national vital statistics reports: infant mortality statistics from the 2006 period linked...

8/9/2019 National Vital Statistics Reports: Infant Mortality Statistics From the 2006 Period Linked Birth/Infant Death Data Set

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National VitalStatistics ReportsVolume58,Number17 April30,2010

Infant Mortality Statistics From the 2006 PeriodLinkedBirth/InfantDeathDataSetbyT.J.Mathews,M.S.,andMarianF.MacDorman,Ph.D.,DivisionofVitalStatistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Disease Control and Prevention

National Center for Health StatisticsNational Vital Statistics System

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

MSAL GA

FL

SC

NC

VAWV

OH

MI

NY

PA

MD

DE

NJ

CT RI

MA

ME

VTNH

DC

Not significantly different from U.S.

Significantly lower than U.S.

10 lowest

HI

AK

Significantly higher than the U.S.10 highestSOURCE: CDC/NCHS, National Vital Statistics System.

Figure1. Infantmortalityratesbystate:UnitedStates,20042006


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2 NationalVitalStatisticsReports,Volume58,Number17,April30,2010Abstract

ObjectivesThis report presents 2006 period infant mortalitystatistics from the linkedbirth/infantdeathdataset (linked file)byavariety of maternal and infant characteristics. The linked file differsfrom the mortality file, which is based entirely on death certificatedata.

MethodsDescriptivetabulationsofdataarepresentedandinterpreted.

ResultsTheU.S.infantmortalityratewas6.68infantdeathsper1,000livebirthsin2006,a3percentdeclinefrom6.86in2005.Infantmortalityratesrangedfrom4.52per1,000livebirthsforCentralandSouth American mothers to 13.35 for non-Hispanic black mothers.Infantmortalityrateswerehigherforthoseinfantswhosemotherswereborn inthe50statesortheDistrictofColumbia,wereunmarried,orwereborn inmultipledeliveries. Infantmortalitywas also higher formale infants and infants born preterm or at low birthweight. Theneonatalmortalityratewasessentiallyunchangedin2006(4.46)from2005(4.54).Thepostneonatalmortalityratedecreased4percent,from2.32in2005to2.22in2006.Infantsbornatthelowestgestationalagesand

birthweights

have

alarge

impact

on

overall

U.S.

infant

mortality.

Forexample,morethanhalfofall infantdeaths intheUnitedStatesin 2006 (54percent) occurred to the 2percent of infants born verypreterm(lessthan32weeksofgestation).Still, infantmortalityratesfor latepreterm infants(3436weeksofgestation)were three timesthoseforterminfants(3741weeks).Thethreeleadingcausesofinfantdeathcongenitalmalformations, lowbirthweight,andsudden infantdeathsyndrometakentogetheraccountedfor46percentofallinfantdeaths.Thepercentageof infantdeaths thatwere preterm-relatedwas36.1percentin2006.Thepreterm-relatedinfantmortalityratefornon-Hispanic black mothers was 3.4 times higher and the rate forPuerto Rican mothers was 84percent higher than for non-Hispanicwhitemothers.Keywords: infanthealthcbirthweightcgestationalagecmaternalcharacteristics

IntroductionThis report presents infantmortality data from the 2006 period

linked file.The linked file contains a numerator file consisting of allinfant deaths occurring in 2006 that have been linked to theircorrespondingbirthcertificates,whetherthebirthoccurredin2005orin2006.

Inthelinkedfile,informationfromthedeathcertificateislinkedtoinformationfromthebirthcertificateforeachinfantunder1yearofagewhodied in the50states, theDistrictofColumbia,PuertoRico, theVirginIslands,orGuamduring2006(1).Linkedbirth/infantdeathdataarenotavailableforAmericanSamoaandtheCommonwealthoftheNorthern Marianas. The purpose of the linkage is to use the manyadditionalvariablesavailablefromthebirthcertificatetoconductmoredetailedanalysesofinfantmortalitypatterns(2).ThisreportpresentsinfantmortalitydatabyraceandHispanicoriginofthemother,birth-weight, period of gestation, sex of infant, plurality, maternal age,live-birthorder,mothersmaritalstatus,mothersplaceofbirth,ageatdeath, and underlying cause of death (Tables18 and AE; Figures16).Othervariablesavailable in the linked file(1)butnotdiscussed in this report include fathersage, race,andHispanicorigin;

birth attendant; place of delivery; mothers weight gain during pregnancy;andmanymedicalandhealthmeasurements.

Anotherreport,basedondataexclusivelyfromthevitalstatisticsmortalityfile,providesfurtherinformationontrendsininfantmortalityandcausesofinfantdeath(3).Thelinkedfileisusedforanalysisandforcalculating infantmortality ratesby raceandethnicity,whicharemoreaccuratelymeasuredfromthebirthcertificate.Someratescalculated from the mortality file differ from those published using thelinkedfile.Amoredetaileddiscussionofthedifferencesinthenumberofinfantdeathsandinfantmortalityratesbetweenthelinkedfileandthemortality file ispresented in TechnicalNotes.

MethodsData shown in this report are based on birth and infant death

certificates registered in all states, the District of Columbia, PuertoRico, the Virgin Islands, and Guam. As part of the Vital StatisticsCooperativeProgram,eachstateprovidedtotheCentersforDiseaseControlandPreventions(CDC)NationalCenter forHealthStatistics(NCHS)matchingbirthanddeathcertificatenumbersforeach infantunder 1 year of age who died in the state during 2006. When thebirth and death occurred in different states, the state of death wasresponsible for contacting the state of birth identified on the deathcertificate toobtain theoriginalbirthcertificatenumber.NCHSusedthe matching birth and death certificate numbers provided by thestates to extract final edited data from the NCHS natality andmortality statistical files. These data were linked to form a singlestatistical record, therebyestablishinganational linkedrecord file.

After the initial linkage, NCHS returned lists of unlinked infantdeathrecordsandrecordswithinconsistentdatabetweenthebirthanddeathcertificatestoeachstate.Stateadditionsandcorrectionswereincorporated,anda finalnational linked filewasproduced. In2006,98.7percent of all infant death records were successfully linked ormatchedtotheircorrespondingbirthrecords.Recordswereweightedtoadjustforthe1.3percentofinfantdeathrecordsthatwerenotlinkedto theircorrespondingbirthcertificates;see TechnicalNotes.

Informationonbirthsbyage,race,ormaritalstatusofmotherisimputedifitisnotreportedonthebirthcertificate.Theseitemswerenot reported for less than1percentofU.S.births in2006(2).

RaceandHispanicoriginarereportedindependentlyonthebirthcertificate.IntabulationsofbirthdatabyraceandHispanicorigin,dataforHispanicpersonsarenotfurtherclassifiedbyracebecausethevastmajorityofwomenofHispanicoriginarereportedaswhite.Data forAmericanIndianorAlaskaNative(AIAN)andAsianorPacificIslander(API)

births

are

not

shown

separately

by

Hispanic

origin

because

the

vastmajorityof thesepopulationsarenon-Hispanic.

Cause-of-deathstatisticsinthispublicationareclassifiedinaccordancewiththeInternationalStatisticalClassificationofDiseasesandRelatedHealthProblems,TenthRevision(ICD10)(4);seeTechnicalNotes.

Thisreportincludesdatabasedonthe1989and2003revisionsofthebirthcertificate.NineteenstatesandPuertoRicoimplementedthe2003revisionoftheU.S.StandardCertificateofLiveBirthonorbefore January 1, 2006 (revised). The remaining reporting areasincludedatawhicharebasedonthe1989revisionoftheU.S.StandardCertificateofLiveBirth(unrevised).Revisedandunreviseddataare
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3NationalVitalStatisticsReports,Volume58,Number17,April30,2010combinedwhencomparable.Formoreinformation,seeNationalVitalStatisticsReports,Volume57Number7,Births:FinalDatafor2006(2).

Threekeydataitemsareconsiderednoncomparablebetweenthe1989and2003revisions:trimesterofpregnancyinwhichprenatalcarebegan,maternaleducationalattainment,andmaternalsmokingduringpregnancy (2).Because infantswhodied in2006wereborn inboth2005and2006,thisreportincludesdataonthesethreetopicsfromthe12states that implemented the2003revisionasofJanuary1,2005(seerespectivetextsectionsandTechnicalNotes).The12statesareFlorida, Idaho, Kansas, Kentucky, Nebraska, New Hampshire, NewYork (excluding NewYork City),Pennsylvania, SouthCarolina,Tennessee,Texas,andWashington.Resultsforthesethreeitemsfromthelimitedreportingareaarenotgeneralizabletothecountryasawhole(2).Databymaternaland infantcharacteristics

This report presents descriptive tabulations of infant mortalitydata by a variety of maternal and infant characteristics. Thesetabulations are useful for understanding the basic relationshipsbetweenrisk factorsand infantmortality,unadjusted for thepossibleeffectsofothervariables.Inreality,womenwithoneriskfactoroftenhave other risk factors as well. For example, teenage mothers aremore likely to also be unmarried and of a low-income status, andmotherswhodonotreceiveprenatalcarearemore likely tobeofalow-incomestatusanduninsured.Thepreferredmethodfordisentangling themultiple interrelationshipsamongrisk factors ismultivariateanalysis; however, an understanding of the basic relationshipsbetweenrisk factorsand infantmortality isanecessaryprecursor tomore sophisticated types of analyses and is the aim of thispublication.

