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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

  1. Centers for Disease Control. Changes in premature mortality--United States, 1979-1986. MMWR 1988;37:47-8.

  2. 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.

  3. 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).

  4. Centers for Disease Control. Years of potential life lost attributable to low birthweight-- United States, 1980 birth cohort. MMWR 1986;35:188-90,195.

  5. 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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