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EPA's Report on the Environment: External Review Draft

Infant Mortality

Note to reviewers of this draft revised ROE: This indicator reflects data through 2009. EPA anticipates updating this indicator in 2014.

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Infant mortality is a particularly useful measure of health status because it both indicates current health status of the population and predicts the health of the next generation (NCHS, 2001). Infant mortality in the U.S. is defined as the death of an infant from time of live birth to the age of 1 year. It does not include still births. Overall infant mortality is composed of neonatal (less than 28 days after birth) and postneonatal (28 days to 11 months after birth) deaths.

This indicator presents infant mortality for the U.S. based on mortality data from the National Vital Statistics System (NVSS) based on death certificate data. The NVSS registers virtually all deaths and births nationwide, with data coverage from 1933 to 2009 and from all 50 states and the District of Columbia.

What the Data Show

In 2009, a total of 26,412 deaths occurred in children under 1 year of age, 1,647 fewer deaths than were recorded in 2008. Exhibit 1 presents the national trends in infant mortality between 1940 and 2009 for all infant deaths as well as infant deaths by sex and race (black and white). A striking decline has occurred during this time period, with overall infant mortality rates dropping from nearly 50 deaths per 1,000 live births in 1940 to under seven deaths per 1,000 live births in 2009. Beginning around 1960, the infant mortality rate has decreased or remained generally level each successive year through 2009.

Infant mortality rates ranged from 6.8-7.0 from 2000 to 2005, were 6.7-6.8 from 2006-2007, and then decreased to 6.6 in 2008 and 6.4 in 2009. Infant mortality rates continue to be highest among males and highest among blacks. The infant mortality rate for blacks decreased from 14.1 per 1,000 live births in 2000 to 12.6 per 1,000 live births in 2009. However, this is still more than twice the rate compared to white infants, which ranged from 5.7 to 5.3 per 1,000 live births between 2000 and 2009.

Infant mortality rates among Hispanic infants have changed little since 2000. In 2009, the infant mortality rate was 5.4 per 1,000 live births for Hispanic infants, a decrease compared to 5.7 in 2008. Additionally, there was a decrease in the infant mortality rate for non-Hispanic white infants, with 5.3 per 1,000 live births in 2009 compared to 5.6 in 2008. No change in rate occurred for non-Hispanic blacks, with a rate of 13.1 per 1,000 live births in 2008 and 2009 (NCHS, 2011, 2012). (Data not shown.)

In 2009, the 10 leading causes of infant mortality in the U.S. accounted for about 69 percent of all infant deaths, with the subgroup consisting of congenital anomalies (i.e., congenital malformations, deformations, and chromosomal abnormalities) having the highest rate at 1.3 per 1,000 live births. This category alone accounts for 20 percent of all infant deaths in 2009 (Exhibit 2). In 2009, the top 10 leading causes and their ranks remained the same as those in 2008 (NCHS, 2011, 2012).

Congenital anomalies were generally ranked highest among the different racial and ethnic groups. However, the leading cause of infant mortality among blacks was short gestation and low birthweight, followed by congenital anomalies. There were small differences in the leading causes of infant mortality between Hispanics and non-Hispanic infants. For example, unintentional injuries and placenta cord membranes were the fifth and sixth leading cause of infant death among non-Hispanic infants, respectively; whereas these two causes of infant death were reversed (i.e., placenta cord membranes was fifth and unintentional injuries was sixth) among Hispanic infants.

In addition, the Centers for Disease Control and Prevention (CDC) reports a substantial difference in the leading causes of death during the neonatal versus the postneonatal periods. Disorders related to short gestation and low birthweight were the leading cause of death for neonates and sudden infant death syndrome was the leading cause of death for postneonates, based on 2009 data (NCHS, 2012). (Data not shown.)


  • Cause of death rankings denote the most frequently occurring causes of death among those causes eligible to be ranked. The rankings do not necessarily denote the causes of death of greatest public health importance. Further, rankings of cause-specific mortality could change depending on the defined list of causes that are considered and, more specifically, the types of categories and subcategories that are used for such rankings (NCHS, 2005).
  • Mortality rates are based on the underlying cause of death as entered on a death certificate by a physician. Incorrect coding and low rates of autopsies that confirm the cause of death may occur. Additionally, some individuals may have had competing causes of death. When more than one cause or condition is entered by the physician, the underlying cause is determined by the sequence of conditions on the certificate, provisions of the ICD [International Classification of Diseases], and associated selection rules and modifications (CDC, n.d.). Consequently, some misclassification of reported mortality might occur as a result of these uncertainties, as well as the underreporting of some causes of death.

Data Sources

Infant mortality data were obtained from a published report by CDC's National Center for Health Statistics (NCHS, 2010), which provides annual natality data from 1975 to 2007 and decadal data for 1940, 1950, 1960, and 1970, as well as 2008 and 2009 data from NCHS's annually published “deaths reports” (NCHS 2011, 2012). Data in the NCHS reports are based in part on unpublished work tables, available on the NCHS website at http://www.cdc.gov/nchs/deaths.htm. Leading cause of infant death data were extracted from CDC's Web-Based Injury Statistics Query and Reporting System (WISQARS) (CDC, 2012) (http://www.cdc.gov/ncipc/wisqars/), with supporting documentation from NVSS reports (NCHS, 2010, 2011, 2012). The underlying data in WISQARS come from CDC/NCHS annual mortality data files.


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