Race and Hispanic origin dataInfant mortality rates are presentedherebyraceanddetailedHispanicoriginofmother.Thelinkedfile isparticularlyusefulforcomputingaccurate infantmortalityratesfor thispurposebecause theraceandHispanicoriginof themotherfromthebirthcertificateareusedinboththenumeratoranddenominator of the infant mortality rate. In contrast, for the vital statisticsmortality file, race information for thedenominator is the raceof themotherasreportedonthebirthcertificateandthatforthenumeratoristheraceofthedecedentasreportedonthedeathcertificate(2,3,5).Thus,standardinfantmortalityratescanbebasedoninconsistentrace

information. In addition, race information from the birth certificatereportedbythemotherisconsideredtobemorereliablethanthatfromthedeathcertificate,wheretheraceandethnicityofthedeceasedinfantarereportedbythefuneraldirectorbasedoninformationprovidedbyaninformantorbyobservation.Thesedifferentreportingmethodscanleadtodifferencesinrace- andethnicity-specificinfantmortalityratesbetween the twodata files(3,5).

The2003revisionof theU.S.StandardCertificateofLiveBirthallows the reportingofmore thanonerace (multipleraces) foreachparent(6,7).Informationonthischangeispresentedinarecentreport(2).Twenty-threestatesreportedmultipleraceontheirbirthcertificatesforeitherpartorallof2006.Toprovideuniformityandcomparabilityof data, multiple race is imputed to a single race (see TechnicalNotes).

Statistical significanceText statements have been tested forstatisticalsignificance,andastatementthatagiveninfantmortalityrateis higher or lower than another rate indicates that the rates aresignificantly different. Information on the methods used to test forstatisticalsignificance,aswellasinformationondifferencesbetweenperiod andcohortdata, theweightingof the linked file,andacomparison of infant mortality data between the linked file and the vitalstatisticsmortality filearepresented in TechnicalNotes.Additionalinformationonmaternalage,maritalstatus,periodofgestation,birth-weight,andcause-of-deathclassification isalsopresented in TechnicalNotes.ResultsandDiscussionTrends in infantmortality

The overall 2006 infant mortality rate from the linked file was6.68infantdeathsper1,000livebirths,3percentlowerthanthe2005rate

of

6.86

(Table

C);

the

2006

rate

from

the

mortality

file

was

6.69

(3).Theneonatalmortality rate for2006 (4.46)wasnotsignificantlydifferentfrom2005(4.54).Thepostneonatalmortalityratedecreasedfrom2.32 in2005 to2.22 in2006(TablesAandB for2006data).

Whiletheinfantmortalityratewas9percentlowerin2000(6.89)than in1995(7.57),theratehasdeclinedonly3percentsince2000(Figure2andTableC).Significantdeclines in2006 from2005wereobservedforinfantsofnon-Hispanicwhitemothers(3percent)andthetotalofHispanicmothers (4percent) (TableC).

TableA. Infant,neonatal,andpostneonataldeathsandmortalityrates,byraceofmother:UnitedStates,2006 linkedfile

Live Numberofdeaths Mortalityrateper1,000 livebirthsRaceofmother births Infant Neonatal Postneonatal Infant Neonatal Postneonatal

All races. . . . . . . . . . . . . . . . . . . 4,265,593 28,509 19,041 9,468 6.68 4.46 2.22White. . . . . . . . . . . . . . . . . . . . . 3,310,331 18,422 12,292 6,130 5.57 3.71 1.85Black. . . . . . . . . . . . . . . . . . . . . 666,494 8,595 5,778 2,818 12.90 8.67 4.23American IndianorAlaskaNative . . . . 47,720 395 205 190 8.28 4.30 3.98AsianorPacific Islander. . . . . . . . . . 241,048 1,097 766 331 4.55 3.18 1.37NOTES: Infantdeathsareweightedsonumbersmaynotexactlyadd to totalsdue torounding.Neonatal is less than28daysandpostneonatal is28days tounder1year.Twenty-threestatesreportedmultiple-racedataon thebirthcertificate for2006.Themultiple-racedata for thesestateswerebridged to thesingle-racecategoriesof the1977standards forcomparabilitywithotherstates;seereference2 in thisreport.


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4 NationalVitalStatisticsReports,Volume58,Number17,April30,2010

. . . Categorynotapplicable.1Originofmothernotstated included in Alloriginsbutnotdistributedamongorigins.2Includesracesother thanwhiteorblack.NOTES: Infantdeathsareweightedsonumbersmaynotexactlyadd to totalsdue torounding.Neonatal is less than28daysandpostneonatal is28days tounder1year.PersonsofHispanicoriginmaybeofany race. In this table,Hispanicwomenareclassifiedonlybyplaceoforigin;non-Hispanicwomenareclassifiedbyrace.Seereference2 in thisreport.Twenty-threestatesreportedmultiple-racedataon thebirthcertificate for2006.Themultiple-racedata for thesestateswerebridged to thesingle-racecategoriesof the1977standards forcomparabilitywithotherstates;seereference2 in thisreport.

InfantmortalitybyraceandHispanicoriginofmother

As inpastyears, infantmortality rates in2006variedconsiderably by race and Hispanic origin of mother (8,9). The highest rate,13.35 per 1,000 live births, was for infants of non-Hispanic blackmothers, nearly three times greater than the lowest rateof 4.52 forinfants of Central and South American mothers and 4.55 for APImothers. Rates were also fairly high for infants ofAIAN (8.28) andPuertoRican(8.01)mothers.Rateswere intermediate,butallbelowthe U.S. rate, for infants of non-Hispanic white (5.58) and Mexican(5.34)mothers.Cubanmothers(5.08)alsohada lowrate(Figure2;TablesAC).Infantmortalitybystate

In2006,compared with2005, only threestates had significantchanges in infant mortality rates. Rates declined in South Carolina

(12percent), California (5percent), andTexas (5percent) (TableD).ToobtainstatisticallyreliableratesbyraceandHispanicorigin,threeyears of data were combined (Table3). Across the United States,rates are generally higher in the South and Midwest and lowerelsewhere (Figure1). For 20042006, infant mortality rates rangedfrom10.63forMississippito4.93forMassachusetts.Thehighestratenoted, 12.57, was for the District of Columbia (D.C.); however, theD.C. rate is more appropriately compared with rates for other largeU.S.citiesbecauseofthehighconcentrationofwomenathighriskintheseareas.

Forinfantsofnon-Hispanicblackmothers,mortalityratesrangedfrom20.85inHawaiito8.12inWashington.Forinfantsofnon-Hispanicwhitemothers,Oklahomahad thehighest infantmortalityrate(7.68)andHawaiihad the lowest rate (3.66)amongstates.Among the41states where infant mortality rates could be reliably computed forHispanic mothers, Rhode Island had the highest rate (7.95) andMinnesotahad the lowest(4.27).

TableB. Infant,neonatal,andpostneonataldeathsandmortalityrates,byHispanicoriginofmotherandbyraceofmother formothersofnon-Hispanicorigin:UnitedStates,2006 linked file

Live Numberofdeaths Mortality rateper1,000 livebirthsHispanicoriginand raceofmother births Infant Neonatal Postneonatal Infant Neonatal Postneonatal

Allorigins1. . . . . . . . . . . . . . . . . . 4,265,593 28,509 19,041 9,468 6.68 4.46 2.22TotalHispanic. . . . . . . . . . . . . . . . 1,039,079 5,622 3,883 1,739 5.41 3.74 1.67

Mexican. . . . . . . . . . . . . . . . . . 718,148 3,837 2,679 1,158 5.34 3.73 1.61PuertoRican. . . . . . . . . . . . . . . 66,932 536 364 172 8.01 5.44 2.57Cuban. . . . . . . . . . . . . . . . . . . 16,936 86 61 24 5.08 3.60 1.42CentralandSouthAmerican. . . . . . 165,321 748 515 233 4.52 3.12 1.41OtherandunknownHispanic . . . . . 71,742 415 264 151 5.78 3.68 2.10

Non-Hispanic total2. . . . . . . . . . . . . 3,196,111 22,493 14,820 7,673 7.04 4.64 2.40Non-Hispanicwhite . . . . . . . . . . . 2,308,654 12,884 8,410 4,474 5.58 3.64 1.94Non-Hispanicblack . . . . . . . . . . . 617,260 8,241 5,525 2,716 13.35 8.95 4.40

Notstated. . . . . . . . . . . . . . . . . . 30,403 395 338 57 ... ... ...

