TABLE 5.1 Infant, neonatal, and postneonatal mortality rates, by race and Hispanic origin of mother, selected years 1983–2002 [CONTINUED]
| TABLE 5.1 | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| Infant, neonatal, and postneonatal mortality rates, by race and Hispanic origin of mother, selected years 1983–2002 [CONTINUED] | |||||||||
| [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 |
| *Estimates are considered unreliable. Rates preceded by an asterisk are based on fewer than 50 deaths in the numerator. Rates not shown are based on fewer than 20 deaths in the numerator. | |||||||||
| aRates based on unweighted birth cohort data. | |||||||||
| bRates based on a period file using weighted data. | |||||||||
| cInfant (under 1 year of age), neonatal (under 28 days), and postneonatal (28 days-11 months). | |||||||||
| dPersons of Hispanic origin may be of any race. | |||||||||
| ePrior to 1995, data shown only for states with an Hispanic-origin item on their birth certificates. | |||||||||
| Notes: The race groups white, black, American Indian or Alaska Native, and Asian or Pacific Islander include persons of Hispanic and non-Hispanic origin. National linked files do not exist for 1992–94. Data for additional years are available. | |||||||||
| SOURCE: Adapted from "Table 19. Infant, Neonatal, and Postneonatal Mortality Rates, according to Detailed Race and Hispanic Origin of Mother: United States, Selected Years 1983–2002," in Health, United States, 2005, Centers for Disease Control and Prevention, National Center for Health Statistics, November 2005, http://www.cdc.gov/nchs/data/hus/hus05.pdf (accessed February 27, 2006) | |||||||||
| Hispanic or Latinod. e | 3.3 | 3.2 | 2.7 | 2.1 | 1.9 | 1.8 | 1.8 | 1.8 | 1.8 |
| Mexican | 3.2 | 3.2 | 2.7 | 2.1 | 1.9 | 1.8 | 1.8 | 1.7 | 1.8 |
| Puerto Rican | 4.2 | 3.5 | 3.0 | 2.8 | 2.6 | 2.4 | 2.4 | 2.5 | 2.4 |
| Cuban | 2.5* | 2.3* | 1.9* | 1.7* | * | * | * | 1.7* | * |
| Center and South American | 2.6 | 2.4 | 2.4 | 1.9 | 1.7 | 1.4 | 1.4 | 1.6 | 1.6 |
| Other and unknown Hispanic or Latino | 4.2 | 3.9 | 3.0 | 2.6 | 2.0 | 2.5 | 2.3 | 2.1 | 2.0 |
| Not Hispanic or Latino: | |||||||||
| Whitee | 3.2 | 3.0 | 2.7 | 2.2 | 2.0 | 1.9 | 1.9 | 1.9 | 1.9 |
| Black or African Americane | 7.0 | 6.4 | 5.9 | 5.0 | 4.5 | 4.6 | 4.4 | 4.5 | 4.6 |
babies are born annually in the United States with birth defects—a rate of one out of every thirty-three babies. The Foundation notes that birth defects are the leading cause of death for children younger than one year of age in the United States.
A birth defect may be a structural defect, a deficiency of function, or a disease present at birth. Some birth defects are genetic—inherited abnormalities such as Tay-Sachs disease (a fatal disease that generally affects children of Eastern European Jewish ancestry), or chromosomal irregularities such as Down syndrome. Other birth defects result from environmental factors—infections during pregnancy, such as rubella (German measles), or drugs used by the pregnant woman. Although the specific causes of many birth defects are unknown, scientists think that many result from a combination of genetic and environmental factors. Though many birth defects are impossible to prevent, some can be prevented, such as those caused by maternal alcohol and drug consumption during pregnancy.
Two birth defects that have been the subject of considerable ethical debate are neural tube defects (NTDs) and permanent disabilities coupled with operable but life-threatening factors. An example of the latter is Down syndrome, a genetic abnormality that causes mental retardation and, frequently, malformations of the heart or kidneys.
Neural Tube Defects
Neural tube defects are abnormalities of the brain and spinal cord resulting from the failure of the neural tube to develop properly during early pregnancy. The neural tube is the embryonic nerve tissue that develops into the brain and the spinal cord. In the period 1995–96, four thousand pregnancies were affected with NTDs. The number dropped to three thousand in 1999–2000. The Centers for Disease Control and Prevention, which reported these figures (Morbidity and Mortality Weekly Report, vol. 53, no. 17, May 7, 2004), suggested that the decline was due to an increase in folic acid consumption by pregnant women during those years.
