Public Use Data File Documentation - National Bureau of Economic

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Public Use Data File Documentation

2004 Period Linked Birth/Infant Death Data Set .

DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics

2004 Period Linked Birth/lnfant Death Data Set Contents 1. Introduction, Methodology, and Classification of Data. 2. Machine used, file and data characteristics. 3. List of data elements and locations. 4. Record layout and definition of items and codes. 5. County geographic codes available on the public-use file. 6. City geographic codes available on the public-use file. 7. PMSA codes available on the public-use file. 8. Titles and codes for the 130 cause-of-death list. 9. Documentation tables 1-6. 10. Infant Mortality Statistics from the 2004 Linked File. 11. Technical Appendix for the 2004 Natality file. 12. Technical Notes from Deaths: Final Data for 2004.

Introduction The linked birth/infant death data set (linked file) is released in two formats - period data and birth cohort data. This documentation is for the 2004 period linked file. Beginning with 1995 data, the period linked files have formed the basis for all official NCHS linked file statistics. Differences between period and birth cohort data are outlined below. Period data - The numerator for the 2004 period linked file consists of all infant deaths occurring in 2004 linked to their corresponding birth certificates, whether the birth occurred in 2003 or 2004. The denominator file for this data set is the 2004 natality file, that is, all births occurring in 2004. In addition, NCHS accepted a small number of late-filed birth certificates needed to link to infant deaths. This reduced the number of unlinked records and slightly increased the number of births in the denominator file. Birth cohort data - The numerator for the 2004 birth cohort linked file consists of deaths to infants born in 2004 whether the death occurred in 2004 or 2005. The denominator file is the 2004 natality file, that is, all births occurring in 2004. The 2004 period linked birth/infant death data set includes several data files. The first file includes all US infant deaths which occurred in the 2004 data year linked to their corresponding birth certificates, whether the birth occurred in 2003 or in 2004 - referred to as the numerator file. The second file contains information from the death certificate for all US infant death records which could not be linked to their corresponding birth certificates - referred to as the unlinked death file. The third file is the 2004 NCHS natality file for the US (plus late-filed records mentioned above), which is used to provide denominators for rate computations. These same three data files are also available for Puerto Rico, the Virgin Islands, and Guam. 1989 and 2003 Revisions of the U.S. Standard Certificate of Live Birth and Certificate of Death This data file includes data based on both the 1989 Revision of the U.S. Standard Certificate of Live Birth (unrevised) and the 2003 revision of the U.S. Standard Certificate of Live Birth (revised). The 2003 revision is described in detail elsewhere. (See the 2003 Revision website at: http://www.cdc.gov/nchs/vital_certs_rev.htm). Pennsylvania and Washington implemented the revised certificate in 2003; five additional states (Idaho, Kentucky, New York (excluding New York City), South Carolina, and Tennessee) implemented as of January 1, 2004. Two additional states, Florida and New Hampshire, implemented the revised birth certificate in 2004, but after January 1. Where comparable, revised data are combined with data from the remaining 41 states and the District of Columbia. (Revised data are denoted by “A;” unrevised data are denoted by “S” in the “Rev” column of the documentation.) Where data for the 1989 and 2003 certificate revisions are not comparable (e.g., educational attainment of the mother), unrevised and revised data are given in separate fields in the data file. This file includes data for ten states (California, Idaho, Michigan, Montana, New Jersey, New York, Oklahoma, South Dakota, Washington, and Wyoming), which implemented the 2003 revision of the U.S. Standard Certificate of Death as of January 1, 2004 or in 2003. Two additional

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states, New Hampshire and Connecticut, implemented the revised death certificate in 2004, but after January 1. Data from all other areas are based on the 1989 revision. Most of the variables from the death certificate in this file are comparable despite changes to item wording and format in the 2003 revision. The 2003 revision is described in detail elsewhere. (See the 2003 Revision website at: http://www.cdc.gov/nchs/vital_certs_rev.htm). Incomplete National Reporting - Using Reporting Flags As a result of the delayed, phased transition to the 2003 U.S. Standard Certificate of Live Birth, the 2004 linked file includes data for reporting areas that use the 2003 revision of the U.S. Standard Certificate of Live Birth (revised) and data for reporting areas that use the 1989 Standard Certificate of Live Birth (unrevised). Although many data items are comparable across certificate revisions and are available for the entire United States, many items have more limited reporting areas. In addition, the 2004 linked file contains information on infants born in both 2003 and 2004 (see description of the period linked file above). As reporting areas changed between 2003 and 2004, this complicates the analysis. Also, birth data are collected by place of occurrence but are typically tabulated by mother’s place of residence. Reporting flags were developed to help the user more readily identify reporting areas for items with less than national reporting for the entirety of 2003 and 2004. Reporting flags are included in the file to assist in accurately excluding records from non-reporting areas when tabulating data by mother’s place of residence. Reporting flags are available for most items on the file. Reporting areas for the 2004 linked file are different from those for the 2004 birth file, as items had to be reported by a state in both 2003 and 2004 to be able to provide complete data. Thus, data for non-comparable items from states that revised in 2004 are excluded from all tabulations. Positions for reporting flags are noted along with each data item in the file layout. Reporting flags must be invoked to generate accurate numbers by residence for items which are not reported by all states. Where applicable, reporting flags are shown in the column “Reporting Flag Position” in the file documentation. Reporting flag codes are “0” (item reported in neither the current or previous year), 1 (item reported in both current and previous year), 2 (item reported in the previous but not in the current year), and 3 (item reported in the current but not in the previous year). When using these data, select reporting flag=1 to get valid and complete data for an item (see SAS code examples below). Translating “blanks” - In the 2004 linked file, for data items which are not common or comparable across certificate revisions, events to residents of a revised state occurring in an unrevised state, and events to residents in an unrevised state occurring in a revised state, are represented by “blanks.” Blanks should be treated as “unknowns” for tabulations. The correct use of reporting flags and translation of blanks will result in an accurate tally of births and infant deaths for items with incomplete national reporting. For further information please contact us at [email protected] or (301)458-4111. Example of SAS code using reporting flags (and translating blanks)

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An example of SAS code that may be used to incorporate the correct use of reporting flags and the translation of blanks is shown below. This example is for the revised prenatal care item. Prenatal care data based on the revised certificate are not considered comparable to data based on the unrevised certificate, and are shown separately. Accordingly, use of the reporting flag for this item will produce 2004 data for the month prenatal care began for the two revised states which had implemented the revised certificate by January 1st 2003. Data for states which implemented the revised certificates in 2004 are excluded, as part of their linked file births (those born in 2003) were reported on the unrevised certificate. Sample SAS program 01 DATA work; 02 INFILE ‘c:link04us.dat’ LRECL=1500; 03 INPUT 04 restatus 138 05 precare 245-246 06 f_mpcb 668; 07 08 /*Exclude foreign residents*/ 09 IF restatus NE 4; 10 /*Select reporting area*/ 11 IF f_mpcb=1; 12 /*Convert blanks to unknown*/ 13 IF precare=. THEN precare=99; 14 15 PROC FREQ; 16 TABLE precare; 17 RUN; In this example, “restatus” is used to exclude births to foreign residents (this is standard practice for all NCHS tabulations). Also in this example, blanks are represented by numeric values SAS code = (.). However, for some items in the file, e.g., obstetric procedures, blanks are represented by character values for which the SAS code is empty quotes (‘ ’). Alternatives to the use of reporting flags - The use of reporting flags provides a relatively quick, accurate way to select records for all areas reporting comparable data for a given item in a particular year. However, should a limited reporting area be needed, specific state(s) of residence may also be selected, or unselected. This approach may be useful, for example, in trend analysis where reporting areas have changed over time. See Table A in the “Natality Technical Appendix” for state-specific information on reporting areas. This approach may also be used to limit the reporting area to only states reporting multiple or single race data (see multiple race section below). Example of SAS code using state of residence (and translating blanks) 01 DATA work; 02 INFILE ‘c:link04us.dat’ LRECL=1500; 03 INPUT 04 restatus 138 05 xmrstate $ 107-108 3

06 07 08 09 10 11 12 13 14 15 16 17

precare 245-246; /*Exclude foreign residents*/ IF restatus NE 4; /*Select reporting area*/ IF xmrstate in (‘ID’,’KY’,’NY’,’PA’,’SC’,’TN’,’WA’); /*Convert blanks to unknown*/ IF precare=. THEN precare=99; PROC FREQ; TABLE precare; RUN;

Single, Multiple, and Bridged Race In 1997, the Office of Management and Budget (OMB) issued revised standards requiring Federal collection programs to allow respondents to select one or more race categories. Beginning with 2003 data, six areas reported multiple race data for all or part of the year: California, Hawaii, Pennsylvania, Utah, and Washington (full year); and Ohio (partial year). Beginning in 2004, six additional areas reported multiple race data for the full year: Idaho, Kentucky, New York State (excluding New York City), South Carolina, Tennessee, and Minnesota. In addition, Florida, and New Hampshire reported multiple race data for part of the year, and Michigan for births at selected facilities only. For the 2004 period linked file, complete data for both 2003 and 2004 births is available from 5 states: California, Hawaii, Pennsylvania, Utah, and Washington. In 2004, multiple race data was reported on the death certificates of 15 states: California, Hawaii, Idaho, Maine, Michigan, Minnesota, Montana, New Hampshire, New Jersey, New York, Oklahoma, South Dakota, Washington, Wisconsin, and Wyoming. In order to provide uniformity and comparability of the data before all or most of the data are available in the new multiple-race format, it was necessary to ‘‘bridge’’ the responses of those for whom more than one race was reported (multiple race) to one, single race. See the “Technical Notes” of “Births: Final Data for 2004” and “Deaths: Final Data for 2004” which are included on this CD ROM for more information. Weighting Beginning with the 1995 linked file, a weight was added to the linked numerator file to correct in part for biases in percent of records linked by major characteristics (see section below on Percent of records linked). The number of infant deaths in the linked file are weighted to equal the sum of the linked plus unlinked infant deaths by age at death and state. The formula for computing the weights is as follows: number of linked infant deaths + number of unlinked infant deaths number of linked infant deaths

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A separate weight is computed for each state of residence of birth and each age at death category (<7 days, 7-27 days, 28 days-1 year). Thus, weights are 1.0 for states which link all of their infant deaths. The denominator file is not weighted. Weights are not computed for the Puerto Rico, Virgin Islands, and Guam file. Birthweight Beginning with the 1995 linked file, an imputation for not-stated birthweight was added to the data set, to reduce potential bias in the computation of birthweight-specific infant mortality rates. Basically, if birthweight is not stated and the period of gestation is known, birthweight is assigned the value from the previous record with the same period of gestation, race, sex, and plurality. Imputed values are flagged. The addition of this imputation has reduced the percent of not-stated responses for birthweight from 4.10 to 0.44 in the numerator file, and from 0.09 to 0.01 in the denominator file, thus greatly reducing (but not eliminating) the potential for underestimation when computing birthweight-specific infant mortality rates. Comparisons of infant mortality data from the linked file with infant mortality data from the vital statistics mortality file Although the time periods are the same, numbers of infant deaths and infant mortality rates by characteristics are not always identical between the period linked file and the vital statistics mortality file. Differences in numbers of infant deaths between the two data sources are primarily due to geographic coverage differences. For the vital statistics mortality file, all deaths occurring in the 50 states and the District of Columbia are included regardless of the place of birth of the infant. In contrast, to be included in the linked file, both the birth and death must occur in the 50 states and the District of Columbia. Also, although every effort has been made to design weights that will accurately reflect the distribution of deaths by characteristics, weighting may contribute to small differences in numbers and rates by specific variables between these two data sets. In most cases, differences between numbers of infant deaths and infant mortality rates between the linked file and those computed from the vital statistics mortality file are negligible. Methodology The methodology used to create the national file of linked birth and infant death records takes advantage of two existing data sources: 1. State linked files for the identification of linked birth and infant death certificates; and 2. NCHS natality and mortality computerized statistical files, the source of computer records for the two linked certificates. Virtually all states routinely link infant death certificates to their corresponding birth certificates for legal and statistical purposes. When the birth and death of an infant occur in different states, copies of the records are exchanged by the state of death and state of birth in order to effect a link. In addition, if a third state is identified as the state of residence at the time of birth or death, that state is also sent a copy of the appropriate certificate by the state where the birth or death occurred.

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The NCHS natality and mortality files, produced annually, include statistical data from birth and death certificates that are provided to NCHS by states under the Vital Statistics Cooperative Program (VSCP). The data have been coded according to uniform coding specifications, have passed rigid quality control standards, have been edited and reviewed, and are the basis for official U.S. birth and death statistics. To initiate processing, NCHS obtained matching birth certificate numbers from states for all infant deaths that occurred in their jurisdiction. We used this information to extract final, edited mortality and natality data from the NCHS natality and mortality statistical files. Individual birth and death records were selected from their respective files and linked into a single statistical record, thereby establishing a national linked record file. After the initial linkage, NCHS returned to the states where the death occurred computer lists of unlinked infant death certificates for follow up linking. If the birth occurred in a state different from the state of death, the state of birth identified on the death certificate was contacted to obtain the linking birth certificate. State additions and corrections were incorporated, and a final, national linked file was produced. Characteristics of the natality and mortality data from which the linked file is constructed are described in detail in the Technical Appendix and Final Reports included in this document. Characteristics of Unlinked File For the 2004 linked file 1.1% of all infant death records could not be linked to their corresponding birth certificates. Unlinked records are included in a separate data file in this data set. The unlinked record file uses the same record layout as the numerator file of linked birth and infant death records. However, except as noted below, locations reserved for information from the matching birth certificate are blank since no matching birth certificate could be found for these records. The sex field contains the sex of infant as reported on the death certificate, rather than the sex of infant from the birth certificate, which is not available. The race field contains the race of the decedent as reported on the death certificate rather than the race of mother as reported on the birth certificate as is the case with the linked record file. The race of mother on the birth certificate is generally considered to be more accurate than the race information from the death certificate (see section on Race and Hispanic origin in the Mortality Technical Notes included in this documentation). Also, date of birth as reported on the death certificate is used to generate age at death. This information is used in place of date of birth from the birth certificate, which is not available. Documentation table 6 shows counts of unlinked records by race and age at death for each state of residence. The user is cautioned in using table 6 that the race and residence items are based on information reported on the death certificate, whereas tables 1-5 present data from the linked file in which the race and residence items are based on information reported on the birth certificate. Percent of Records Linked The 2004 linked file for the 50 States and D.C. includes 27,612 linked infant death records and 308 unlinked infant death records. The linked file is weighted to the sum of linked plus unlinked

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records, thus the total number of weighted infant deaths by place of occurrence is 27,920. While the overall percent linked for infant deaths in the 2004 file is 98.9%, there are differences in percent linked by certain variables. These differences have important implications for how the data is analyzed. Table 1 below shows the percent of infant deaths linked by state of occurrence of death. While many states link all of their infant deaths, linkage rates for some states are below the national average. Note in particular the percent linked for California (96.9), Massachusetts (97.0), New Jersey (97.3), and Texas (96.7). When a high percentage of deaths remain unlinked, unweighted infant mortality rates computed for these states are underestimated. It is for this reason that weights were added to the file to correct for biases in the data due to poor data linkage for particular states. Table 1. Percent of infant deaths linked by state of occurrence of death: United States, 2004 linked file United States Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana

98.9 100.0 100.0 98.7 99.7 96.9 100.0 100.0 100.0 100.0 99.8 100.0 100.0 99.2 97.6 99.4 100.0 100.0 99.4 98.6 100.0 100.0 97.0 100.0 100.0 99.2 99.9 100.0