TableC. Infantmortalityrates,byraceandHispanicoriginofmother:UnitedStates,1995,20002006 linked filesPercentchange

RaceandHispanicoriginofmother 1995 2000 2001 2002 2003 2004 2005 2006 20002006 20052006All races. . . . . . . . . . . . . . . . . . . 7.57 6.89 6.84 6.95 6.84 6.78 6.86 6.68 **3.0 **2.6White. . . . . . . . . . . . . . . . . . . . . 6.30 5.71 5.69 5.79 5.72 5.66 5.73 5.57 **2.5 **2.8Black. . . . . . . . . . . . . . . . . . . . . 14.58 13.48 13.34 13.81 13.50 13.25 13.26 12.90 **4.3 2.7American IndianorAlaskaNative . . . . 9.04 8.30 9.65 8.64 8.73 8.45 8.06 8.28 0.2 2.7AsianorPacific Islander. . . . . . . . . . 5.27 4.87 4.73 4.77 4.83 4.67 4.89 4.55 6.6 7.0Hispanic . . . . . . . . . . . . . . . . . . . 6.27 5.59 5.44 5.62 5.65 5.55 5.62 5.41 3.2 **3.7

Mexican. . . . . . . . . . . . . . . . . . 6.03 5.43 5.22 5.42 5.49 5.47 5.53 5.34 1.7 3.4PuertoRican. . . . . . . . . . . . . . . 8.88 8.21 8.53 8.20 8.18 7.82 8.30 8.01 2.4 3.5Cuban. . . . . . . . . . . . . . . . . . . 5.29 4.54 4.28 3.72 4.57 4.55 4.42 5.08 11.9 14.9CentralandSouthAmerican. . . . . . 5.52 4.64 4.98 5.06 5.04 4.65 4.68 4.52 2.6 3.4

Non-Hispanicwhite. . . . . . . . . . . . . 6.28 5.70 5.72 5.80 5.70 5.66 5.76 5.58 2.1 **3.1Non-Hispanicblack. . . . . . . . . . . . . 14.65 13.59 13.46 13.89 13.60 13.60 13.63 13.35 1.8 2.1** Significantatp


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Mortalityratescouldbereliablycomputed foronly13statesforinfantsofAIANmothersandfor31statesforinfantsofAPImothers.ForinfantsofAIANmothers,mortalityratesrangedfrom12.28inSouthDakotato6.30inCalifornia.MortalityratesforinfantsofAPImothersranged from8.64 in Iowa to3.19 inConnecticut.Sex of infant

In2006,theoverallmortalityrateformale infantswas7.31per1,000 live births, 21percent higher than the rate for female infants(6.02).InfantmortalityrateswerehigherformalethanfemaleinfantsineachraceandHispanic-origingroup(Tables1and2),althoughthedifference was not significant for infants of Cuban and Central andSouthAmericanmothers.Multiplebirths

Formultiplebirths,theinfantmortalityratewas30.07,morethanfivetimestherateof5.87forsingletonbirths(Tables1and2).Infantmortality rates for multiple births were higher than the rates forsingletonbirths forall raceandHispanic-origingroups.

Theriskofinfantdeathincreaseswiththeincreasingnumberofinfants in the pregnancy. In 2006, the infant mortality rate for twins(27.92)wasnearlyfivetimestherateforsingletonbirths(5.87).Theratefortriplets(69.63)wasnearly12timesandtherateforquadruplets(146.48)was25 timeshigher than the rate forsingletonbirths (Figure3).Areliable infantmortality rate forquintupletandhigherorderbirthscouldnotbecomputeddue tosmallnumbersof infantdeathsforthatcategory.Infantmortalityratesforsingletonandtwinbirthsweresignificantlylowerin2006thanin2005,whiletheinfantmortalityratefor tripletswassignificantlyhigher in2006comparedwith2005.

Multiplepregnancycanleadtoanaccentuationofmaternalrisksandcomplicationsassociatedwithpregnancy(2,1012).Forexample,multiplebirthsaremuchmorelikelytobepretermandoflowbirthweightthansingletonbirths(2,1012).Thehigherriskprofileofmultiplebirths

has a substantial impact on overall infant mortality (10,1315). Forexample,in2006multiplesaccountedfor3percentofalllivebirths,but15percentofall infantdeaths in theUnitedStates (Table1).Ageatdeath

In 2006, two-thirds of all infant deaths (19,041 out of 28,509)occurred during the neonatal period (from birth through 27 days of

TableD. Infantmortalityrates,bystate:2000,2005,and2006 linked files[Byplaceof residence]

Infantmortality rateper1,000 livebirths Percent

changeState 2000 2005 2006 20052006

Total

. . . . . . . . . . . . . . . . . . . . .

6.89

6.86

6.68

**2.6

Alabama. . . . . . . . . . . . . . . . . . . 9.51 9.53 8.98 5.7Alaska . . . . . . . . . . . . . . . . . . . . 6.92 5.93 7.00 18.1Arizona. . . . . . . . . . . . . . . . . . . . 6.75 6.85 6.36 7.2Arkansas. . . . . . . . . . . . . . . . . . . 8.23 7.83 8.45 7.9California. . . . . . . . . . . . . . . . . . . 5.42 5.32 5.04 **5.2Colorado. . . . . . . . . . . . . . . . . . . 6.14 6.44 5.77 10.5Connecticut . . . . . . . . . . . . . . . . . 6.51 5.85 6.17 5.5Delaware. . . . . . . . . . . . . . . . . . . 9.59 9.02 8.09 10.3DistrictofColumbia . . . . . . . . . . . . 12.13 13.67 11.85 13.3Florida . . . . . . . . . . . . . . . . . . . . 6.91 7.24 7.26 0.3Georgia . . . . . . . . . . . . . . . . . . . 8.45 8.07 8.07 0.0Hawaii . . . . . . . . . . . . . . . . . . . . 8.09 6.58 5.85 11.2Idaho. . . . . . . . . . . . . . . . . . . . . 7.56 5.98 6.82 14.0Illinois . . . . . . . . . . . . . . . . . . . . 8.48 7.38 7.29 1.2Indiana. . . . . . . . . . . . . . . . . . . . 7.79 8.04 7.91 1.6Iowa . . . . . . . . . . . . . . . . . . . . . 6.43 5.44 5.12 5.9Kansas. . . . . . . . . . . . . . . . . . . . 6.55 7.37 7.15 3.0Kentucky. . . . . . . . . . . . . . . . . . . 7.10 6.73 7.50 11.4Louisiana. . . . . . . . . . . . . . . . . . . 9.03 9.85 9.96 1.1Maine. . . . . . . . . . . . . . . . . . . . . 4.85 6.87 6.29 8.5Maryland. . . . . . . . . . . . . . . . . . . 7.51 7.30 7.95 9.0Massachusetts . . . . . . . . . . . . . . . 4.61 5.13 4.85 5.3Michigan. . . . . . . . . . . . . . . . . . . 8.19 7.89 7.33 7.0Minnesota . . . . . . . . . . . . . . . . . . 5.62 5.09 5.18 1.8Mississippi. . . . . . . . . . . . . . . . . . 10.64 11.46 10.53 8.1Missouri . . . . . . . . . . . . . . . . . . . 7.19 7.52 7.45 1.0Montana . . . . . . . . . . . . . . . . . . . 6.02 7.25 6.00 17.3Nebraska. . . . . . . . . . . . . . . . . . . 7.18 5.66 5.54 2.2Nevada. . . . . . . . . . . . . . . . . . . . 6.45 5.66 6.62 16.9NewHampshire. . . . . . . . . . . . . . . 5.82 5.27 5.91 12.2NewJersey . . . . . . . . . . . . . . . . . 6.26 5.17 5.44 5.3NewMexico. . . . . . . . . . . . . . . . . 6.72 6.17 5.71 7.5New York . . . . . . . . . . . . . . . . . . 6.40 5.82 5.64 3.0NorthCarolina. . . . . . . . . . . . . . . . 8.60 8.81 8.09 8.2NorthDakota . . . . . . . . . . . . . . . . 8.34 5.96 5.92 0.7Ohio . . . . . . . . . . . . . . . . . . . . . 7.66 8.17 7.76 5.1Oklahoma . . . . . . . . . . . . . . . . . . 8.40 7.95 7.96 0.1Oregon. . . . . . . . . . . . . . . . . . . . 5.57 5.99 5.38 10.1Pennsylvania . . . . . . . . . . . . . . . . 7.10 7.29 7.65 5.0Rhode Island . . . . . . . . . . . . . . . . 6.24 6.46 6.22 3.6SouthCarolina . . . . . . . . . . . . . . . 8.77 9.46 8.32 **12.1SouthDakota . . . . . . . . . . . . . . . . 5.22 6.98 6.88 1.4Tennessee. . . . . . . . . . . . . . . . . . 9.11 8.77 8.65 1.3Texas. . . . . . . . . . . . . . . . . . . . . 5.60 6.55 6.19 **5.4Utah . . . . . . . . . . . . . . . . . . . . . 5.32 4.52 5.12 13.3Vermont . . . . . . . . . . . . . . . . . . . 6.46 6.49 5.68 12.4Virginia. . . . . . . . . . . . . . . . . . . . 6.91 7.47 7.10 5.0Washington . . . . . . . . . . . . . . . . . 5.20 5.07 4.70 7.3WestVirginia . . . . . . . . . . . . . . . . 7.38 8.16 7.07 13.3Wisconsin . . . . . . . . . . . . . . . . . . 6.64 6.54 6.37 2.5Wyoming. . . . . . . . . . . . . . . . . . . 6.72 6.63 6.78 2.2** Significantatp


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age)(TablesAandB).In2006,theneonatalmortalityratewas4.46deathsper1,000livebirths,essentiallyunchangedfromthepreviousyear (4.54). The 2006 postneonatal (28 days to under 1 year)mortality rateof2.22was4percent lower than the2005 rate (2.32)butwasnotsignificantlydifferentfromthe2004rate(2.25)(2004and2005datanotshown).

