US Infant and Youth Mortality Rates Remain High

Ricki Lewis, PhD

October 02, 2018

Infant and youth mortality rates generally declined from 1999 through 2015 in the United States, Canada, and England/Wales, but were highest in the United States, according to a comparison of mortality records.

"Infant and youth mortality rates in the United States are notably higher than other high-income countries, despite having the highest health expenditures per capita in the world," the researchers write.

In addition, "striking racial disparities still exist, with black individuals and AI/ANs[American Indian/Alaskan Natives] still far from reaching target goals in certain age groups, with particularly large disparities observed for infant mortality," they explain.

In the United States, cases of sudden infant death syndrome (SIDS), deaths due to unintentional injury, and homicides fell, but suicide and drug poisoning death rates increased for all groups.

Sahar Q. Khan, MS, from the Division of Cancer Epidemiology and Genetics at the National Cancer Institute, and colleagues reported their findings online October 1 in JAMA Pediatrics.

The researchers investigated the possible role of racial/ethnic disparities in youth mortality rates. They compared publicly available data from the United States with those from Canada and England/Wales, because economics, healthcare systems, and population demographics were similar.

The investigators calculated the average annual percent change in mortality rates from 1999 to 2015 and the absolute rate change from 1999 to 2002 and from 2012 to 2015, considering age group, race/ethnicity, and cause of death.

Mortality rates fell for all age groups, but the decrease was more striking in England/Wales compared with the United States; in 2015, mortality rates were 2.5-fold higher for those aged 20 to 24 years in the United States than in England/Wales.

Black infants in the United States had the highest all-cause mortality rate (1128/100,000) compared with American Indians/Alaskan Natives (968/100,000), whites (498/100,000), Latinos (466/100,000), and Asian and Pacific Islanders (390/100,000). For the other age groups, American Indians/Alaskan Natives had the highest mortality rates, and Asian and Pacific Islanders the lowest.

All-cause mortality rates fell in most age and racial/ethnic groups from 1999 to 2015. For all three populations, 38.5% of deaths were in infants, 10.6% in children aged 1 to 9 years, 5% in children and adolescents aged 10 to 14 years, 17.7% in adolescents and young adults aged 15 to 19 years, and 28.1% in young adults aged 20 to 24 years. Rates were highest in the United States.

The United States saw annual declines in all-cause mortality rates for all age groups of black, Latino, and white individuals, except that rates remained stable among whites aged 20 to 24 years. Mortality rates declined with regard to most major causes of death for the two periods, especially for SIDS, unintentional injury, and homicide. Rates of heart disease and cancer fell for all age groups.

Rates of suffocation and strangulation in bed for infants increased (difference between 2012 - 2015 and 1999 - 2002 range, 6.11 - 29.03 per 100,000); however, the researchers attribute part of the increase to reclassification of some SIDS-related deaths as a result of improved death scene investigation protocol. Mortality rates for motor vehicle accidents and drownings fell for children.

Suicide rates in the United States increased overall. Although suicides by firearms were up slightly among whites aged 15 to 24 years, they decreased for blacks and Latinos in that age range. Suicide rates from hanging and drug poisoning increased in all three races/ethnicities.

The investigation revealed increases in drug poisoning death rates among whites, blacks, and Latinos aged 20 to 24 years, causing approximately 2100 unintentional deaths in 2015. The researchers relate the increase to the opioid epidemic in the United States.

The researchers estimate that, because of reductions in mortality, there were 12,000 fewer deaths in the United States in 2015, although rates remain significantly higher than in Canada and England/Wales, and there are pronounced racial disparities.

"Black individuals had the largest absolute declines in mortality rates in each age group examined; however, in 2015, mortality rates were still higher among black than white individuals across age groups, even among young adults where no improvements were observed among white individuals," the researchers conclude. They attribute these disparities to "long-standing social and economic inequality, which influences access of care, quality of care, and attitudes of patients and clinicians."

Study limitations included the inability to distinguish intentional from accidental overdose in opioid-linked deaths and use of age-specific mortality rates from the earlier period to predict outcomes in 2015.

The authors have disclosed no relevant financial relationships.

JAMA Pediatr. Published online October 1, 2018. Full text

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