Folic acid has been shown to prevent 50-70% of NTDs if women contemplating pregnancy consume sufficient folic acid before conception and then throughout the first trimester of pregnancy. Thus, in 1992, the U.S. Public Health Service recommended that all women capable of becoming pregnant consume four hundred micrograms of folic acid daily. In addition, the U.S. Food and Drug Administration (FDA) mandated that as of January 1998 all enriched cereal grain products be fortified with folic acid.
The two most common NTDs are anencephaly and spina bifida.
ANENCEPHALY
Anencephalic infants die before birth (in utero or stillborn) or shortly thereafter. The incidence of anencephaly dropped significantly from 1991 (0.018%) to 2003 (0.011%) in the states where data were reported. The largest drop during that time period was from 1991 to 1992. Since then, the general trend has been downward. (See Figure 5.1.)
Issues of brain death and organ donation sometimes surround anencephalic infants. One case that gained national attention was that of Theresa Ann Campo in 1992. Prior to their daughter's birth, Theresa's parents (a Florida couple) discovered through prenatal testing that their baby would be born without a fully developed brain. They decided to carry the fetus to term and donate her organs for transplantation. When baby Theresa was born, her parents asked for her to be declared brain dead. But Theresa's brain stem was still functioning, so the court ruled against the parents' request. Baby Theresa died ten days later and her organs were not usable for transplant, having deteriorated as a result of oxygen deprivation.
TABLE 5.2 Infant deaths and infant mortality rates, by age, race, and Hispanic origin, 2002 and 2003
| TABLE 5.2 | ||||
|---|---|---|---|---|
| Infant deaths and infant mortality rates, by age, race, and Hispanic origin, 2002 and 2003 | ||||
| [Data are based on the continuous file of records received from the states. Rates per 1,000 live births. Figures for 2003 are based on weighted data rounded to the nearest individual, so categories may not add to totals. Rates for Hispanic origin should be interpreted with caution because of the inconsistencies between reporting Hispanic origin on birth and death certificates.] | ||||
| Age and race and Hispanic origin | 2003 | 2002 | ||
| Number | Rate | Number | Rate | |
| aIncludes races other than white or black. | ||||
| bRace and Hispanic origin are reported separately on both the birth and death certificate. Race categories are consistent with the 1977 Office of Management and Budget standards. California, Hawaii, Idaho, Maine, Montana, New York, and Wisconsin reported multiple-race data in 2003. The multiple-race data for these states were bridged to the single race categories of the 1977 Office of Management and Budget standards for comparability with other states. Data for persons of Hispanic origin are included in the data for each race group, according to the decedent's reported race. | ||||
| cIncludes all persons of Hispanic origin of any race. | ||||
| Note: Data are subject to sampling or random variation. | ||||
| SOURCE: Donna L. Hoyert, et al., "Table 4. Infant Deaths and Infant Mortality Rates, by Age and Race and Hispanic Origin: United States, Final 2002 and Preliminary 2003," in "Deaths, Preliminary Data for 2003," National Vital Statistics Reports, vol. 53, no. 15, February 28, 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_15.pdf (accessed February 28, 2006) | ||||
| All racesa | ||||
| Under 1 year | 28,428 | 6.9 | 28,034 | 7.0 |
| Under 28 days | 19,108 | 4.7 | 18,747 | 4.7 |
| 28 days-11 months | 9,320 | 2.3 | 9,287 | 2.3 |
| Total whiteb | ||||
| Under 1 year | 18,768 | 5.8 | 18,369 | 5.8 |
| Under 28 days | 12,698 | 3.9 | 12,354 | 3.9 |
| 28 days-11 months | 6,070 | 1.9 | 6,015 | 1.9 |
| Non-Hispanic white | ||||
| Under 1 year | 13,450 | 5.8 | 13,463 | 5.9 |
| Under 28 days | 9,048 | 3.9 | 9,014 | 3.9 |
| 28 days-11 months | 4,402 | 1.9 | 4,449 | 1.9 |
| Total blackb | ||||
| Under 1 year | 8,437 | 14.1 | 8,524 | 14.4 |
| Under 28 days | 5,626 | 9.4 | 5,646 | 9.5 |
| 28 days-11 months | 2,812 | 4.7 | 2,878 | 4.8 |
| Hispanicc | ||||
| Under 1 year | 5,389 | 5.9 | 4,943 | 5.6 |
| Under 28 days | 3,676 | 4.0 | 3,331 | 3.8 |
| 28 days-11 months | 1,712 | 1.9 | 1,612 | 1.8 |
Some physicians and ethicists agree that even if anencephalic babies have a brain stem, they should be considered brain dead. Lacking a functioning higher brain, these babies can feel nothing; they have no consciousness. Others fear that declaring anencephalic babies dead could be the start of a "slippery slope" that might eventually include babies with other birth defects, such as spina bifida, in the same category. Spina bifida defects range from mild to severe. Other people are concerned that anencephalic babies may be kept alive for the purpose of harvesting their organs for transplant at a later date.