The neonatal mortality rate for infants of non-Hispanic blackmothers(8.95)wasmorethantwicethoseforinfantsofAIAN(4.30),non-Hispanic white (3.64), API (3.18), Mexican (3.73), Central andSouth American (3.12), and Cuban women (3.60) (Figure4). TheneonatalmortalityrateforPuertoRicanwomen(5.44)wasthesecondhighest after that for non-Hispanic black women. Neonatal mortalityratesdidnotdeclinesignificantlyforanyraceorethnicgroupin2006from2005 (datanotshown).

Infantsofnon-Hispanicblack(4.40)andAIAN(3.98)mothershadthehighestpostneonatalmortalityratesofanygroupmorethantwicethatfornon-Hispanicwhitewomen(1.94)(Figure4).Thepostneonatalmortality rate forPuertoRicanwomen (2.57)was32percenthigherthanfornon-Hispanicwhitewomen.Incontrast,postneonatalmortalityratesforMexican(1.61),API(1.37),andCentralandSouthAmericanwomen(1.41)were1729percent lowerthanfornon-Hispanicwhitewomen (Figure4; TablesA and B). Postneonatal mortality ratesdeclined in 2006 from 2005 for non-Hispanic white (2.05 to 1.94,respectively)andMexican(1.75to1.61,respectively)women;ratesforother race and Hispanic origin groups were essentially unchanged(2005datanotshown).Periodofgestation

Thegestationalageofan infant isperhaps themost importantpredictor of his or her subsequent health and survival. Infants borntoosmalland toosoonhaveamuchgreaterriskofdeathandbothshort- andlong-termdisabilitythanthosebornatterm(3741weeksofgestation),andthepercentageofpretermbirthshasbeenlinkedtovariations in infant mortality rates betweencountries (1621). Infant

0

30

60

90

120

150

QuadrupletTripletTwinSingletonAllpluralities

Rateper1,0

00livebirths

6.86 5.87

27.92

69.63

146.48

Includes quintuplet and higher order births not shown separately.

SOURCE: CDC/NCHS, National Vital Statistics System.

Figure3. Infantmortalityrates,byplurality:UnitedStates,2006

0

2

4

6

8

10 Neonatal

Centraland

SouthAmerican

CubanMexicanAmericanIndian orAlaskaNative

TotalPuertoRican

NonHispanic

black

Rateper1,0

00livebirths

NonHispanic

white

Asian orPacific

Islander

Postneonatal

Includes persons of Hispanic and nonHispanic origin.


Difference between neonatal and postneonatal is not significant.

8.95

4.40

5.44

2.57

4.46

2.22

4.303.98

3.73

1.61

3.64

1.94

3.60

1.42

3.18

1.37

3.12

1.41

NS

Figure4.Neonatalandpostneonatalmortalityrates,byraceandethnicityofmother:UnitedStates,2006


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7NationalVitalStatisticsReports,Volume58,Number17,April30,2010mortality rates are highest for very preterm (less than 32 weeks)infants, and the risk decreases sharply with increasing gestationalage(1620).In2006,theinfantmortalityrateforverypreterminfants(175.94)was74timestherateof2.39forterminfants(TableE).Themortalityrateforinfantsbornat3233weeksofgestationwas16.19,nearlyseven times the rate for term infants.Althoughmortality fallswith increasinggestationalage,even infantsbornonlya fewweeksearly have a substantially increased risk of death when comparedwith term infants (2224). In 2006, the infant mortality rate for latepreterm infants (3436weeksofgestation)was7.08, 2.9 times therate for term infants. Even within the term period, infants born at3739 weeks of gestation had mortality rates that were 28percenthigher than those for infants born at 4041 weeks of gestation(Tables1and2).

Becauseof theirmuchgreaterriskofdeath, infantsbornatthelowest gestational ages have a large impact on overall U.S. infantmortality.Forexample, infantsbornverypretermaccounted foronly2percentofbirthsbutmorethanone-halfofallinfantdeaths(54percent)intheUnitedStatesin2006(TableE).Conversely,infantsbornat37weeksofgestationormoreaccountedfor87percentofbirthsbut32percentof infantdeaths.Afteraplateaufrom2000to2005,theinfantmortalityrateforverypreterminfantsdeclinedby4percentin2006from2005.In2006,theinfantmortalityrateforverypreterminfantswas175.94,comparedwith

183.24in2005and180.95in2000(TableE).Changesin2006from2005forotherspecificgestationalagecategorieswerenotstatisticallysignificant.

Therewerelargedifferencesinthepercentageofpretermbirthsby raceandethnicity,and thesedifferenceshavea large impactoninfantmortalityrates(15,25).In2006,thepercentageofpretermbirthsranged from10.9percentofbirths toAPImothersto18.5percentofbirthstonon-Hispanicblackmothers(Tables4and5).Thepercentageofpretermbirths in theUnitedStateshasbeen increasingsince themid-1980s(2).Aportionoftheincreaseisrelatedtoariseinmultiplebirths (in part due to growth in the use of assisted reproductivetechnologies),althoughthepercentageofpretermbirthshasalsorisenforsingletons(2).Changesinthemedicalmanagementofpregnancy(i.e.,increasesincesareansectionandinductionoflaborforpreterminfants)mayhavealsohadan impact(2,12,22,2628).

Somedifferencesoccurredingestationalage-specificinfantmortalityratesbyraceandethnicity(Tables1and2).Infantmortalityratesweresignificantlyhigherfornon-Hispanicblackthanfornon-Hispanicwhitemothersforthegestationalagecategorieslessthan32weeks,3436weeks,3741weeks,and42weeksormore.Whencomparedwithnon-Hispanicwhitemothers,infantmortalityrateswerehigherforAIANmothersat3436weeksand3741weeksofgestation,whileinfantmortalityrateswerehigherforPuertoRicanmothersatlessthan32weeksofgestation. Comparedwith non-Hispanicwhitemothers,

TableE. Infantmortalityrates,andpercentdistributionof livebirthsand infantdeaths,byperiodofgestation:UnitedStates,20002006 linked files

Preterm (less than37weeks)Very Late

All preterm preterm Term Post-termgestational Total (less than 3233 (3436 (3741 (42weeks

Year ages1 preterm 32weeks) weeks weeks) weeks) ormore)Infantmortality rate1

2006 . . . . . . . . . . . . . . . . . . . . . 6.68 35.15 175.94 16.19 7.08 2.39 2.802005 . . . . . . . . . . . . . . . . . . . . . 6.86 36.55 183.24 16.69 7.30 2.43 2.662004 . . . . . . . . . . . . . . . . . . . . . 6.78 36.56 182.47 16.06 7.32 2.39 2.872003 . . . . . . . . . . . . . . . . . . . . . 6.84 37.21 188.24 16.42 7.12 2.42 2.882002 . . . . . . . . . . . . . . . . . . . . . 6.95 37.86 186.39 17.63 7.66 2.48 3.072001 . . . . . . . . . . . . . . . . . . . . . 6.84 36.94 181.00 17.62 7.32 2.54 2.952000 . . . . . . . . . . . . . . . . . . . . . 6.89 37.88 180.95 17.37 7.96 2.59 2.91

Percentdistributionof infantdeaths22006 . . . . . . . . . . . . . . . . . . . . . 100.0 68.1 54.3 4.0 9.8 29.5 2.42005 . . . . . . . . . . . . . . . . . . . . . 100.0 68.6 54.9 3.9 9.8 29.1 2.32004 . . . . . . . . . . . . . . . . . . . . . 100.0 68.3 54.7 3.8 9.7 29.1 2.72003 . . . . . . . . . . . . . . . . . . . . . 100.0 68.1 55.0 3.8 9.3 29.2 2.72002 . . . . . . . . . . . . . . . . . . . . . 100.0 67.3 53.7 4.0 9.7 29.6 3.02001

. . . . . . . . . . . . . . . . . . . . .

