In 1989, the infant mortality rate for the United States -- 9.8 infant deaths per 1000 live births--was the lowest final rate ever recorded; the previous low (10.0 per 1000 live births) was recorded in 1988 (Figure 1). However, the infant mortality rate in the United States remains higher than that in many other developed countries. This report summarizes 1989 infant mortality data based on information from death certificates compiled through the Vital Statistics System of CDC's National Center for Health Statistics (NCHS) (1) and compares findings with those for 1988.

In this report, cause-of-death statistics are based on the underlying cause of death * reported on the death certificate by the attending physician, medical examiner, or coroner in a manner specified by the World Health Organization and endorsed by CDC. In 1989, NCHS changed the method of tabulating live births from race of child to race of mother (2). Because the number of live births comprises the denominator of infant mortality rates, 1989 rates by race of mother for specific race groups are not comparable with those of previous years. For this report, data for 1989 were tabulated by both race of child and race of mother. Comparison of changes in rates from 1988 to 1989 are based on the number of live births tabulated by race of child.

In 1989, the mortality rates (by race of mother) for white ** and black ** infants were 8.1 and 18.6 per 1000 live births, respectively. For white infants, the rate (by race of child) in 1989 (8.2 per 1000 live births) was 4% lower than the rate from the previous year (8.5); for black infants, the rate (by race of child) was 17.7 in 1989, compared with 17.6 in 1988.

From 1988 to 1989, the neonatal (infants less than 28 days of age) mortality rate declined from 6.3 to 6.2 deaths per 1000 live births. In 1989, the neonatal mortality rates (by race of mother) for white and black infants were 5.1 and 11.9 per 1000 live births, respectively. For white infants, the rate (by race of child) in 1989 (5.2) was 4% lower than the 1988 rate (5.4); for black infants, the rate (by race of child) was 11.3 in 1989, compared with 11.5 in 1988.

In 1989, the overall postneonatal (infants aged 28 days-11 months) mortality rate was 3.6 per 1000 live births for the fourth consecutive year. The rates (by race of mother) were 2.9 and 6.7 per 1000 live births for white and black infants, respectively. The 1989 rate (by race of child) for white infants (3.0) was 3% lower than the 1988 rate (3.1); the rate (by race of child) for black infants was 6.4 in 1989, compared with 6.2 in 1988.

From 1988 to 1989, among the 10 leading causes of death, the largest increases were for disorders relating to short gestation and unspecified low birthweight (LBW) (16%); respiratory distress syndrome (10%); and newborn affected by maternal complications of pregnancy and newborn affected by complications of placenta, cord, and membranes (5% each). The largest decreases were for intrauterine hypoxia and birth asphyxia (10%), and congenital anomalies and pneumonia and influenza (4% each).

The rank order of the 10 leading causes of infant death differed by race (Table 1). For white infants, the leading cause of death was congenital anomalies (197.7 deaths per 100,000 live births), accounting for nearly 25% of all deaths among white infants. For black infants, the leading cause of death was disorders relating to short gestation and unspecified LBW (277.4 deaths per 100,000 live births), accounting for 15% of all deaths among black infants. The first four leading causes of death accounted for 56% of all infant deaths among whites and 49% of all infant deaths among blacks; the remaining six leading causes accounted for 15% or less of infant deaths for each race group.

In 1989, the risk of dying within the first year of life was 2.3 times greater for black than for white infants, and for all of the leading causes of death, the risk was higher for black than for white infants; however, there were large variations by cause. The causes of death with the highest black-to-white rate ratios were disorders relating to short gestation and unspecified LBW (4.5:1); accidents *** and adverse effects (2.6:1); and pneumonia and influenza, newborn affected by maternal complications of pregnancy, and infections specific to the perinatal period (2.5:1 each). The causes with the lowest ratios were congenital anomalies (1.1:1) and sudden infant death syndrome and newborn affected by complications of placenta, cord, and membranes (2.0:1 each).

