RESUMEN

PURPOSE: In 1997, the Office of Management and Budget (OMB) introduced revised standards for classification of federal data on race. The new standards include the option to report more than one race. Reasons for the new standards include a change over time in childbearing patterns by race. OBJECTIVE: To better understand how the new standards could impact different racial groups, we examined trends in interracial births in the United States from 1971-1995. DESIGN: Birth certificate data were used to analyze over 36,000,000 US births from 1971-1995. Race of mother and race of father were divided into four categories (Black, White, American Indian, and Asian or Pacific-Islander), and four Asian or Pacific-Islander subcategories (Chinese, Japanese, Hawaiian, Filipino). The national percent of interracial births was calculated by race of parents for five-year intervals. RESULTS: The percent of interracial births in the United States more than tripled from the 1971-1975 period to the 1991-1995 period, but remained relatively small overall (3.9% in 1991-95). The percent of interracial births increased most dramatically among Black (from 0.8% to 4.0%) and White (0.8% to 2.6%) mothers, but these births were much more common among American Indian and Asian or Pacific-Islander (47% and 22% in 1991-1995, respectively) mothers. Nearly half (45%) of all interracial births occurred to White-Black parents, followed by White-Asian or Pacific-Islander parents (33%). CONCLUSION: Future statistical reporting of demographic and health characteristics by race of American Indian and Asian or Pacific-Islander populations could be impacted the most by the new OMB standards. For Whites and Blacks, the impact of multiracial reporting will be smaller, but is likely to increase.

Asunto(s)

Tasa de Natalidad/etnología , Negro o Afroamericano , Indígenas Norteamericanos , Estado Civil , Población Blanca , Adulto , Negro o Afroamericano/estadística & datos numéricos , Femenino , Humanos , Indígenas Norteamericanos/estadística & datos numéricos , Masculino , Islas del Pacífico , Padres , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricos

RESUMEN

OBJECTIVES: This report presents 1998 period infant mortality statistics from the linked birth/infant death data set (linked file) by a variety of maternal and infant characteristics. METHODS: Descriptive tabulations of data are presented. RESULTS: In general, mortality rates were lowest for infants born to Cuban mothers (3.6 per 1,000), Central and South American (5.3), Asian or Pacific Islander (5.5), Mexican (5.6), and non-Hispanic white mothers (6.0), followed by Puerto Rican (7.8), American Indian (9.3), and black mothers (13.8). Infant mortality rates (IMRs) were higher for those infants whose mothers had no prenatal care, were teenagers, had 9-11 years of education, were unmarried, or smoked during pregnancy. Infant mortality was also higher for male infants, multiple births, and infants born preterm or at low birthweight. In 1998, 65 percent of all infant deaths occurred to the 7.6 percent of infants born at low birthweight. The three leading causes of infant death--Congenital anomalies, Disorders relating to short gestation and unspecified low birthweight (low birthweight), and Sudden infant death syndrome (SIDS)--taken together accounted for 46 percent of all infant deaths in the United States in 1998. Cause-specific mortality rates varied considerably by race and Hispanic origin. For infants of black mothers, the IMR for low birthweight was nearly four times that for white mothers. For infants of American Indian mothers, the SIDS rate was 3.8 times that for Asian or Pacific Islander (API) mothers. For infants of Hispanic mothers, the SIDS rate was 44 percent lower than that for non-Hispanic white mothers.

Asunto(s)

Etnicidad/estadística & datos numéricos , Mortalidad Infantil/tendencias , Peso al Nacer , Causas de Muerte , Femenino , Humanos , Recién Nacido , Estudios Longitudinales , Masculino , Embarazo , Estados Unidos/epidemiología