Nebraska Nevada New Hampshire New Jersey New Mexico New York State New York City North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Puerto Rico Virgin Islands Guam

99.5 99.5 100.0 97.3 100.0 97.8 99.6 100.0 100.0 98.5 99.0 99.6 99.6 100.0 100.0 100.0 99.9 96.7 100.0 100.0 100.0 99.8 100.0 100.0 100.0 99.5 100.0 100.0

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In general, a slightly higher percentage of postneonatal (28 days to under 1 year) than neonatal (less than 28 days) deaths were linked (99.1 and 98.8, respectively.) While the weighting protocol has been designed to correct for possible bias due to variations in match rates by characteristics, no statistical method can correct perfectly for data limitations. Therefore, variations in the percent of records linked should be taken into consideration when comparing infant mortality rates by detailed characteristics. Confidentiality To minimize the risk of disclosure of individual or institutional information NCHS public-use data files do not contain the actual day of the birth or the dates of birth of the mother or father. Also, for the linked files, only counties and cities of a population size of 250,000 or more are separately identified. Geographic classification Geographic codes in this data set are based on the results of the 2000 census, and only identify areas with a population size of 250,000 or more. Users should refer to the geographic code outline in this document for the list of available areas and codes. For events to be included in the linked file, both the birth and death must occur inside the 50 states and D.C. in the case of the 50 states and D.C. file; or in Puerto Rico, the Virgin Islands or Guam in the case of the Puerto Rico, Virgin Islands and Guam file. In tabulations of linked data and denominator data events occurring in each of the respective areas to nonresidents are included in tabulations that are by place of occurrence, and excluded from tabulations by place of residence. These exclusions are based on the usual place of residence of the mother. This item is contained in both the denominator file and the birth section of the numerator (linked) file. Nonresidents are identified by a code 4 in location 138 of these files. Metropolitan statistical areas - Metropolitan statistical areas in this file are based the 1994 Office of Management and Budget (OMB) definition effective July 1, 1994. This definition has been used to define metropolitan statistical areas for natality files since 1994. A listing of the Metropolitan Statistical Areas (MSA’s), Primary Metropolitan Statistical Areas (PMSA’s), and New England County Metropolitan Areas (NECMA’s) is included in this documentation. The 18 Consolidated Metropolitan Statistical Areas (CMSA’s) are also included. In June of 2003 the OMB substantially revised the methodology for classifying and coding metropolitan areas in the United States. NCHS plans to convert to the new classification scheme with the release of 2005 natality data. Demographic and Medical Classification The documents listed below describe in detail the procedures employed for demographic classification on both the birth and death records and medical classification on death records. These documents, while not absolutely essential to the proper interpretation of the data for a number of general applications, should nevertheless be studied carefully prior to any detailed analysis of demographic or medical data variables. In particular, there are a number of exceptions to the ICD rules in multiple cause-of-death coding which, if not treated properly, may result in

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faulty analysis of the data. Volumes 1, 2 and 3 of the ICD-10 may be purchased from the World Health Organization (WHO) Publication Center USA, 49 Sheridan Avenue, Albany, New York, 12210 (http://www.who.int/whosis/icd10/index.html). Many of the instruction manuals listed below are available electronically on the NCHS website at: http://www.cdc.gov/nchs/about/major/dvs/im.htm. In addition, users who do not already have access to these documents may request them from the Chief, Mortality Medical Classification Branch, Division of Vital Statistics, National Center for Health Statistics, P.O. Box 12214, Research Triangle Park, North Carolina 27709. The technical appendices for natality and mortality included in this document also provide information on the source of data, coding procedures, quality of the data, etc. A.

National Center for Health Statistics. Vital statistics, Instructions for Classifying the Underlying Cause-of-Death, 2007. NCHS Instruction Manual, Part 2a. Hyattsville, Maryland: Public Health Service.

B.

National Center for Health Statistics. Vital statistics, Instructions for Classifying Multiple Cause-of-Death, 2007. NCHS Instruction Manual, Part 2b. Hyattsville, Maryland: Public Health Service.

C.

National Center for Health Statistics. Vital statistics, ICD-10 ACME Decision Tables for Classifying Underlying Causes-of-Death, 2007. NCHS Instruction Manual, Part 2c. Hyattsville, Maryland: Public Health Service.

D.

National Center for Health Statistics. Specifications for U.S. Standard Certificate of Birth – 2003 Revision. (replaces NCHS Instruction Manual, Part 3a). Available at: http://www.cdc.gov/nchs/about/major/dvs/im.htm.

E.

National Center for Health Statistics. Specifications for U.S. Standard Certificate of Death – 2003 Revision. (replaces NCHS Instruction Manual, Part 4). Available at: http://www.cdc.gov/nchs/about/major/dvs/im.htm.

F.

National Center for Health Statistics. Vital statistics, Computer Edits for Natality Data, Effective 1993. NCHS Instruction Manual Part 12. Hyattsville, Maryland: Public Health Service.

G.

National Center for Health Statistics. Vital statistics, Computer Edits for Mortality Data, Effective 2007. NCHS Instruction Manual Part 11. Hyattsville, Maryland: Public Health Service.

Also see: http://www.cdc.gov/nchs/vital_certs_rev.htm for the most recent information about revised certificates. Underlying Cause of Death Data Mortality statistics by cause of death are compiled from entries on the medical certification portion of the death certificate. The U.S. Standard Certificate of Death is shown in the Mortality Technical

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Appendix which is included in this documentation. Causes of death include “all those diseases, morbid conditions or injuries which either resulted in or contributed to death and the circumstances of the accident or violence which produced these injuries”. The medical certification of death is divided into two sections. In Part I, the physician is asked to provide the causal chain of morbid conditions that led to death, beginning with the condition most proximate to death on line (a) and working backwards to the initiating condition. The lines (a) through (d) in Part I are connected by the phrase “due to, or as a consequence of.” They were designed to encourage the physician to provide the causally related sequence of medical conditions that resulted in death. Thus, the condition on line (a) should be due to the condition on line (b), and the condition on line (b) should be a consequence of the condition on line (c), etc., until the full sequence is described back to the originating or initiating condition. If only one step in the chain of morbid events is recorded, a single entry on line (a) is adequate. Part I of the medical certification is designed to facilitate the selection of the underlying cause of death when two or more causes are recorded on the certificate. The underlying cause of death is defined by the WHO in the ICD-10 as “(a) the disease or injury which initiated the chain of morbid events leading directly to death, or (b) the circumstances of the accident or violence that produced the fatal injury” and is generally considered the most useful cause from a public health standpoint. Part II of the cause-of-death section of the death certificate solicits other conditions that the certifier believed contributed to death, but were not in the causal chain. While some details of the death certificate vary by state, all states use the same general format for medical certification outlined in the U.S. Standard Certificate. The U.S. Standard Certificate, in turn, closely follows the format recommended by the WHO. If the death certificate is properly completed, the disease or condition listed on the lowest used line in Part I is usually accepted as the underlying cause of death. This is an application of “The General Principle.” The General Principle is applied unless it is highly improbable that the condition on the lowest line used could have given rise to all of the diseases or conditions listed above it. In some cases, the sequence of morbid events entered on the death certificate is not specified correctly. A variety of errors may occur in completing the medical certification of death. Common problems include the following: The causal chain may be listed in reverse order; the distinction between Part I and Part II may have been ignored so that the causal sequence in Part I is simply extended unbroken into Part II; or the reported underlying cause is unlikely, in an etiological sense, to have caused the condition listed above it. In addition, sometimes the certifier attributes the death to uninformative causes such as cardiac arrest or pulmonary arrest. To resolve the problems of incorrect or implausible cause-of-death statements, the WHO designed standardized rules to select an underlying cause of death from the information available on the death certificate that is most informative from a public health perspective. The rules for the Tenth Revision as updated by WHO since the publication of ICD-10 are described in NCHS instruction manual Part 2A. Coding rules beyond the General Principle are invoked if the cause-of-death section is completed incorrectly or if their application can improve the specificity and characterization of the cause of death in a manner consistent with the ICD. The rules are applied in two steps: selection of a tentative underlying cause of death, and modification of the tentative underlying cause in view of the other conditions reported on the certificate in either Part I or Part II. Modification involves several considerations by the medical coder: determining whether conditions in Part II could have given rise to the underlying cause, giving preference to specific terms over

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generalized terms, and creating linkages of conditions that are consistent with the terminology of the ICD. For a given death, the underlying cause is selected from the condition or conditions recorded by the certifier in the cause-of-death section of the death certificate. NCHS is bound by international agreement to make the selection of the underlying cause through the use of the ICD-10 classification structure, and the selection and modification rules contained in this revision of the ICD. These rules are contained in a computer software program called ACME (Automated Classification of Medical Entities). ACME does exactly what a coder would do to select the underlying cause of death. The ACME program has been used for final mortality data since 1968. The WHO selection rules take into account the certifier’s ordering of conditions and their causal relationships to systematically identify the underlying cause of death. The intent of these rules is to improve the usefulness of mortality statistics by giving preference to certain classification categories over others and consolidating two or more conditions on the certificate into a single classification category. In addition to changes due to the implementation of a new ICD revision, rules for coding a cause of death may occasionally require modification at other times, when evidence suggests that such modifications will improve the quality of cause-of-death data. These changes may affect comparability of data between years for select causes of death. For example, a change was made in a coding rule in 2004 to not code conditions classified to P703-P720, P722-P749, Transitory endocrine and metabolic disorders specified to the fetus and newborn, as the underlying cause of death (there were 20 deaths coded to these categories in the 2003 mortality data). Thus, if this was the only cause listed, the record would be coded to P969, Condition originating in the perinatal period, unspecified; if another cause was also listed, the other cause was preferred. Multiple Cause of Death Data The limitations of the underlying cause concept and the need for more comprehensive data suggested the need for coding and tabulating all conditions listed on the death certificate. Coding all listed conditions on the death certificate was designed with two objectives in mind. First, to facilitate studies of the relationships among conditions reported on the death certificate, which require presenting each condition and its location on the death certificate in the exact manner given by the certifier. Secondly, the coding needed to be carried out in a manner by which the underlying cause-of-death could be assigned using the WHO coding rules. Thus, the approach in developing multiple cause data was to provide two fields: 1) entity axis and 2) record axis. For entity axis, NCHS suspends the provisions of the ICD that create linkages between conditions for the purpose of coding each individual condition, or entity, with minimum regard to other conditions present on the death certificate. Record axis is designed for the generation of person-based multiple cause statistics. Person-based analysis requires that each condition be coded within the context of every other condition on the same death certificate and modified or linked to such conditions as provided by ICD-10. By definition, the entity data cannot meet this requirement since the linkage provisions modify the character and placement of the information originally recorded by the certifier. Essentially, the axis

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of the classification has been converted from an entity basis to a record (or person) basis. The record axis codes are assigned in terms of the set of codes that best describe the overall medical certification portion of the death certificate. This translation is accomplished by a computer system called TRANSAX (Translation of Axis). TRANSAX selectively uses the traditional linkage and modification rules for mortality coding. Underlying cause linkages which simply prefer one code over another for purposes of underlying cause selection are not included. Each entity code on the record is examined and modified or deleted as necessary to create a set of codes that are free of contradictions and are the most precise within the constraints of ICD-10 and medical information on the record. Repetitive codes are deleted. The process may 1) combine two entity axis categories together to a new category thereby eliminating a contradiction or standardizing the data; or 2) eliminate one category in favor of another to promote specificity of the data or resolve contradictions. The following examples from ICD-10 illustrate the effect of this translation: Case 1:

When reported on the same record as separate entities, cirrhosis of liver and alcoholism are coded to K74.6 (Other and unspecified cirrhosis of liver) and F10.2 (Mental and behavioral disorders due to use of alcohol; dependence syndrome), respectively. Tabulation of records with K74.6 would imply that such records had no mention of alcohol. A preferable code would be K70.3 (Alcoholic cirrhosis of liver) in lieu of both K74.6 and F10.2.

Case 2:

If “gastric ulcer” and “bleeding gastric ulcer” are reported on a record they are coded to K25.9 (Gastric ulcer, unspecified as acute or chronic, without mention of hemorrhage or perforation) and K25.4 (Gastric ulcer, chronic or unspecified with hemorrhage), respectively. A more concise code is K25.4 which shows both the gastric ulcer and the bleeding.

Entity Axis Codes The original conditions coded for selection of the underlying cause-of-death are reformatted and edited prior to creating the public-use data file. The following paragraphs describe the format and application of entity axis data. 1. Format. Each entity-axis code is displayed as an overall seven byte code with subcomponents as follows: 1. Line indicator:

The first byte represents the line of the death certificate on which the code appears. Six lines (1-6) are allowable with the fourth and fifth denoting one or two written in “due to”s beyond the three lines provided in Part I of the U.S. standard death certificate. Line “6" represents Part II of the death certificate.

2. Position indicator: The next byte indicates the position of the code on the line, i.e., it is the first (1), second (2), third (3) .... eighth (8) code on the line.

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3. Cause category:

The next four bytes represent the ICD-10 cause code.

4. The last byte is blank. A maximum of 20 of these seven byte codes are captured on a record for multiple cause purposes. This may consist of a maximum of 8 codes on any given line with up to 20 codes distributed across three or more lines depending on where the subject conditions are located on the certificate. Codes may be omitted from one or more lines, e.g., line 1 with one or more codes, line 2 with no codes, line 3 with one or more codes. In writing out these codes, they are ordered as follows: line 1 first code, line 1 second code, etc. ---- line 2 first code, line 2 second code, etc. ----- line 3 ---- line 4 ----- line 5 ----- line 6. Any space remaining in the field is left blank. The specifics of locations are contained in the record layout given later in this document. 2. Edit. The original conditions are edited to remove invalid codes, reverify the coding of certain rare causes of death, and assure age/cause and sex/cause compatibility. Detailed information relating to the edit criteria and the sets of cause codes which are valid to underlying cause coding and multiple cause coding are provided in NCHS Instruction Manual Part 11. 3. Entity Axis Applications. The entity axis multiple cause data file is appropriate for analyses that require that each condition be coded as a stand alone entity without linkage to other conditions and/or require information on the placement of such conditions in the death certificate. Within this framework, the entity data are appropriate to examine relationships among conditions and the validity of traditional assumptions in underlying cause selection. Additionally, the entity data provide in certain categories a more detailed code assignment that could be excluded in creating record axis data. Where such detail is needed for a study, the user should use entity data. Finally, the researcher may not wish to be bound by the assumptions used in the axis translation process. The main limitation of entity axis data is that it does not necessarily reflect the best code for a condition when considered within the context of the medical certification as a whole. As a result, certain entity codes can be misleading or even contradict other codes in the record. For example, category K80.2 is titled “Calculus of gallbladder without cholecystitis.” Within the framework of entity codes this is interpreted to mean that the codable entity itself contained no mention of cholecystitis rather than that cholecystitis was not mentioned anywhere on the record. Tabulation of records with a “K80.2" as a count of persons having Calculus of gallbladder without cholecystitis would therefore be erroneous. This illustrates the fact that under entity coding the ICD-10 titles cannot be taken literally. The user should study the rules for entity coding as they relate to his/her research prior to use of entity data. The user is further cautioned that the inclusion notes in ICD-10 that relate to modifying and combining categories are seldom applicable to entity coding (except where provided NCHS Instruction Manual Part 2b). In tabulating the entity axis data, one may count codes with an individual code representing the number of times the condition(s) appears in the file. In this kind of tabulation of morbid conditions, the counts among categories may be added together to produce counts for groups of codes. Alternatively, subject to the limitations given above, one may count persons having mention of the

