Infant Mortality by Selected Maternal Characteristics and Race and Hispanic Origin in the United States, 2019-2021.

Objectives- This report presents infant mortality rates for selected maternal characteristics (prepregnancy body mass index, cigarette smoking during pregnancy, receipt of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) benefits during pregnancy, timing of prenatal care, and source of payment for delivery) for the five largest maternal race and Hispanic-origin groups in the United States for combined years 2019-2021. Methods-Descriptive tabulations based on data from the linked birth/infant death files for 2019-2021 are presented. The linked birth/infant death file is based on birth and death certificates registered in all 50 states and the District of Columbia. Infant mortality rates are presented for each maternal race and Hispanic-origin group overall and by selected characteristics. Results-Infant mortality rates varied across the five largest maternal race and Hispanic-origin groups and by selected maternal characteristics. For most race and Hispanic-origin groups, mortality rates were higher among infants of women with prepregnancy obesity compared with those of women who were normal weight, and were higher for infants of women who smoked cigarettes during pregnancy, received late or no prenatal care, or were covered by Medicaid as the source of payment for delivery. Overall, mortality rates were higher for infants of women who received WIC during pregnancy, but results varied across race and Hispanic-origin groups. Mortality rates for the maternal characteristics examined were generally highest among infants of Black non-Hispanic and American Indian and Alaska Native non-Hispanic women and lowest for Asian non-Hispanic women.

Births: Final Data for 2022.

Objectives- This report presents 2022 data on U.S. births by selected characteristics. Trends in fertility patterns and maternal and infant characteristics are described. Methods-Descriptive tabulations based on birth certificates of the 3.67 million births registered in 2022 are shown by maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates also are shown. Trends for 2010 to 2022 are presented for selected items, and by race and Hispanic origin for 2016-2022. Results-A total of 3,667,758 births occurred in the United States in 2022, essentially unchanged from 2021. The general fertility rate declined 1% from 2021 to 56.0 births per 1,000 females ages 15-44 in 2022. The birth rate for females ages 15-19 declined 2% from 2021 to 2022; birth rates fell 7% for women ages 20-24, rose 1% to 5% for women ages 25-29 and 35-44, and rose 12% for women ages 45-49 (the first increase since 2016). The total fertility rate declined less than 1% to 1,656.5 births per 1,000 women in 2022. Birth rates declined for unmarried women but increased for married women from 2021 to 2022. Prenatal care beginning in the first trimester declined to 77.0% in 2022; the percentage of women who smoked during pregnancy declined to 3.7%. The cesarean delivery rate was unchanged in 2022 (32.1%); Medicaid was the source of payment for 41.3% of births. The preterm birth rate declined 1% to 10.38%; the low birthweight rate rose 1% to 8.60%. The twin birth rate was unchanged in 2022 (31.2 per 1,000 births); the 2% decrease in the triplet and higher-order multiple birth rate.

Maternal Characteristics and Infant Outcomes by Hispanic Subgroup and Nativity:United States, 2021.

Objectives-This report presents comparisons of maternal characteristics and infant outcomes of Hispanic women and their infants by nativity (whether they were born in or outside the United States) for all Hispanic women and for the six largest Hispanic subgroups by nativity.

Infant Mortality in the United States, 2021: Data From the Period Linked Birth/Infant Death File.

Objective-This report presents 2021 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined. Methods-Descriptive tabulations of data are presented and interpreted for infant deaths and infant mortality rates using the 2021 period linked birth/infant death file. The linked birth/infant death file is based on birth and death certificates registered in all 50 states and the District of Columbia. Results-A total of 19,928 infant deaths were reported in the United States in 2021, up 2% from 2020. The U.S. infant mortality rate was 5.44 infant deaths per 1,000 live births, essentially unchanged from the rate of 5.42 in 2020. The neonatal mortality rate was essentially unchanged from 3.56 in 2020 to 3.49 in 2021, but the postneonatal mortality rate increased from 1.86 to 1.95. The overall infant mortality rate increased for infants of Asian non-Hispanic women and declined for infants of Dominican women in 2021 compared with 2020; changes in rates for the other race and Hispanic-origin groups were not significant. Infants of Black non-Hispanic women had the highest mortality rate (10.55) in 2021, followed by infants of Native Hawaiian or Pacific Islander non-Hispanic and American Indian or Alaska Native non-Hispanic (7.76 and 7.46, respectively), Hispanic (4.79), White non-Hispanic (4.36), and Asian non-Hispanic (3.69) women. By gestational age, infants born very preterm (less than 28 weeks of gestation) had the highest mortality rate (353.76), 170 times as high as that for infants born at term (37-41 weeks of gestation) (2.08). The five leading causes of infant death in 2021 were the same as in 2020. Infant mortality rates by state for 2021 ranged from a low of 2.77 in North Dakota to a high of 9.39 in Mississippi.