RESUMEN

CONTEXT: Multiple births account for an increasing percentage of all low-birth-weight infants, preterm births, and infant mortality in the United States. Since 1981, the percentage of women with multiple births who received intensive prenatal care (defined as a high number of visits, exceeding the recommendation of the American College of Obstetricians and Gynecologists by approximately 1 SD beyond the mean number of visits for women initiating care within each trimester) has increased significantly. OBJECTIVES: To explore the hypothesis that more aggressive management of twin-birth pregnancies may be associated with changes in birth outcomes in this population. DESIGN, SETTING, AND SUBJECTS: Cross-sectional and trend analysis of data from the National Center for Health Statistics' birth and infant death records for all twin births occurring in the United States between 1981 and 1997, excluding those with missing or inconsistent data. MAIN OUTCOME MEASURES: Trends in preterm birth, low birth weight, preterm and term small-for-gestational-age (SGA) births, and infant mortality, by level of prenatal care utilization. RESULTS: The preterm birth rate for twins increased from 40.9% in 1981 to 55.0% in 1997. The percentage of low-birth-weight infants increased from 51.0% to 54.0%. The preterm SGA rate also increased from 11.9% to 14.1%, while the term SGA rate decreased from 30.7% to 20.5%. For women with intensive prenatal care utilization, the preterm birth rate increased from 35.1% to 55.8%, compared with an increase from 50.6% to 59.2% among women with only adequate use. Twin preterm deliveries involving either induction or first cesarean delivery also increased from 21.9% to 27.3% between 1989-1991 and 1995-1997. The twin infant mortality rate for women with intensive prenatal care use declined between 1983 and 1996 and remained lower than the overall twin infant mortality rate. CONCLUSIONS: An apparent increase in medical interventions in the management of twins may result in the seeming incongruity of more prenatal care and more preterm births; however, these data suggest that women with intensive prenatal care utilization also have a lower infant mortality rate. JAMA. 2000;283:335-341

Asunto(s)

Resultado del Embarazo , Atención Prenatal/estadística & datos numéricos , Gemelos , Estudios Transversales , Femenino , Humanos , Mortalidad Infantil , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Funciones de Verosimilitud , Modelos Logísticos , National Center for Health Statistics, U.S. , Embarazo , Estados Unidos/epidemiología

RESUMEN

Most vital statistics indicators of the health of Americans were stable or showed modest improvements between 1997 and 1998. The preliminary birth rate in 1998 was 14.6 births per 1000 population, up slightly from the record low reported for 1997 (14.5). The fertility rate, births per 1000 women aged 15 to 44 years, increased 1% to 65.6 in 1998, compared with 65.0 in 1997. The 1998 increases, although modest, were the first since 1990, halting the steady decline in the number of births and birth and fertility rates in the 1990s. Fertility rates for total white, non-Hispanic white, and Native American women each increased from 1% to 2% in 1998. The fertility rate for black women declined 19% from 1990 to 1996, but has changed little since 1996. The rate for Hispanic women, which dropped 2%, was lower than in any year for which national data have been available. Birth rates for women 30 years or older continued to increase. The proportion of births to unmarried women remained about the same at one third. The birth rate for teen mothers declined again for the seventh consecutive year, and the use of timely prenatal care (82.8%) improved for the ninth consecutive year, especially for black (73.3%) and Hispanic (74.3%) mothers. The number and rate of multiple births continued their dramatic rise; the number of triplet and higher-order multiple births jumped 16% between 1996 and 1997, accounting, in part, for the slight increase in the percentage of low birth weight (LBW) births. LBW continued to increase from 1997 to 1998 to 7.6%. The infant mortality rate (IMR) was unchanged from 1997 to 1998 (7.2 per 1000 live births). The ratio of the IMR among black infants to that for white infants (2.4) remained the same in 1998 as in 1997. Racial differences in infant mortality remain a major public health concern. In 1997, 65% of all infant deaths occurred to the 7.5% of infants born LBW. Among all of the states, Maine, Massachusetts, and New Hampshire had the lowest IMRs. State-by-state differences in IMR reflect racial composition, the percentage LBW, and birth weight-specific neonatal mortality rate for each state. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth increased slightly to 76.7 years for all gender and race groups combined. Death rates in the United States continue to decline, including a drop in mortality from human immunodeficiency virus. The age-adjusted death rate for suicide declined 6% in 1998; homicide declined 14%. Death rates for children from all major causes declined again in 1998. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.