100.0

66.1

52.8

3.8

9.0

30.9

3.0

2000 . . . . . . . . . . . . . . . . . . . . . 100.0 65.6 52.0 3.7 9.4 31.2 3.2

Percentdistributionof livebirths22006 . . . . . . . . . . . . . . . . . . . . . 100.0 12.8 2.0 1.6 9.1 81.5 5.72005 . . . . . . . . . . . . . . . . . . . . . 100.0 12.7 2.0 1.6 9.1 81.4 5.82004 . . . . . . . . . . . . . . . . . . . . . 100.0 12.5 2.0 1.6 8.9 81.3 6.22003 . . . . . . . . . . . . . . . . . . . . . 100.0 12.3 2.0 1.6 8.8 81.3 6.42002 . . . . . . . . . . . . . . . . . . . . . 100.0 12.1 2.0 1.5 8.6 81.2 6.72001 . . . . . . . . . . . . . . . . . . . . . 100.0 11.9 1.9 1.5 8.4 81.2 6.92000 . . . . . . . . . . . . . . . . . . . . . 100.0 11.6 1.9 1.5 8.1 81.1 7.31Infantmortalityratesaredeaths less than1yearper1,000 livebirths inspecifiedgroup.2Infantdeathsandbirthswithnotstatedgestationalagearesubtracted from the totalnumberofeventsusedasdenominators forpercentagecomputations.


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8 NationalVitalStatisticsReports,Volume58,Number17,April30,2010infantmortalityrates forAPImotherswere lowerat3436weeksofgestation; for Mexican mothers, infant mortality rates were lower at3741 weeks of gestation; and for Central and South Americanmothers,infantmortalityrateswereloweratbothlessthan32weeksand3741weeksofgestation.Birthweight

Birthweight is another important predictor of infant health. It iscloselyassociatedbutdoesnotexactlycorrespondwiththeperiodofgestation. Infant mortality rates are highest for the smallest infantsand decrease sharply as birthweight increases. In 2006, infantmortalityratesweremuchhigherforlowbirthweight(lessthan2,500grams) infants(55.38per1,000)thanfor infantswithbirthweightsof2,500 grams or more (2.24) (Table1). The infant mortality rate forvery low birthweight (less than 1,500 grams) infants was 240.44,more than 100 times the rate for infants with birthweights of 2,500grams ormore. When detailed birthweight categoriesareexamined(Table6), 85percent of infants with birthweights of less than 500grams(1 lb.1oz.or less)diedwithinthefirstyearof life.Reportingofdeathsamongtheseverysmallinfantsmaybeincomplete(29).Aninfants chances of survival increases rapidly with increasing birth-weight: Infant mortality rates were lowest at birthweights of3,0004,999grams.

Becauseoftheirmuchhighermortalityrates,infantsbornatthelowestbirthweightshaveasubstantialimpactonoverallinfantmortalityrates. For example, infants born weighing less than 1,000 gramsaccountedforonly0.7percentofbirthsbutnearlyone-halfofallinfantdeaths (48.0percent) in theUnitedStates in2006 (tabulardatanotshown).Conversely,91.7percentofinfantsbornintheUnitedStatesin2006weighed2,500gramsormore,buttheseinfantsaccountedforlessthanone-thirdofinfantdeaths(31.0percent).ThelargeraceandHispanic-originvariationsinthepercentageofbirthsatlowbirthweight(less than 2,500 grams)from 6.6percent for Mexican mothers to14.0percentfornon-Hispanicblackmothersmeanthatsomeraceorethnicgroupsaredisproportionatelyimpactedbythehighinfantmortality rates for lowbirthweight infants (Tables4and5).

From2000to2006,infantmortalityratesforthetotalpopulationdeclinedby10percentforinfantsweighing1,0001,249gramsandby814percentforinfantsweighing1,5003,999gramsatbirth(Table6).Changesforotherdetailedbirthweightcategorieswerenotstatisticallysignificant.

Fornon-Hispanicwhitewomen from2000 to2006,birthweightspecificinfantmortalityratesdeclinedforspecificbirthweightcategories(1,0001,249gramsand2,0003,499grams),whilefornon-HispanicblackandHispanicwomen,declinesweresignificant for infantswithbirthweights of 2,5003,999 grams. No significant changes for anydetailedbirthweightcategorywereobservedforAIANandAPIwomen.TheinfantmortalityratesforseveralraceandHispanicorigingroupsdeclined foroneorbothof thesummarycategories less than2,500gramsor2,500gramsormore(Table6).Prenatalcare

This report includes data on the timing of prenatal care basedonlyonthe12statesthathadimplementedthe2003RevisiontotheU.S.StandardCertificateofLiveBirthasofJanuary1,2005(2).The2003revisionof thebirthcertificate introducedsubstantivechanges

in item wording and to the sources of prenatal information (seeMethods and Technical Notes). Accordingly, prenatal care databasedon the2003and1989 revisionsarenotdirectlycomparable.Only ratesbasedon the2003 reviseddataareshown in thisreport(seeTableII, TechnicalNotes).

The timingandqualityofprenatalcare receivedby themotherduringpregnancy is important to the infantssubsequenthealthandsurvival (3033). Early comprehensive prenatal care can promotehealthierpregnanciesbyprovidinghealthbehavioradviceaswellasearlydetectionandtreatmentofriskfactorsandsymptoms(30,31).Theinitiationandsubsequentutilizationofprenatalcareisalsoviewedasan indicator foraccess tocare(33).Maternalage

Infantmortalityratesvarywithmaternalage:Infantsofteenagemothers(9.78)andmothersaged40yearsandover(8.01)havethehighestrates.Thelowestratesareforinfantsofmothersintheirlatetwentiesandearly thirties(Tables1and2).

In 2006, among births to teenagers, infants of the youngestmothers(under15years)hadthehighestmortalityrate(18.14).Therateforinfantsofmothersaged1517was10.42,a9-percentdecreasefrom2005(11.40);therateforinfantsofmothersaged1819was9.30in2006comparedwith9.60in2005(tabulardatanotshown);andtherateforinfantsofmothersaged2024decreased4percentfrom7.86in2005 to7.55 in2006.

Withinracialandethnicsubgroups,amonggroupsforwhichratescould be reliably computed, infant mortality rates for births to non-Hispanic white mothers under age 20 years were higher than formothersaged40andover.Incontrast,forMexicanmothers,ratesforbirths to the oldest women were higher than rates for infants ofteenagers.Maternaleducation

Information on educational attainment in this report is drawnfrom the 12 states that had implemented the 2003 U.S. StandardCertificateofLiveBirthasofJanuary1,2005(2).The formatof theeducation item on the 2003 revised birth certificate substantivelydiffers from that of the unrevised (1989) standard certificate (seeMethods and Technical Notes). Only rates based on the 2003revised data are shown in this report (see TableII, TechnicalNotes).

Infant mortality rates are known to decrease with increasingeducational levels, which may reflect socioeconomic differences;womenwithmoreeducationtendtohavehigherincomelevels(9,34).Livebirthorder

Infantmortalityratesweregenerallyhigherforfirstbirthsthanforsecondbirths,and thengenerally increasedasbirthorder increased(Tables1and2).Overall,theinfantmortalityrateforfirstbirths(6.69)was14percenthigherthanforsecondbirths(5.89).Therateforfifthandhigherorderbirths (10.13)was 72percenthigher than the rateforsecondbirths.Thehigherparitiesandthereforethehighest-orderbirths (fifth child and above) are more likely to be associated witholdermaternalage,multiple births,and lowersocioeconomic status(2,35).


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9NationalVitalStatisticsReports,Volume58,Number17,April30,2010Maritalstatus

Maritalstatusmaybeamarker for thepresenceorabsenceofsocial,emotional,andfinancialresources(36,37).Infantsofmotherswhoarenotmarriedhavebeenshown tobeathigher risk forpooroutcomes (38,39). In 2006, infants of unmarried mothers had aninfantmortalityrateof9.19per1,000,80percenthigherthantheratefor infants of married mothers (5.11) (Tables1 and 2). Within eachrace and Hispanic origin group, infants of unmarried mothers hadhigherratesofmortality,andwith theexceptionofAIANandCubaninfants, thesedifferencesweresignificant.Nativity

In 2006, the infant mortality rate for mothers born in the 50statesandtheDistrictofColumbia(7.03)was38percenthigherthantherateformothersbornelsewhere(5.09)(Figure5;Tables1and2).Among race and Hispanic origin groups for whom infant mortalityrates could be calculated, except for Puerto Rican, Cuban, andCentralandSouthAmericanmothers,mothersborn in the50statesand the District of Columbia had higher infant mortality rates thanmothersbornelsewhere(Tables1and2).

Avarietyofhypotheseshavebeenadvancedtoaccountforthelowerinfantmortalityrateamong infantsofmothersbornoutsidethe50statesandtheDistrictofColumbia, includingpossibledifferencesinmigrationselectivity,socialsupport,andriskbehaviors(40,41).Also,womenbornoutsidethe50statesandtheDistrictofColumbiahave

been shown to have different characteristics than their U.S.-borncounterpartswithregardtosocioeconomicandeducationalstatus(42).Maternalsmoking

Informationonsmokingduringpregnancyinthisreportisbasedonthe2003revisionofthebirthcertificate,whichdifferssubstantivelyfrom that of the unrevised (1989) standard certificate (2). For the2006linkedfile,reviseddataareavailablefor11ofthe12statesthatrevised their certificates as of January 1, 2005; Florida revised thecertificate but had a noncomparable question (see Methods andTechnical Notes). Only rates based on the 2003 revised data areshown in thisreport(seeTableII, TechnicalNotes).