13

disease represented by a code or codes. In this instance it is not correct to add counts for individual codes to create person counts for groups of codes. Since more than one code in the researcher’s interest may appear together on the certificate, totaling must account for higher order interactions among codes. Up to 20 codes may be assigned on a record; therefore, a 20-way interaction is theoretically possible. All totaling must be based on mention of one or more of the categories under investigation. Record Axis Codes The following paragraphs describe the format and application of record-axis data. Part 2f of the Instruction Manual Series (ICD-10 TRANSAX Disease Reference Tables for classifying Multiple Causes-of-Death) describes the TRANSAX process for creating record axis data from entity axis data. 1. Format. Each record (or person) axis code is displayed in five bytes. Location information is not relevant. The Code consists of the following components: 1. Cause category: The first four bytes represent the ICD-10 cause code. 2. The last byte is blank. Again, a maximum of 20 codes are captured on a record for multiple cause purposes. The codes are written in a 100-byte field in ascending code number (5 bytes) order with any unused bytes left blank. 2. Edit. The record axis codes are edited for rare causes and age/cause and sex/cause compatibility. Likewise, individual code validity is checked. The valid code set for record axis coding is the same as that for entity coding. 3. Record Axis Applications. The record axis multiple cause data are the basis for NCHS core multiple cause tabulations. Location of codes is not relevant to this data, and conditions have been linked into the most meaningful categories for the certification. The most immediate consequence for the user is that the codes on the record already represent mention of a disease assignable to that particular ICD-10 category. This is in contrast to the entity code which is assigned each time such a disease is reported on different lines of the certification. Secondly, the linkage implies that within the constraints of ICD-10 the most meaningful code has been assigned. The translation process creates for the user a data file that is edited for contradictions, duplicate codes, and imprecisions. In contrast to entity axis data, record axis data are classified in a manner comparable to underlying cause of death classification thereby facilitating joint analysis of these variables. A potential disadvantage of record axis data is that some detail is sacrificed in a number of the linkages. The user can take the record axis codes as literally representing the information conveyed in ICD10 category titles. While knowledge of the rules for combining and linking and coding conditions is useful, it is not a prerequisite to meaningful analysis of the data as long as one is willing to accept the assumptions of the axis translation process. The user is cautioned, however, that due to special

14

rules in mortality coding, not all linkage notes in ICD-10 are used. (NCHS Instruction Manual Part 2f). The user should proceed with caution in using record axis data to count conditions as opposed to people with conditions, since linkages have been invoked and duplicate codes have been eliminated. As with entity data, person-based tabulations that combine individual cause categories must take into account the possible interaction of up to 20 codes on a single certificate. Additional Information In using the NCHS multiple cause data files, the user is urged to review the information in this document and its references. The instructional material does change from year to year and ICD revision to ICD revision. The user is cautioned that coding of specific ICD-10 categories should be checked in the appropriate instruction manual. What may appear on the surface to be the correct code by ICD-10 may in fact not be correct as given in the instruction manuals. If on the surface it is not obvious whether entity axis or record axis data should be employed in a given application, detailed examination of NCHS Instruction Manual Part 2f and its attachments will probably provide the necessary information to make a decision. It allows the user to determine the extent of the trade-offs between the two sets of data in terms of specific categories and the assumption of axis translation. In certain situations, a combination of entity and record axis data may be the more appropriate alternative.

15

2004 Period Linked Birth/Infant Death Data Set I. Numerator File: United States A. Record count: B. Record length: C. Data counts: Territories A. Record count: B. Record length:

27,612 1,259 a. By occurrence: 27,612 b. By residence: 27,553 c. To foreign residents: 59 459 1,259

II. Denominator File: United States A. Record count: B. Record length: C. Data counts: Territories A. Record count: B. Record length:

4,118,951 868 a. By occurrence: 4,118,951 b. By residence: 4,112,055 c. To foreign residents: 6,896 56,336 868

III. Unlinked File: United States A. Record count: B. Record length: C. Data counts: Territories A. Record count: B. Record length:

308 1,259 a. By occurrence: 308 b. By residence: 308 c. To foreign residents: 0 2 1,259

Linked 2004 Data Elements and Locations

Data Items 1. a. b. c. d. e. f.

2. a. b. c. d.

3. a. b. c. d. e. f. g. h. i. j.

4. a. b. c. d. e. f. g. h. i.

5. a. b. c. d. e. f.

6.

Unlinked File

15-18 -137 138 776-83 751

15-18 -137 138 ---

-1188-91 -1151 ---

15-18 * 1188-91 -1151 ---

30-31 32-33 37-39 40

30-31 32-33 37-39 40

1152-53 1157-58 1154-55 1159

1152-53 1157-58 1154-55 1159

109-10 107-8 114-16 132 120-24 133 135 125-6 127-30 131

109-10 107-8 114-16 132 120-24 133 135 125-6 127-30 131

1160-61 1176-77 1166-67 1182 1169-73 1174 1175 1184-85 1178-81 --

1160-61 1176-77 1166-67 1182 1169-73 1174 1175 1184-85 1178-81 --

--436 451-57 463-66 423 415-17 29 19-20

--436 451-57 463-66 423 415-17 29 19-20

872-77 ------1187 1258-59

872-77+ 139-44* 436* ----1187 1258-59

89-93 139-44 155-8 153 96-97,100 148-49

89-93 139-44 155-8 153 96-97,100 148-49

-------

-------

184-87 188-91, 199-200 195-96

184-87 188-91, 199-200 195-96

--

--

---

---

256-59 270-73 215-17 210-12 204-5 206-7 208-9 220-21

256-59 270-73 215-17 210-12 204-5 206-7 208-9 220-21

---------

---------

Occurrence State Expanded state County Population size

Residence State Expanded state County Population size – County Place(city) Population size – City Metropolitan/Nonmetropolitan county CMSA PMSA/MSA Population of statistical area

Infant Age at death Race Sex Gestation Birthweight Plurality Apgar score Day of week of birth/death Month of birth/death

Mother Age Race Education Marital status Place of birth Hispanic origin

Father Age Race

c.

Hispanic origin

a. b. c. d. e. f. g. h.

Numerator File Birth Death

General Year of birth Year of death Record type Resident status Record weight Flag indicating records included in both numerator and denominator files

a. b.

7.

Denominator File

Pregnancy items Month prenatal care began Number of prenatal visits Total birth order Live birth order Born alive, now living Born alive, now dead Other terminations Date of last live birth month

i.

8. a. b. c.

d. e. f. g. h. i. j.

9. a. b. c. d. e. f. g. h. i.

Date of last live birth year

222-25

222-25

--

--

395-401 328-44

395-401 328-44

---

---

282-94 295-98 276-78 355-61 374-89 483-91 504-25 ----

282-94 295-98 276-78 355-61 374-89 483-91 504-25 ----

-------884-87 889-91 903-1148

-------884-87 889-91 903-1148

569-773 9 42,59 408 ------

569-773 9 42,59 408 ------

---1186 882 878 879 880

---1186 882 878 879 880

Medical and Health Data Method of delivery Medical risk factors Other risk factors Tobacco Alcohol Weight gain during pregnancy Obstetric procedures Complications of labor and delivery Abnormal conditions of the newborn Congenital anomalies Underlying cause of death 130 Infant cause recode Multiple conditions

Other items Residence Reporting Flags Late record flag Place of birth Attendant at birth Place of death and decedent’s status Place of injury Manner of death Method of Disposition Autopsy

*

For the unlinked file, these items are from the death certificate.

+

For the unlinked file, date of birth as reported on the death certificate is used to generate age at death.

Position

Len

Field

Description

1-6

6

FILLER

Filler

7

1

REVISION

Revision

Reporting Flag Position

Vers*

Values Definition

Blank U,R

A S

Data based on the 2003 revision of the US Standard Birth Certificate (Revised) Data based on the 1989 revision of the US Standard Birth Certificate (Unrevised)

8

1

FILLER

Filler

9

1

LATEREC

Late Record Flag

10-14

5

FILLER

Filler

15-18

4

DOB_YY

Birth Year

U,R

2003 2004

Year of birth

19-20

2

DOB_MM

Birth Month

U,R

01 02 03 04 05 06 07 08 09 10 11 12

January February March April May June July August September October November December

21-28

8

FILLER

Filler

U,R

Blank

29

1

DOB_WK

Weekday

U,R

1 2 3 4 5 6 7

30-31

2

OSTATE

Occurrence FIPS State

U,R

U,R U R

Blank U,R

0 1

Not late record Late record

Blank

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

1

Position

Len

Field

Description

Reporting Flag Position

United States

U,R U R

Vers*

Values Definition

AK AL AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC

Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

2

Position

Len

Field

Description

Reporting Flag Position

Vers*

Possessions

32-33

2

U,R U R

XOSTATE

U,R

Expanded Occurrence FIPS State United States

Values Definition

SD TN TX UT VA VT WA WI WV WY

South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

AS GU MP PR VI

American Samoa Guam Northern Marianas Puerto Rico Virgin Islands

AK AL AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA MA MD ME MI

Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

3

Position

Len

Field

Description

Reporting Flag Position

Vers*

Possessions

Values Definition

MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY YC

Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming New York City

AS GU MP PR VI

American Samoa Guam Northern Marianas Puerto Rico Virgin Islands

34-36

3

FILLER

Filler

37-39

3

OCNTYFIPS

Occurrence FIPS County

U,R

000-nnn County of Occurrence

40

1

OCNTYPOP

Occurrence County Pop

U,R

0

U,R U R

Blank

County of 1,000,000 or more

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

4

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

1 2 9

County of 500,000 to 1,000,000 County of 250,000 to 500,000 County less than 250,000

41

1

FILLER

Filler

42

1

UBFACIL

Birth Place

43-58

16

FILLER

Filler

59

1

BFACIL3

Birth Place Recode

60-86

26

FILLER

Filler

87

1

MAGE_IMPFLG Mother’s Age Imputed

U,R

Blank 1

Age not imputed Age imputed

88

1

MAGE_REPFLG Reported Age of Mother Flag

U,R

Blank 1

Reported age not used Reported age used

89-90

2

MAGER

U,R

12 13 14 15 16 17 18 19 20 21 22 23 24 25

10 – 12 years 13 years 14 years 15 years 16 years 17 years 18 years 19 years 20 years 21 years 22 years 23 years 24 years 25 years

U,R U R

Blank U,R

1 2 3 4 5 9

Hospital Freestanding Birthing Center Clinic / Doctor’s Office Residence Other Unknown

Blank U,R

1 2 3

In Hospital Not in Hospital Unknown or Not Stated

Blank

Mother’s Age Recode 41

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

5

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

26 years 27 years 28 years 29 years 30 years 31 years 32 years 33 years 34 years 35 years 36 years 37 years 38 years 39 years 40 years 41 years 42 years 43 years 44 years 45 years 46 years 47 years 48 years 49 years 50-54 years

91-92

2

MAGER14

Mother’s Age Recode 14

U,R

01 03 04 05 06 07 08 09 10 11 12 13 14

Under 15 Years 15 years 16 years 17 years 18 years 19 years 20-24 years 25-29 years 30-34 years 35-39 years 40-44 years 45-49 years 50-54 years

93

1

MAGER9

Mother’s Age Recode 9

U,R

1

Under 15 years

U,R U R

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

6

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

2 3 4 5 6 7 8 9 94-95

2

FILLER

Filler

96-97

2

UMBSTATE

Mother’s Birth State United States

U,R U R

15-19 years 20-24 years 25-29 years 30-34 years 35-39 years 40-44 years 45-49 years 50-54 years

Blank U,R

AK AL AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA MA MD ME MI MN MO MS MT NC ND

Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

7

Position

Len

Field

Description

Reporting Flag Position

Values Definition

NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

Possessions

AS GU MP PR VI

American Samoa Guam Northern Marianas Puerto Rico Virgin Islands

Foreign

CC CU MX YY ZZ

Canada Cuba Mexico Rest of the World Not Classifiable

98-99

2

FILLER

Filler

100

1

MBSTATER3

Mother’s Birth State Recode

U,R U R

Vers*

Blank U,R

1 2 3

Native born (with the 50 States and DC) Foreign born (outside the 50 States and DC) Unknown or Not Stated

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

8

Position

Len

Field

Description

101-106

6

FILLER

Filler

107-108

2

XMRSTATE

Expanded State of Residence of Mother United States

U,R U R

Reporting Flag Position

Vers*

Values Definition

Blank U,R

AK AL AR AZ CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR

Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

9

Position

Len

109-110

2

U,R U R

Field

MRSTATEFIPS

Description

Reporting Flag Position

Vers*

Values Definition

PA RI SC SD TN TX UT VA VT WA WI WV WY YC

Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming New York City

Possessions

AS GU MP PR VI

American Samoa Guam Northern Marianas Puerto Rico Virgin Islands

Foreign

CC CU MX XX ZZ

Canada Cuba Mexico Not Applicable Not Classifiable

AK AL AR AZ CA CO CT DE DC FL GA HI ID

Alaska Alabama Arkansas Arizona California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho

U,R

Mother’s Residence FIPS State United States

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

10

Position

Len

Field

Description

Reporting Flag Position

Possessions U,R U R

Vers*

Values Definition

IL IN IA KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

Illinois Indiana Iowa Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

AS GU

American Samoa Guam

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

11

Position

Len

Field

Description

Reporting Flag Position

Vers*

Foreign

111-113

3

FILLER

Filler

114-116

3

MRCNTYFIPS

Mother’s County of Residence

117-119

3

FILLER

Filler

120-124

5

MRCITYFIPS

Mother’s Residence City

U,R

125-126

2

CMSA

Consolidated Metropolitan Statistical Areas United States

U,R

Values Definition

MP PR VI

Northern Marianas Puerto Rico Virgin Islands

CC CU MX XX ZZ

Canada Cuba Mexico Not Applicable Not Classifiable

Blank U,R

000 Foreign residents 001-999 See Geographic Tables Blank 00000 Foreign residents 00001-99999 See Geographic Table 00 07 14 21 28 31 34 35 42 49 56 63 70 77 79 82 84

U,R U R

Not a CMSA Boston, Worchester, Lawrence, MA-NH-ME-CT, CMSA Chicago-Gary-Kenosha, IL-IN-WI, CMSA Cincinnati-Hamilton, OH-KY-IN, CMSA Cleveland-Akron, OH, CMSA Dallas-Fort Worth, TX, CMSA Denver-Bolder-Greeley, CO, CMSA Detroit-Ann Arbor-Flint, MI, CMSA Houston-Galveston-Brazoria, TX, CMSA Los Angeles-Riverside-Orange County, CA, CMSA Miami-Fort Lauderdale, FL, CMSA Milwaukee-Racine, WI, CMSA New York-Northern New Jersey-Long Island, NY-NJ-CTPA, CMSA Philadelphia-Wilmington-Atlantic City, PA-NJ-DE-MD, CMSA Portland-Salem, OR-WA, CMSA Sacramento-Yolo, CA, CMSA San Francisco-Oakland-San Jose, CA, CMSA

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

12

Position

Len

Field

Description

Reporting Flag Position

Vers*

US Territories

Values Definition

91 97

Seattle-Tacoma-Bremerton, WA, CMSA Washington-Baltimore, DC-MD-VA-WV, CMSA

87

00 Not a CMSA San Juan-Caguas-Arecibo, PR, CMSA

127-130

4

MSA

Metropolitan Statistical Areas

U,R

0000 Nonmetropolitan counties or Foreign residence 0040-9360 Code Range

131

1

MSA_POP

Population of Statistical Area

U,R

1 2 9 Z

Area of 250,000 or more Area of less than 250,000 Nonmetropolitan area Foreign resident

132

1

RCNTY_POP

Population of Residence County

U,R

0 1 2 9 Z

County of 1,000,000 or more County of 500,000 to 1,000,000 County of 250,000 to 500,000 County less than 250,000 Foreign resident

133

1

RCITY_POP

Population of Residence City

U,R

0 1 2 9 Z

City of 1,000,000 or more City of 500,000 to 1,000,000 City of 250,000 to 500,000 All other areas in the US Foreign resident

134

1

FILLER

Filler

135

1

METRORES

Metropolitan Residence County

136

1

FILLER

Filler

137

1

RECTYPE

Record Type

Blank U,R

1 2 Z Blank

U,R

1 2

138

1 U,R U R

RESTATUS

Metropolitan County Nonmetropolitan County Foreign resident

U,R

Residence Status United States

1

RESIDENT: State and county of occurrence and residence are the same. NONRESIDENT: State and county of occurrence and residence are different. RESIDENT: State and county of occurrence and residence

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

13

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

2 3 4 US Territories

1

2 3 4 139-140

2

MBRACE

Mother’s Bridged Race R** Includes only states reporting multiple race. Codes 01-14 used for individuals reporting only one race. Codes 21-24 used for individuals reporting more than one race that have been bridged to a single race. Code 24 also used for individuals reporting more than one Asian/ Pacific Islander group; see “Technical Appendix.” ** Also includes unrevised states that report multiple race.

