Last data update: Jan 27, 2025. (Total: 48650 publications since 2009)
Records 1-15 (of 15 Records) |
Query Trace: Macdorman MF[original query] |
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Behind international rankings of infant mortality: how the United States compares with Europe
MacDorman MF , Mathews TJ . NCHS Data Brief 2009 (23) 1-8 Infant mortality is an important indicator of the health of a nation, and the recent stagnation (since 2000) in the U.S. infant mortality rate has generated concern among researchers and policy makers. The percentage of preterm births in the United States has risen 36% since 1984 (1). In this report we compare infant mortality rates between the United States and Europe. We also compare two factors that determine the infant mortality rate-gestational age-specific infant mortality rates and the percentage of preterm births. U.S. data are from the Linked Birth/Infant Death Data Set (2,3), and European data for 2004 are from the recently published European Perinatal Health Report (4). We also examine requirements for reporting a live birth among countries to assess the possible effect of reporting differences on infant mortality data. |
Explaining the recent decrease in US infant mortality rate, 2007-2013
Callaghan WM , Macdorman MF , Shapiro-Mendoza CK , Barfield WD . Am J Obstet Gynecol 2016 216 (1) 73 e1-73 e8 BACKGROUND: The U.S. infant mortality rate has been steadily decreasing in recent years as has the preterm birth rate; preterm birth is a major factor associated with death during the first year of life. The degree to which changes in gestational age-specific mortality and changes in the distribution of births by gestational age have contributed to the decrease in the infant mortality rate requires clarification. OBJECTIVES: To better understand the major contributors to the 2007-2013 infant mortality decline for the total population, and for infants born to non-Hispanic black, non-Hispanic white, and Hispanic women. STUDY DESIGN: We identified births and infant deaths from 2007 and 2013 Centers for Disease Control and Prevention National Vital Statistics System's period linked birth and infant death files. We included all deaths and births for which there was a reported gestational age at birth on the birth certificate of 22 weeks or greater. The decrease in the infant mortality rate was disaggregated such that all of the change could be attributed to improvements in gestational age-specific infant mortality rates and changes in the distribution of gestational age, by week of gestation, using the Kitagawa method. Sensitivity analyses were performed to account for records where obstetric estimate of gestational age was missing and for deaths and births less than 22 weeks gestation. Maternal race and ethnicity information was obtained from the birth certificate. RESULTS: The infant mortality rates after exclusions were 5.72 and 4.92 per 1000 live births for 2007 and 2013 respectively with an absolute difference of -0.80 (14% decrease). Infant mortality rates declined by 11% for non-Hispanic whites, by 19% for non-Hispanic blacks, and by 14% for Hispanics during the period. Compared to 2007, the proportion of births in each gestational age category was lower in 2013 with the exception of 39 weeks where there was an increase in the proportion of births from 30.1 percent in 2007 to 37.5 percent in 2013. Gestational age-specific mortality decreased for each gestational age category between 2007 and 2013 except 33 weeks and >42 weeks. About 31 percent of the decrease in the US infant mortality rate from 2007-2013 was due to changes in the gestational age distribution, and 69 percent was due to improvements in gestational age-specific survival. Improvements in the gestational age distribution from 2007-2013 benefitted infants of non-Hispanic white women (48%) the most, followed by infants of non-Hispanic black (31%) and Hispanic (17%) women. CONCLUSIONS: Infant mortality improved between 2007 and 2013 as a result of both improvements in the distribution of gestational age at birth and improvements in survival after birth. The differential contribution of improvements in the gestational age distribution at birth by race and ethnicity suggests that preconception and antenatal health and health care aimed at preventing or delaying preterm birth may not be reaching all populations. |
Annual summary of vital statistics: 2012-2013