SPINA BIFIDA
Spina bifida, which literally means "divided spine," is caused by the failure of the vertebrae (backbone) to completely cover the spinal cord early in fetal development, leaving the spinal cord exposed. Depending upon the amount of nerve tissue exposed, spina bifida defects range from minor developmental disabilities to paralysis.
Before the advent of antibiotics in the 1950s, most babies with severe spina bifida died soon after birth. With antibiotics and numerous medical advances, some of these newborns can be saved.
The treatment of newborns with spina bifida can pose serious ethical problems. Should an infant with a milder form of the disease be treated actively while another with severe defects is left untreated? In severe cases should the newborn be sedated and not be given nutrition and hydration until death occurs? Or should this seriously disabled infant be cared for while suffering from bladder and bowel malfunctions, infections, and paralysis? What if infants who have been left to die unexpectedly survive? Would they be more disabled than if they had been treated right away?
The development of fetal surgery to correct spina bifida before birth added another dimension to the debate. There are risks for both the mother and the fetus during and after fetal surgery, but techniques have improved since the first successful surgery of this type in 1997. In 2003 the National Institute of Child Health and Human Development (NICHD), a part of the National Institutes of Health (NIH), funded a study to compare how babies who have prenatal surgery do compared with those who have postnatal surgery. In 2006 the study was ongoing. The NICHD predicts that by the year 2020, routine diagnosis and treatment of congenital malformations by means of fetal surgery will be standard therapy for most disabling malformations that are currently treated in young infants.
In the United States the rates of spina bifida have been declining since 1960, and, though there was a slight increase in the mid-1990s, the rates decreased from nearly 0.025% in 1991 to about 0.019% in 2003. (See Figure 5.2; note that not all states participated in reporting spina bifida cases.) As mentioned previously, the decline is an early indicator of successful efforts to
TABLE 5.3 Deaths and life expectancy at birth, by race and sex; maternal and infant deaths and mortality rates, by race, 2002 and 2003
| TABLE 5.3 | ||||||
|---|---|---|---|---|---|---|
| Deaths and life expectancy at birth, by race and sex; maternal and infant deaths and mortality rates, by race, 2002 and 2003 | ||||||
| Measure and sex | All racesa | White | Black | |||
| 2003 | 2002 | 2003 | 2002 | 2003 | 2002 | |
| aIncludes races other than white and black. | ||||||
| bAge-adjusted death rates are per 100,000 U.S. standard population, based on the year 2000 standard. | ||||||
| cLife expectancy at birth stated in years. | ||||||
| SOURCE: Donna L. Hoyert, et al., "Table 1. Deaths, Age-Adjusted Death Rates, and Life Expectancy at Birth, by Race and Sex; Maternal and Infant Deaths and Mortality Rates, by Race: United States, 2002 and 2003," in Deaths: Final Data for 2003, Health E-Stats, Centers for Disease Control and Prevention, National Center for Health Statistics, January 19, 2006, http://www.cdc.gov/nchs/data/hestat/finaldeaths03_tables.pdf#2 (accessed February 27, 2006) | ||||||
| All deaths | 2,448,288 | 2,443,387 | 2,103,714 | 2,102,589 | 291,300 | 290,051 |
| Age-adjusted death rateb | 832.7 | 845.3 | 817.0 | 829.0 | 1,065.9 | 1,083.3 |
| Male | 994.3 | 1,013.7 | 973.9 | 992.9 | 1,319.1 | 1,341.4 |
| Female | 706.2 | 715.2 | 693.1 | 701.3 | 885.6 | 901.8 |
| Life expectancy at birthc | 77.5 | 77.3 | 78.0 | 77.7 | 72.7 | 72.3 |
| Male | 74.8 | 74.5 | 75.3 | 75.1 | 69.0 | 68.8 |
| Female | 80.1 | 79.9 | 80.5 | 80.3 | 76.1 | 75.6 |
| All maternal deaths | 495 | 357 | 280 | 190 | 183 | 148 |
| Maternal mortality rate | 12.1 | 8.9 | 8.7 | 6.0 | 30.5 | 24.9 |
| All infant deaths | 28,025 | 28,034 | 18,440 | 18,369 | 8,402 | 8,524 |
| Infant mortality rated | 6.85 | 6.97 | 5.72 | 5.79 | 14.01 | 14.36 |
prevent this defect by increasing folic acid consumption among women of childbearing age.