141-142

2 U,R U R

MRACE

01 02 03 04 05 06 07 08 09 10 11 12 13 14 21 22 23 24 Blank

are the same. INTRASTATE NONRESIDENT: State of occurrence and residence are the same but county is different. INTERSTATE NONRESIDENT: State of occurrence and residence are different but both are one of the 50 US states or District of Columbia. FOREIGN RESIDENT: The state of residence is not one of the 50 US states or District of Columbia. RESIDENT: State and county of occurrence and residence are the same. (Unique to Guam, all US residents are considered residents of Guam and thus are assigned 1.) INTRATERRITORY NONRESIDENT: Territory of occurrence and residence are the same but county is different. INTERTERRITORY RESIDENT: Territory of occurrence and residence are different but both are US Territories. FOREIGN RESIDENT: The residence is not a US Territory. White – single race Black – single race American Indian / Alaska Native – single race Asian Indian – single race Chinese – single race Filipino – single race Japanese – single race Korean – single race Vietnamese – single race Other Asian – single race Hawaiian – single race Guamanian – single race Samoan – single race Other Pacific Islander – single race White – bridged multiple race Black – bridged multiple race American Indian/Alaskan Native – bridged multiple race Asian / Pacific Islander – bridged multiple race Not on certificate

U

Mother’s Race

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

14

Position

Len

Field

Description

Reporting Flag Position

Vers*

Includes only states exclusively reporting single race. Some areas report additional Asian or Pacific Islander codes for race. Codes 18-68 replace old code 08 for these areas. Code 78 replaces old code 08 for all other areas. See reporting flag at pos. 650 for expanded API reporting area.

Values Definition

01 02 03 04 05 06 07 18 28 38 48 58 68

Blank

White Black American Indian/Alaska Native Chinese Japanese Hawaiian (includes part Hawaiian) Filipino Asian Indian Korean Samoan Vietnamese Guamanian Other Asian or Pacific Islander in areas reporting codes 18-58. Combined other Asian or Pacific Islander, includes 18-68 for areas that do not report them separately. Not on certificate.

Puerto Rico

01 02 00 Blank

White Black Other races Not on certificate

Guam

01 02 03 04 05 06 07 08 58 Blank

White Black American Indian & Alaskan Natives Chinese Japanese Hawaiian (includes part Hawaiian) Filipino Other Asian or Pacific Islander Guamanian Not on certificate

All other Territories

01 02 03

White Black American Indian & Alaskan Natives Chinese Japanese Hawaiian (includes part Hawaiian)

78

04 05 06 U,R U R

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

15

Position

Len

143

1

Field

MRACEREC

Description

Reporting Flag Position

Vers*

Mother’s Race Recode U,R Includes individuals reporting only one race and those reporting more than one race bridged to a single race. United States and non-Puerto Rican Territories

Puerto Rico

07 08 Blank

Filipino Other Asian or Pacific Islander Not on certificate

1 2 3 4

White Black American Indian / Alaskan Native Asian / Pacific Islander

1 2 0

White Black Other (not classified as White or Black)

Blank 1 2

Mother’s race not imputed Unknown race imputed All other races, formerly coded 09, imputed.

144

1

MRACEIMP

Mother’s Race Imputed

145-147

3

FILLER

Filler

148

1

UMHISP

Mother’s Hispanic Origin

569

U,R

0 1 2 3 4 5 9

Non-Hispanic Mexican Puerto Rican Cuban Central American Other and Unknown Hispanic Origin unknown or not stated

149

1

MRACEHISP

Mother’s Race/Hispanic Origin 569

U,R

1 2 3 4 5 6 7 8 9

Mexican Puerto Rican Cuban Central or South American Other and Unknown Hispanic Non-Hispanic White Non-Hispanic Black Non-Hispanic Other Races Origin unknown or not stated

U,R U R

U,R

Values Definition

Blank

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

16

Position

Len

Field

Description

Reporting Flag Position

Vers*

150-152

3

FILLER

Filler

153

1

MAR

Mother’s Marital Status 652 U,R United States & all non-Puerto Rican Territories 1 2 9

Blank

Puerto Rico

154

1

MAR_IMP

Mother’s Marital Status Imputed

155

1

MEDUC

Mother’s Educ –Revised

156-157

2

U,R U R

UMEDUC

Values Definition

571

Mother’s Educ –Unrevised 647

Yes No Unknown or not Stated

1 2 3 9

Yes Unmarried parents living together Unmarried parents not living together Unknown or not stated

U,R

Blank 1

Marital Status not imputed Marital Status imputed

R

1 2 3 4 5 6 7 8 9 Blank

8th grade or less 9th through 12th grade with no diploma High school graduate or GED completed Some college credit, but not a degree. Associate degree (AA,AS) Bachelor’s degree (BA, AB, BS) Master’s degree (MA, MS, MEng, MEd, MSW, MBA) Doctorate (PhD, EdD) or Professional Degree (MD, DDS, DVM, LLB, JD) Unknown Not on certificate

00 01-08 09 10 11 12 13 14 15 16 17 99 Blank

No formal education Years of elementary school 1 year of high school 2 years of high school 3 years of high school 4 years of high school 1 year of college 2 years of college 3 years of college 4 years of college 5 or more years of college Not stated Not on certificate

U

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

17

Position

Len

Field

Description

158

1

MEDUC_REC

Mother’s Education Recode 647

159-174

16

FILLER

Filler

175

1

FAGERPT_FLG

Father’s Reported Age Used

176-181

6

FILLER

Filler

182-183

2

FAGECOMB

Father’s Combined Age (Revised)

R

09-98 99 Blank

Father’s combined age in years Unknown or not stated Not on certificate

184-185

2

UFAGECOMB

Father’s Combined Age

U,R

09-98 99

Father’s combined age in years Unknown or not stated

186-187

2

FAGEREC11

Father’s Age Recode 11

U,R

01 02 03 04 05 06 07 08 09 10 11

Under 15 years 15-19 years 20-24 years 25-29 years 30-34 years 35-39 years 40-44 years 45-49 years 50-54 years 55-98 years Not stated

188-189

2

FBRACE

Father’s Bridged Race R** Includes only states reporting multiple race. Codes 01-14 used for individuals reporting only one race. Codes 21-24 used for individuals reporting more than one race that have been bridged to a single race. Code 24 also used for individuals reporting more than one Asian/ Pacific Islander group; see “Technical Appendix.”

01 02 03 04 05 06 07

White – single race Black – single race American Indian / Alaska Native – single race Asian Indian – single race Chinese – single race Filipino – single race Japanese – single race

U,R U R

Reporting Flag Position

Vers*

Values Definition

U

1 2 3 4 5 6 Blank

0 – 8 years 9 – 11 years 12 years 13 – 15 years 16 years and over Not stated Not on certificate

Blank U,R

Blank 1

Father’s reported age not used Father’s reported age used

Blank

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

18

Position

Len

Field

Description

Reporting Flag Position

Vers*

** Also includes unrevised states that report multiple race.

190

1

FILLER

Filler

191

1

FRACEREC

Father’s Race Recode U,R Includes individuals reporting only one race and those reporting more than one race bridged to a single race. United States and non-Puerto Rican Territories

Values Definition

08 09 10 11 12 13 14 21 22 23 25 Blank

Korean – single race Vietnamese – single race Other Asian – single race Hawaiian – single race Guamanian – single race Samoan – single race Other Pacific Islander – single race White – bridged multiple race Black – bridged multiple race American Indian/Alaskan Native – bridged multiple race Asian / Pacific Islander – bridged multiple race Not on certificate

Blank

Puerto Rico

1 2 3 4 9

White Black American Indian / Alaskan Native Asian / Pacific Islander Unknown or not stated

1 2 9 0

White Black Unknown or not stated Other (not classified as White or Black)

192-194

3

FILLER

Filler

195

1

UFHISP

Father’s Hispanic Origin

570

U,R

0 1 2 3 4 5 9

Non-Hispanic Mexican Puerto Rican Cuban Central American Other and Unknown Hispanic Origin unknown or not stated

196

1

FRACEHISP

Father’s Race/Hisp Origin 570

U,R

1

Mexican

U,R U R

Blank

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

19

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

2 3 4 5 6 7 8 9 197-198

2

FILLER

Filler

199-200

2

UFRACE

Father’s Race United States

Blank U

01 02 03 04 05 06 07 18 28 38 48 58 68

99 Blank

White Black American Indian & Alaskan Natives Chinese Japanese Hawaiian (includes part Hawaiian) Filipino Asian Indian Korean Samoan Vietnamese Guamanian Other Asian or Pacific Islander in areas reporting codes 18-58. Combined other Asian or Pacific Islander, includes 18-68 for areas that do not report them separately. Unknown or not stated Not on certificate

Puerto Rico

01 03 00 99 Blank

White Black Other races not classified white or black Unknown or not stated Not on certificate

Guam

01 02 03 04

White Black American Indian & Alaskan Natives Chinese

78

U,R U R

Puerto Rican Cuban Central or South American Other and Unknown Hispanic Non-Hispanic White Non-Hispanic Black Non-Hispanic Other Races Origin unknown or not stated

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

20

Position

Len

Field

Description

Reporting Flag Position

Vers*

All other Territories

Values Definition

05 06 07 08 58 99 Blank

Japanese Hawaiian (includes part Hawaiian) Filipino Other Asian or Pacific Islander Guamanian Unknown or not stated Not on certificate

01 02 03 04 05 06 07 08 99 Blank

White Black American Indian & Alaskan Natives Chinese Japanese Hawaiian (includes part Hawaiian) Filipino Other Asian or Pacific Islander Unknown or not stated Not on certificate

201-203

3

FILLER

Filler

204-205

2

PRIORLIVE

Prior Births Now Living

U,R

00-30 99

Number of children still living from previous live births. Unknown or not stated

206-207

2

PRIORDEAD

Prior Births Now Dead

U,R

00-30 99

Number of children dead from previous live births. Unknown or not stated

208-209

2

PRIORTERM

Prior Other Terminations

U,R

00-30 99

Number other terminations Unknown or not stated

210-211

2

LBO

Live Birth Order

U,R

01-31 99

Sum of all previous live births (now living and now dead) plus this one. Unknown or not stated

1-7 8 9

Number of live birth order. 8 or more live births Unknown or not stated

212

1

LBO_REC

Live Birth Order Recode

213-214

2

FILLER

Filler

215-216

2

TBO

Total Birth Order

U,R U R

Blank

U,R

Blank U,R

01-40

Sum of all previous pregnancies plus this one

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

21

Position

Len

Field

Description

Reporting Flag Position

Vers*

99

Unknown or not stated

1-7 8 9

Number of total birth order. 8 or more total births Unknown or not stated

217

1

TBO_REC

Total Birth Order Recode

218-219

2

FILLER

Filler

220-221

2

DLLB_MM

Date of Last Live Birth – Month

U,R

01 02 03 04 05 06 07 08 09 10 11 12 88 99

January February March April May June July August September October November December Not applicable Unknown or not stated

222-225

4

DLLB_YY

Date of Last Live Birth – Year

U,R

nnnn 8888 9999

Year of last live birth Not applicable Unknown or not stated

226-244

19

FILLER

Filler

245-246

2

PRECARE

Month Prenatal Care Began 668

R

00 01-10 99 Blank

No prenatal care Month prenatal care began Unknown or not stated Not on certificate

247

1

PRECARE_REC

Month Prenatal Care Began Recode 668

R

1 2 3 4 5

1st to 3rd month 4th to 6th month 7th to final month No prenatal care Unknown or not stated

U,R U R

U,R

Values Definition

Blank

Blank

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

22

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

Blank

Not on certificate

248-255

8

FILLER

Filler

256-257

2

MPCB

Month Prenatal Care Began 669

U

00 01-10 99 Blank

No prenatal care Month prenatal care began Unknown or not stated Not on certificate

258

1

MPCB_REC6

Month Prenatal Care Began Recode 6 669

U

1 2 3 4 5 6 Blank

1st to 2nd month 3rd month 4th to 6th month 7th to final month No prenatal care Unknown or not stated Not on certificate

259

1

MPCB_REC5

Month Prenatal Care Began Recode 5 669

U

1 2 3 4 5 Blank

1st trimester (1st to 3rd month) 2nd trimester (4th to 6th month) 3rd trimester (7th to final month) No prenatal care Unknown or not stated Not on certificate

260-269

10

FILLER

Filler

270-271

2

UPREVIS

Number of Prenatal Visits

U,R

00-49 99

Number of prenatal visits Unknown or not stated

272-273

2

PREVIS_REC

Number of Prenatal Visits Recode

U,R

01 02 03 04 05 06 07 08

No visits 1 to 2 visits 3 to 4 visits 5 to 6 visits 7 to 8 visits 9 to 10 visits 11 to 12 visits 13 to 14 visits

U,R U R

Blank

Blank

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

23

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

09 10 11 12

15 to 16 visits 17 to 18 visits 19 or more visits Unknown or not stated

274-275

2

FILLER

Filler

276-277

2

WTGAIN

Weight Gain

648

U,R

00-97 98 99

Weight gain in pounds 98 pounds and over Unknown or not stated

278

1

WTGAIN_REC

Weight Gain Recode

648

U,R

1 2 3 4 5 6 7 8 9

Less than 16 pounds 16 to 20 pounds 21 to 25 pounds 26 to 30 pounds 31 to 35 pounds 36 to 40 pounds 41 to 45 pounds 46 or more pounds Unknown or not stated

279

1

U_APNCU

Adequacy of Prenatal Care Utilization Index 669

1 2 3 4 5 Blank

Inadequate Intermediate Adequate Adequate+ Unknown Not on certificate

280

1

DFPC_IMP

Day of Date First Prenatal Care Imputed

Blank 1

Day of date first prenatal care not imputed Day of date first prenatal care imputed

281-283

3

FILLER

Filler

284-285

2

CIG_1

Cigarettes 1st Trimester

575

R

00-97 98 99 Blank

Number of cigarettes daily 98 or more cigarettes daily Unknown or not stated Not on certificate

286-287

2

CIG_2

Cigarettes 2nd Trimester

575

R

00-97 98

Number of cigarettes daily 98 or more cigarettes daily

U,R U R

Blank

R

Blank

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

24

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

99 Blank

Unknown or not stated Not on certificate

288-289

2

CIG_3

Cigarettes 3rd Trimester

575

R

00-97 98 99 Blank

Number of cigarettes daily 98 or more cigarettes daily Unknown or not stated Not on certificate

290

1

TOBUSE

Tobacco Use

667

U

1 2 9 Blank

Yes No Unknown or not stated Not on certificate

291-292

2

CIGS

Cigarettes per Day

U

00-97 98 99 Blank

Number of cigarettes daily 98 or more cigarettes daily Unknown or not stated Not on certificate

293

1

UCIG_REC6

Cigarette Recode (Unrevised)

U

0 1 2 3 4 5 6 Blank

Non-smoker 1 to 5 cigarettes daily 6 to 10 cigarettes daily 11 to 20 cigarettes daily 21 to 40 cigarettes daily 41 or more cigarettes daily Unknown or not stated Not on certificate

294

1

CIG_REC

Cigarette Recode (Revised) 575

R

Y N U Blank

Yes No Unknown or not stated Not on certificate

295

1

ALCOHOL

Alcohol Use

649

U

1 2 9 Blank

Yes No Unknown or not stated Not on certificate

296-297

2

DRINKS

Drinks per Week

649

U

00-97 98 99 Blank

Number of drinks weekly 98 or more drinks weekly Unknown or not stated Not on certificate

U,R U R

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

25

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

298

1

DRINKS_REC

Drinks Recode

649

U

0 1 2 3 4 5 Blank

299-327

29

FILLER

Filler

328-344

17

Risk Factors The checkbox items indented below follow this structure: The version is all 1989 Standard unless otherwise noted.