Osterman MJ , Kochanek KD , MacDorman MF , Strobino DM , Guyer B . Pediatrics 2015 135 (6) 1115-25 The number of births in the United States declined by 1% between 2012 and 2013, to a total of 3 932 181. The general fertility rate also declined 1% to 62.5 births per 1000 women, the lowest rate ever reported. The total fertility rate was down by 1% in 2013 (to 1857.5 births per 1000 women). The teenage birth rate fell to another historic low in 2013, 26.5 births per 1000 women. Birth rates also declined for women 20 to 29 years, but the rates rose for women 30 to 39 and were unchanged for women 40 to 44. The percentage of all births that were to unmarried women declined slightly to 40.6% in 2013, from 40.7% in 2012. In 2013, the cesarean delivery rate declined to 32.7% from 32.8% for 2012. The preterm birth rate declined for the seventh straight year in 2013 to 11.39%; the low birth weight (LBW) rate was essentially unchanged at 8.02%. The infant mortality rate was 5.96 infant deaths per 1000 live births in 2013, down 13% from 2005 (6.86). The age-adjusted death rate for 2013 was 7.3 deaths per 1000 population, unchanged from 2012. Crude death rates for children aged 1 to 19 years declined to 24.0 per 100 000 population in 2013, from 24.8 in 2012. Unintentional injuries and suicide were, respectively, the first and second leading causes of death in this age group. These 2 causes of death jointly accounted for 45.7% of all deaths to children and adolescents in 2013. |
American Indian and Alaska Native infant and pediatric mortality, United States, 1999-2009
Wong CA , Gachupin FC , Holman RC , Macdorman MF , Cheek JE , Holve S , Singleton RJ . Am J Public Health 2014 104 Suppl 3 S320-8 OBJECTIVES: We described American Indian/Alaska Native (AI/AN) infant and pediatric death rates and leading causes of death. METHODS: We adjusted National Vital Statistics System mortality data for AI/AN racial misclassification by linkage with Indian Health Service (IHS) registration records. We determined average annual death rates and leading causes of death for 1999 to 2009 for AI/AN versus White infants and children. We limited the analysis to IHS Contract Health Service Delivery Area counties. RESULTS: The AI/AN infant death rate was 914 (rate ratio [RR] = 1.61; 95% confidence interval [CI] = 1.55, 1.67). Sudden infant death syndrome, unintentional injuries, and influenza or pneumonia were more common in AI/AN versus White infants. The overall AI/AN pediatric death rates were 69.6 for ages 1 to 4 years (RR = 2.56; 95% CI = 2.38, 2.75), 28.9 for ages 5 to 9 years (RR = 2.12; 95% CI = 1.92, 2.34), 37.3 for ages 10 to 14 years (RR = 2.22; 95% CI = 2.04, 2.40), and 158.4 for ages 15 to 19 years (RR = 2.71; 95% CI = 2.60, 2.82). Unintentional injuries and suicide occurred at higher rates among AI/AN youths versus White youths. CONCLUSIONS: Death rates for AI/AN infants and children were higher than for Whites, with regional disparities. Several leading causes of death in the AI/AN pediatric population are potentially preventable. |
Infant deaths - United States, 2005-2008
MacDorman MF , Mathews TJ . MMWR Suppl 2013 62 (3) 171-5 Infant mortality rates are associated with maternal health, quality of and access to medical care, socioeconomic conditions, and public health practices, which makes infant mortality an increasingly important public health concern. After large declines throughout the twentieth century, the U.S. infant mortality rate did not decline significantly during 2000-2005. Analysis of 2000-2004 infant mortality in the United States indicated considerable disparities by race and Hispanic origin. Race and ethnic disparities in U.S. infant mortality have been apparent since vital statistics data began to be collected more than 100 years ago. These disparities have persisted over time, and research indicates that not all groups have benefited equally from social and medical advances. |
Trends and characteristics of home vaginal birth after cesarean delivery in the United States and selected states
MacDorman MF , Declercq E , Mathews TJ , Stotland N . Obstet Gynecol 2012 119 (4) 737-44 OBJECTIVE: To examine trends and characteristics of home vaginal birth after cesarean delivery (VBAC) in the United States and selected states from 1990-2008. METHODS: Birth certificate data were used to track trends in home and hospital VBACs from 1990-2008. Data on planned home VBAC were analyzed by sociodemographic and medical characteristics for the 25 states reporting this information in 2008 and compared with hospital VBAC data. RESULTS: In 2008, there were approximately 42,000 hospital VBACs and approximately 1,000 home VBACs in the United States, up from 664 in 2003 and 656 in 1990. The percentage of home births that were VBACs increased from less than 1% in 1996 to 4% in 2008, whereas the percentage of hospital births that were VBACs decreased from 3% in 1996 to 1% in 2008. Planned home VBACs had a lower risk profile than hospital VBACs with fewer births to teenagers, unmarried women, or smokers; fewer preterm or low-birth-weight deliveries; and higher maternal education levels. CONCLUSION: Recent increases in the proportion of U.S. women with a prior cesarean delivery mean that an increasing number of women are faced with the choice and associated risks of either VBAC or repeat cesarean delivery. Recent restrictions in hospital VBAC availability have coincided with increases in home VBACs; however, home VBAC remains rare, with approximately 1,000 occurrences in 2008. LEVEL OF EVIDENCE: II. |