Homicides Among Infants in the United States,2017-2020.

Objectives-This report describes homicide rates among infants (under age 1 year) by selected maternal, pregnancy-related, and infant characteristics. Methods-Linked birth/infant death files based on data collected on U.S. birth and death certificates were used to calculate homicide rates among infants for the period 2017-2020. Results-A total of 1,067 homicides occurred among infants in the United States from 2017 through 2020, an average of 267 per year. More than one-half of all infant homicides occurred among infants aged 3 months and under. Homicide rates were higher among infants born to mothers who were young, had multiple previous live births, were Black non-Hispanic, were born in the United States, had lower levels of education, lived in rural areas, had no prenatal care, and delivered outside of a hospital. Rates were also higher for infants who were part of a multiple-gestation pregnancy, were born preterm or low birthweight, or were admitted to a neonatal intensive care unit.

Births: Final Data for 2021.

Objectives-This report presents 2021 data on U.S. births according to a variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.

Infant Mortality in the United States, 2020: Data From the Period Linked Birth/Infant Death File.

Objectives-This report presents 2020 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined.

Infant Mortality in the United States, 2019:Data From the Period Linked Birth/Infant Death File.

Objectives-This report presents 2019 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined.

Prepregnancy Body Mass Index and Infant Outcomes by Race and Hispanic Origin: United States, 2020.

Objectives-This report presents data on distributions in prepregnancy body mass index (BMI), including the three classes of obesity, by maternal race and Hispanic origin for women who gave birth in 2020. It also examines newborn outcomes by BMI by maternal race and Hispanic origin.

Births: Final Data for 2020.

Objectives-This report presents 2020 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.

Births: Final Data for 2019.

Objectives-This report presents 2019 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.75 million births that occurred in 2019 are presented. Data are presented for maternal age, livebirth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age are also shown. Trend data for 2010 through 2019 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2019. Results-A total of 3,747,540 births were registered in the United States in 2019, down 1% from 2018. The general fertility rate declined from 2018 to 58.3 births per 1,000 women aged 15-44 in 2019. The birth rate for females aged 15-19 fell 4% between 2018 and 2019. Birth rates declined for women aged 20-34 and increased for women aged 35-44 for 2018-2019. The total fertility rate declined to 1,706.0 births per 1,000 women in 2019. Birth rates declined for both married and unmarried women from 2018 to 2019. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.6% in 2019; the percentage of all women who smoked during pregnancy declined to 6.0%. The cesarean delivery rate decreased to 31.7% in 2019 (Figure 1). Medicaid was the source of payment for 42.1% of all births in 2019. The preterm birth rate rose for the fifth straight year to 10.23% in 2019; the rate of low birthweight was essentially unchanged from 2018 at 8.31%. Twin and triplet and higher-order multiple birth rates both declined in 2019 compared with 2018.

Effects of Changes in Maternal Age Distribution and Maternal Age-specific Infant Mortality Rates on Infant Mortality Trends: United States, 2000-2017.