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

URF_ANEMIA URF_CARDC URF_LUNG URF_DIAB URF_GEN URF_HYDR URF_HEMO URF_CHYPER URF_PHYPER URF_ECLAM URF_INCERV URF_PRE4000 URF_PRETERM URF_RENAL URF_RH URF_UTERINE URF_OTHER

Anemia 681 Cardiac 682 Acute or Chronic Lung Disease 683 Diabetes 684 Genital Herpes 685 Hydramnios / Oligohydramnios 686 Hemoglobinopathy 687 Cronic Hypertension 688 Prepregnacny Associated Hypertension 689 Eclampsia 690 Incompetent Cervix 691 Previous Infant 4000+ Grams 692 Previous Preterm Small for Gestation 693 Renal Disease 694 Rh Sensitization 695 Uterine Bleeding 696 Other medical risk factors 697

345-354

10

FILLER

Filler

355-361

7

Obstetric Procedures The checkbox items indented below follow this structure: The version is all 1989 Standard unless otherwise noted.

328 329 330 331 332 333 334 335 336 337 338 339 340 341 342 343 344

U,R U R

Non drinker 1 drink per week 2 drinks per week 3-4 drinks per week 5 or more drinks per week Unknown or not stated Not on certificate

Blank U

1 2 8 9 Blank

Yes No Not on certificate Unknown Not on certificate

U,R

U,R U,R U,R

Blank U

1 2 9

Yes No Unknown or not stated

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

26

Position

Len

Field

Description

Reporting Flag Position

1 1 1 1 1 1 1

UOP_AMNIO UOP_MONIT UOP_INDUC UOP_STIML UOP_TOCOL UOP_ULTRA UOP_OTHER

Amniocentesis Electronic Fetal Monitoring Induction of Labor Stimulation of Labor Tocolysis Ultrasound Other Obstetric Procedures

701 702 703 704 705 706 707

362-373

12

FILLER

Filler

374-389

16

Complications of Labor and Delivery The checkbox items indented below follow this structure: The version is all 1989 Standard unless otherwise noted.

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

ULD_FEBR ULD_MECO ULD_RUPTR ULD_ABRUP ULD_PREPLA ULD_EXCBL ULD_SEIZ ULD_PRECIP ULD_PROLG ULD_DYSFN ULD_BREECH ULD_CEPHAL ULD_CORD ULD_ANEST ULD_DISTR ULD_OTHER

Febrile Meconium Premature Rupture of Membrane Abruptio Placenta Placenta Previa Other Excessive Bleeding Seizures During Labor Precipitous Labor Prolonged Labor Dysfunctional Labor Breech Cephalopelvic Disproportion Cord Prolapse Anesthetic Comlications Fetal Distress Other Complications

390-394

5

FILLER

Filler

395-400

6

Method of Delivery The checkbox items indented below follow this structure:

395

1

UME_VAG

U,R U R

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

355 356 357 358 359 360 361

374 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389

Vaginal

Vers*

Values Definition

Blank

Not on certificate

U,R U,R

Blank U

711 712 713 714 715 716 717 718 719 720 721 722 723 724 725 726

1 2 9 Blank

Yes No Unknown or not stated Not on certificate

U,R

U,R U,R

Blank U,R

730

27

1 2 9 Blank

Yes No Unknown or not stated Not on certificate

Position

396 397 398 399 400 401

Len

Field

Description

Reporting Flag Position

1 1 1 1 1

UME_VBAC UME_PRIMC UME_REPEC UME_FORCP UME_VAC

Vaginal after C-Section Primary C-Section Repeat C-Section Forceps Vacuum

731 732 733 734 735

1

DMETH_REC

Delivery Method Recode

Vers*

Values Definition

U,R

1 2 3 4 5 6 7

402-407

6

FILLER

Filler

408

1

ATTEND

Attendent

409-414

6

FILLER

Filler

415

2

APGAR5

Five Minute APGAR Score 574

U,R

00-10 99

417

1

APGAR5R

Five Minute APGAR Recode 574

U,R

1 2 3 4 5

418-422

5

FILLER

Filler

423

1

DPLURAL

Plurality Recode

U,R U R

Vaginal (excludes vaginal after previous C-section) Vaginal after previous c-section Primary C-section Repeat C-section Not stated Vaginal (unknown if previous c-section) (2003 Standard only) C-section (unknown if previous c-section) (2003 Standard only)

Blank U,R

1 2 3 4 5 9

Doctor of Medicine (MD) Doctor of Osteopathy (DO) Certified Nurse Midwife (CNM) Other Midwife Other Unknown or not stated

Blank A score of 0-10 Unknown or not stated A score of 0-3 A score of 4-6 A score of 7-8 A score of 9-10 Unknown or not stated

Blank U,R

1 2

Single Twin

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

28

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

3 4 5

Triplet Quadruplet Quintuplet or higher

424

1

FILLER

Filler

425

1

IMP_PLUR

Plurality Imputed

426-435

10

FILLER

Filler

436

1

SEX

Sex of Infant

U,R

M F

Male Female

437

1

IMP_SEX

Imputed Sex

U,R

Blank 1

Infant Sex not Imputed Infant Sex is Imputed

438-439

2

DLMP_MM

Last Normal Menses – Month

U,R

01 02 03 04 05 06 07 08 09 10 11 12 99

January February March April May June July August September October November December Unknown or not stated

440-441

2

DLMP_DD

Last Normal Menses – Day

U,R

01-31 99

As applicable to month of LMP Unknown or not stated

442-445

4

DLMP_YY

Last Normal Menses – Year

U,R

nnnn 9999

Year of last normal menses Unknown or not stated

446-447

2

ESTGEST

Obstetric/ Clinical Gestation Est.

U,R

00-98 99

Estimated weeks of gestation Unknown or not stated

448-450

3

FILLER

Filler

U,R U R

Blank U,R

Blank 1

Plurality is not imputed Plurality is imputed

Blank

573

Blank

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

29

Position

Len

Field

Description

451-452

2

COMBGEST

453-454

2

455

Vers*

Values Definition

Gestation – Detail in Weeks

U,R

17-47 99

17th through 47th week of Gestation Unknown

GESTREC10

Gestation Recode 10

U,R

01 02 03 04 05 06 07 08 09 10

Under 20 weeks 20-27 weeks 28-31 weeks 32-35 weeks 36 weeks 37-39 weeks 40 weeks 41 weeks 42 weeks and over Unknown

1

GESTREC3

Gestation Recode 3

U,R

1 2 3

Under 37 weeks 37 weeks and over Not stated

456

1

OBGEST_FLG

Clinical Estimate of Gestation Used Flag

U,R

Blank 1

Clinical Estimate is not used Clinical Estimate is used

457

1

GEST_IMP

Gestation Imputed Flag

U,R

Blank 1

Gestation is not imputed Gestation is imputed

458-466

9

FILLER

Filler

Blank

467-470

4

BRTHWGT

Birth Weight – Detail in Grams

U,R 9999

0227-8165 Number of grams Not stated birth weight

471-472

2

BWTR12

Birth Weight Recode 14

01 02 03 04 05 06 07 08 09 10 11

499 grams or less 500 – 749 grams 750 - 999 grams 1000 - 1249 grams 1250 – 1499 grams 1500 – 1999 grams 2000 – 2499 grams 2500 – 2999 grams 3000 – 3400 grams 3500 – 3999 grams 4000 – 4499 grams

U,R U R

Reporting Flag Position

U,R

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

30

Position

Len

Field

Description

Reporting Flag Position

Vers*

12 13 14

4500 – 4999 grams 5000 – 8165 grams Not Stated

1 2 3 4

1499 grams or less 1500 – 2499 grams 2500 grams or more Unknown or not stated

473

1

BWTR4

Birth Weight Recode 4

474

1

FILLER

Filler

475

1

BWTIMP

Imputed Birth Weight Flag

476-482

7

FILLER

Filler

483-491

9

Abnormal Conditions of the Newborn The checkbox items indented below follow this structure:

1 1 1 1 1 1 1 1 1

UAB_ANEM UAB_INJURY UAB_ALCOH UAB_HYAL UAB_MECON UAB_VENL30 UAB_VEN30M UAB_NSEIZ UAB_OTHER

Anemia Birth Injury Fetal Alcohol Syndrome Hyaline Membrane Disease Meconium Aspiration Syndrome Assisted Ventilation < 30 min Assisted Ventilation >= 30 min Seizures Other Abnormal Conditions

492-503

12

FILLER

Filler

504-525

22

Congenital Anomalies of the Newborn The checkbox items indented below follow this structure: The version is all 1989 Standard unless otherwise noted.

504 505

1 1

UCA_ANEN UCA_SPINA

U,R U R

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

483 484 485 486 487 488 489 490 491

Anencephalus Spina Bifida / Meningocele

U,R

Values Definition

Blank U

Blank 1

Birth Weight is not imputed Birth Weight is imputed

Blank U

1 2 9 Blank

Complication reported Complication not reported Complication not classifiable Not on certificate

740 741 742 743 744 745 746 747 748 Blank U

752 753

31

U,R U,R

1 2 9 Blank

Anomaly reported Anomaly not reported Anomaly not classifiable Not on certificate

Position

Len

Field

Description

1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1

UCA_HYDRO UCA_MICRO UCA_NERV UCA_HEART UCA_CIRC UCA_RECTAL UCA_TRACH UCA_OMPHA UCA_GASTRO UCA_GENITAL UCA_RENAL UCA_UROGEN UCA_CELFTLP UCA_ADACTY UCA_CLUBFT UCA_HERNIA UCA_MUSCU UCA_DOWNS UCA_CHROM UCA_OTHER

Hydrocephalus 754 Microcephalus 755 Other Central Nervous System Anomalies 756 Heart Malformations 757 Other Circulatory / Respiratory Anomalies 758 Rectal Atresia / Stenosis 759 Tracheo-Esophageal Fistula 760 Omphalocele / Gastroschisis 761 Other Gastrointestinal Anomalies 762 Malformed Genitalia 763 Renal Agenesis 764 Other Urogenital Anomalies 765 Cleft Lip / Palate 766 Polydactyly / Syndactyly / Adactyly 767 Club Foot 768 Diaphramatic Hernia 769 Other Musculoskeletal Anomalies 770 Downs Syndrome 771 Other Chromosomal Anomalies 772 Other Congenital Anomalies 773

526-568

43

FILLER

Filler

569-773

184

Flag File for Reporting Flags The reporting flags must be invoked to generate accurate numbers by residence. This coding structure allows for four possible outcomes for the two years of birth in the period file (see text Linked Introduction text).

506 507 508 509 510 511 512 513 514 515 516 517 518 519 520 521 522 523 524 525

F_MORIGIN F_FORIGIN F_MEDUC FILLER F_CLINEST F_APGAR5 F_TOBACO FILLER F_MED

Reporting Flag Position

Vers*

Values Definition

U,R

U,R

U,R

Blank

Origin of Mother Origin of Father Education of Mother Filler Clinical Estimate of Gestation Five minute APGAR Tobacco use Filler Mother’s Education

U,R U,R R

0 1 2 3

Reporting in neither the current or previous year Reporting in both the current and previous year Reporting in the previous but not in the current year Reporting in the current but not the previous year

569 570 571 572 573 574 575 576-646 647

1 1 1 1 1 1 1 71 1

U,R U R

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

U,R U,R R U

32

Blank

Blank

Position

Len

Field

Description

Reporting Flag Position

648 649 650 651-666 667 668 669 670-680 681 682 683 684 685 686 687 688 689 690 691 692 693 694 695 696 697 698-700 701 702 703 704 705 706 707 708-710 711 712 713 714 715 716 717

1 1 1 16 1 1 1 11 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 3 1 1 1 1 1 1 1 3 1 1 1 1 1 1 1

F_WTGAIN F_ALCOL F_API FILLER F_TOBAC F_MPCB F_MPCB_U FILLER F_URF_ANEMIA

U,R U R

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

Weight Gain Alcohol use API Codes Filler Tobacco Use Month Prenatal Care Began Month Prenatal Care Began Filler Anemia F_URF_CARDIAC Cardiac Disease F_URF_LUNG Acute or Chronic Lung Disease F_URF_DIABETES Diabetes F_URF_HERPES Genital Herpes F_URF_HYDRA Hydramnios/Oligohydramnios F_URF_HEMO Hemoglobinopathy F_URF_CHYPER Chronic Hypertension F_URF_PHYPER Pregnancy-Associated Hypertension F_URF_ECLAMP Eclampsia F_URF_INCERVIX Incompetent Cervix F_URF_PRE4000 Previous Infant 4000+ Grams F_URF_PRETERM Previous Preterm or Small for Gestation Infant F_URF_RENAL Renal Disease F_URF_RH Rh Sensitization F_URF_UTERINE Uterine Bleeding F_URF_OTHERMR Other Medical Risk Factors FILLER Filler F_UOB_AMNIO Amniocentesis F_UOB_MONITOR Electronic Fetal Monitoring F_UOB_INDUCT Induction of Labor F_UOB_STIMUL Stimulation of Labor F_UOB_TOCOL Tocolysis F_UOB_ULTRAS Ultrasound F_UOB_OTHEROB Other Obstetric Procedures FILLER Filler F_ULD_FEBRILE Febrile F_ULD_MECONIUM Meconium F_ULD_RUPTURE Premature Rupture of Membrane F_ULD_ABRUPTIO Abruptio Placenta F_ULD_PREPLACE Placenta Previa F_ULD_EXCEBLD Other Excessive Bleeding F_ULD_SEIZURE Seizures During Labor