Asunto(s)

Estadísticas Vitales , Adolescente , Adulto , Distribución por Edad , Tasa de Natalidad/etnología , Tasa de Natalidad/tendencias , Causas de Muerte/tendencias , Niño , Preescolar , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Esperanza de Vida/etnología , Esperanza de Vida/tendencias , Masculino , Mortalidad/tendencias , Grupos Raciales , Estados Unidos

RESUMEN

OBJECTIVES: This report provides a summary of current knowledge and research on the quality and reliability of death rates by race and Hispanic origin in official mortality statistics of the United States produced by the National Center for Health Statistics (NCHS). It also provides a quantitative assessment of bias in death rates by race and Hispanic origin. It identifies areas for targeted research. METHODS: Death rates are based on information on deaths (numerators of the rates) from death certificates filed in the states and compiled into a national database by NCHS, and on population data (denominators) from the Census Bureau. Selected studies of race/Hispanic-origin misclassification and under coverage are summarized on deaths and population. Estimates are made of the separate and the joint bias on death rates by race and Hispanic origin from the two sources. Simplifying assumptions are made about the stability of the biases over time and among age groups. Original results are presented using an expanded and updated database from the National Longitudinal Mortality Study. RESULTS: While biases in the numerator and denominator tend to offset each other somewhat, death rates for all groups show net effects of race misclassification and under coverage. For the white population and the black population, published death rates are overstated in official publications by an estimated 1.0 percent and 5.0 percent, respectively, resulting principally from undercounts of these population groups in the census. Death rates for the other minority groups are understated in official publications approximately as follows: American Indians, 21 percent; Asian or Pacific Islanders, 11 percent; and Hispanics, 2 percent. These estimates do not take into account differential misreporting of age among the race/ethnic groups.

Asunto(s)

Etnicidad/estadística & datos numéricos , Hispánicos o Latinos/estadística & datos numéricos , Mortalidad , Grupos Raciales , Adolescente , Adulto , Negro o Afroamericano/estadística & datos numéricos , Factores de Edad , Anciano , Anciano de 80 o más Años , Asiático/estadística & datos numéricos , Sesgo , Censos , Niño , Preescolar , Bases de Datos como Asunto , Certificado de Defunción , Femenino , Humanos , Indígenas Norteamericanos/estadística & datos numéricos , Lactante , Mortalidad Infantil , Masculino , Persona de Mediana Edad , Grupos Minoritarios/estadística & datos numéricos , Reproducibilidad de los Resultados , Estados Unidos/epidemiología , Población Blanca/estadística & datos numéricos

Asunto(s)

Geografía , Sistemas de Información , Estadísticas Vitales , Interpretación Estadística de Datos , Métodos Epidemiológicos , Humanos , National Center for Health Statistics, U.S. , Programas Informáticos , Gobierno Estatal , Estados Unidos

RESUMEN

OBJECTIVES: This report presents 1997 period infant mortality statistics from the linked birth/infant death data set (linked file) by a wide variety of maternal and infant characteristics. METHODS: Descriptive tabulations of data are presented. RESULTS: In general, mortality rates were lowest for infants born to Asian and Pacific Islander mothers (5.0), followed by white (6.0), American Indian (8.7), and black (13.7) mothers. Infant mortality rates were higher for Puerto Rican mothers (7.9) than for Mexican (5.8), Cuban (5.5), Central and South American (5.5), or non-Hispanic white mothers (6.0). Infant mortality rates were higher for those infants whose mothers began prenatal care after the first trimester of pregnancy, were teenagers or 40 years of age or older, did not complete high school, were unmarried, or smoked during pregnancy. Infant mortality was also higher for male infants, multiple births, and infants born preterm or at low birthweight. In 1997, 65 percent of all infant deaths occurred to the 7.5 percent of infants bom at low birthweight. The three leading causes of infant death--Congenital anomalies, Disorders relating to short gestation and unspecified low birthweight (low birthweight), and Sudden infant death syndrome (SIDS) taken together accounted for nearly one-half of all infant deaths in the United States in 1997. Cause-specific mortality rates varied considerably by race and Hispanic origin. For black mothers, the infant mortality rate for low birthweight was four times that for white mothers. For American Indian mothers, the SIDS rate was 2.4 times that for white mothers. For Hispanic mothers, the SIDS rate was one-third lower than that for non-Hispanic white mothers.

