The challenge of infant mortality: have we reached a plateau?

OBJECTIVES: Infant mortality is a major indicator of the health of a nation. We analyzed recent patterns and trends in U.S. infant mortality, with an emphasis on two of the greatest challenges: (1) persistent racial and ethnic disparities and (2) the impact of preterm and low birthweight delivery.
METHODS: Data from the national linked birth/infant death datasets were used to compute infant mortality rates per 100,000 live births by cause of death (COD), and per 1,000 live births for all other variables. Infant mortality rates and other measures of infant health were analyzed and compared. Leading and preterm-related CODs, and international comparisons of infant mortality rates were also examined.
RESULTS: Despite the rapid decline in infant mortality during the 20th century, the U.S. infant mortality rate did not decline from 2000 to 2005, and declined only marginally in 2006. Racial and ethnic disparities in infant mortality have persisted and increased, as have the percentages of preterm and low birthweight deliveries. After decades of improvement, the infant mortality rate for very low birthweight infants remained unchanged from 2000 to 2005. Infant mortality rates from congenital malformations and sudden infant death syndrome declined; however, rates for preterm-related CODs increased. The U.S. international ranking in infant mortality fell from 12th place in 1960 to 30th place in 2005.
CONCLUSIONS: Infant mortality is a complex and multifactorial problem that has proved resistant to intervention efforts. Continued increases in preterm and low birthweight delivery present major challenges to further improvement in the infant mortality rate.