33

Vers*

U,R U U U R U U U U U U U U U U U U U U U U U U

Values Definition

Blank

Blank

U U U U U U U U U U U U U U

Position

Len

Field

Description

Reporting Flag Position

F_ULD_PRECIP Precipitous Labor

Vers*

Values Definition

718 719 720 721 722 723 724 725 726 727 730 731 732 733 734 735 736-739 740 741 742 743 744 745 746 747 748 749-751 752 753 754 755 756 757 758 759 760 761 762 763 764 765

1 1 1 1 1 1 1 1 1 3 1 1 1 1 1 1 4 1 1 1 1 1 1 1 1 1 3 1 1 1 1 1 1 1 1 1 1 1 1 1 1

U U U U U U U U U

U,R U R

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

F_ULD_PROLONG Prolonged Labor F_ULD_DYSFUNC Dysfunctional Labor

F_ULD_BREECH Breech F_ULD_CEPHALO Cephalopelvic Disproportion F_ULD_CORD Cord Prolapse F_ULD_ANESTHE Anesthetic Complications F_ULD_DISTRESS Fetal Distress F_ULD_OTHERLD Other Complications FILLER Filler F_U_VAGINAL Vaginal F_U_VBAC Vaginal After C-Section F_U_PRIMAC Primary C-Section F_U_REPEAC Repeat C-Section F_U_FORCEP Forceps F_U_VACUUM Vacuum FILLER Filler F_UAB_ANEMIA Anemia F_UAB_INJURY Birth Injury F_UAB_ALCOSYN Fetal Alcohol Syndrome F_UAB_HYALINE Hyaline Membrane Disease F_UAB_MECONSYN Meconium Aspiration Syndrome F_UAB_VENL30 Assisted Ventilation < 30 min F_UAB_VEN30M Assisted Ventilation >= 30 min F_UAB_NSEIZ Seizures F_UAB_OTHERAB Other Abnormal Conditions FILLER Filler F_UCA_ANEN Anencephalus F_UCA_SPINA Spina Bifida F_UCA_HYDRO Hydrocephalus F_UCA_MICROCE Microcephalus

U U U U U U U U U U U U U U U

F_UCA_NERVOUS Other Central Nervous System Anomalies

F_UCA_HEART Heart Malformations F_UCA_CIRCUL Other Circulatory/Respiratory Anomalies F_UCA_RECTAL Rectal Atresia/Stenosis F_UCA_TRACHEO Tracheo-Esophageal Fistula F_UCA_OMPHALO Omphalocele/Gastroschisis F_UCA_GASTRO Other Gastrointestinal Anomalies F_UCA_GENITAL Malformed Genitalia F_UCA_RENALAG Renal Agenesis F_UCA_UROGEN Other Urogenital Anomalies

34

U U U U U U U U U U U U U U

Position

Len

Field

1 1 1 1 1 1 1 1

F_UCA_CLEFTLP Cleft Lip/Palate F_UCA_ADACTYL Polydactyly/Syndactyly/Adactyly

F_UCA_CLUB Club Foot F_UCA_HERNIA Diaphramatic Hernia F_UCA_MUSCULO Other Musculoskeletal Anomalies F_UCA_DOWNS Downs Syndrome F_UCA_CHROMO Other Chromosomal Anomalies F_UCA_OTHRCON Other Congenital Anomalies

774-799

26

FILLER

800-823

24

Mother’s Race Edited

766 767 768 769 770 771 772 773

Description

Reporting Flag Position

Vers*

U U U U U U U U Blank

Filler R**

800 3 MRACE1E 803 3 MRACE2E 806 3 MRACE3E 809 3 MRACE4E 812 3 MRACE5E 815 3 MRACE6E 818 3 MRACE7E 821 3 MRACE8E ** Also includes unrevised States that report multiple race. 824-834

11

FILLER

835-858

24

Father’s Race Edited

100-999 Mother’s Race Edited Code A00-R99

Blank

Filler R**

835 3 FRACE1E 838 3 FRACE2E 841 3 FRACE3E 844 3 FRACE4E 847 3 FRACE5E 850 3 FRACE6E 853 3 FRACE7E 856 3 FRACE8E ** Also includes unrevised States that report multiple race. 859-867

9

FILLER

Filler

868

1

FLGND

Flag indicating records in both numerator and denominator file

U,R U R

Values Definition

100-999 Father’s Race Edited Code A00-R99

Blank U,R

1

Record in both files

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

35

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

Blank

Record not in numerator file

Here ends the Denominator file. Documentation of the Mortality Section of the Numerator (Linked) file begins on the next page.

869-871

3

FILLER

Filler

Blank

872-874

3

AGED

Age at Death in Days

000-365 Number of days

U,R U R

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

36

Position

Len

Field

Description

875

1

AGER5

Infant age recode 5

876-877 2

AGER22

878

1

MANNER

879

1

DISPO

U,R U R

Reporting Flag Position

Vers*

Values Definition

1 2 3 4 5

Under 1 hour 1 – 23 hours 1 – 6 days 7 – 27 days (late neonatal) 28 days and over (postneonatal)

Blank 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22

Age 1 year and over or not stated Under 1 hour (includes not stated hours and minutes) 1 – 23 hours 1 day (includes not stated days) 2 days 3 days 4 days 5 days 6 days 7 days (includes not stated weeks) 14 – 20 days 21 – 27 days 1 month (includes not stated months) 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months

Manner of Death

1 2 3 4 5 6 7 Blank

Accident Suicide Homicide Pending investigation Could not determine Self-inflicted Natural Not specified

Method of Disposition

B C

Burial Cremation

Infant age recode 22

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

37

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

D E R O U

Donation Entombment Removal from State Other Unknown Yes No Unknown

880

1

AUTOPSY

Autopsy

Y N U

881

1

FILLER

Filler

Blank

882

1

PLACE

Place of injury for causes W00-Y34, except Y06.and Y07.-

0 1 2 3 4 5 6 7 8 9 Blank

883

1

FILLER

Filler

Blank

884-891

Home Residential institution School, other institution and public administrative area Sports and athletics area Street and highway Trade and service area Industrial and construction area Farm Other Specified Places Unspecified place Cause other than W00-Y34, except Y06.- and Y07.-

UNDERLYING CAUSE OF DEATH

884-887

4

UC0D

ICD Code (10th Revision) See the International Classification of Diseases, 1992 Revision, Volume 1.

888

1

FILLER

Filler

Blank

889-891

3

UCODR130

130 Infant Cause Recode

001-158 Code Range

892 893-900

1 8

FILLER RECWT

Filler Record Weight (no weights computed for possessions file)

Blank 1.XXXXXX

901-902

2

FILLER

Filler

Blank

U,R U R

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

38

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

903-1148

281

MULTIPLE CONDITIONS

903-904

2

EANUM

Number of Entity-Axis Conditions

905-1148

140

ENTITY

Entity-Axis Conditions Space has been provided for a maximum of 20 conditions. Each condition takes 7 positions in the record. The 7th position will be blank. Records that do not have 20 conditions are blank in the unused area.

00-20

Position 1:

Part/line number on certificate

1 2 3 4 5 6

… … … … … …

Position 2:

Sequence of condition within part/line

1-7



Code range

Part I, line 1 (a) Part I, line 2 (b) Part I, line 3 (c) Part I, line 4 (d) Part I, line 5 (e) Part II,

Code range

Position 3 – 6: Condition code See Table 1 for a complete list of codes 905-911 912-918 919-925 926-932 933-939 940-946 947-953 954-960 961-967 968-974 975-981 982-988 989-995 996-1002

7 7 7 7 7 7 7 7 7 7 7 7 7 7 U,R U R

1st Condition 2nd Condition 3rd Condition 4th Condition 5th Condition 6th Condition 7th Condition 8th Condition 9th Condition 10th Condition 11th Condition 12th Condition 13th Condition 14th Condition

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

39

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

1003-1009 1010-1016 1017-1023 1024-1030 1031-1037 1038-1044

7 7 7 7 7 7

1045-1046

2

FILLER

Filler

Blank

1047-1048

2

RANUM

Number of Record-Axis Conditions

00-20

1049-1148

100

RECORD

Record-Axis Conditions Space has been provided for a maximum of 20 conditions. Each condition takes 5 positions in the record. The 5th position will be blank. Records that do not have 20 conditions are blank in the unused area.

15th Condition 16th Condition 17th Condition 18th Condition 19th Condition 20th Condition

Code range

Positions 1 – 4: Condition Code See Table 1 for a complete list of codes 1049-1053 1054-1058 1059-1063 1064-1068 1069-1073 1074-1078 1079-1083 1084-1088 1089-1093 1094-1098 1099-1103 1104-1108 1109-1113 1114-1118 1119-1123 1124-1128 1129-1133 1134-1138 1139-1143 1144-1148 U,R U R

5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5 5

1st Condition 2nd Condition 3rd Condition 4th Condition 5th Condition 6th Condition 7th Condition 8th Condition 9th Condition 10th Condition 11th Condition 12th Condition 13th Condition 14th Condition 15th Condition 16th Condition 17th Condition 18th Condition 19th Condition 20th Condition

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

40

Position

Len

Field

Description

1149-1150

2

FILLER

Filler

1151

1

RESSTATD

Death Resident Status

Reporting Flag Position

Vers*

Values Definition

Blank

United States Occurrence

1 2 3 4

Puerto Rico Occurrence

1 2 3 4

Virgin Islands Occurrence

1 2 3 4

Guam Occurrence U,R U R

1

RESIDENTS State and County of Occurrence and Residence are the same. INTRASTATE NONRESIDENTS State of Occurrence and Residence are the same, but County is different. INTERSTATE NONRESIDENTS State of Occurrence and Residence are different, but both are in the U.S. FOREIGN RESIDENTS State of Occurrence is one of the 50 States or the District of Columbia, but Place of Residence is outside of the U.S. RESIDENTS Territory and County-equivalent of Occurrence and Residence are the same. INTRASTATE NONRESIDENTS Territory of Occurrence and Residence are the same, but County-equivalent is different. INTERTERRITORY NONRESIDENTS Territory of occurrence and residence are different, but both are a Territory. FOREIGN RESIDENTS Occurred in Puerto Rico to a resident of any other place. RESIDENTS Territory and County-equivalent of Occurrence and Residence are the same. INTRASTATE NONRESIDENTS Territory of Occurrence and Residence are the same, but County-equivalent is different. INTERTERRITORY NONRESIDENTS Territory of occurrence and residence are different, but both are a Territory. FOREIGN RESIDENTS Occurred in Virgin Islands to a resident of any other place. RESIDENTS

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

41

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

3 4

1152-1185

34

FEDERAL INFORMATION PROCESSING STANDARDS (FIPS) GEOGRAPHIC CODES Refer to the Geographic Code Outline further back in this document for a detailed list of areas and codes. For an explanation of FIPS codes, reference should be made to various National Institute of Standards and Technology (NIST) publications. Some geographic codes have been changed to reflect the results of the 2000 Census.

1152-1159

8

PLACE OF OCCURRENCE of Death

1152-1153

2

STOCCFIPD

State of Occurrence (FIPS) of Death United States

U,R U R

Occurred in Guam to a resident of Guam or to a resident of the U.S. INTERTERRITORY NONRESIDENTS Territory of occurrence and residence are different, but both are a Territory. FOREIGN RESIDENTS Occurred in Guam to a resident of any place other than Guam or the U.S.

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

42

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

1154-1155

U,R U R

3

CNTOCFIPD

Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Puerto Rico

PR

Puerto Rico

Virgin Islands

VI

Virgin Islands

Guam GU County of Occurrence (FIPS) of Death Counties and county equivalents (independent and coextensive cities) are numbered alphabetically within each State and identify each county. (Note: To uniquely identify

Guam

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

43

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

a county, both the state and county codes must be used.) A complete list of counties is shown in the Geographic Code Outline further back in this document. 001-nnn Code range 999 County with less than 250,000 1157-1158

2

ESTATOCD

Expanded State of Occurrence Code of Death This item is designed to separately identify New York City records (YC) from other New York State records. Note: YC is not an official FIPS code. United States

U,R U R

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

44

Position

Len

1159

1

1160-1185

U,R U R

26

Field

CNTOCPPD

Description

Reporting Flag Position

Vers*

Values Definition

NH NJ NM NY YC NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

New Hampshire New Jersey New Mexico New York New York City North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Puerto Rico

PR

Puerto Rico

Virgin Islands

VI

Virgin Islands

Guam

GU

Guam

Population Size of County of Occurrence of Death Based on the results of the 2000 Census

0 1 2 9

County of 1,000,000 or more County of 500,000 to 1,000,000 County of 250,000 to 500,000 County of less than 250,000

PLACE OF RESIDENCE Refer to the Geographic Code Outline further back in this document for a detailed list of areas and codes. Beginning with 2003 data, some areas started reporting additional codes Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

45

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

for foreign residents. 1160-1161

2

STRESFIPD

State of Residence (FIPS) US Occurrence

U,R U R

ZZ AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH

Foreign residents Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

46

Position

Len

Field

Description

Reporting Flag Position

Values Definition

OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Territories

PR VI GU AS MP

Puerto Rico Virgin Islands Guam American Samoa Northern Marianas

Puerto Rico Occurrence

PR Puerto Rico AL-WY, VI,AS,GU, MP,ZZ Foreign residents: refer to U.S. for specific code structure.

Virgin Islands Occurrence

VI Virgin Islands AL-WY, PR,AS,GU, MP, ZZ Foreign residents: refer to U.S. for specific code structure.

Guam Occurrence

GU Guam AL-WY U.S. resident. Also considered a resident of Guam. PR,AS, VI,MP, ZZ Foreign residents: refer to U.S. for specific code structure.

1162-1163

2

FILLER

Filler

1164-1165

2

DRCNTY

State/Country of Residence of Death Recode

U,R U R

Vers*

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

47

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

See Country of Residence (location 1162-1163) for detailed Country information. Note: Canada (CC) and Remainder of world (YY) are not official FIPS codes. United States Occurrence

U,R U R

AL AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

48

Position

Len

1166-1168

U,R U R

3

Field

CNTYRFPD

Description

Reporting Flag Position

Vers*

Values Definition

OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Territorial residents

PR VI GU AS MP

Puerto Rico Virgin Islands Guam American Samoa Northern Marianas

Foreign residents

CC MX CU YY

Canada Mexico Cuba Remainder of the world

Puerto Rico Occurrence

PR AL-ZZ

Puerto Rico Foreign residents: refer to U.S. for specific code structure.

Virgin Islands Occurrence

VI AL-ZZ

Virgin Islands Foreign residents: refer to U.S. for specific code structure.

Guam Occurrence

GU Guam AL-WY U.S. resident. Also considered a resident of Guam PR,VI,AS, MP,ZZ Foreign residents: refer to U.S. for specific code structure.

County of Residence (FIPS) of Death Counties and county equivalents (independent and coextensive cities) are numbered alphabetically within each State and identify each county. (Note: To uniquely

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

49

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

identify a county, both the state and county codes must be used.) A complete list of counties is shown in the Geographic Code Outline further back in this document. 000 Foreign residents 001-nnn Code range 999 County with less than 250,000 1169-1173

1174

5

1

1175

DRCITYPOP

1

1176-1177

DRCITY

2

METRRESD

DRSTATE

City of Residence (FIPS) of Death A complete list of cities is shown in the Geographic code outline further back in this document. Effective with the 1994 data year, the FIPS place code has been added to the Mortality record. Foreign residents

0 1 2 9 Z

Place of 1,000,000 or more Place of 500,000 to 1,000,000 Place of 250,000 to 500,000 Place of less than 250,000 Foreign residents

code range Cities of less than 250,000 population

Population Size of City of Residence Based on the results of the 2000 Census.