Tobaccouseduringpregnancycausesthepassageofsubstancessuchasnicotine,hydrogencyanide,andcarbonmonoxide from theplacenta into the fetal blood supply. These substances restrict thegrowinginfantsaccesstooxygenandcanleadtoadversepregnancyandbirthoutcomessuchas lowbirthweight,pretermdelivery, intrauterine growth retardation, and infant mortality (43,44). Maternalsmoking has also been shown to increase the risk of respiratoryinfectionsand inhibitallergic immune responses in infants (45,46).Leadingcausesof infantdeath

Infantmortality rates for the five leadingcausesof infantdeatharepresented inTable7byraceandHispanicoriginofmother.Theleading cause of infant death in the United States in 2006 was

0

3

6

9

12

15 Born in the U.S.

Centraland

SouthAmerican

CubanMexicanAmericanIndian orAlaskaNative

TotalPuertoRican

NonHispanic

black

Rateper1,0

00livebirths

NonHispanic

white

Asian orPacific

Islander

Born elsewhere

13.54

10.01

8.35

NA

7.56

8.70

7.03

5.09

5.92

4.985.59

4.04

5.76

4.19

5.304.76

4.994.43

NS

NSNS

Includes persons of Hispanic and nonHispanic origin.


Difference between born in the U.S. and born elsewhere is not significant.Not applicable, for mothers born elsewhere there are fewer than 20 infant deaths.

Figure5. Infantmortalityrates,bymothersplaceofbirthandraceandethnicityofmother:UnitedStates,2006


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10 NationalVitalStatisticsReports,Volume58,Number17,April30,2010Congenitalmalformations,deformationsandchromosomalabnormalities(congenitalmalformations),accountingfor21percentofallinfantdeaths.Disordersrelatingtoshortgestationand lowbirthweight,notelsewhere classified (low birthweight) was second, accounting for17percent of all infant deaths, followed by Sudden infant deathsyndrome (SIDS) at 8percent of infant deaths. The fourth and fifthleading causesNewborn affected by maternal complications ofpregnancy (maternalcomplications), followedbyAccidents (unintentional injuries)accounted for 6percent and4percent, respectively,of all infant deaths in 2006. Together the five leading causesaccounted for56percentofall infantdeaths in theUnitedStates in2006.Theorderof the top four leadingcauseswas thesameas in2005. The fifth leading cause of death in 2006 was unintentionalinjuries, which was ranked sixth in 2005. Newborn affected bycomplicationsofplacenta,cordandmembranes(cordcomplications)was fifth in2005butdropped tosixth in2006. Infantmortality ratesfor the five leadingcausesdidnotchangesignificantly in2006 from2005,exceptformaternalcomplications,whichdeclinedby8percentin2006 fromayearearlier(2005datanotshown).

In2006,therankorderofleadingcausesof infantdeathvariedsubstantially by race and Hispanic origin of the mother. Congenitalmalformations was the leading cause of infant death for all groupsexceptfornon-HispanicblackandPuertoRicanwomen,forwhomlowbirthweightwas the leadingcause.

When differences between cause-specific infant mortality rateswereexaminedbyraceandethnicity,infantmortalityratesfromCongenitalmalformationswere38percenthigher fornon-Hispanicblackand20percenthigherforMexicanthanfornon-Hispanicwhitewomen.InfantmortalityratesfromCongenitalmalformationswere14percentlower forAPI than fornon-Hispanicwhitewomen.

Infantsofnon-Hispanicblackmothershad thehighestmortalityratesfromlowbirthweight.Theratefornon-Hispanicblackmotherswasnearlyfourtimestheratefornon-Hispanicwhitemothers.TherateforPuertoRicanmotherswasmorethantwicetheratefornon-Hispanicwhitemothers.

SIDS rates were highest for AIAN and non-Hispanic blackmothers2.1 and 1.9 times those for non-Hispanic white mothers,respectively. As most SIDS deaths occur during the postneonatalperiod,thehighSIDSratesforinfantsofnon-HispanicblackandAIANmothers accounted for much of their elevated risk of postneonatalmortality.Comparedwithnon-Hispanicwhitemothers,SIDSrateswere54percent lower for Mexican mothers, 59percent lower for APImothers, and 73percent lower for Central and South Americanmothers.

Formaternalcomplications(e.g., incompetentcervix,prematureruptureofmembranes,andmultiplepregnancy,amongothers),infantsof non-Hispanic black mothers had the highest mortality rates2.8times those fornon-Hispanicwhitemothers.Rates forPuertoRicanmotherswere74percenthigherthanfornon-Hispanicwhitemothers.Infantsofnon-HispanicblackandPuertoRicanwomenhaveamuchhigherpercentageoflowbirthweight(Tables4and5),whichmayhelptoexplain theirhigher infantmortality rates frommaternalcomplications, as this cause occurs predominantly among low birthweightinfants.Infantmortalityratesfrommaternalcomplicationswere26percentlowerforAPIand52percentlowerforCentralandSouthAmericanwomen than fornon-Hispanicwhitewomen.

ForAIANwomen,infantmortalityratesfromunintentionalinjurieswere triple those for non-Hispanic white women. For non-Hispanicblackwomen,ratesfromunintentional injuriesweredoublethosefornon-Hispanic white women. Infant mortality rates from unintentionalinjurieswere47percentlowerforMexicanand50percentlowerforAPIwomen than fornon-Hispanicwhitewomen.

An examination of cause-specific differences in infant mortalityratesamongraceandHispanicorigingroupscanhelpinunderstandingoveralldifferences in infantmortality ratesamong thesegroups.Forexample, 29percent of the elevated infant mortality rate for non-Hispanic black mothers, when compared with non-Hispanic whitemothers,canbeaccountedforbytheirhigherratefromlowbirthweight,and7percentbydifferencesinmaternalcomplications.Inotherwords,ifnon-Hispanicblackinfantmortalityratesforthesetwocausescouldbereducedtothelevelsfornon-Hispanicwhiteinfants,thedifferencein the infant mortality rate between non-Hispanic black and non-Hispanicwhitemotherswouldbereducedby36percent.

ForAIAN mothers, 24percent of their elevated infant mortalityrate, when compared with non-Hispanic white mothers, can beaccountedforbytheirhigherSIDSrateand19percentbydifferencesinunintentional injuries.Thus, ifAIAN infantmortalityrates forthesetwocausescouldbereducedtonon-Hispanicwhitelevels,thedifferenceintheinfantmortalityratebetweenAIANandnon-Hispanicwhitemotherswouldbe reducedby43percent.

Similarly,37percentofthedifferencebetweenPuertoRicanandnon-Hispanic white infant mortality rates can be accounted for bydifferencesinlowbirthweightand10percentbydifferencesinmaternalcomplications. Thus, if Puerto Rican infant mortality from these twocausescouldbereducedtonon-Hispanicwhitelevels,thedifferencein the infant mortality rate between Puerto Rican and non-Hispanicwhite infantswouldbereducedby47percent.Preterm-relatedcausesofdeath

In order to more fully assess the impact of preterm birth oninfant mortality, CDC researchers have developed a grouping ofpreterm-related causes of death. A cause of death is consideredpreterm related if75percentormore of infantswhose deathswereattributedtothatcausewerebornatlessthan37weeksofgestation,and the cause of death was a direct consequence of preterm birthbasedonaclinicalevaluationand reviewof the literature(47,48).

Thisgroupingwasdevelopedbecause it isdifficult,using traditionalanalysesof the leadingcausesof infantdeath, toassess theoverall impactofpreterm-related infantdeathson infantmortality. Inparticular,thecategoryofDisordersrelatedtoshortgestationandlowbirthweight, not elsewhere classified, includes the phrase not elsewhere classified, indicating that many other preterm-related infantdeathsareclassified toothercause-of-deathcategories.

The comprehensive list of preterm-related cause-of-death categories(ICD10codes)isshownintheTable8footnote.Notethateventhis more comprehensive listing probably underestimates the totalimpactofpreterm-related infantdeath,assomecause-of-deathcategories(notablythosebeginningwiththewordsotherandallother)hadahighpercentageofpreterm infantdeathsbut lackedsufficientspecificitytobeabletoestablishtheetiologicconnectiontoprematuritywithanydegreeofcertainty.


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NationalVitalStatisticsReports,Volume58,Number17,April30,2010 11Table8shows trends inpreterm-related infantmortalityby race

andHispanicoriginofmotherfrom2000to2006.Ofthetotal28,509infantdeathsintheUnitedStatesin2006,10,303werepretermrelated.In 2006, 36.1percentofall infantdeaths in the United Stateswerepreterm related, slightly lower than in 2005 (36.5percent), but still4percenthigher than in2000 (34.6percent).

The impactofpreterm-related infantdeathsvariedconsiderablybymaternalraceandethnicity.In2006,45percentofinfantdeathstonon-Hispanicblackwomenand41percentofinfantdeathstoPuertoRicanwomenwereduetopreterm-relatedcauses,whilepercentagesweresomewhat lower forother raceandethnicgroups (Table8).