Down Syndrome
Down syndrome is a birth defect caused by chromosomal irregularities. Instead of the normal forty-six chromosomes, Down syndrome newborns have an extra copy of chromosome 21, giving them a total of forty-seven chromosomes. Along with having certain anatomical differences from non-Down syndrome children, Down children have varying degrees of mental retardation, and approximately 40% have congenital heart diseases.
The CDC estimates prevalence of Down syndrome at birth as approximately ten cases per ten thousand live births. The occurrence of this birth defect rises with increasing maternal age, with a marked increase seen in children of women over thirty-five years of age.
In the past babies born with Down syndrome were usually institutionalized. Many died in infancy. Today, with the help of modern medical care, children with Down syndrome are typically raised at home and attain adulthood, although their life expectancy is shorter than average (approximately fifty-five years). Except for the most severe heart defects, many other malformations accompanying Down syndrome may be corrected by surgery. Depending on the degree of mental retardation, many people with Down syndrome are able to hold jobs and live independently.
Birth Defects Prevention Acts of 1998 and 2003
On April 21, 1998, President Bill Clinton signed into law the Birth Defects Prevention Act (PL 105-168), which authorized a nationwide network of birth defects research and prevention programs and called for a nationwide information clearinghouse on birth defects.
The Children's Health Act of 2000 (PL 106-310) authorized expanded research and services for a variety of childhood health problems. In addition, it created the National Center on Birth Defects and Developmental Disabilities (NCBDDD) at the CDC. Developmental disabilities are conditions that impair day-to-day functioning, such as difficulties with communication, learning, behavior, and motor skills. They are chronic conditions that initially appear in persons age eighteen years or younger.
The Birth Defects and Developmental Disabilities Prevention Act of 2003 revised and extended the Birth Defects Prevention Act of 1998. It also reauthorized the NCBDDD through 2007. The NCBDDD works with state health departments, academic institutions, and other public health partners to monitor birth defects and developmental disabilities, as well as to support research to identify their causes or risk factors. In addition, the center develops strategies and promotes programs to prevent birth defects and developmental disabilities.
The Economic Cost of Long-Term Care for Birth Defects and Developmental Disabilities
Research examining selected developmental disabilities associated with major birth defects was reported by Pierre Decoufle et al ("Increased Risk for Developmental Disabilities in Children Who Have Major Birth Defects: A Population-Based Study," Pediatrics, vol. 108, no. 3,
TABLE 5.4 Ten leading causes of infant deaths and infant mortality rates, by race and Hispanic origin, 2003
| TABLE 5.4 | |||
|---|---|---|---|
| Ten leading causes of infant deaths and infant mortality rates, by race and Hispanic origin, 2003 | |||
| [Data are based on a continuous file of records received from the states. Rates are per 100,000 live births. Figures are based on weighted data rounded to the nearest individual, so categories may not add to totals or subtotals. Rates for Hispanic origin should be interpreted with caution because of inconsistencies between reporting Hispanic origin on birth and death certificates.] | |||
| Ranka | Cause of death and age | Number | Rate |
| All racesb | |||
| … | All causes | 28,422 | 694.7 |
| 1 | Congenital malformations, deformations and chromosomal abnormalities | 5,714 | 139.7 |
| 2 | Disorders related to short gestation and low birth weight, not elsewhere classified | 4,844 | 118.4 |
| 3 | Sudden infant death syndrome | 1,994 | 48.7 |
| 4 | Newborn affected by maternal complications of pregnancy | 1,734 | 42.4 |
| 5 | Newborn affected by complications of placenta, cord and membranes | 1,112 | 27.2 |