Objectives-This report assesses the contributions of the changing maternal age distribution and maternal age-specific infant mortality rates on overall and race and Hispanic origin-specific infant mortality rates in the United States from 2000 to 2017. Methods-The analyses used 2000-2017 linked birth and infant death data from the National Vital Statistics System. Age-adjusted infant mortality rates, based on the 2000 U.S. maternal age distribution, were calculated for each year. These rates were compared with crude rates for all births and for specific race and Hispanic-origin groups. Decomposition analysis was used to estimate the proportion of the decline due to changes in maternal age distribution and in age-specific mortality rates. Results-During 2000-2017, the age of women giving birth rose as infant mortality rates declined, although unevenly across maternal age groups. The maternal age-adjusted infant mortality rate in 2017 was 6.13 compared with the crude rate of 5.79, resulting in a 0.34 percentage point difference. Changes in the maternal age distribution accounted for 31.3% of the decline in infant mortality rates for all births and for births to non-Hispanic white women, and for 4.8% of the decline in births to non-Hispanic black women. Declines in age-specific mortality rates accounted for the remainder of the decline for these groups and for all of the decline in births to Hispanic women. Conclusion-Changes in the age distribution of women giving birth accounted for about one-third of the decline in infant mortality rates from 2000 through 2017; declines in maternal age-specific mortality rates accounted for about two-thirds of this decline. These patterns varied by race and Hispanic origin.

Infant Mortality in the United States, 2018: Data From the Period Linked Birth/Infant Death File.

Objectives-This report presents 2018 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined. Methods-Descriptive tabulations of data are presented and interpreted for infant deaths and infant mortality rates using the 2018 period linked birth/infant death file; the linked birth/infant death file is based on birth and death certificates registered in all states and the District of Columbia. Results-A total of 21,498 infant deaths were reported in the United States in 2018. The U.S. infant mortality rate was 5.67 infant deaths per 1,000 live births, lower than the rate of 5.79 in 2017 and an historic low in the country. The neonatal and post neonatal mortality rates for 2018 (3.78 and 1.89, respectively) demonstrated a nonsignificant decline compared with 2017 (3.85 and 1.94, respectively). The 2018 mortality rate declined for infants of Hispanic women compared with the 2017 rate; changes in rates for other race and Hispanic-origin groups were not statistically significant. The 2018 infant mortality rate for infants of non-Hispanic black women (10.75) was more than twice as high as that for infants of non-Hispanic white (4.63), non-Hispanic Asian (3.63), and Hispanic women (4.86). Infants born very preterm (less than 28 weeks of gestation) had the highest mortality rate (382.20), 186 times as high as that for infants born at term (37-41 weeks of gestation) (2.05). The five leading causes of infant death in 2018 were the same as in 2017; cause-of-death rankings and mortality rates varied by maternal race and Hispanic origin. Infant mortality rates by state for 2018 ranged from a low of 3.50 in New Hampshire to a high of 8.41 in Mississippi.

Infant Mortality in the United States, 2017: Data From the Period Linked Birth/Infant Death File.

Objectives-This report presents 2017 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, maternal state of residence, gestational age, and leading causes of death. Trends in infant mortality are also examined. Methods-Descriptive tabulations of data are presented and interpreted for infant deaths and infant mortality rates using the 2017 period linked birth/infant death file; the linked birth/infant death file is based on birth and death certificates registered in all states and the District of Columbia. Results-A total of 22,341 infant deaths were reported in the United States in 2017. The U.S. infant mortality rate was 5.79 infant deaths per 1,000 live births, not statistically different from the rate of 5.87 in 2016. The neonatal and postneonatal mortality rates for 2017 (3.85 and 1.94, respectively) were also essentially unchanged from 2016. The 2017 infant mortality rate for infants of non-Hispanic black women (10.97) was more than twice as high as that for infants of non-Hispanic white (4.67), non-Hispanic Asian (3.78), and Hispanic (5.10) women. Infant mortality rates by state for 2017 ranged from a low of 3.66 in Massachusetts to a high of 8.73 in Mississippi. Infants born very preterm (less than 28 weeks of gestation) had the highest mortality rate (384.39), 183 times as high as that for infants born at term (37-41 weeks of gestation) (2.10). The five leading causes of infant death in 2017 were the same as in 2016; cause of death rankings and mortality rates varied by maternal race and Hispanic origin. Preterm-related causes of death accounted for 34% of the 2017 infant deaths, unchanged from 2016.

Maternal Characteristics and Infant Outcomes in Appalachia and the Delta.