Metropolitan - Nonmetropolitan County of Residence NOTE: Guam and the Virgin Islands do not have any metropolitan areas. 1 2 Z

Metropolitan county Nonmetropolitan county Foreign residents

AL

Alabama

Expanded State of Residence of Death Code This item is designed to separately identify New York City records (YC) from other New York State records. Note: YC, CC, and YY are not official FIPS codes. United States Occurrence

U,R U R

00000 00001nnnnn 99999

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

50

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

AK AZ AR CA CO CT DE DC FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY YC NC ND OH OK OR PA RI SC U,R U R

Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York New York City North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

51

Position

Len

1178-1181

4

Field

SMSARFIPD

Description

Reporting Flag Position

Vers*

Values Definition

SD TN TX UT VT VA WA WV WI WY

South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Territorial residents

PR VI GU AS MP

Puerto Rico Virgin Islands Guam American Samoa Northern Marianas

Foreign residents

CC MX CU YY

Canada Mexico Cuba Remainder of the world

Puerto Rico Occurrence

PR AL-ZZ

Puerto Rico Foreign residents: refer to U.S. for specific code structure.

Virgin Islands Occurrence

VI AL-ZZ

Virgin Islands Foreign residents: refer to U.S. for specific code structure.

Guam Occurrence

GU Guam AL-WY U.S. resident. Also considered a resident of Guam. PR,VI,AS, MP,ZZ Foreign residents: refer to U.S. for specific code structure.

PMSA/MSA of Residence of Death(FIPS) Primary Metropolitan Statistical Areas and Metropolitan Statistical Areas are those defined by the U.S. Office of Management and Budget (OMB) as of 2000. For New England, the New England County Metropolitan Areas (NECMA) are used. 0000 0040-

U,R U R

Nonmetropolitan counties or foreign residents

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

52

Position

Len

1182

1

1183

1

1184-1185

2

Field

CNTRSPPD

POPSMASD

CMSAD

Description

Reporting Flag Position

Vers*

Values Definition

9360

Code range

0 1 2 9 Z

County of 1,000,000 or more County of 500,000 to 1,000,000 County of 250,000 to 500,000 County of less than 250,000 Foreign residents

1 2 9 Z

Area of 250,000 or more Area of less than 250,000 Nonmetropolitan area Foreign residents

All Areas

00

Not a CMSA

United States Occurrence

07 14 21 28 31 34 35 42 49 56 63 70

Boston - Worcester-Lawrence, MA-NH-ME-CT, CMSA Chicago - Gary-Kenosha, IL-IN-WI, CMSA Cincinnati - Hamilton, OH-KY-IN, CMSA Cleveland - Akron, OH, CMSA Dallas - Fort Worth, TX, CMSA Denver - Boulder-Greeley, CO, CMSA Detroit - Ann Arbor-Flint, MI, CMSA Houston - Galveston-Brazoria, TX, CMSA Los Angeles -Riverside- Orange County, CA, CMSA Miami - Fort Lauderdale, FL, CMSA Milwaukee - Racine, WI, CMSA New York -Northern New Jersey-Long Island, NY-NJ-CTPA, CMSA Philadelphia - Wilmington-Atlantic City, PA-NJ-DE-MD, CMSA Portland - Salem, OR-WA, CMSA

Population Size of County of Residence of Death Based on the results of the 2000 Census

PMSA/MSA Population Size of Residence Based on the results of the 2000 Census

CMSA of Residence of Death(FIPS) Consolidated Metropolitan Statistical Areas are groupings of certain Primary Metropolitan Statistical Areas and are defined by the U.S. Office of Management and Budget (OMB) as of 2000.

77 79 U,R U R

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

53

Position

Len

Field

Description

Reporting Flag Position

Puerto Rico Occurrence 1186

1

HOSPD

Place of Death and Decendent’s Status

Vers*

Values Definition

82 84 91 97

Sacramento - Yolo, CA, CMSA San Francisco -Oakland-San Jose, CA, CMSA Seattle - Tacoma-Bremerton, WA, CMSA Washington - Baltimore, DC-MD-VA-WV, CMSA

87

San Juan -Caguas-Arecibo, PR, CMSA

1 2 3 4 5 6 7 9

Hospital, clinic or Medical Center – Inpatient Hospital, clinic or Medical Center – Outpatient or admitted to Emergency Room Hospital, clinic or Medical Center – Dead on Arrival Decedent’s home Hospice facility Nursing home/long term care Other Place of death unknown

1 2 3 4 5 6 7 9

Sunday Monday Tuesday Wednesday Thursday Friday Saturday Unknown

2004

1187

1

WEEKDAYD

Day of Week of Death

1188-1191

4

DTHYR

Year of Death

2004

1192-1257

66

FILLER

Filler

Blank

1258-1259

2

DOD_MM

Month of Death

U,R U R

01 02 03 04 05 06

January February March April May June

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

54

Position

Len

Field

Description

Reporting Flag Position

Vers*

Values Definition

07 08 09 10 11 12

U,R U R

July August September October November December

Includes data based on both the 1989 Revision of the U.S. Certificate of Live Birth (unrevised), and the 2003 Revision of the U.S. Certificate of Live Birth (revised). Includes data based on the 1989 Revision of U.S. Certificate of Live Birth; excludes data based on the 2003 Revision. Includes data based on the 2003 Revision of U.S. Certificate of Live Birth; excludes data based on the 1989 Revision.

55

Listings of Counties Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data Page

State

County

01 073 089 097 02

State and County Name Alabama Jefferson Madison Mobile Alaska Anchorage, coext. with Anchorage city

04 013 019

Arizona Maricopa Pima

119

Arkansas Pulaski

001 013 019 029 037 053 059 065 067 071 073 075 077 081 083 085 087 095 097 099 107 111

California Alameda Contra Costa Fresno Kern Los Angeles Monterey Orange Riverside Sacramento San Bernardino San Diego San Francisco, coext. with San Francisco city San Joaquin San Mateo Santa Barbara Santa Clara Santa Cruz Solano Sonoma Stanislaus Tulare Ventura

05

06

1

Listings of Counties Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data Page State 08

County

State and County Name

Colorado 001Adams 005Arapahoe 013Boulder 031Denver, coext. with Denver city 041El Paso 059Jefferson 069Larimer

09 001 003 009 011

Connecticut Fairfield Hartford New Haven New London

003

Delaware New Castle

001

District of Columbia District of Columbia

009 011 021 031 033 057 071 081 083 086 095 099 101 103 105 115 117 127

Florida Brevard Broward Collier Duval Escambia Hillsborough Lee Manatee Marion Miami-Dade Orange Palm Beach Pasco Pinellas Polk Sarasota Seminole Volusia

10

11

12

2

Listings of Counties Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data Page State

County State and County Name

13 067 089 121 135

Georgia Cobb De Kalb Fulton Gwinnett

003

Hawaii Honolulu

001

Idaho Ada

15

16

17 031 043 089 097 111 119 163 197 201 18

Illinois Cook Du Page Kane Lake McHenry Madison St. Clair Will Winnebago

003 089 097 141

Indiana Allen Lake Marion St. Joseph

153

Iowa Polk

091 173

Kansas Johnson Sedgwick

067 111

Kentucky Fayette, coext. with Lexington-Fayette Jefferson

19

20

21

3

Listings of Counties Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data Page State

County

22

State and County Name

017 033 051 071

Louisiana Caddo East Baton Rouge Jefferson Orleans, coext. with New Orleans city

005

Maine Cumberland

003 005 031 033 510

Maryland Anne Arundel Baltimore Montgomery Prince George's Baltimore city

005 009 013 017 021 023 027

Massachusetts Bristol Essex Hampden Middlesex Norfolk Plymouth Worcester

23

24

25

26 049 065 081 099 125 161 163

Michigan Genesee Ingham Kent Macomb Oakland Washtenaw Wayne

003 037 053 123

Minnesota Anoka Dakota Hennepin Ramsey

049

Mississippi Hinds

27

28

4

Listings of Counties Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data Page State

County

29 095 183 189 510

State and County Name Missouri Jackson St. Charles St. Louis St. Louis city

30

Montana

31 055 109

Nebraska Douglas Lancaster

003 031

Nevada Clark Washoe

32

33 011 015

New Hampshire Hillsborough Rockingham

001 003 005 007 013 015 017 021 023 025 027 029

New Jersey Atlantic Bergen Burlington Camden Essex Gloucester Hudson Mercer Middlesex Monmouth Morris Ocean

031 035 039

Passaic Somerset Union

001

New Mexico Bernalillo

34

35

5

Listings of Counties Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data Page State

County

36

State and County Name

001 027 029 055 059 085 081 061 047 005 067 071 087 103 119

New York Albany Dutchess Erie Monroe Nassau Staten Island borough, Richmond county Queens borough, Queens county Manhattan borough, New York county Brooklyn borough, Kings county Bronx borough, Bronx county Onondaga Orange Rockland Suffolk Westchester

051 067 081 119 183

North Carolina Cumberland Forsyth Guilford Mecklenburg Wake

37

38

North Dakota

39 017 035 049 061 093 095 099 113 151 153

Ohio Butler Cuyahoga Franklin Hamilton Lorain Lucas Mahoning Montgomery Stark Summit

109 143

Oklahoma Oklahoma Tulsa

40

6

Listings of Counties Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data Page State

County

41

State and County Name

005 039 047 051 067

Oregon Clackamas Lane Marion Multnomah Washington

003 011 017 029 043 045 049 071 077 079 091 095 101 129 133

Pennsylvania Allegheny Berks Bucks Chester Dauphin Delaware Erie Lancaster Lehigh Luzerne Montgomery Northampton Philadelphia, coext. with Philadelphia city Westmoreland York

42

44 007

Rhode Island Providence

019 045 079 083

South Carolina Charleston Greenville Richland Spartanburg

45

46

South Dakota

47 037 065 093 157

Tennessee Davidson Hamilton Knox Shelby

7

Listings of Counties Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data Page State

County

48

State and County Name

029 061 085 113 121 141 157 167 201 215 245 339 355 439 453

Texas Bexar Cameron Collin Dallas Denton El Paso Fort Bend Galveston Harris Hidalgo Jefferson Montgomery Nueces Tarrant Travis

035 049

Utah Salt Lake Utah

041 059 087 153 810

Virginia Chesterfield Fairfax Henrico Prince William Virginia Beach city

033 053 061 063

Washington King Pierce Snohomish Spokane

025 079 133

Wisconsin Dane Milwaukee Waukesha

49

51

53

55

8

Listings of Counties Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data Page State

County

72 127 78

State and County Name Puerto Rico San Juan Virgin Islands

66

010

Guam

00

000

Canada

00

000

Cuba

00

000

Mexico

00

000

Remainder of World

9

Listing of Cities/Places Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data State

FIPS Codes City/Place State and City/Place Name

AK

Alaska 03000

AZ

Anchorage Arizona

46000 55000 77000

Mesa Phoenix Tucson

AR

Arkansas

CA

California Anaheim Fresno Long Beach Los Angeles Oakland Riverside Sacramento San Diego San Francisco San Jose Santa Ana

02000 27000 43000 44000 53000 62000 64000 66000 67000 68000 69000 CO

Colorado 04000 16000 20000

Aurora Colorado Springs Denver

CT

Connecticut

DE

Delaware

DC

District of Columbia Washington

50000 FL

Florida 35000 45000 71000

GA

Jacksonville Miami Tampa Georgia

04000

Atlanta

Page 1

Listing of Cities/Places Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data State

City/Place

HI 17000 ID

State and City/Place Name Hawaii Honolulu Idaho

IL

Illinois 14000

IN

Chicago Indiana

36003 KS

Kansas 79000

KY

Wichita Kentucky

46027 48000 LA

Lexington-Fayette Louisville

55000

Louisiana New Orleans

04000

Maryland Baltimore

07000

Massachusetts Boston

MD

MA

MI

Indianapolis

Michigan 22000 Detroit

MN 43000 58000

Minnesota Minneapolis St. Paul

38000 65000

Missouri Kansas City St. Louis

37000

Nebraska Omaha

40000

Nevada Las Vegas

MO

NB

NV

Page 2

Listing of Cities/Places Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data State NJ

City/Place

New Jersey 51000 Newark

NM 02000

New Mexico Albuquerque

51000 51000 11000 51000 51000 51000

New York Brooklyn borough, Kings county Bronx borough, Bronx county Buffalo Manhattan borough, New York county Queens borough, Queens county Staten Island borough, Richmond county

12000 55000

North Carolina Charlotte Raleigh

NY

NC

OH

OK

State and City/Place Name

Ohio 15000 16000 18000 77000

Cincinnati Cleveland Columbus Toledo

Oklahoma 55000 75000 75000

Oklahoma City Tulsa, part Tulsa, part

OR 59000

Oregon Portland

60000 61000

Pennsylvania Philadelphia Pittsburgh

48000 52006

Tennessee Memphis Nashville-Davidson

PA

TN

Page 3

Listing of Cities/Places Identified in the Linked Data Set Vital Statistics Geographic Code Outline Effective With 2000 Data State

City/Place

TX

State and City/Place Name Texas

04000 05000 17000 19000 24000 27000 35000 65000 VA 82000

Virginia Virginia Beach

63000

Washington Seattle

WA

WI 53000 WY

Arlington Austin Corpus Christ Dallas El Paso Fort Worth Houston San Antonio

Wisconsin Milwaukee Wyoming

PR

00000

Puerto Rico

VI

00000

Virgin Islands

GU

00000

Guam

00

00000

Canada

00

00000

Cuba

00

00000

Mexico

00

00000

Remainder of the World

Page 4

Listing of Primary Metropolitan Statistical Areas Identified in the Linked Data Set and their Component Counties United States

1

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States Vital Statistics Codes P/MSA

State

County

FIPS Codes P/MSA Name and County Components

P/MSA

0080

067 077

Akron, OH, PMSA Ohio Portage Summit

0160

001 027 039 042 043 044

Albany-Schenectady-Troy, NY, MSA New York Albany Montgomery Rensselaer Saratoga Schenectady Schoharie

0200

001 024 033

Albuquerque, NM, MSA New Mexico Bernalillo Sandoval Valencia

0240

013 039 048

Allentown-Bethlehem-Easton, PA, MSA Pennsylvania Carbon Lehigh Northampton

0380

003

Anchorage, AK, MSA Alaska Anchorage

0440

046 047 081

Ann Arbor, MI, PMSA Michigan Lenawee Livingston Washtenaw

002 OH

004 NY

005 NM

007 PA

010 AK 011 MI

State Cnty

OH 133 153

NY 001 057 083 091 093 095 NM 001 043 061

PA 025 077 095

AK 020 MI 091 093 161

2

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

013

0460

008 045 071

Appleton-Oshkosh-Neenah, WI, MSA Wisconsin Calumet Outagamie Winnebago

0520

007 008 022 028 031 033 038 044 048 056 058 060 067 075 107 110 112 122 126 147

Atlanta, GA, MSA Georgia Barrow Bartow Carroll Cherokee Clayton Cobb Coweta De Kalb Douglas Fayette Forsyth Fulton Gwinnett Henry Newton Paulding Pickens Rockdale Spalding Walton