Infant deaths - United States, 2000-2007
MacDorman MF , Mathews TJ . MMWR Suppl 2011 60 (1) 49-51 Infant mortality rates are an important indicator of the health of a nation because they are associated with maternal health, quality of and access to medical care, socioeconomic conditions, and public health practices (1,2). The U.S. infant mortality rate (the number of deaths among infants aged <1 year per 1,000 live births) declined from approximately 100 deaths per 1,000 births in 1900 (3) to 6.89 in 2000 (4). However, the rate did not decline substantially from 2000 to 2005. The infant mortality rate declined slightly but significantly from 6.86 in 2005 to 6.68 in 2006. The 2007 rate (6.75) was not significantly different from the 2006 rate (6.68) (4--6). In addition, considerable differences in infant mortality rates among racial/ethnic groups have persisted and even increased, demonstrating that not all racial/ethnic groups have benefited equally from social and medical advances (5,7). | | To analyze trends and variations in infant mortality in the United States, CDC analyzed data from linked birth--infant death data sets (linked files) for 2000--2006 (8). In these data sets, information from the birth certificate is linked to information from the death certificate for each infant (aged <1 year) who dies in the United States. This allows researchers to use the more accurate race/ethnicity data from the birth certificate for infant mortality analysis (8,9). Linked data are available through 2006. Data by maternal race and Hispanic ethnicity are based on information reported by the mother during the birth registration process. Race and ethnicity are reported separately on birth certificates, and persons of Hispanic origin might be of any race. Data from the main mortality file (i.e., death certificates not linked to birth certificates) are available for 2007 and are used for the overall infant mortality rate but not for race/ethnicity comparisons (6). Infant mortality rates were calculated as the number of infant deaths per 1,000 live births in the specified group. Percentage change over time was calculated by comparing the rates for the beginning and end points in each period. Differences between infant mortality rates were assessed for statistical significance by using the z test (p<0.05). National data on infant mortality according to educational attainment and family income status were not analyzed; these data are not available because they are either not collected or collected inconsistently. |
Race and ethnic disparities in fetal mortality, preterm birth, and infant mortality in the United States: an overview
MacDorman MF . Semin Perinatol 2011 35 (4) 200-8 Infant mortality, fetal mortality, and preterm birth all represent important health challenges that have shown little recent improvement. The rate of decrease in both fetal and infant mortality has slowed in recent years, with little decrease since 2000 for infant mortality, and no significant decrease from 2003 to 2005 for fetal mortality. The percentage of preterm births increased by 36% from 1984 to 2006, and then decreased by 4% from 2006 to 2008. There are substantial race and ethnic disparities in fetal and infant mortality and preterm birth, with non-Hispanic black women at greatest risk of unfavorable birth outcomes, followed by American Indian and Puerto Rican women. Infant mortality, fetal mortality, and preterm birth are multifactorial and interrelated problems with similarities in etiology, risk factors and disease pathways. Preterm birth prevention is critical to lowering the infant mortality rate, and to reducing race and ethnic disparities in infant mortality. |
United States home births increase 20 percent from 2004 to 2008
MacDorman MF , Declercq E , Mathews TJ . Birth 2011 38 (3) 185-90 BACKGROUND: After a gradual decline from 1990 to 2004, the percentage of births occurring at home increased from 2004 to 2008 in the United States. The objective of this report was to examine the recent increase in home births and the factors associated with this increase from 2004 to 2008. METHODS: United States birth certificate data on home births were analyzed by maternal demographic and medical characteristics. RESULTS: In 2008, there were 28,357 home births in the United States. From 2004 to 2008, the percentage of births occurring at home increased by 20 percent from 0.56 percent to 0.67 percent of United States births. This rise was largely driven by a 28 percent increase in the percentage of home births for non-Hispanic white women, for whom more than 1 percent of births occur at home. At the same time, the risk profile for home births has been lowered, with substantial drops in the percentage of home births of infants who are born preterm or at low birthweight, and declines in the percentage of home births that occur to teen and unmarried mothers. Twenty-seven states had statistically significant increases in the percentage of home births from 2004 to 2008; only four states had declines. CONCLUSION: The 20 percent increase in United States home births from 2004 to 2008 is a notable development that will be of interest to practitioners and policymakers. |