| 6 | Accidents (unintentional injuries) | 928 | 22.7 |
| 7 | Diseases of the circulatory system | 834 | 20.4 |
| 8 | Respiratory distress of newborn | 819 | 20.0 |
| 9 | Bacterial sepsis of newborn | 766 | 18.7 |
| 10 | Neonatal hemorrhage | 648 | 15.8 |
| … | All other causes | 9,029 | 220.7 |
| Total whitec | |||
| … | All causes | 18,800 | 582.4 |
| 1 | Congenital malformations, deformations and chromosomal abnormalities | 4,378 | 135.6 |
| 2 | Disorders related to short gestation and low birth weight, not elsewhere classified | 2,769 | 85.8 |
| 3 | Sudden infant death syndrome | 1,246 | 38.6 |
| 4 | Newborn affected by maternal complications of pregnancy | 1,117 | 34.6 |
| 5 | Newborn affected by complications of placenta, cord and membranes | 756 | 23.4 |
| 6 | Accidents (unintentional injuries) | 621 | 19.2 |
| 7 | Diseases of the circulatory system | 539 | 16.7 |
| 8 | Respiratory distress of newborn | 537 | 16.6 |
| 9 | Neonatal hemorrhage | 476 | 14.8 |
| 10 | Bacterial sepsis of newborn | 465 | 14.4 |
| … | All other causes | 5,896 | 182.7 |
| Non-Hispanic white | |||
| … | All causes | 13,454 | 579.7 |
| 1 | Congenital malformations, deformations and chromosomal abnormalities | 3,002 | 129.3 |
| 2 | Disorders related to short gestation and low birth weight, not elsewhere classified | 1,894 | 81.6 |
| 3 | Sudden infant death syndrome | 1,025 | 44.2 |
| 4 | Newborn affected by maternal complications of pregnancy | 803 | 34.6 |
| 5 | Newborn affected by complications of placenta, cord and membranes | 559 | 24.1 |
| 6 | Accidents (unintentional injuries) | 501 | 21.6 |
| 7 | Diseases of the circulatory system | 398 | 17.1 |
| 8 | Respiratory distress of newborn | 388 | 16.7 |
| 9 | Neonatal hemorrhage | 359 | 15.5 |
| 10 | Bacterial sepsis of newborn | 346 | 14.9 |
| … | All other causes | 4,179 | 180.1 |
September 2001). The investigators linked data from two independent population-based surveillance systems to find out if major birth defects were associated with serious developmental disabilities.
When compared with children who had no major birth defects, the prevalence of developmental disabilities among children with major birth defects was extremely high. The researchers observed that conditions such as
TABLE 5.4 Ten leading causes of infant deaths and infant mortality rates, by race and Hispanic origin, 2003 [CONTINUED]
| TABLE 5.4 | ||||
|---|---|---|---|---|
| Ten leading causes of infant deaths and infant mortality rates, by race and Hispanic origin, 2003 [CONTINUED] | ||||
| [Data are based on a continuous file of records received from the states. Rates are per 100,000 live births. Figures are based on weighted data rounded to the nearest individual, so categories may not add to totals or subtotals. Rates for Hispanic origin should be interpreted with caution because of inconsistencies between reporting Hispanic origin on birth and death certificates.] | ||||
| Ranka | Cause of death and age | Number | Rate | |
| aRank based on number of deaths. | ||||
| bIncludes races other than white and black. | ||||
| cRace and Hispanic origin are reported separately on both the birth and death certificate. Race categories are consistent with the 1977 Office of Management and Budget standards. California, Hawaii, Idaho, Maine, Montana, New York, and Wisconsin reported multiple-race data in 2003. The multiple-race data for these states were bridged to the single race categories of the 1977 Office of Management and Budget standards for comparability with other states. Data for persons of Hispanic origin are included in the data for each race group, according to the decedent's reported race. | ||||
| dIncludes all persons of Hispanic origin of any race. | ||||
| Notes: "…"=Category not applicable. Data are subject to sampling or random variation. | ||||
| SOURCE: Donna L. Hoyert, et al., "Table 8. Infant Deaths and Infant Mortality Rates for the 10 Leading Causes of Infant Death, by Race and Hispanic Origin: United States, Preliminary 2003," in "Deaths, Preliminary Data for 2003," National Vital Statistics Reports, vol. 53, no. 15, February 28, 2005, http://www.cdc.gov/nchs/data/nvsr/nvsr53/nvsr53_15.pdf (accessed February 28, 2006) | ||||
