Leading causes of infant deaths in the District of Columbia.

Causes of infant deaths were analyzed from the linked vital records of 1988 for the District of Columbia. According to a new cause-of-death classification, 57% of the deaths were attributed to "prematurity and related conditions," as compared with only 31% due to "disorders relating to short gestation and unspecified low birthweight" and respiratory distress syndrome (RDS) in the three-digit ICD-9 classification. Two thirds of infant deaths were "preventable." However, 92% of these occurred to infants weighing less than 1500 g. Not only was a greater proportion of black deaths (71%) preventable as compared to nonblacks (40%), but also 15% of the preventable deaths among blacks were due to causes unrelated to prematurity. The Infant Mortality Rate (IMR) in the District of Columbia would be reduced from 23.2 to 7.7 if all preventable deaths were prevented, to 20.9 if only the preventable deaths not related to prematurity were prevented, and to 15.2 if the percentage of "preventable" deaths among blacks was brought down to the level of nonblacks. Mortality from RDS was substantially higher in the District of Columbia compared with blacks nationally and appeared to offer the best opportunity for reduction. However, detailed examination of circumstances surrounding each infant death would be necessary to inform the strategies for the reduction in IMR.