The infant mortality rate (IMR) of 6.0 per 1000 live births in the United States in 2013 is nearly the highest among developed countries. Moreover, the IMR among blacks is >twice that among whites—11.11 versus 5.06 deaths per 1000 live births.This higher IMR and racial disparity in IMR is due to a higher preterm birth rate (11.4% of live births in 2013) and higher IMR among term infants. The United States also ranks near the bottom for maternal mortality and life expectancy among the developed nations—despite ranking highest in the proportion of gross national product spent on health care. This suggests that factors other than health care contribute to the higher IMR and racial disparity in IMR. One factor is disadvantaged socioeconomic status. All of the actionable determinates that negatively impact health—personal behavior, social factors, heath-care access and quality and the environment—disproportionately affect the poor. Addressing disadvantaged socioeconomic status by improving access to quality health care and increasing social expenditures would have the greatest impact on the USA’s IMR and racial disparity in IMR.
Subscribe to Journal
Get full journal access for 1 year
only $20.67 per issue
All prices are NET prices.
VAT will be added later in the checkout.
Rent or Buy article
Get time limited or full article access on ReadCube.
All prices are NET prices.
World Health Statistics 2015, Part II. Global Health Indicators (Table 7); Health expenditures (p 126-132). 2015 Available at: http://apps.who.int/iris/bitstream/10665/170250/1/9789240694439_eng.pdf?ua=1&. (Accessed on 24 August 2015).
Mathews TJ, MacDorman MF, Thoma ME . Infant moratlity statistics from 2013 from linked birth/infant death data set. NVSS 2015; 64: 1–28.
Organization for Economic Development and Cooperation. StatExtracts, Health, Health Status, Maternal and Infant Mortality 2015. Available at: http://stats.oecd.org/Index.aspx?DataSetCode=HEALTH_STAT# (accessed on 24 August 2015).
Joseph KS, Liu S, Rouleau J, Lisonkova S, Hutcheon JA, Sauve R et al. Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study. BMJ 2012; 344: e746.
Deb-Rinker P, León JA, Gilbert NL, Rouleau J, Andersen AM, Bjarnadóttir RI et al. Differences in perinatal and infant mortality in high-income countries: artifacts of birth registration or evidence of true differences? BMC Pediatr 2015; 15: 112–126.
MacDorman MF, Gregory ECW . Fetal and perinatal mortality: United States, 2013. NVSR 2015; 64: 1–23.
Martin JA, Michelle JK, Osterman MHS, Sutton PD . Are PTBs on the decline in the United States? Recent data from the national vital statistics system. NCHS Data Brief 2012; 39: 1–8.
Hamilton BE, Martin JA, Osterman MJK, Curtin SC, Mathews TJ . Births: final data for 2013. NVSR 2015; 64 (12): 1–68.
MacDorman MF, Mathews TJ, Mohango AD, Zeitlin J . International comparisons of infant mortality and related factors: United States and Europe. NVSR 2014; 63 (5):1–6.
MacDorman MF . Race and ethnic disparities in fetal mortality, preterm birth, and infant mortality in the United States: an overview. Sem Neonatol 2011; 35: 200–208.
Ananth CV, Liu S, Joseph KS, Kramer MS . Ethnic disparities in fetal mortality, preterm Birth, and infant mortality in the United Steillance System. A comparison of foetal and infant mortality in the United States and Canada. Int J Epidemiol. 2009; 38: 480–489.
Lisonkova S, Sabr Y, Butler B, Joseph K . International comparisons of preterm birth: higher rates of late preterm birth are associated with lower rates of stillbirth and neonatal death. BJOG 2012; 119: 1630–1639.
Dietz PM, England LJ, Shapiro-Mendoza CK, Tong VT, Farr SL, Callaghan WM . Infant morbidity and mortality attributable to prenatal smoking in the U.S. Am J Prev Med 2010; 39: 45–52.
Ananth CV, Joseph KS, Oyelese Y, Demissie K, Vintzileos AM . Trends in preterm births and perinatal mortality among singleton births: United States, 1989 through 2000. Am J Obstet Gynecol 2005; 105: 1084–1091.
Lisonkova S, Hutcheon JA, Joseph KS . Temporal trends in neonatal outcomes following iatrogenic preterm delivery. BMC Preg Childbirth 2011; 11: 39.
VanderWeele TJ, Lantos JD, Lauderdale DS . Rising PTB rates, 1989-2004: changing demographics or changing obstetric practice? Soc Sci Med 2012; 74: 196–201.