Preterm-relatedinfantmortalityratesvariedconsiderablybyraceand ethnicity of the mother (Figure6 and Table8). Preterm-relatedinfant mortality rates were 3.4 times higher for non-Hispanic black(6.01)thanfornon-Hispanicwhitemothers(1.79).Infact,in2006thepreterm-related infant mortality rate for non-Hispanic black motherswashigherthanthetotalinfantmortalityratefornon-Hispanicwhite,Mexican,CentralandSouthAmerican,andAPIwomen.ThepretermrelatedinfantmortalityrateforPuertoRicanwomen(3.30)was84percenthigherthanfornon-Hispanicwhitewomen.Preterm-relatedinfantmortalityratesforAPI(1.49)andCentralandSouthAmerican(1.52)womenweresignificantly lower than fornon-Hispanicwhitewomen.Changes inpreterm-related infantmortality rates in2006 from2005were not statistically significant except for API women, who had a14percentdecline inpreterm-related infantmortality.

Aswiththeleadingcausesofdeath,itispossibletocomputethecontributionofpreterm-related infantmortality toraceandethnicdifferences in infant mortality rates.Thus,54percent of the difference

betweenthenon-Hispanicblackandnon-Hispanicwhiteinfantmortalityrates isduetopreterm-relatedcauses.Ifpreterm-related infantmortalityfornon-Hispanicblackwomencouldbereducedtonon-Hispanicwhite levels, thedifference in the infantmortality ratebetweennon-Hispanicblackandnon-Hispanicwhitemotherswouldbereducedby54percent.

Similarly,forPuertoRicanwomen,62percentofthedifferenceininfantmortalityratescomparedwithnon-Hispanicwhitewomenisdueto differences in preterm-related causes of death, and reducingpreterm-relatedinfantmortalityforPuertoRicanwomentothelevelsfor non-Hispanic white women would lower the difference in ratesbetweenthetwogroupsbythesamepercentage.Inadditiontohelpingtoexplaindifferencesininfantmortalityratesbetweenvariousgroups,comparisons such as these can be helpful in targeting preventionefforts.

References1. National Center for Health Statistics. Public-use data file documenta

tion:2006period linkedbirth/infantdeathdataset [online].Hyattsville,MD.Available from:http://www.cdc.gov/nchs/data_access/VitalStatsOnline.htm.

2. MartinJA,HamiltonBE,SuttonPD,etal.Births:Finaldata for2006.Nationalvital statistics reports;vol57 no 7. Hyattsville, MD: NationalCenter forHealthStatistics.2009.

3. Heron M, Hoyert DL, Murphy SL, et al. Deaths: Final data for 2006.Nationalvitalstatisticsreports;vol57no14.Hyattsville,MD:NationalCenter forHealthStatistics.2009.

0

3

6

9

12

15 Total

Centraland

SouthAmerican

MexicanAmericanIndian orAlaskaNative

TotalPuertoRican

NonHispanic

black

Rateper1,0

00livebirths

NonHispanic

white

Asian orPacific

Islander

Pretermrelated

13.35

6.01

8.28

2.10

8.01

3.30

6.68

2.42

5.58

1.79

5.34

1.71

4.55

1.49

4.52

1.52

Preterm-related deaths are those where the infant was born preterm (before 37 completed weeks of gestation) with the underlying cause of death assigned to one of the following

International Classification of Diseases, Tenth Revision catagories: K550, P000, P010, P011, P015, P020, P021, P027, P070P073, P102, P220P229, P250P279, P280, P281, P360P369,

P520P523, and P77; see Technical Notes.

Includes persons of Hispanic and Non-Hispanic origin.


Figure6.Totalandpreterm-related infantmortalityrates,byraceandethnicityofmother:UnitedStates,2006
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ListofDetailedTables1. Infant mortality rates, live births, and infant deaths, by selected

characteristics and race of mother: United States, 2006 linkedfile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

2. Infant mortality rates, live births, and infant deaths, by selectedcharacteristics and Hispanic origin of mother and by race ofmother for mothers of non-Hispanic origin: United States, 2006l inked file . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

3. Infant mortality rates, by race and Hispanic origin of mother:United States and each state, Puerto Rico, Virgin Islands, andGuam, 20042006 linked files . . . . . . . . . . . . . . . . . . . . . . . 20

4. Percentage of live births with selected maternal and infantcharacteristics, by race of mother: United States, 2006 linkedfile . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

5.

Percentage

of

live

births

with

selected

maternal

and

infant

characteristics,byHispanicorigin ofmotherand raceofmotherfor mothers of non-Hispanic origin: United States, 2006 linkedfile. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

6. Live births and infant, neonatal, and postneonatal deaths andmortality rates, by race and Hispanic origin of mother andbirthweight:UnitedStates,2006linkedfile,andpercentchangeinbirthweight-specific infantmortality,20002006 linked files. . . . . 22

7. Infant deaths and mortality rates for the five leading causes ofinfantdeath,byraceandHispanicoriginofmother:UnitedStates,2006 linked file . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

8. Number and percent of preterm-related infant deaths andpreterm-related infantmortalityrates,byraceandHispanicoriginofmother:UnitedStates,20002006 linked files. ... . ... . .. 26
http://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.cdc.gov/nchs/nvss/vital_certificate_revisions.htmhttp://www.cdc.gov/nchs/data/dvs/panelreport_acc.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.whitehouse.gov/omb/rewrite/fedreg/ombdir15.htmlhttp://www.naphsis.org/index.asp?downloadid=75http://www.cdc.gov/nchs/data/dvs/Record_Layout_2006.pdfhttp://www.cdc.gov/nchs/nvss/mortality/comparability_icd.htmhttp://www.cdc.gov/nchs/nvss/vital_certificate_revisions.htmhttp://www.cdc.gov/nchs/data/dvs/panelreport_acc.pdfhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdfhttp://www.whitehouse.gov/omb/rewrite/fedreg/ombdir15.htmlhttp://www.naphsis.org/index.asp?downloadid=75http://www.cdc.gov/nchs/data/dvs/Record_Layout_2006.pdfhttp://www.cdc.gov/nchs/nvss/mortality/comparability_icd.htmhttp://www.cdc.gov/nchs/data/TechApp03_1-09.pdf


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14 NationalVitalStatisticsReports,Volume58,Number17,April30,2010Table1. Infantmortalityrates, livebirths,and infantdeaths,byselectedcharacteristicsandraceofmother:UnitedStates,2006 linked file

RaceofmotherAmerican

All Indianor AsianorCharacteristic races White Black AlaskaNative Pacific Islander

Infantmortalityratesper1,000 livebirths inspecifiedgroupTotal . . . . . . . . . . . . . . . . . . . . . . . . . . 6.68 5.57 12.90 8.28 4.55

AgeatdeathTotal neonatal. . . . . . . . . . . . . . . . . . . . . 4.46 3.71 8.67 4.30 3.18

Earlyneonatal (less than7days). . . . . . . . 3.55 2.95 6.93 3.29 2.56Lateneonatal(727days). . . . . . . . . . . . 0.91 0.77 1.74 1.03 0.63

Postneonatal . . . . . . . . . . . . . . . . . . . . . 2.22 1.85 4.23 3.98 1.37Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . 7.31 6.12 13.91 9.54 5.09Female. . . . . . . . . . . . . . . . . . . . . . . . . 6.02 4.98 11.84 6.96 3.98

PluralitySingle births. . . . . . . . . . . . . . . . . . . . . . 5.87 4.87 11.39 7.84 3.96Plural births . . . . . . . . . . . . . . . . . . . . . 30.07 25.57 52.18 26.38 24.32

BirthweightLess than 2,500 grams . . . . . . . . . . . . . . . 55.38 50.10 72.95 54.71 38.55

Less than1,500grams. . . . . . . . . . . . . . 240.44 228.21 269.15 227.56 206.821,5002,499grams . . . . . . . . . . . . . . . . 14.11 13.95 15.09 18.81 11.04

2,500 grams or more . . . . . . . . . . . . . . . . 2.24 2.06 3.33 4.49 1.50Periodofgestation

Less than32weeks . . . . . . . . . . . . . . . . . 175.94 162.26 208.41 139.88 160.223233 weeks . . . . . . . . . . . . . . . . . . . . . 16.19 15.83 17.11 * 16.913436 weeks . . . . . . . . . . . . . . . . . . . . . 7.08 6.61 9.11 9.69 5.273741 weeks . . . . . . . . . . . . . . . . . . . . . 2.39 2.17 3.68 4.85 1.65

3739 weeks . . . . . . . . . . . . . . . . . . . 2.58 2.34 3.96 4.79 1.744041 weeks . . . . . . . . . . . . . . . . . . . 2.02 1.84 3.06 5.05 1.46

42 weeks or more . . . . . . . . . . . . . . . . . . 2.80 2.65 3.83 * 2.09Ageofmother

Under 20 years. . . . . . . . . . . . . . . . . . . . 9.78 8.30 13.94 8.83 9.512024 years. . . . . . . . . . . . . . . . . . . . . . 7.55 6.26 12.72 8.45 5.402529 years. . . . . . . . . . . . . . . . . . . . . . 5.95 4.99 11.94 8.28 4.093034 years. . . . . . . . . . . . . . . . . . . . . . 5.32 4.46 12.96 7.67 3.393539 years. . . . . . . . . . . . . . . . . . . . . . 6.09 5.14 13.73 6.68 5.284054 years. . . . . . . . . . . . . . . . . . . . . . 8.01 6.92 14.88 * 7.80

Livebirthorder1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.69 5.61 13.15 7.82 4.252 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.89 5.08 11.14 6.87 4.213 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6.39 5.24 12.33 7.79 5.004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7.78 6.30 13.80 10.61 7.025 or more . . . . . . . . . . . . . . . . . . . . . . . 10.13 7.88 16.97 12.86 7.57

MaritalstatusMarried . . . . . . . . . . . . . . . . . . . . . . . . 5.11 4.68 10.71 7.28 4.17Unmarried . . . . . . . . . . . . . . . . . . . . . . .

