Current Trends
Trends in Years of Potential Life Lost Due to Infant Mortality and
Perinatal Conditions, 1980-1983 and 1984-1985
The majority of deaths from three of the seven leading causes
of
years of potential life lost (YPLL) occur during the first year of
life (1). Analysis of overall YPLL from infant deaths and of YPLL
from
perinatal conditions* for 1980-1983 (2) and 1984-1985 reveals that
YPLL for all genders and races has declined.
Data from the national mortality computer tapes and natality
statistics (3) from the National Center for Health Statistics,
CDC,
were used for this analysis. The classification scheme for
perinatal
and other causes of death and the formula used for calculating
YPLL
have been described (2,4). Since YPLL from infant deaths for any
given
year should be evaluated in light of the number of live births for
that year, average YPLL per 1,000 live births was calculated.
Between 1980-1983 and 1984-1985, the average annual YPLL per
1,000
live births declined for all genders and races. Declines were
greatest
for white female infants (14%) and white male infants (13%). Black
male infants and male infants of other races had a 12% decline,
and
black and other female infants had a 10% decline. YPLL rates
declined
most rapidly for deaths caused by birth trauma/asphyxia (Table 1).
The
average YPLL for birth trauma/asphyxia dropped 33% for whites
(from
36/1,000 live births to 24/1,000) and 31% for blacks and others
(from
59/1,000 to 41/1,000).
For 1980-1983, the average annual YPLL for deaths occurring
within
the first year of life was 2,787,465; 1,861,691 (66.8%) occurred
because of deaths during the neonatal period (less than 28 days),
and
925,774, because of deaths during the postneonatal period (28 days
toless than 1 year) (2). For 1984-1985, the average annual YPLL
within
the first year of life was 2,579,920; 1,685,549 (65.3%) occurred
because of deaths during the neonatal period, and 896,741, because
of
deaths during the postneonatal period. The average YPLL per 1,000
live
births declined from 749 for the period 1980-1983 to 694 for
1984-1985.
Conditions arising during the perinatal period were
responsible
for 47% (1,301,746) of YPLL among infants from 1980-1983 (2) and
45%
(1,162,490) of YPLL among infants from 1984-1985. During both
study
periods, respiratory conditions accounted for approximately
one-third
of the average YPLL due to perinatal conditions; respiratory
distress
syndrome was the most frequent respiratory condition. Male infants
had
higher annual YPLL rates than female infants (Table 2).
Differences in
YPLL rates by gender were greatest for deaths due to respiratory
distress syndrome; the rate for male infants exceeded the rate for
female infants by 34%. The ratio of blacks to whites for all
perinatal
conditions was 2.3 for male infants and 2.5 for female infants.
Reported by: Pregnancy Epidemiology Br, Research and Statistics
Br,
Div of Reproductive Health, Center for Health Promotion and
Education,
CDC.
Editorial Note: Deaths due to prematurity as defined in Table V
(see page 255) exclude conditions such as slow fetal growth and
fetal
maturation (International Classification of Diseases, Ninth
Revision
(ICD-9) 764), birth trauma (ICD-9 767), asphyxia (ICD-9 768),
respiratory conditions of the fetus and newborn other than
respiratory
distress syndrome (ICD-9 770), and other perinatal conditions
(ICD-9
640-676, 760.0-760.1, 760.3-762.9, 766, 772-779). An analysis of
deaths resulting from perinatal conditions includes these causes
and,
thus, gives a more comprehensive estimate of YPLL due to infant
deaths.
The marked decline in YPLL due to birth trauma/asphyxia
suggests
improvements in care given at the time of labor and delivery
and/or in
neonatal care for infants with birth trauma/asphyxia. Further
studies
are needed to explore these possible conclusions.
For the period 1984-1985, YPLL due to perinatal conditions per
1,000 live births was 2.4 times greater for blacks than for whites
(Table 2). This analysis suggests that YPLL may be lower for other
minorities than for whites. However, the outcomes for infants vary
considerably by minority group (5), and additional analysis is
necessary. Since the publication of the Report of the Secretary's
Task
Force on Black and Minority Health in 1985 (5), new strategies
have
been designed to diminish the excess infant deaths among blacks
and to
evaluate outcomes for infants among other minority populations.
Evaluation of activities that narrow the disparity between blacks
and
whites will be needed.
References
Centers for Disease Control. Changes in premature
mortality--United States, 1979-1986. MMWR 1988;37:47-8.
Centers for Disease Control. Years of potential life lost
before
age 65 due to perinatal conditions--United States, 1980-1983.
MMWR
1987;36:179-80,185-7.
National Center for Health Statistics. Advance report of final
natality statistics, 1985. Hyattsville, Maryland: National
Center
for Health Statistics, 1987; DHHS publication no.
(PHS)87-1120.
(Monthly vital statistics report; vol. 36, no. 4, supplement).
Centers for Disease Control. Years of potential life lost
attributable to low birthweight-- United States, 1980 birth
cohort. MMWR 1986;35:188-90,195.
US Department of Health and Human Services. Report of the
Secretary's Task Force on Black and Minority Health.
Washington,
DC: US Department of Health and Human Services, Public Health
Service, 1986.
*Conditions arising between 28 weeks gestation and 7 days of life.
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