| Total blackc | ||||
| … | All causes | 8,400 | 1,401.4 | |
| 1 | Disorders related to short gestation and low birth weight, not elsewhere classified | 1,903 | 317.4 | |
| 2 | Congenital malformations, deformations and chromosomal abnormalities | 1,041 | 173.7 | |
| 3 | Sudden infant death syndrome | 656 | 109.5 | |
| 4 | Newborn affected by maternal complications of pregnancy | 563 | 93.9 | |
| 5 | Newborn affected by complications of placenta, cord and membranes | 311 | 51.9 | |
| 6 | Bacterial sepsis of newborn | 279 | 46.6 | |
| 7 | Accidents (unintentional injuries) | 272 | 45.4 | |
| 8 | Respiratory distress of newborn | 255 | 42.6 | |
| 9 | Diseases of the circulatory system | 241 | 40.3 | |
| 10 | Necrotizing enterocolitis of newborn | 158 | 26.4 | |
| … | All other causes | 2,721 | 453.9 | |
| Hispanicd | ||||
| … | All causes | 5,425 | 594.7 | |
| 1 | Congenital malformations, deformations and chromosomal abnormalities | 1,381 | 151.4 | |
| 2 | Disorders related to short gestation and low birth weight, not elsewhere classified | 888 | 97.4 | |
| 3 | Newborn affected by maternal complications of pregnancy | 319 | 35.0 | |
| 4 | Sudden infant death syndrome | 245 | 26.9 | |
| 5 | Newborn affected by complications of placenta, cord and membranes | 201 | 22.1 | |
| 6 | Respiratory distress of newborn | 152 | 16.6 | |
| 7 | Diseases of the circulatory system | 142 | 15.5 | |
| 8 | Accidents (unintentional injuries) | 123 | 13.5 | |
| 9 | Bacterial sepsis of newborn | 120 | 13.1 | |
| 10 | Neonatal hemorrhage | 120 | 13.1 | |
| … | All other causes | 1,734 | 190.1 | |
mental retardation, cerebral palsy (a disorder marked by muscular impairment usually caused by brain damage), epilepsy (a disorder of the brain that results in seizures), autism (a brain disorder that affects communication, social interaction, and imaginative play), profound hearing loss, and legal blindness "prove costly in terms of special education services, medical and supportive care, demands on caregivers, and economic loss to society." They concluded, "Our data suggest that birth defects
FIGURE 5.1 Anencephalus rates and number of live births with anencephalus, 1991–2003
| FIGURE 5.1 | |||
|---|---|---|---|
| Anencephalus rates and number of live births with anencephalus, 1991–2003 | |||
| Year | Anencephalus | Total live births | Rate |
| Note: Excludes data for Maryland, New Mexico, and New York, which did not require reporting for anencephalus for some years. | |||
| SOURCE: Adapted from "Figure 2. Anencephalus Rates, 1991–2002," and "Table 2. Number of Live Births and Anencephalus Cases and Rates per 100,000 Live Births for the United States, 1991–2002," Trends in Spina Bifida and Anencephalus in the United States, 1991–2002, Centers for Disease Control and Prevention, National Center for Health Statistics, 2004, http://www.cdc.gov/nchs/products/pubs/pubd/hestats/spine_anen.htm (accessed December 1, 2005). Data for 2003 are unpublished from the National Vital Statistics System, NCHS, CDC, December 1, 2005. | |||
| 2003 | 441 | 3,715,577 | 11.14 |
| 2002 | 348 | 3,645,770 | 9.55 |
| 2001 | 343 | 3,640,555 | 9.42 |
| 2000 | 376 | 3,640,376 | 10.33 |
| 1999 | 382 | 3,533,565 | 10.81 |
| 1998 | 349 | 3,519,240 | 9.92 |
| 1997 | 434 | 3,469,667 | 12.51 |
| 1996 | 416 | 3,478,723 | 11.96 |
| 1995 | 408 | 3,484,539 | 11.71 |
| 1994 | 387 | 3,527,482 | 10.97 |
| 1993 | 481 | 3,562,723 | 13.50 |
| 1992 | 457 | 3,572,890 | 12.79 |
| 1991 | 655 | 3,564,453 | 18.38 |
pose a greater burden on society than previously recognized."
The majority of people with birth defects and/or developmental disabilities require long-term care or services. Table 5.5 shows the economic costs of mental retardation, cerebral palsy, hearing loss, and vision impairment. Of these four developmental disabilities, mental retardation has the highest rate, at twelve affected children per one thousand, and the highest cost at more than $1 million per person.
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