9.19

7.33

13.82

8.82

6.48

Mothersplaceofbirth

Born in the50statesandD.C. . . . . . . . . . . 7.03 5.66 13.36 8.35 5.76Born elsewhere. . . . . . . . . . . . . . . . . . . . 5.09 4.82 8.65 * 4.19See footnotesatendof table.


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NationalVitalStatisticsReports,Volume58,Number17,April30,2010 15Table1. InfantUnitedStates, mortalityrates, livebirths,2006 linked fileCon. and infantdeaths,byselectedcharacteristicsandraceofmother:

Characteristic Allraces

Raceofmother

White BlackAmericanIndianor

AlaskaNative AsianorPacific Islander

Total . . . . . . . . . . . . . . . . . . . . . . . . . . Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . Female . . . . . . . . . . . . . . . . . . . . . . . .

PluralitySinglebirths . . . . . . . . . . . . . . . . . . . . . Plural births . . . . . . . . . . . . . . . . . . . . . .

BirthweightLess than2,500grams . . . . . . . . . . . . . . .

Less than1,500grams . . . . . . . . . . . . . 1,5002,499grams . . . . . . . . . . . . . . . .

2,500gramsormore . . . . . . . . . . . . . . . . Not stated . . . . . . . . . . . . . . . . . . . . . .

PeriodofgestationLess than 32 weeks . . . . . . . . . . . . . . . . 3233 weeks . . . . . . . . . . . . . . . . . . . . . 3436 weeks . . . . . . . . . . . . . . . . . . . . . 3741 weeks . . . . . . . . . . . . . . . . . . . . .

3739weeks . . . . . . . . . . . . . . . . . . . 4041 weeks . . . . . . . . . . . . . . . . . . .

42 weeks or more . . . . . . . . . . . . . . . . . Not stated . . . . . . . . . . . . . . . . . . . . . .

AgeofmotherUnder 20 years . . . . . . . . . . . . . . . . . . . 2024 years . . . . . . . . . . . . . . . . . . . . . 2529 years . . . . . . . . . . . . . . . . . . . . . 3034 years . . . . . . . . . . . . . . . . . . . . . 3539 years

. . . . . . . . . . . . . . . . . . . . .

4054 years . . . . . . . . . . . . . . . . . . . . .

Livebirthorder1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 or more . . . . . . . . . . . . . . . . . . . . . . Not stated . . . . . . . . . . . . . . . . . . . . . .

MaritalstatusMarried . . . . . . . . . . . . . . . . . . . . . . . . Unmarried . . . . . . . . . . . . . . . . . . . . . .

MothersplaceofbirthBorn

in

the

50

states

and

D.C.

. . . . . . . . . .

Bornelsewhere . . . . . . . . . . . . . . . . . . . Not stated . . . . . . . . . . . . . . . . . . . . . . See footnotesatendof table.

4,265,5932,184,2602,081,333

4,121,964143,629

353,46064,456

289,0043,911,038

1,095

86,54768,579

387,7913,456,4242,303,0211,153,403

240,58925,663

441,8341,080,4511,181,909

950,267498,620

112,512

1,697,0001,354,418

716,673288,771185,022

23,709

2,623,6231,641,970

3,191,345

1,058,70715,541

3,310,3311,695,8861,614,445

3,199,491110,840

239,31040,366

198,9443,070,169

852

55,75648,264

285,8392,709,3291,792,662

916,667190,709

20,434

311,948818,260935,936756,478399,118

88,591

1,312,3471,067,145

563,322220,968131,031

15,518

2,206,7671,103,564

2,545,857

755,7138,761

Live666,494339,844326,650

641,86924,625

90,94020,71070,230

575,385169

26,29416,12977,746

508,501349,822158,679

34,9592,865

113,616213,884166,862104,123

53,964

14,045

257,537189,937115,040

53,64043,480

6,860

198,596467,898

555,151

105,6525,691

births47,72024,30823,412

46,5451,175

3,601624

2,97744,111

8

1,008874

4,84837,29224,41012,882

3,451247

8,38516,44712,197

6,7803,143

768

16,75412,947

8,7254,6184,431

245

16,89230,828

44,659

2,952109

241,048124,222116,826

234,0596,989

19,6092,756

16,853221,373

66

3,4893,312

19,358201,302136,127

65,17511,470

2,117

7,88531,86066,91482,88642,395

9,108

110,36284,38929,586

9,5456,0801,086

201,36839,680

45,678

194,390980


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16 NationalVitalStatisticsReports,Volume58,Number17,April30,2010Table1. Infantmortalityrates, livebirths,and infantdeaths,byselectedcharacteristicsandraceofmother:UnitedStates,2006 linked fileCon.

RaceofmotherAmerican

All Indianor AsianorCharacteristic races White Black AlaskaNative Pacific Islander

InfantdeathsTotal . . . . . . . . . . . . . . . . . . . . . . . . . . 28,509 18,422 8,595 395 1,097

AgeatdeathTotalneonatal . . . . . . . . . . . . . . . . . . . . 19,041 12,292 5,778 205 766

Earlyneonatal (less than7days) . . . . . . . 15,148 9,760 4,616 157 616Lateneonatal (727days) . . . . . . . . . . . 3,893 2,533 1,161 49 151

Postneonatal . . . . . . . . . . . . . . . . . . . . . 9,468 6,130 2,818 190 331Sex

Male . . . . . . . . . . . . . . . . . . . . . . . . . . 15,973 10,384 4,726 232 632Female . . . . . . . . . . . . . . . . . . . . . . . . 12,536 8,039 3,869 163 465

PluralitySinglebirths . . . . . . . . . . . . . . . . . . . . . 24,190 15,588 7,310 365 927Pluralbirths. . . . . . . . . . . . . . . . . . . . . . 4,319 2,834 1,285 31 170

BirthweightLess than2,500grams . . . . . . . . . . . . . . . 19,576 11,989 6,634 197 756

Less than1,500grams . . . . . . . . . . . . . 15,498 9,212 5,574 142 5701,5002,499grams . . . . . . . . . . . . . . . . 4,078 2,776 1,060 56 186

2,500gramsormore . . . . . . . . . . . . . . . . 8,779 6,331 1,918 198 333Notstated . . . . . . . . . . . . . . . . . . . . . . 154 103 44 8

PeriodofgestationLess than32weeks . . . . . . . . . . . . . . . . 15,227 9,047 5,480 141 5593233weeks . . . . . . . . . . . . . . . . . . . . . 1,110 764 276 14 56 3436weeks . . . . . . . . . . . . . . . . . . . . . 2,746 1,890 708 47 1023741weeks . . . . . . . . . . . . . . . . . . . . . 8,272 5,888 1,871 181 332

3739weeks . . . . . . . . . . . . . . . . . . . 5,937 4,198 1,385 117 2374041weeks . . . . . . . . . . . . . . . . . . . 2,335 1,690 485 65 95

42weeksormore . . . . . . . . . . . . . . . . . 674 505 134 11 24 Notstated . . . . . . . . . . . . . . . . . . . . . . 481 329 127 1 24

AgeofmotherUnder20years . . . . . . . . . . . . . . . . . . . 4,320 2,588 1,584 74 752024years . . . . . . . . . . . . . . . . . . . . . 8,156 5,124 2,721 139 1722529years . . . . . . . . . . . . . . . . . . . . . 7,036 4,669 1,992 101 2743034years . . . . . . . . . . . . . . . . . . . . . 5,058 3,376 1,349 52 2813539years . . . . . . . . . . . . . . . . . . . . . 3,039 2,053 741 21 2244054years . . . . . . . . . . . . . . . . . . . . . 901 613 209 8 71

Livebirthorder1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11,345 7,359 3,387 131 4692 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7,977 5,417 2,116 89 3553 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4,583 2,949 1,418 68 1484 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2,248 1,393 740 49 675 or more . . . . . . . . . . . . . . . . . . . . . . 1,874 1,033 738 57 46Notstated . . . . . . . . . . . . . . . . . . . . . . 482 271 197 2 12

MaritalstatusMarried . . . . . . . . . . . . . . . . . . . . . . . . 13,419 10,330 2,127 123

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