Jackson RA, Gibson KA, Wu YW, Croughan MS . Perinatal outcomes in singletons following in vitro fertilization: a meta–analysis. Obstet Gynecol 2004; 103: 551–563.
Merrit TA, Goldstein M, Philips R, Peverini R, Rodriquez, Oshiro B . Impact of ART in California: an analysis of maternity outcomes and insights into the added burden of neonatal intensive care. J Perinatal 2014; 34: 345–350.
Blondel B, Kogan MD, Alexander GR, Dattani N, Kramer MS, Macfarlane A et al. The impact of the increasing number of multiple births on the rates of preterm birth and low birthweight: an international study. Am J Pub Health 2002; 92: 1323–1330.
Gould JB, Mayo J, Shaw GM, Stevenson DK . Swedish and American studies show that initiatives to decrease maternal obesity could play a key role in reducing preterm birth. Acta Paediatr 2014; 103: 586–591.
Blumenshine P, Egerter S, Barclay CJ, Cubbin C, Braverman PA . Socioeconomic disparities and birth outcomes. A systematic review. Am J Prev Med 2010; 39: 263–272.
Chang HH, Larson J, Blencowe H, Spong CY, Howson CP, Cairns-Smith S et al. Preventing PTBs: analysis of trends and potential reductions with interventions in 39 countries with very high human development index. Lancet 2013; 381: 223–234.
Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV . Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the public health disparities geocoding project. Am J Pub Health 2005; 95: 312–323.
Foster HW, Wu L, Bracken MB, Semenya K, Thomas J, Thomas J . Intergenerational effects of high socioeconomic status on low birthweight and PTB in African Americans. J Natl Med Assoc 2000; 92: 213–221.
Kramer MR, Hogue CJ, Dunlop AL, Menon R . Preconceptional stress and racial disparities in PTB: an overview. Acta Obstet Gynecol Scand 2011; 90: 1307–1316.
Nkansah-Amankra S, Luchok KJ, Hussey JR, Watkins K, Liu X . Effects of maternal stress on low birth weight and preterm birth outcomes across neighborhoods of South Carolina, 2000–2003. Matern Child Health J 2010; 14: 215–226.
Nkansah-Amankra S, Dhawain A, Hussey JR, Luchok KJ . Maternal social support and neighborhood income inequality as predictors of low birth weight and preterm birth outcome disparities: analysis of South Carolina pregnancy risk assessment and Monitoring System Survey, 2000–2003. Matern Child Health J 2010; 14: 774–785.
MacDorman MF, Mathews TJ . Understanding racial and ethnic disparities in US infant mortality rates. NCHS Data Brief 2011; 74: 1–8.
United States vital statistics data 2005-09Available at: http://www.cdc.gov/nchs/data_access/vitalstatsonline.htm. (accessed on 1 July 2014).
Khoshnood B, Lee KS, Wall S, Hsieh HL, Mittendorf R . Short inter-pregnancy intervals and the risk of adverse birth outcome among five racial/ethnic groups in the United States. Am J Epidemiol. 1998; 148: 798–805.
Fiscella K . Racial disparities in PTBs. The role of urogenital infections. Pub Health Rep 1996; 11: 104–113.
Lu MC, Hafton N . Racial and ethnic disparities in birth outcomes: a life-course prospective. Mat Child Health J 2003; 7: 13–30.
Flegal KM, Carroll MD, Ogden CL, Curtin LR . Prevalence and trends in obesity among US adults, 1999–2008. JAMA 2010; 303: 235–241.
Wise PH . The anatomy of a disparity in infant mortality. Annu Rev Public Health 2003; 24: 341–362.
Paul DA, Locke R, Zook K, Leef KH, Stefano JL, Colmorgen G . Racial differences in prenatal care of mothers delivering very low birth weight infants. J Perinatol 2006; 26: 74–78.
Herbert PL, Chassin MR, Howell EA . The contribution of geography to black/white differences in the use of low neonatal mortality hospitals in New York City. Med Care 2011; 49: 200–206.
Partridge S, Balayla J, Holcroft CA, Abenhaim HA . Inadequate prenatal care utilization and risks of infant mortality and poor birth outcome: a Retrospective Analysis of 28,729,765 U.S. Deliveries over 8 Years. Am J Perinatol 2012; 29: 787–794.