Trends and characteristics of home births in the United States by race and ethnicity, 1990-2006
Macdorman MF , Declercq E , Menacker F . Birth 2011 38 (1) 17-23 BACKGROUND: After a gradual decline from 1990 to 2004, the percentage of births occurring at home in the United States increased by 5 percent in 2005 and that increase was sustained in 2006. The purpose of the study was to analyze trends and characteristics in home births in United States by race and ethnicity from 1990 to 2006. METHODS: U.S. birth certificate data on home births were analyzed and compared with hospital births for a variety of demographic and medical characteristics. RESULTS: From 1990 to 2006, both the number and percentage of home births increased for non-Hispanic white women, but declined for all other race and ethnic groups. In 2006, non-Hispanic white women were three to four times more likely to have a home birth than women of other race and ethnic groups. Home births were more likely than hospital births to occur to older, married women with singleton pregnancies and several previous children. For non-Hispanic white women, fewer home births than hospital births were born preterm, whereas for other race and ethnic groups a higher percentage of home births than hospital births were born preterm. For non-Hispanic white women, two-thirds of home births were delivered by midwives. In contrast, for other race and ethnic groups, most home births were delivered by either physicians or "other" attendants, suggesting that a higher proportion of these births may be unplanned home births because of emergency situations. CONCLUSIONS: Differences in the risk profile of home births by race and ethnicity are consistent with previous research, suggesting that, compared with non-Hispanic white women, a larger proportion of non-Hispanic black and Hispanic home births represent unplanned, emergency situations. (BIRTH 38:1 March 2011). |
Obstetrical intervention and the singleton preterm birth rate in the United States from 1991-2006
MacDorman MF , Declercq ER , Zhang J . Am J Public Health 2010 100 (11) 2241-7 OBJECTIVES: We examined the relationship between obstetrical intervention and preterm birth in the United States between 1991 and 2006. METHODS: We assessed changes in preterm birth, cesarean delivery, labor induction, and associated risks. Logistic regression modeled the odds of preterm obstetrical intervention after risk adjustment. RESULTS: From 1991 to 2006, the percentage of singleton preterm births increased 13%. The cesarean delivery rate for singleton preterm births increased 47%, and the rate of induced labor doubled. In 2006, 51% of singleton preterm births were spontaneous vaginal deliveries, compared with 69% in 1991. After adjustment for demographic and medical risks, the mother of a preterm infant was 88% (95% confidence interval [CI]=1.87, 1.90) more likely to have an obstetrical intervention in 2006 than in 1991. Using new birth certificate data from 19 states, we estimated that 42% of singleton preterm infants were delivered via induction or cesarean birth without spontaneous onset of labor. CONCLUSIONS: Obstetrical interventions were related to the increase in the US preterm birth rate between 1991 and 2006. The public health community can play a central role in reducing medically unnecessary interventions. |
Behind international rankings of infant mortality: how the United States compares with Europe
MacDorman MF , Mathews TJ . Int J Health Serv 2010 40 (4) 577-588 In 2005, the United States ranked 30th in the world in infant mortality. Infant mortality rates for preterm (<37 weeks of gestation) infants are lower in the United States than in most European countries; however, infant mortality rates for infants born at 37 or more weeks of gestation are higher in the United States than in most European countries. One in 8 births in the United States were preterm in 2005, compared with 1 in 18 births in Ireland and Finland, and 1 in 16 in France and Sweden. If the United States had Sweden's distribution of births by gestational age, nearly 8,000 infant deaths in the United States would be averted each year, and the U.S. infant mortality rate would be one-third lower. The main cause of the United States' high infant mortality rate when compared with Europe is the very high percentage of preterm births in the United States, the period when infant mortality is greatest. |