Objectives-This report compares maternal characteristics and outcomes for infants born to mothers in Appalachia, the Delta, and the rest of the United States. Methods-The 2017 vital statistics natality file and the 2016-2017 linked birth/infant death data files were used to compare maternal characteristics (e.g., race and Hispanic origin, age, and marital status) of women who gave birth in Appalachia, the Delta, and the rest of the United States. Comparisons of infant outcomes (preterm, low birthweight, and infant mortality) across the three regions were made overall and within categories of these maternal characteristics. Results-Characteristics of women who gave birth differed across the three regions. Women in the Delta were most likely to be teenagers, unmarried, and not have a college degree, followed by women in Appalachia, and then by women in the rest of the United States. Overall and within most categories of maternal characteristics, infants born in the Delta were more likely to be preterm (12.37%) or low birthweight (10.75%) and were more likely to die in their first year of life (8.17 infant deaths per 1,000 live births) than those born in Appalachia (10.75%, 8.87%, and 6.82, respectively), while those born in the rest of the United States were the least likely (9.78%, 8.14%, and 5.67, respectively). Conclusions-Maternal characteristics associated with poor infant outcomes are most common among women who give birth in the Delta, followed by women in Appalachia, and then the rest of the United States. Within most categories of these maternal characteristics, infants born in the Delta have the worst outcomes, followed by those born in Appalachia, and then those born in the rest of the United States.

Births: Final Data for 2018.

Objectives-This report presents 2018 data on U.S. births according to a wide variety of characteristics. Trends in fertility patterns and maternal and infant characteristics are described and interpreted. Methods-Descriptive tabulations of data reported on the birth certificates of the 3.79 million births that occurred in 2018 are presented. Data are presented for maternal age, live-birth order, race and Hispanic origin, marital status, tobacco use, prenatal care, source of payment for the delivery, method of delivery, gestational age, birthweight, and plurality. Selected data by mother's state of residence and birth rates by age also are shown. Trend data for 2010 through 2018 are presented for selected items. Trend data by race and Hispanic origin are shown for 2016-2018. Results-3,791,712 births were registered in the United States in 2018, down 2% from 2017. Compared with rates in 2017, the general fertility rate declined to 59.1 births per 1,000 women aged 15-44. The birth rate for females aged 15-19 fell 7% in 2018. Birth rates declined for women aged 20-34 and increased for women aged 35-44. The total fertility rate declined to 1,729.5 births per 1,000 women in 2018. Birth rates for both married and unmarried women declined from 2017 to 2018. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.5% in 2018; the percentage of all women who smoked during pregnancy declined to 6.5%. The cesarean delivery rate decreased to 31.9% in 2018 following an increase in 2017. Medicaid was the source of payment for 42.3% of all 2018 births, down 2% from 2017. The preterm birth rate rose for the fourth straight year to 10.02% in 2018; the rate of low birthweight was unchanged at 8.28%. Twin and triplet and higher-order multiple birth rates declined in 2018 (Figure 1).

Disparities in Incidence of COVID-19 Among Underrepresented Racial/Ethnic Groups in Counties Identified as Hotspots During June 5-18, 2020 - 22 States, February-June 2020.

During January 1, 2020-August 10, 2020, an estimated 5 million cases of coronavirus disease 2019 (COVID-19) were reported in the United States.* Published state and national data indicate that persons of color might be more likely to become infected with SARS-CoV-2, the virus that causes COVID-19, experience more severe COVID-19-associated illness, including that requiring hospitalization, and have higher risk for death from COVID-19 (1-5). CDC examined county-level disparities in COVID-19 cases among underrepresented racial/ethnic groups in counties identified as hotspots, which are defined using algorithmic thresholds related to the number of new cases and the changes in incidence.† Disparities were defined as difference of ≥5% between the proportion of cases and the proportion of the population or a ratio ≥1.5 for the proportion of cases to the proportion of the population for underrepresented racial/ethnic groups in each county. During June 5-18, 205 counties in 33 states were identified as hotspots; among these counties, race was reported for ≥50% of cumulative cases in 79 (38.5%) counties in 22 states; 96.2% of these counties had disparities in COVID-19 cases in one or more underrepresented racial/ethnic groups. Hispanic/Latino (Hispanic) persons were the largest group by population size (3.5 million persons) living in hotspot counties where a disproportionate number of cases among that group was identified, followed by black/African American (black) persons (2 million), American Indian/Alaska Native (AI/AN) persons (61,000), Asian persons (36,000), and Native Hawaiian/other Pacific Islander (NHPI) persons (31,000). Examining county-level data disaggregated by race/ethnicity can help identify health disparities in COVID-19 cases and inform strategies for preventing and slowing SARS-CoV-2 transmission. More complete race/ethnicity data are needed to fully inform public health decision-making. Addressing the pandemic's disproportionate incidence of COVID-19 in communities of color can reduce the community-wide impact of COVID-19 and improve health outcomes.

