | 5.1 | 3.5 | 3.4 | 4.6 | 3.9 | 4.1 | 4.0 | 4.1 |
| Hawaiian | 7.0* | 5.7* | 4.3* | 4.0* | 7.2* | 4.9* | 6.2* | 3.6* | 5.6* |
| Other Asian or Pacific Islander | 5.0 | 5.4 | 4.4 | 3.7 | 3.9 | 3.3 | 3.4 | 3.2 | 3.3 |
| Hispanic or Latinod, e | 6.2 | 5.7 | 4.8 | 4.1 | 3.9 | 3.9 | 3.8 | 3.6 | 3.8 |
| Mexican | 5.9 | 5.4 | 4.5 | 3.9 | 3.7 | 3.7 | 3.6 | 3.5 | 3.6 |
| Puerto Rican | 8.7 | 7.6 | 6.9 | 6.1 | 5.2 | 5.9 | 5.8 | 6.0 | 5.8 |
| Cuban | 5.0* | 6.2 | 5.3 | 3.6* | 2.7* | 3.5* | 3.2* | 2.5* | 3.2* |
| Central and South American | 5.8 | 5.6 | 4.4 | 3.7 | 3.6 | 3.3 | 3.3 | 3.4 | 3.5 |
| Other and unknown Hispanic or Latino | 6.4 | 5.6 | 5.0 | 4.8 | 4.5 | 4.8 | 4.6 | 3.9 | 5.1 |
| Not Hispanic or Latino: | |||||||||
| Whitee | 5.9 | 5.6 | 4.5 | 4.0 | 3.9 | 3.8 | 3.8 | 3.8 | 3.9 |
| Black or African Americane | 12.0 | 11.9 | 11.0 | 9.6 | 9.4 | 9.6 | 9.2 | 9.0 | 9.3 |
| Postneonatalc deaths per 1,000 live births | |||||||||
| All mothers | 3.8 | 3.6 | 3.2 | 2.6 | 2.4 | 2.3 | 2.3 | 2.3 | 2.3 |
| White | 3.2 | 3.1 | 2.7 | 2.2 | 2.0 | 1.9 | 1.9 | 1.9 | 1.9 |
| Black or African American | 6.7 | 6.3 | 5.9 | 5.0 | 4.4 | 4.5 | 4.3 | 4.4 | 4.5 |
| American Indian or Alaska Native | 7.7 | 7.0 | 7.0 | 5.1 | 4.4 | 4.3 | 3.9 | 5.4 | 4.0 |
| Asian or Pacific Islander | 3.1 | 2.9 | 2.7 | 1.9 | 1.7 | 1.7 | 1.4 | 1.6 | 1.4 |
| Chinese | 4.0 | 2.5* | 2.0* | 1.5* | 1.3* | 1.2* | 1.0* | 1.3* | 0.7* |
| Japanese | * | 2.9* | * | * | * | * | * | * | * |
| Filipino | 2.8* | 2.7 | 2.5 | 2.2 | 1.6 | 1.9 | 1.6 | 1.5* | 1.7 |
| Hawaiian | 4.2* | 4.3* | 3.8* | * | * | * | * | 3.7* | 4.0* |
| Other Asian or Pacific Islander | 3.0 | 3.0 | 3.0 | 1.9 | 1.8 | 1.8 | 1.4 | 1.6 | 1.4 |
Disorders related to short gestation (premature birth) and low birth weight accounted for the second-leading cause of infant mortality (4,844 out of 28,422, or 17%). Among African-American infants, such disorders were the leading cause of death (22.7%; 1,903 out of 8,400 deaths from all causes). Other causes of infant deaths were sudden infant death syndrome (SIDS), maternal complications of pregnancy, and complications of the placenta, cord, and membranes. These five leading causes of infant mortality accounted for more than half (54.2%) of the total infant deaths in all races. (See Table 5.4.)
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