Collins J, David R, Symons R, Handler A, Wall S, Dwyer L . Low-income African American mothers’ perception of exposure to racial discrimination and infant birth weight. Epidemiol 2000; 11: 337–339.
Foster HW, Wu L, Bracken MB, Semenya K, Thomas J, Thomas J . Intergenerational effects of high socioeconomic status on low birthweight and preterm birth in African Americans. J Natl Med Assoc 2000; 92: 213–221.
Mustillo S, Krieger N, Gunderson E, Sidney S, McCreath H, Kiefe C . Self-reported experiences of racial discrimination and Black-White differences in preterm and low-birth-weight deliveries: the CARDIA study. Am J Pub Health 2004; 94: 2125–2131.
Collins JW, David RJ, Simon DM, Prachand NG . PTB among African American and white women with a lifelong residence in high-income Chicago neighborhoods: an exploratory study. Ethnic Dis 2007; 17: 113–117.
Dominguez TP . Adverse birth outcomes in African American women: the social context of persistent reproductive disadvantage. Soc Work Pub Health 2011; 26: 3–16.
Marks J . New information, enduring questions: race, genetics, and medicine in the 21st century. GeneWatch 2014; 18: 11–16.
Barbujani G, Colonna V . Human genetic diversity: frequently asked questions. Trends Genet 2010; 26: 285–296.
David R, Collins J . Disparities in infant mortality: what’s genetics got to do with it? Am J Pub Health 2007; 97: 1191–1197.
York TP, Strauss JF III, Neale MC, Eaves LJ . Racial differences in genetic and environmental risk to preterm birth. PLoS One 2010; 5: e12391.
Schroeder SA . We can do better – improving the health of the American people. N Eng J Med 2007; 357: 1221–1228.
Organization for Economic Development and Cooperation. An Overview of Growing Income Inequalities in OECD Countries: Main Findings 2011. Available at: www.oecd.org/els/soc/49499779.pdf (accessed on 24 August 2015).
Bradley EH, Elkins BR, Herrin J, Elbel B . Heath and social services expenditures: associations with health outcomes. BMJ Qual Saf 2011; 20: 826–831.
Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L . Interventions for promoting smoking cessation during pregnancy. Cochrane Database Syst Rev 2009; (3): CD001055.
Fonseca EB, Celik E, Parra M, Singh M, Nicolaides KH . Progesterone and the risk of PTB among women with a short cervix. N Engl J Med 2007; 357: 462–469.
Hassan SS, Romero R, Vidyadhari D, Fusey S, Baxter JK, Khandelwal M et al. Vaginal progesterone reduces the rate of PTB in women with a sonographic short cervix: a multicenter, randomized, double-blind, placebo-controlled trial. PREGNANT Trial. Ultrasound Obstet Gynecol 2011; 38: 18–31.
Owen J, Hankins G, Iams JD, BerghellaV, Sheffield JS, Perez-Delboy A et al. Multicenter randomized trial of cerclage for PTB prevention in high-risk women with shortened midtrimester cervical length. Am J Obstet Gynecol 2009; 201 (375): e1–e8.
Clark SL, Frye DR, Meyers JR, Belfort MA, Dildy GA, Kofford S et al. Reduction in elective delivery at <39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth. Am J Obstet Gynecol 2010; 203: e1–e6.
Dickey RP . The relative contribution of assisted reproductive technologies and ovulation induction to multiple births in the United States 5 years after the Society for Assisted Reproductive Technology/American Society for Reproductive Medicine recommendation to limit the number of embryos transferred. Fertil Steril 2007; 88: 1554–1561.
Herron M . Deaths: leading causes for 2009. Natl Vital Stat Rep 2012; 61: 1–96.
We acknowledge Jonathan Gordon for his critical review of the manuscript. This work was supported by the Health Policy Center at New York-Presbyterian.
The authors declare no conflict of interest.
About this article
Cite this article
Lorenz, J., Ananth, C., Polin, R. et al. Infant mortality in the United States. J Perinatol 36, 797–801 (2016) doi:10.1038/jp.2016.63
Scientific Reports (2019)
Privilege and deprivation in Detroit: infant mortality and the Index of Concentration at the Extremes
International Journal of Epidemiology (2019)
Cardiovascular Revascularization Medicine (2019)
The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families
Pediatric Research (2019)
Birth Planning in Uncertain or Life-Limiting Fetal Diagnoses: Perspectives of Physicians and Parents
Journal of Palliative Medicine (2019)