Three of the 10 leading causes of infant death accounted for 41% of the difference in infant mortality between black and white infants: disorders relating to short gestation and unspecified LBW, 20%; sudden infant death syndrome, 12%; and respiratory distress syndrome, 9%.

Reported by: Div of Vital Statistics, National Center for Health Statistics, CDC.

Editorial Note

Editorial Note: Infant mortality is one of the most widely used general indices of health in the United States and other countries. During the 1970s, the infant mortality rate in the United States declined rapidly (by an average of 4.7% per year). The rate of decline slowed during the 1980s, to an annual average of 2.8%. In 1987 (the latest year these data are available), the United States ranked 24th in the world in infant mortality (3), compared with 20th in 1980 (4).

Since the mid-1970s, the ratio of mortality rates between black and white infants has steadily increased--primarily because the mortality rate for black infants has declined more slowly than that for white infants. The ratio of black-to-white infant mortality increased from 1.8:1 during the early 1970s, to 2.1:1 in 1987 and 1988, and 2.2:1 in 1989, based on rates computed from the number of live births by race of child.

The downward trend in overall infant mortality has slowed since 1981 for the black population; for white infants, before the 4% decline from 1988 through 1989, the rate of decline had slowed since the late 1970s. Since 1960, neonatal mortality rates have decreased for both races, but the rate of decline was more rapid for white (4%) than for black infants (3%). However, from 1960 through 1989, the rate of decline in postneonatal mortality was faster for black (3%) than for white infants (2%).

One of the national health objectives for the year 2000 is to reduce the infant mortality rate for the total population to less than or equal to 7 infant deaths per 1000 live births, and for the black population to less than or equal to 11 (5). If the average annual decline of 2.8% for the total population during the 1980s continues, the overall infant mortality objective for the year 2000 will be achieved. However, for the black population, the year 2000 objective for infant mortality is unlikely to be met if current trends continue. For the objective to be met, the rate of decline of 2.1% per year for black infants from 1980 to 1989 would need to double from 1989 to 2000.

Current efforts to reduce infant mortality include expanding access to prenatal care for low income families through changes in Medicaid eligibility. Increased use of prenatal care is likely to have greatest impact on neonatal deaths resulting from causes other than birth defects. Because the underlying etiologies of some of the major causes of neonatal death (particularly birth defects and preterm delivery) are poorly understood, these problems are high priorities for research efforts. Most postneonatal deaths resulting from "pneumonia and influenza" (ICD-9 codes 480-487) and "accidents and adverse effects" (ICD-9 codes E800-E949) are preventable with current knowledge. To prevent these deaths, programmatic efforts need to emphasize well-baby care and parenting skills. However, strategies to prevent the leading cause of postneonatal death--sudden infant death syndrome--will require identification of the underlying pathologic mechanisms for this problem.

References

1. NCHS. Advance report of final mortality statistics, 1989. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1992. (Monthly vital statistics report; vol 40, no. 8, suppl 2).

2. NCHS. Advance report of final natality statistics, 1989. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1991. (Monthly vital statistics report; vol 40, no. 8, suppl).

3. NCHS. Health, United States, 1990. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1991; DHHS publication no. (PHS)91-1232.

4. NCHS. Health, United States, 1988. Hyattsville, Maryland: US Department of Health and Human Services, Public Health Service, CDC, 1989; DHHS publication no. (PHS)89-1232.

5. Public Health Service. Healthy people 2000: national health promotion and disease prevention objectives--full report, with commentary. Washington, DC: US Department of Health and Human Services, Public Health Service, 1991; DHHS publication no. (PHS)91-50212.

• Defined by the World Health Organization's International

Classification of Diseases, Ninth Revision (ICD-9) as "(a) the disease or injury which initiated the train of morbid events leading directly to death, or (b) the circumstances of the accident or violence which produced the fatal injury."

** Includes Hispanic and non-Hispanic infants. *** When a death occurs under "accidental" circumstances, the preferred term within the public health community is "unintentional injury."

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