Infant and Youth Mortality Trends by Race/Ethnicity and Cause of Death in the United States
Infant and Youth Mortality Trends by Race/Ethnicity and Cause of Death in the United States
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DOI：
10.1001/jamapediatrics.2018.3317
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发表时间：
2018-12-01
期刊：
影响因子：
26.1
通讯作者：
Shiels, Meredith S.
中科院分区：
文献类型：
--
作者：
Khan, Sahar Q.;de Gonzalez, Amy Berrington;Shiels, Meredith S.
重要性：美国的婴儿和青年死亡率高于其他高收入国家，种族/族裔群体之间存在显著差异。了解按年龄和种族/族裔划分的主要死亡原因的变化趋势，是重点干预的必要条件。目的：按年龄组和种族/民族估计1999年至2015年美国婴儿和青年死亡率的趋势，确定主要死亡原因，并与加拿大和英格兰/威尔士的死亡率进行比较。设计、环境和参与者本描述性研究分析了来自美国国家卫生统计中心、加拿大统计局和英国国家统计局的死亡证明数据，其中包括25岁以下个体的所有死亡。该研究于1999年1月1日至2015年12月31日进行，分析于2017年9月开始。暴露种族/民族。1999年至2015年死亡率的平均年百分比变化以及1999年至2002年和2012年至2015年每个年龄组、种族/民族和死因的绝对死亡率变化。结果1999年至2015年，在出生至24岁的个体中，美国发生1169537例死亡，加拿大发生80540例，英格兰/威尔士发生121183例。在美国，64%的死亡发生在男性个体中，52.6%发生在白人个体中（25.1%的死亡发生在黑人个体中，17.9%发生在拉丁美洲个体中）。1999年至2015年，美国、加拿大和英格兰/威尔士所有年龄组（1岁以下婴儿[38.5%]、1-9岁儿童[10.6%]、10-14岁青少年早期[5%]、15-19岁青少年晚期[17.7%]和20-24岁年轻人[28.1%]）的全因死亡率均有所下降。然而，美国的比率最高。在美国，所有年龄组的黑人、拉丁裔和白人的全因死亡率每年都在下降，除了20至24岁的白人，他们的死亡率保持稳定。1999年至2002年和2012年至2015年期间，大多数主要死因的死亡率都有所下降，婴儿猝死综合症、意外伤害死亡和他杀的死亡率显著下降。在婴儿中，意外窒息和床上窒息增加（2012-2015年与1999-2002年的差异为6.11-29.03 / 10万）。此外，10至24岁的拉丁裔和白人（范围，0.21-2.63 / 10万）以及10至19岁的黑人（范围，0.10-0.45 / 10万）的自杀率有所上升，白人年轻人的意外伤害死亡率也有所上升（0.79 / 10万）。意外伤害死亡的增加归因于药物中毒的增加，在黑人和拉丁裔年轻人中也观察到这种情况。1999年至2015年，由于婴儿猝死综合征、意外伤害死亡和他杀的减少，美国婴儿和青少年的死亡率普遍下降。然而，美国的死亡率仍然高于加拿大和英格兰/威尔士，黑人和美洲印第安人/阿拉斯加土著青年的死亡率特别高。此外，在美国青少年和年轻人中，自杀和毒品中毒死亡率的上升令人担忧。
IMPORTANCE The United States has higher infant and youth mortality rates than other high-income countries, with striking disparities by racial/ethnic group. Understanding changing trends by age and race/ethnicity for leading causes of death is imperative for focused intervention.OBJECTIVE To estimate trends in US infant and youth mortality rates from 1999 to 2015 by age group and race/ethnicity, identify leading causes of death, and compare mortality rates with Canada and England/Wales.DESIGN, SETTING, AND PARTICIPANTS This descriptive study analyzed death certificate data from the US National Center for Health Statistics, Statistics Canada, and the UK Office of National Statistics for all deaths among individuals younger than 25 years. The study took place from January 1, 1999, to December 31, 2015, and analyses started in September 2017.EXPOSURES Race/ethnicity.MAIN OUTCOMES AND MEASURES Average annual percent changes in mortality rates from 1999 to 2015 and absolute rate change between 1999 to 2002 and 2012 to 2015 for each age group, race/ethnicity, and cause of death.RESULTS Among individuals from birth to age 24 years, 1169 537 deaths occurred in the United States, 80 540 in Canada, and 121183 in England/Wales from 1999 to 2015. In the United States, 64% of deaths occurred in male individuals and 52.6% occurred in white individuals (25.1% deaths occurred in black individuals and 17.9% in Latino individuals). All-cause mortality declined for all age groups (infants younger than 1 year [38.5% of deaths], children aged 1-9 years [10.6%], early adolescents aged 10-14 years [5%], late adolescents aged 15-19 years [17.7%], and young adults aged 20-24 years [28.1%]) in the United States, Canada, and England/Wales from 1999 to 2015. However, rates were highest in the United States. Within the United States, annual declines in all-cause mortality rates occurred among all age groups of black, Latino, and white individuals, except for white individuals aged 20 to 24 years, whose rates remained stable. Mortality rates declined across most major causes of death from 1999 to 2002 and 2012 to 2015, with notable declines observed for sudden infant death syndrome, unintentional injury death, and homicides. Among infants, unintentional suffocation and strangulation in bed increased (difference between 2012-2015 and 1999-2002 range, 6.11-29.03 per 100 000). Further, suicide rates among Latino and white individuals aged 10 to 24 years (range, 0.21-2.63 per 100 000) and black individuals aged 10 to 19 years (range, 0.10-0.45 per 100 000) increased, as did unintentional injury deaths in white young adults (0.79 per 100 000). The rise in unintentional injury deaths is attributed to increases in drug poisonings and was also observed in black and Latino young adults.CONCLUSIONS AND RELEVANCE Mortality rates in the United States have generally declined for infants and youths from 1999 to 2015 owing to reductions in sudden infant death syndrome, unintentional injury death, and homicides. However, US mortality rates remain higher than Canada and England/Wales, with particularly elevated rates among black and American Indian/Alaskan Native youth. Further, there is a concerning increase in suicide and drug poisoning death rates among US adolescents and young adults.