Asunto(s)

Mortalidad Infantil , Adolescente , Adulto , Peso al Nacer , Anomalías Congénitas/mortalidad , Escolaridad , Etnicidad , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Edad Materna , Embarazo , Embarazo Múltiple/estadística & datos numéricos , Grupos Raciales , Estados Unidos/epidemiología , Estadísticas Vitales

RESUMEN

OBJECTIVES: Strong evidence based on case record reviews indicates that the incidence of child homicide reported from death certificates is under ascertained. The characteristics of infant injury fatalities with undetermined, but suspicious, intent were compared for the probability that they should be considered homicides. METHODS: Using linked birth and death certificates for all birth cohorts in the US from 1983-91, 2345 injury fatalities reported as intentional, 7594 as unintentional, and 431 as undetermined intent were identified. Maternal and infant variables potentially predictive of injury fatalities were selected based on increased bivariate associations. Relative risks of injury death by intentional, unintentional, and undetermined intent were assessed for maternal and infant characteristics. RESULTS: Relative risks were consistently higher across all intent categories for infants of mothers with the least education, no prenatal care, young maternal age, and single marital status, as well as for infants who are second or later born, preterm, black, or American Indian. Fatalities with undetermined intent have larger relative risks in the highest risk categories than either intentional or unintentional injuries. Deaths with undetermined intent have risk profiles that more closely resemble profiles for intentional deaths than unintentional. CONCLUSIONS: Injury homicide rates would be almost 20% greater than official classifications indicate if deaths with undetermined intent were included. In analyses of infant homicide, excluding deaths of undetermined intent may lead to an underestimation of the magnitude of the public health problem of intentional injuries among infants. Other studies based on record reviews from multiple sources indicate that misclassification and under ascertainment of homicides may be even greater.

Asunto(s)

Heridas y Lesiones/mortalidad , Adolescente , Adulto , Causas de Muerte , Humanos , Lactante , Recién Nacido , Infanticidio , Factores de Riesgo , Factores Socioeconómicos , Estados Unidos/epidemiología , Heridas y Lesiones/etiología

RESUMEN

Many positive trends in the health of Americans continued into 1997. In 1997, the preliminary birth rate declined slightly to 14.6 births per 1000 population, and the fertility rate, births per 1000 women 15 to 44 years of age, was unchanged from the previous year (65.3). These indicators suggest that the downward trend in births observed since the early 1990s may have abated. Fertility rates for white, black, and Native American women were essentially unchanged between 1996 and 1997. Fertility among Hispanic women declined 2% in 1997 to 103.1, the lowest level reported since national data for this group have been available. For the sixth consecutive year, birth rates dropped for teens. Birth rates for women 30 years or older continued to increase. The proportion of births to unmarried women (32.4%) was unchanged in 1997. The trend toward earlier utilization of prenatal care continued for 1997; 82.5% of women began prenatal care in the first trimester. There was no change in the percentage with late (third trimester) or no care in 1997. The cesarean delivery rate rose slightly to 20.8% in 1997, a reversal of the downward trend observed since 1989. The percentage of low birth weight (LBW) infants rose again in 1997 to 7.5%. The percentage of very low birth weight was up only slightly to 1.41%. Among births to white mothers, LBW increased for the fifth consecutive year, to 6.5%, whereas the rate for black mothers remained unchanged at 13%. Much, but not all, of the rise in LBW for white mothers during the 1990s can be attributed to an increase in multiple births. In 1996, the multiple birth rate rose again by 5%, and the higher-order multiple birth rate climbed by 20%. Infant mortality reached an all time low level of 7.1 deaths per 1000 births, based on preliminary 1997 data. Both neonatal and postneonatal mortality rates declined. In 1996, 64% of all infant deaths occurred to the 7.4% of infants born at LBW. Infant mortality rates continue to be more than two times greater for black than for white infants. Among all the states in 1996, Maine, Massachusetts, and New Hampshire had the lowest infant mortality rates. Despite declines in infant mortality, the United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth reached a new high in 1997 of 76.5 years for all gender and race groups combined. Age-adjusted death rates declined in 1997 for diseases of the heart, accidents and adverse affects (unintentional injuries), homicide, suicide, malignant neoplasms, cerebrovascular disease, chronic liver disease and cirrhosis, and diabetes. In 1997, mortality due to HIV infection declined by 47%. Death rates for children from all major causes declined again in 1997. Motor vehicle traffic injuries and firearm injuries were the two major causes of traumatic death. A large proportion of childhood deaths continue to occur as a result of preventable injuries.

