Explaining the recent decrease in US infant mortality rate, 2007-2013
Explaining the recent decrease in US infant mortality rate, 2007-2013
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DOI：
10.1016/j.ajog.2016.09.097
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发表时间：
2017-01-01
影响因子：
9.8
通讯作者：
Barfield, Wanda D.
中科院分区：
文献类型：
--
作者：
Callaghan, William M.;MacDorman, Marian F.;Barfield, Wanda D.
背景：近年来，美国婴儿死亡率和早产率一直在稳步下降。早产是与生命第一年死亡相关的主要因素。特定孕龄死亡率的变化和按孕龄出生分布的变化对婴儿死亡率下降的影响程度需要澄清。 目的：本研究的目的是更好地了解 2007-2013 年总人口以及非西班牙裔黑人、非西班牙裔白人和西班牙裔妇女所生婴儿死亡率下降的主要因素。 研究设计： 确定了 2007 年和 2013 年疾病控制和预防中心国家生命统计系统时期的出生和婴儿死亡数据，并将其与出生和婴儿死亡档案联系起来。我们纳入了出生证明上报告的出生时孕龄为 22 周或以上的所有死亡和出生。对婴儿死亡率的下降进行了分类，因此所有变化都可以归因于特定胎龄婴儿死亡率的改善以及使用北川方法按孕周计算的胎龄分布的变化。进行了敏感性分析，以解释产科估计胎龄缺失的记录以及妊娠不足 22 周的死亡和出生情况。母亲种族和民族信息从出生证明中获得。结果：2007年和2013年排除后的婴儿死亡率分别为每1000名活产儿5.72和4.92，绝对差异为-0.80（下降14%）。在此期间，非西班牙裔白人的婴儿死亡率下降了 11%，非西班牙裔黑人下降了 19%，西班牙裔下降了 14%。与2007年相比，2013年除39周外，各胎龄类别的出生比例均有所下降，在此期间，出生比例从2007年的30.1%上升至2013年的37.5%。2007年至2013年间，除33周和> 42周外，各胎龄类别的特定孕龄死亡率均有所下降。 2007 年至 2013 年美国婴儿死亡率下降约 31% 是由于胎龄分布的变化，69% 是由于胎龄特异性生存率的改善。 2007 年至 2013 年孕龄分布的改善使非西班牙裔白人女性的婴儿受益最多 (48%)，其次是非西班牙裔黑人 (31%) 和西班牙裔 (14%) 女性的婴儿。 结论：2007 年至 2013 年间，婴儿死亡率有所改善，这是由于出生时孕龄分布的改善和出生后生存率的提高。按种族和民族划分的出生胎龄分布改善的不同贡献表明，旨在预防或延迟早产的孕前和产前保健和保健可能并未惠及所有人群。
BACKGROUND: The US 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.OBJECTIVE: The objective of the study was 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 in which the 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 with 2007, the proportion of births in each gestational age category was lower in 2013 with the exception of 39 weeks during which there was an increase in the proportion of births from 30.1% in 2007 to 37.5% in 2013. Gestational ageespecific mortality decreased for each gestational age category between 2007 and 2013 except 33 weeks and > 42 weeks. About 31% of the decrease in the US infant mortality rate from 2007 through 2013 was due to changes in the gestational age distribution, and 69% was due to improvements in gestational ageespecific survival. Improvements in the gestational age distribution from 2007 through 2013 benefited infants of non-Hispanic white women (48%) the most, followed by infants of non-Hispanic black (31%) and Hispanic (14%) women.CONCLUSION: 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.