BirthStats: percentage of preterm births, United States and selected European countries, 2004
MacDorman MF , Mathews TJ . Birth 2010 37 (2) 168 Compared with 18 European countries, as shown in the graph below, the United States had the highest percentage of preterm births (12.4%) in 2004 (1). Except for Austria (11.4%), the other countries had levels of 8.9 percent or less. Ireland had the lowest percentage (5.5%) followed by Finland (5.6%), Greece (6.0%), and Sweden and France (6.3%). In other words, 1 of every 8 U.S. babies were born preterm in 2004, compared with 1 of 16 in Sweden and France, 1 of 17 in Greece, and 1 of 18 in Ireland and Finland. Because preterm babies are at greater risk of death than term babies, countries with a higher percentage of preterm births tend to have higher infant mortality rates. European data are from the European Perinatal Health Report (2), whereas data for the United States are from the linked birth/infant death data set (3). Births at less than 22 weeks of gestation were excluded to promote comparability between countries (1,2). |
Neonatal mortality risk for repeat cesarean compared to vaginal birth after cesarean (VBAC) deliveries in the United States, 1998-2002 birth cohorts
Menacker F , Macdorman MF , Declercq E . Matern Child Health J 2010 14 (2) 147-54 To examine trends in repeat cesarean delivery, the characteristics of women who have repeat cesareans, and the risk of neonatal mortality for repeat cesarean birth compared to vaginal birth after cesarean (VBAC). Trends and characteristics of repeat cesareans were examined for: the period 1998-2002 for [1] all births, [2] low-risk births (singleton, term, vertex births) and [3] "no indicated risk" (NIR) births (singleton, term, vertex presentation births with no reported medical risks or complications). For low-risk and NIR births, neonatal mortality rates for repeat cesareans and VBACs were compared. Multivariate logistic regression was used to examine the risk of neonatal mortality for repeat cesareans and VBACs, after controlling for demographic and health factors. In 2002 the repeat cesarean rate was 87.4%, and varied little by maternal risk status or by demographic and health characteristics. From 1998-2002 rates increased by 20% for low risk and by 21% for NIR births, respectively. For low-risk women for the 1998-2002 birth cohorts, the adjusted odds ratio for neonatal mortality associated with repeat cesarean delivery (compared with VBAC) was 1.36 (95% C.I. 1.20-1.55). For NIR women, the adjusted odds ratio was 1.24 (0.99-1.55). The experience of a prior cesarean has apparently become a major indication for a repeat cesarean. Regardless of maternal risk status, almost 90% of women with a prior cesarean have a subsequent (i.e., repeat) cesarean delivery. This is the case even if there was no other reported medical indication. Our findings do not support the widely-held belief that neonatal mortality risk is significantly lower for repeat cesarean compared to VBAC delivery. |
The challenge of infant mortality: have we reached a plateau?
MacDorman MF , Mathews TJ . Public Health Rep 2009 124 (5) 670-81 OBJECTIVES: Infant mortality is a major indicator of the health of a nation. We analyzed recent patterns and trends in U.S. infant mortality, with an emphasis on two of the greatest challenges: (1) persistent racial and ethnic disparities and (2) the impact of preterm and low birthweight delivery. METHODS: Data from the national linked birth/infant death datasets were used to compute infant mortality rates per 100,000 live births by cause of death (COD), and per 1,000 live births for all other variables. Infant mortality rates and other measures of infant health were analyzed and compared. Leading and preterm-related CODs, and international comparisons of infant mortality rates were also examined. RESULTS: Despite the rapid decline in infant mortality during the 20th century, the U.S. infant mortality rate did not decline from 2000 to 2005, and declined only marginally in 2006. Racial and ethnic disparities in infant mortality have persisted and increased, as have the percentages of preterm and low birthweight deliveries. After decades of improvement, the infant mortality rate for very low birthweight infants remained unchanged from 2000 to 2005. Infant mortality rates from congenital malformations and sudden infant death syndrome declined; however, rates for preterm-related CODs increased. The U.S. international ranking in infant mortality fell from 12th place in 1960 to 30th place in 2005. CONCLUSIONS: Infant mortality is a complex and multifactorial problem that has proved resistant to intervention efforts. Continued increases in preterm and low birthweight delivery present major challenges to further improvement in the infant mortality rate. |
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