Asunto(s)

Estadísticas Vitales , Adolescente , Adulto , Tasa de Natalidad , Peso al Nacer , Población Negra , Causas de Muerte , Niño , Preescolar , Femenino , Hispánicos o Latinos , Humanos , Lactante , Mortalidad Infantil , Recién Nacido , Masculino , Progenie de Nacimiento Múltiple/estadística & datos numéricos , Embarazo , Embarazo en Adolescencia/estadística & datos numéricos , Atención Prenatal , Estados Unidos/epidemiología , Población Blanca

RESUMEN

STUDY OBJECTIVE: To determine if there are significant differences in birth outcomes and survival for infants delivered by certified nurse midwives compared with those delivered by physicians, and whether these differences, if they exist, remain after controlling for sociodemographic and medical risk factors. DESIGN: Logistic regression models were used to examine differences between certified nurse midwife and physician delivered births in infant, neonatal, and postneonatal mortality, and risk of low birthweight after controlling for a variety of social and medical risk factors. Ordinary least squares regression models were used to examine differences in mean birthweight after controlling for the same risk factors. STUDY SETTING: United States. PATIENTS: The study included all singleton, vaginal births at 35-43 weeks gestation delivered either by physicians or certified nurse midwives in the United States in 1991. MAIN RESULTS: After controlling for social and medical risk factors, the risk of experiencing an infant death was 19% lower for certified nurse midwife attended than for physician attended births, the risk of neonatal mortality was 33% lower, and the risk of delivering a low birthweight infant 31% lower. Mean birthweight was 37 grams heavier for the certified nurse midwife attended than for physician attended births. CONCLUSIONS: National data support the findings of previous local studies that certified nurse midwives have excellent birth outcomes. These findings are discussed in light of differences between certified nurse midwives and physicians in prenatal care and labour and delivery care practices. Certified nurse midwives provide a safe and viable alternative to maternity care in the United States, particularly for low to moderate risk women.

Asunto(s)

Enfermeras Obstetrices/estadística & datos numéricos , Obstetricia/estadística & datos numéricos , Resultado del Embarazo , Atención Prenatal/organización & administración , Adulto , Peso al Nacer , Estudios de Cohortes , Parto Obstétrico/estadística & datos numéricos , Femenino , Humanos , Mortalidad Infantil , Recién Nacido , Masculino , Análisis Multivariante , Embarazo , Atención Prenatal/normas , Análisis de Regresión , Factores de Riesgo , Factores Socioeconómicos , Estados Unidos

