Elsevier

Obstetrics & Gynecology

Volume 98, Issue 4, October 2001, Pages 620-627
Obstetrics & Gynecology

Infant mortality from congenital malformations in the United States, 1970–1997

https://doi.org/10.1016/S0029-7844(01)01507-1Get rights and content

Abstract

OBJECTIVE:

We examined a trend in infant mortality caused by congenital malformations in the United States, particularly for the racial disparity between whites and nonwhites.

METHODS:

We used US annual summary data on cause-specific infant mortality for 1970–97 and detailed birth and infant death linked data for 1985–87, 1989–91, and 1995–97.

RESULTS:

Congenital malformations became a more prominent cause of infant mortality in 1997 and accounted for 22.1% of all infant deaths compared with 15.1% in 1970. Congenital malformations of nervous, cardiovascular, and respiratory systems accounted for more than 60% of all malformation deaths. Malformations incompatible with life (anencephaly, encephalocele, hypoplastic lungs, renal agenesis, and trisomies 13 and 18) were the cause of one-third of all malformation deaths. In 1970–71, infant mortality caused by congenital malformations in nonwhites was lower, 2.6 (confidence interval [CI] 2.5, 2.7) per 1000, compared with whites, 3.1 (CI 3.0, 3.1) per 1000. However, in 1996–97, the rate of congenital malformation-specific infant mortality was higher in nonwhites, 1.7 (CI 1.7, 1.8) per 1000, compared with whites, 1.6 (CI 1.5, 1.6) per 1000. This trend was most pronounced with central nervous system malformations. Although whites had an almost two-fold higher infant mortality rate from central nervous system malformations compared with nonwhites in 1970–71, this disparity was no longer present by 1996–97.

CONCLUSION:

Congenital malformations have become a leading cause of infant mortality in the 1990s. Over the last several decades, this mortality declined more slowly in nonwhites than in whites.

Section snippets

Materials and methods

We used two US data sets from the National Center for Health Statistics. The first set included annual reports on infant deaths in the United States for the years 1970 through 1997.1, 2, 8, 9, 10, 11, 12, 13, 14 In this data set, race on infant deaths by cause was reported as whites and nonwhites before 1979 and from thereon, whites, blacks, and other. The proportion of blacks among nonwhite live births progressively decreased from 89.4% in 1970 to 84.2% in 1979. This proportion further

Results

In the United States, overall infant mortality decreased by 64.8% from 20.0 per 1000 in 1970 to 7.1 per 1000 live births in 1997. In this same period, infant mortality for congenital malformations declined from 3.0 to 1.6 per 1000 live birth, a decrease of 48.4%. Thus, congenital malformations became a more prominent cause of infant mortality in 1997, 22.1% of all infant deaths, as compared with 15.1% in 1970.

Over the last three decades, three organ systems, the nervous, cardiovascular, and

Discussion

In the last several decades, infant mortality in the United States has fallen dramatically.1, 2 This reduction has been mainly attributed to a remarkable improvement in perinatal care.17, 18 On the other hand, mortality from congenital malformations has declined more slowly and hence, has become an increasingly prominent component of infant mortality.1, 2, 19

Obtaining a complete understanding of the trend in congenital malformations requires ascertainment of data in all pregnancy outcomes for a

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  • Cited by (0)

    1

    Li Chen, MD, is a WHO Research Scholar from Yunnan Provincial MCH Hospital, Kunning, China.

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