Trends in Number and Distribution of COVID-19 Hotspot Counties - United States, March 8-July 15, 2020.

The geographic areas in the United States most affected by the coronavirus disease 2019 (COVID-19) pandemic have changed over time. On May 7, 2020, CDC, with other federal agencies, began identifying counties with increasing COVID-19 incidence (hotspots) to better understand transmission dynamics and offer targeted support to health departments in affected communities. Data for January 22-July 15, 2020, were analyzed retrospectively (January 22-May 6) and prospectively (May 7-July 15) to detect hotspot counties. No counties met hotspot criteria during January 22-March 7, 2020. During March 8-July 15, 2020, 818 counties met hotspot criteria for ≥1 day; these counties included 80% of the U.S. population. The daily number of counties meeting hotspot criteria peaked in early April, decreased and stabilized during mid-April-early June, then increased again during late June-early July. The percentage of counties in the South and West Census regions* meeting hotspot criteria increased from 10% and 13%, respectively, during March-April to 28% and 22%, respectively, during June-July. Identification of community transmission as a contributing factor increased over time, whereas identification of outbreaks in long-term care facilities, food processing facilities, correctional facilities, or other workplaces as contributing factors decreased. Identification of hotspot counties and understanding how they change over time can help prioritize and target implementation of U.S. public health response activities.

Changing Sociodemographic Factors and Teen Fertility: 1991-2009.

This study analyzed the roles of trends in sociodemographic factors known to be related to the risk of a teen birth. The goal was to analyze the roles of these trends in maternal education, family structure and mother's age at first birth in the likelihood of adolescents becoming teen mothers across multiple birth cohorts of women covering the years since 1991. Data are from the 1995, 2002, 2006-2010 and 2011-2013 National Surveys of Family Growth (NSFG). Consecutive birth cohorts of female respondents were constructed and retrospectively followed to estimate the risk of a teen birth for each cohort. Logistic regression models estimate the odds of a teen birth across cohorts and within strata of the predictors across cohorts. Maternal education rose across cohorts; the proportion who were non-Hispanic white declined. In general, the likelihood of an adolescent birth did not change within categories of the predictors that are considered at higher risk for a teen birth across birth cohorts. Specifically, there was no change in the odds of a teen birth among women whose mothers did not finish high school, those born to teen mothers and those not from two-parent families. The odds of a birth declined across cohorts for black women. The findings suggest that much of the decline in teen birth rates is due to declines in the proportion of teens in higher risk categories, rather than to declines within those categories.

Adult outcomes of teen mothers across birth cohorts.

BACKGROUND: Teen and young adult mothers have lower socioeconomic status than older mothers. OBJECTIVE: This study analyzes the socioeconomic status (SES) of teen, young adult, and older adult mothers across four five-year birth cohorts from 1956 to 1975 who were teens from 1971 to 1994. METHODS: Data were pooled from the 1995, 2002, and 2006-2010 National Survey of Family Growth (NSFG). Mothers were categorized by age at first birth and by their birth cohorts. The SES (education, single motherhood, poverty, employment) of teen, young adult, and older mothers was compared across cohorts and within cohorts. RESULTS: Among teen mothers, the odds of fulltime employment improved across birth cohorts and the odds of educational attainment beyond high school did not vary. Their odds of single motherhood and living in poverty increased across cohorts. The odds of higher education and single motherhood increased across birth cohorts for young adult mothers as did the odds of living in poverty, even if working fulltime. Among older adult mothers, educational attainment and the odds of single motherhood rose for recent cohorts. CONCLUSIONS: Comparisons between teen mothers and both young adult and all adult mothers within cohorts suggest that gaps in single motherhood and poverty between teen and adult mothers have widened over time, to the detriment of teen mothers. Teen mothers have become more likely to be single and poor than in the past and compared to older mothers.