RESUMEN

OBJECTIVES: This report presents infant mortality statistics from the linked birth/infant death data set (linked file)-1995 period data by a variety of maternal and infant characteristics. Trends in birthweight-specific infant mortality rates from 1985-95 are also discussed. METHODS: Descriptive tabulations of data from the linked file are presented. The data include infant deaths in 1995, which are linked to their corresponding birth certificates, whether the birth occurred in 1995 or 1994. The denominator used to compute infant mortality rates is the National Center for Health Statistics (NCHS) natality file, which includes all births in 1995. Data are weighted to compensate for the 2.5 percent of infant death records that could not be linked to their corresponding birth certificates. RESULTS: In general, mortality rates were lowest for infants born to Asian and Pacific Islander mothers, followed by white, American Indian, and black mothers. Rates for infants of Hispanic origin mothers were slightly lower than or comparable to those for infants of white mothers, except for infants of Puerto Rican mothers who had higher infant mortality rates. Infant mortality rates were higher for those infants whose mothers began prenatal care after the first trimester of pregnancy, were teenagers or 40 years of age or older, did not complete high school, were unmarried, or smoked during pregnancy. Infant mortality was also higher for male infants, multiple births, and infants born preterm or at low birthweight. In 1995, 63 percent of all infant deaths occurred to the 7.3 percent of infants born at low birthweight. From 1985-95, birthweight-specific infant mortality rates declined most rapidly for infants weighing 750-1,499 grams at birth. The leading causes of infant death varied considerably by race and Hispanic origin. For infants of black mothers, Disorders related to short gestation and unspecified low birthweight was the leading cause of infant death, with an infant mortality rate 4.5 times higher than that for infants of white mothers. For infants of American Indian mothers, rates for Sudden infant death syndrome were 2.9 times and for Accidents and adverse effects 3.6 times higher than those for infants of white mothers. For infants of Hispanic mothers, mortality rates from Sudden infant death syndrome were one-third lower than those for infants of white mothers.

Asunto(s)

Mortalidad Infantil , Adolescente , Adulto , Causas de Muerte , Etnicidad , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Masculino , Embarazo , Estados Unidos

RESUMEN

Several recent trends in the vital statistics of the United States continued in 1996, including an increase in life expectancy and declines in infant mortality, births to teenage mothers, age-adjusted death rates, and death rates for children and adolescents. In 1996, there were an estimated 3 914 953 births in the United States. The preliminary birth rate remained unchanged at 14.8 births per 1000 population, and the fertility rate, births per 1000 women 15 to 44 years of age, was essentially the same at 65.7. Fertility rates rose slightly for most racial and ethnic groups except black women, for whom the rate hit a historic low of 70.8. Overall, fertility remains particularly high for Hispanic women, although there is considerable variation within this heterogenous group. For the fifth consecutive year, birth rates dropped for teenagers. Birth rates for women >/=30 years of age continued to increase. The birth rate for unmarried women declined 1% in 1996 to 44.6 births per 1000 unmarried women, continuing the decline noted in 1995 for the first time in 2 decades. The percentage of women who began prenatal care in the first trimester rose in 1996 to 81.8%, whereas the percentage with late (third trimester) or no care dropped to 4.1%. The rise in timely prenatal care was greatest for black and Hispanic women. The percentage of low birth weight (LBW) infants reached 7.4% in 1996, its highest level since 1975. The very low birth weight rate remained unchanged at 1.4%. The rise in LBW occurred primarily among white women, whereas the LBW rate for black women dropped to 13.0%, the lowest rate reported since 1987. The rise among white women is only partially a result of increases in multiple births, because LBW rates have also risen among white singleton births. The multiple birth ratio rose again in 1996 by 2%, as it has since 1980. The rise was particularly large for higher-order multiple births. Infant mortality reached an all time low level of 7.2 deaths per 1000 births, based on preliminary 1996 data. Neonatal and postneonatal rates declined, as did rates for both black and white infants. National birth weight specific mortality rates are reported here for the first time. In 1995, 63% of infant deaths occurred to the 7.3% of the population that was born LBW. The four leading cause of infant death were congenital anomalies, disorders relating to short gestation and unspecified birth weight, sudden infant death syndrome, and respiratory distress syndrome, accounting for more than half of infant deaths in 1996. Despite the declines in infant mortality, the United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth reached a new high in 1996 of 76.1 years for all gender and race groups combined. Age-adjusted mortality rates declined in 1996 for diseases of the heart, malignant neoplasms, cerebrovascular diseases, accidents and adverse effects, chronic liver disease and cirrhosis, and suicide. They rose, as in the past several years, for chronic obstructive pulmonary diseases, diabetes mellitus, and pneumonia and influenza. For the first time since human immunodeficiency virus infection was created as a special cause-of-death category in 1987, death rates for human immunodeficiency virus infection declined from 15.6 in 1995 to 11.6 in 1996. The homicide rate also declined, as it has since 1991. Death rates for children between 1 and 19 years of age declined in 1996, with an estimated 29 183 deaths to children. Unintentional injury mortality has dropped by approximately 50% among children and adolescents since 1979, although it remains the leading cause of death for all age groups of children from 1 to 19 years. Homicide was the fourth leading cause of death for children 1 to 4 and 5 to 9 years of age, the third leading cause for children 10 to 14, and the second leading cause for 15 to 19 year olds.

Asunto(s)

Estadísticas Vitales , Adolescente , Adulto , Tasa de Natalidad/tendencias , Causas de Muerte/tendencias , Niño , Preescolar , Femenino , Humanos , Lactante , Mortalidad Infantil/tendencias , Recién Nacido , Masculino , Atención Prenatal/estadística & datos numéricos , Estados Unidos/epidemiología

RESUMEN

The association between sudden infant death syndrome (SIDS) and maternal smoking was compared between the United States and Sweden-two countries with different health care and social support programs and degrees of sociocultural heterogeneity. For 1990-1991 among the five US race/ethnic groups studied, SIDS rates ranged from a high of 3.0 infant deaths per 1,000 live births for American Indians to a low of 0.8 for Hispanics and Asian and Pacific Islanders. The SIDS rate for Sweden (using 1983-1992 data) was 0.9. The strong association between maternal smoking and SIDS persisted after controlling for maternal age and live birth order. Adjusted odds ratios ranged from 1.6 to 2.5 for mothers who smoked 1-9 cigarettes per day during pregnancy (compared with nonsmokers) and from 2.3 to 3.8 for mothers who smoked 10 or more cigarettes per day during pregnancy. Although birth weight had a strong independent effect on SIDS, the addition of birth weight to the models lowered the odds ratios for maternal smoking only slightly, suggesting that the effect of smoking on SIDS is not mediated through birth weight. SIDS rates increased with the amount smoked for all US race/ethnic groups and for Sweden. Smoking is one of the most important preventable risk factors for SIDS, and smoking prevention/intervention programs have the potential to substantially lower SIDS rates in the United States and Sweden and presumably elsewhere as well.

Asunto(s)

Complicaciones del Embarazo/epidemiología , Fumar/epidemiología , Muerte Súbita del Lactante/epidemiología , Adolescente , Adulto , Peso al Nacer , Intervalos de Confianza , Femenino , Humanos , Lactante , Recién Nacido , Madres , Oportunidad Relativa , Embarazo , Factores de Riesgo , Muerte Súbita del Lactante/etiología , Suecia/epidemiología , Estados Unidos/epidemiología

RESUMEN

OBJECTIVES: This report describes changes in the number and ratio of live births in triplet and other higher order multiple deliveries from 1971 to 1994 by maternal race, age, education, and marital status. The report also examines the birth outcomes of triplets compared with singletons, including overall gestation specific, and birthweight specific infant mortality rates. METHODS: Birth data are obtained from the U.S. certificates of live birth. Mortality data were obtained from the Linked Birth and Infant Death Data Sets for the 1983-91 birth cohorts. Most analyses are based on triplet and other higher-order multiple births (quadruplet and quintuplet and greater births) in the aggregate. (Triplet births comprise about 92 percent of all higher order multiple births.) Triplet and other higher order birth ratios for most variables are computed by combining data for years 1982-84 and 1992-94, and for infant mortality by combining birth cohorts for years 1987-91. FINDINGS: Between 1971 and 1994 the number and ratio of triplet births quadrupled, rising from 1,034 to 4,594, and from 29.1 to 116.2 per 100,000 live births. Most of the increase was among births to white mothers, particularly among married and more educated mothers. Only about one-third of the increase in triplet birthing among white mothers between 1989 and 1994 could be attributed to changes in the maternal age distribution. Massachusetts reported the highest triplet birth ratio (215.9), more than twice the U.S. ratio (105.5). Other States with comparatively high ratios were New Hampshire, New Jersey, and Iowa. Nine of 10 triplets were born preterm compared with 1 of 10 singletons. The average triplet weighed 1,698 grams at birth, one-half that of the average singleton (3,358 grams). Triplets were about 12 times more likely to die during the first year of life as singletons, but had a survival advantage over singletons at lower gestations and birthweights.

Asunto(s)

Trillizos/estadística & datos numéricos , Adulto , Peso al Nacer , Causas de Muerte , Escolaridad , Etnicidad , Femenino , Edad Gestacional , Humanos , Mortalidad Infantil , Recién Nacido , Recien Nacido Prematuro , Matrimonio/estadística & datos numéricos , Edad Materna , Persona de Mediana Edad , Embarazo , Estados Unidos/epidemiología

Asunto(s)

Causas de Muerte , Enfermedad/clasificación , Cooperación Internacional , Vigilancia de la Población/métodos , United States Public Health Service , Humanos , National Center for Health Statistics, U.S. , Estados Unidos

RESUMEN

This report examines the mortality experience of infants born between 1985 and 1987 to mothers of Hispanic origin who resided in a study area of 20 States and the District of Columbia and compares it with that of non-Hispanic white infants. Maternal characteristics are also compared. For all Hispanic-origin mothers combined, the infant mortality rate (8.5) was very close to the non-Hispanic white rate (8.3). Among the Hispanic-origin subgroups, the rate for Puerto Rican mothers was higher (10.9) and the rate for Central and South American mothers lower (7.8) than the non-Hispanic white rate. The infant mortality rates of 8.2 for Mexicans and 7.6 for Cubans were not significantly different from the non-Hispanic white rate. The infant mortality experience of the Hispanic-origin population has been termed an ''epidemiological paradox,'' because of their generally favorable birth outcomes despite a higher prevalence of socioeconomic and demographic risk factors. In general, a higher proportion of Hispanic than non-Hispanic white infants were born to mothers traditionally considered to be at elevated risk for infant mortality-teenagers, unmarried mothers, those who have not completed high school, and those beginning prenatal care after the first trimester or not at all. In general, infant mortality rates were higher for these high-risk groups among Hispanic as well as non-Hispanic white mothers. However, the difference in infant mortality rates between high-risk and low-risk groups for each of these maternal characteristics was less for some Hispanic origin subgroups than for non-Hispanic whites.

RESUMEN

From 1960 to 1988 the infant mortality rate for the United States declined by 60 percent from 26.0 to 10.0 infant deaths per 1,000 live births. The infant mortality rate declined slowly from 1960 to 1964, rapidly from 1965 to 1981, and then moderately from 1981 to 1988. Since 1970 neonatal (under 28 days) mortality has declined more rapidly than postneonatal (28 days-11 months) mortality, reversing the historic pattern of more rapid declines in postneonatal mortality. Because of this, a smaller percent of infant deaths occurred during the neonatal period in 1988 (64 percent) than in 1960 (72 percent). The gap in mortality between black and white infants narrowed during the 1960's, but widened during the 1970's and 1980's. The ratio of black to white infant mortality rates (or mortality race ratio) declined from 1,93 in 1960 to 1.77 in 1971, due to a more rapid decline in postneonatal mortality for black than white infants. However, since 1971, the infant mortality race ratio increased substantially to 2.07 in 1988, reflecting the slower decline in neonatal mortality for black infants. While for many years the gap between black and white infant mortality was wider during the postneonatal than the neonatal period, the gap in 1988 was wider during the neonatal period.