0560

001 005

Atlantic-Cape May, NJ, PMSA New Jersey Atlantic Cape May

0600

036 094 121

Augusta-Aiken, GA-SC, MSA Georgia Columbia McDuffie Richmond

WI

016 GA

017 NJ

018 GA

SC 002 019 019 TX 011 028 105 227 246

WI 015 087 139

GA 013 015 045 057 063 067 077 089 097 113 117 121 135 151 217 223 227 247 255 297 NJ 001 009 GA 073 189 245

South Carolina Aiken Edgefield

SC 003 037

Austin-San Marcos, TX, MSA Texas Bastrop Caldwell Hays Travis Williamson

3

0640 TX 021 055 209 453 491

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

020

0680

015

Bakersfield, CA, MSA California Kern

0720

002 003 004 007 013 014 018

Baltimore, MD, PMSA Maryland Anne Arundel Baltimore Baltimore city Carroll Harford Howard Queen Anne's

0760

003 017 032 061

Baton Rouge, LA, MSA Louisiana Ascension East Baton Rouge Livingston West Baton Rouge

0840

100 123 181

Beaumont-Port Arthur, TX, MSA Texas Hardin Jefferson Orange

0875

002 016

Bergen-Passaic, NJ, PMSA New Jersey Bergen Passaic

0920

023 024 030

Biloxi-Gulfport-Pascagoula, MS, MSA Mississippi Hancock Harrison Jackson

0960

003 050

Binghamton, NY, MSA New York Broome Tioga

CA 021 MD

024 LA

025 TX

028 NJ

030 MS

031 NY

CA 029 MD 003 005 510 013 025 027 035

LA 005 033 063 121

TX 199 245 361

NJ 003 031

MS 045 047 059

NY 007 107

4

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States- con. 032

1000

005 037 058 059

Birmingham, AL, MSA Alabama Blount Jefferson St. Clair Shelby

1010

008 030

Bismarck, ND, MSA North Dakota Burleigh Morton

1080

001 014

Boise City, ID, MSA Idaho Ada Canyon

1123

006 008 009

Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH Massachusetts Bristol Essex Middlesex Norfolk Plymouth Suffolk Worcester New Hampshire Hillsborough Rockingham Strafford

1125

007

Boulder-Longmont, CO, PMSA Colorado Boulder

1240

031

Brownsville-Harlingen-San Benito, TX, MSA Texas Cameron

1280

014 030

Buffalo-Niagara Falls, NY, MSA New York Erie Niagara

AL

033 ND

036 ID

037 MA 003 005 009 011 012 013 014 NH

038 CO

041 TX

043 NY

AL 009 073 115 117

ND 015 059

ID 001 027

5

MA 005 009 017 021 023 025 027 NH 011 015 017 CO 013

TX 061

NY 029 063

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

045

1320

010 076

Canton-Massillon, OH, MSA Ohio Carroll Stark

1350

013

Casper, WY, MSA Wyoming Natrona

1440

008 010 018

Charleston-North Charleston, SC, MSA South Carolina Berkeley Charleston Dorchester

1480

020 040

Charleston, WV, MSA West Virginia Kanawha Putnam Charlotte-Gastonia-Rock Hill, NC-SC, MSA North Carolina Cabarrus Gaston Lincoln Mecklenburg Rowan Union South Carolina York

1520

1560

033 058

Chattanooga, TN-GA, MSA Georgia Catoosa Dade Walker Tennessee Hamilton Marion

1580

011

Cheyenne, WY, MSA Wyoming Laramie

OH

046 WY

049 SC

050 WV

051 NC 013 036 055 060 080 090 SC 046

053 GA 023 041 146 TN

054 WY

OH 019 151 WY 025

SC 015 019 035 WV 039 079 NC 025 071 109 119 159 179 SC 091

GA 047 083 295 TN 065 115

WY 021

6

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States 055

Chicago, IL, PMSA Illinois Cook De Kalb Du Page Grundy Kane Kendall Lake McHenry Will

1600

1640

008 013 031 083

Cincinnati, OH-KY-IN, PMSA Indiana Dearborn Ohio Kentucky Boone Campbell Gallatin Grant Kenton Pendleton Ohio Brown Clermont Hamilton Warren

1680

004 018 028 043 047 052

Cleveland-Lorain-Elyria, OH, PMSA Ohio Ashtabula Cuyahoga Geauga Lake Lorain Medina

1720

021

Colorado Springs, CO, MSA Colorado El Paso

1760

032 040

Columbia, SC, MSA South Carolina Lexington Richland

IL 016 019 022 032 045 047 049 056 099 057 IN 015 058 KY 008 019 039 041 059 096 OH

059 OH

060 CO

062 SC

IL 031 037 043 063 089 093 097 111 197

IN 029 115 KY 015 037 077 081 117 191 OH 015 025 061 165

OH 007 035 055 085 093 103 CO 041

SC 063 079

7

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

- con. 063

1800

026 072 106

Columbus, GA-AL, MSA Alabama Russell Georgia Chattahoochee Harris Muscogee

1840

021 023 025 045 049 065

Columbus, OH, MSA Ohio Delaware Fairfield Franklin Licking Madison Pickaway

1880

178 205

Corpus Christi, TX, MSA Texas Nueces San Patricio

1920

043 057 061 070 107 116 129 199

Dallas, TX, PMSA Texas Collin Dallas Denton Ellis Henderson Hunt Kaufman Rockwall

1960

082

Davenport-Moline-Rock Island, IA-IL, MSA Illinois Henry Rock Island Iowa Scott

2000

012 029 055 057

Dayton-Springfield, OH, MSA Ohio Clark Greene Miami Montgomery

2020

018 064

Daytona Beach, FL, MSA Florida Flagler Volusia

AL 057 GA

064 OH

065 TX

067 TX

069 IL 037 081 IA 070 OH

071 FL

AL 113 GA 053 145 215 OH 041 045 049 089 097 129 TC 355 409

TX 085 113 121 139 213 231 257 397

IL 073 161 IA 163 OH 023 057 109 113 FL 035 127

8

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

074

2080

001 003 016 018 030

Denver, CO, PMSA Colorado Adams Arapahoe Denver Douglas Jefferson

2120

025 077 091

Des Moines, IA, MSA Iowa Dallas Polk Warren

2160

044 050 058 063 074 082

Detroit, MI, PMSA Michigan Lapeer Macomb Monroe Oakland St. Clair Wayne

2190

001

Dover, DE, MSA Delaware Kent

2200

031

Dubuque, IA, MSA Iowa Dubuque

2281

013

Dutchess County, NY, PMSA New York Dutchess

CO

075 IA

076 MI

078 DE 079 IA

081 NY

CO 001 005 031 035 059

IA 049 153 181 MI 087 099 115 125 147 163

DE 001 IA 061

9

NY 027

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

083

2320

071

El Paso, TX, MSA Texas El Paso

2335

007

Elmira, NY, MSA New York Chemung

2340

024

Enid, OK, MSA Oklahoma Garfield

2360

025

Erie, PA, MSA Pennsylvania Erie

2400

020

Eugene-Springfield, OR, MSA Oregon Lane

2440

065 082

Evansville-Henderson, IN-KY, MSA Indiana Posey Vanderburgh

TX

085 NY 086 OK

087 PA 088 OR 089 IN

087 KY 051

091

TX 141

NY 015 OK 047

PA 049 OR 039 IN 129 163

Warrick Kentucky Henderson

173 KY 101

2560

026

Fayetteville, NC, MSA North Carolina Cumberland

2580

004 072

Fayetteville-Springdale-Rogers, AR, MSA Arkansas Benton Washington Flint, MI, PMSA Michigan

2640

NC 092 AR

093 MI 025

NC 051 AR 007 143 MI

Genesee

049

10

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

096

2670

035

Fort Collins-Loveland, CO, MSA Colorado Larimer

2680

006

Fort Lauderdale, FL, PMSA Florida Broward

2700

036

Fort Myers-Cape Coral, FL, MSA Florida Lee

2710

043 056

Fort Pierce-Port St. Lucie, FL, MSA Florida Martin St. Lucie

2760

001 002 017 035 090 092

Fort Wayne, IN, MSA Indiana Adams Allen De Kalb Huntington Wells Whitley

2800

111 126 184 220

Fort Worth-Arlington, TX, PMSA Texas Hood Johnson Parker Tarrant

2840

010 020

Fresno, CA, MSA California Fresno Madera

2920

084

Galveston-Texas City, TX, PMSA Texas Galveston

CO 097 FL 098 FL 099 FL

102 IN

103 TX

104 CA

107 TX

CO 069 FL 011 FL

FL 085 111

IN 001 003 033 069 179 183

TX 221 251 367 439 CA 019 039

11

TX 167

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

108

Gary, IN, PMSA Indiana Lake Porter

2960

Grand Forks, ND-MN, MSA Minnesota Polk North Dakota Grand Forks

2985

3000

003 041 061 070

Grand Rapids-Muskegon-Holland, MI, MSA Michigan Allegan Kent Muskegon Ottawa

3040

007

Great Falls, MT, MSA Montana Cascade

3120

001 029 030 034 041 076 085 099

Greensboro--Winston-Salem--High Point, NC, MSA North Carolina Alamance Davidson Davie Forsyth Guilford Randolph Stokes Yadkin

3160

004 011 023 039 042

Greenville-Spartanburg-Anderson, SC, MSA South Carolina Anderson Cherokee Greenville Pickens Spartanburg

IN 045 064

111 MN 060 ND 018 112 MI

113 MT

116 NC

118 SC

IN 089 127

MN 119 ND

MI 005 081 121 139 MT 013

12

NC 001 057 059 067 081 151 169 197

SC 007 021 045 077 083

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

120

3200

009

Hamilton-Middletown, OH, PMSA Ohio Butler

3240

021 022 038 050

Harrisburg-Lebanon-Carlisle, PA, MSA Pennsylvania Cumberland Dauphin Lebanon Perry

3283

002 004 007

Hartford, CT, NECMA Connecticut Hartford Middlesex Tolland

3290

002 012 014 018

Hickory-Morganton, NC, MSA North Carolina Alexander Burke Caldwell Catawba

3320

002

Honolulu, HI, MSA Hawaii Honolulu

3360

036 079 101 146 170 237

Houston, TX, PMSA Texas Chambers Fort Bend Harris Liberty Montgomery Waller

3400

006 050

Huntington-Ashland, WV-KY-OH, MSA Kentucky Boyd Carter Greenup Ohio Lawrence West Virginia Cabell Wayne

3440

042 045

Huntsville, AL, MSA Alabama Limestone Madison

OH 121 PA

122 CT

124 NC

125 HI

127 TX

128 KY 010 022 045 OH 044 WV

129 AL

OH 017 PA 041 043 075 099 CT 003 007 013

NC 003 023 027

HI 003

TX 071 157 201 291 339 473 KY 019 043 089 OH 087 WV 011 099 AL 083 089

13

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States – con. 130

3480

006 029 030 032 041 048 049 055 073

Indianapolis, IN, MSA Indiana Boone Hamilton Hancock Hendricks Johnson Madison Marion Morgan Shelby

3560

025 045 061

Jackson, MS, MSA Mississippi Hinds Madison Rankin

3600

010 016 045 055

Jacksonville, FL, MSA Florida Clay Duval Nassau St. Johns

3640

009

Jersey City, NJ, PMSA New Jersey Hudson Johnson City-Kingsport-Bristol, TN-VA, MSA Tennessee Carter Hawkins Sullivan Unicoi Washington Virginia Bristol city Scott Washington

3660

IN

133 MS

135 FL

139 NJ 140 TN 010 037 082 086 090 VA 015 115 129

IN 011 057 059 063 081 095 097 109 145

MS 049 089 121

FL 019 031 089 109

NJ 017

14

TN 019 073 163 171 179 VA 520 169 191

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

143

Kalamazoo-Battle Creek, MI, MSA Michigan Calhoun Kalamazoo Van Buren

3720

3760

019 024 025 048 054 083 089

Kansas City, MO-KS, MSA Kansas Johnson Leavenworth Miami Wyandotte Missouri Cass Clay Clinton Jackson Lafayette Platte Ray

3810

014 050

Killeen-Temple, TX, MSA Texas Bell Coryell

3840

001 005 047 053 078 087

Knoxville, TN, MSA Tennessee Anderson Blount Knox Loudon Sevier Union

MI 013 039 080 145 KA 046 052 061 105 MI

147 TX

148 TN

MI 025 077 159

KS 091 103 121 209 MO 037 047 049 095 107 165 177

TX 027

TN 001 009 093 105 155 173

15

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con. 151

3880

001 028 049 050

Lafayette, LA, MSA Louisiana Acadia Lafayette St. Landry St. Martin

3980

053

Lakeland-Winter Haven, FL, MSA Florida Polk

4000

036

Lancaster, PA, MSA Pennsylvania Lancaster

4040

019 023 033

Lansing-East Lansing, MI, MSA Michigan Clinton Eaton Ingham

4120

003 013

Las Vegas, NV-AZ, MSA Arizona Mohave Nevada Clark Nye

4150

023

Lawrence, KS, MSA Kansas Douglas

4280

009 025 034 057 076 105 120

Lexington, KY, MSA Kentucky Bourbon Clark Fayette Jessamine Madison Scott Woodford

LA

154 FL 155 PA 156 MI

159 AZ 009 NV

160 KS

163 KY

LA 001 055 097 099

FL 105 PA 071 MI 037 045 065

AZ 015 NV 003 023 KS 045

KY 017 049 067 113 151 209 239

16

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

165

4360

055

Lincoln, NE, MSA Nebraska Lancaster

4400

023 043 060 063

Little Rock-North Little Rock, AR, MSA Arkansas Faulkner Lonoke Pulaski Saline

4480

019

Los Angeles-Long Beach, CA, PMSA California Los Angeles Louisville, KY-IN, MSA Indiana Clark Floyd Harrison Scott Kentucky Bullitt Jefferson Oldham

4520

NE 166 AR

168 CA 169 IN 010 022 031 072 KY 015 056 093 172 011 076 084 111 143

Macon, GA, MSA Georgia Bibb Houston Jones Peach Twiggs

013

Madison, WI, MSA Wisconsin Dane

GA

173 WI

NE 109 AR 045 085 119 125

CA 037 IN 019 043 061 143 KY 029 111 185 4680 GA 021 153 169 225 289 4720 WI 025

17

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

175

4880

108

McAllen-Edinburg-Mission, TX, MSA Texas Hidalgo

4900

005

Melbourne-Titusville-Palm Bay, FL, MSA Florida Brevard

4920

024 079 084

Memphis, TN-AR-MS, MSA Arkansas Crittenden Mississippi De Soto Tennessee Fayette Shelby Tipton

5000

013

Miami, FL, PMSA Florida Dade

5015

010 012 018

Middlesex-Somerset-Hunterdon, NJ, PMSA New Jersey Hunterdon Middlesex Somerset

5080

041 046 067 068

Milwaukee-Waukesha, WI, PMSA Wisconsin Milwaukee Ozaukee Washington Waukesha

5120

048 056

Minneapolis-St. Paul, MN-WI, MSA Minnesota Anoka Carver Chisago Dakota Hennepin Isanti Ramsey Scott Sherburne Washington Wright Wisconsin Pierce St. Croix

5160

002 049

Mobile, AL, MSA Alabama Baldwin Mobile

TX

177 FL 178 AR 018 MS 017 TN

180 FL 181 NJ

182 WI

183 MN 002 010 013 019 027 030 062 070 071 082 086 WI

184 AL

TX 215

FL 009 AR 035 MS 033 TN 047 157 167

FL 025 NJ 019 023 035 WI 079 089 131 133 MN 003 019 025 037 053 059 123 139 141 163 171 WI 093 109 AL 003 097

18

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con. 185

5170

050

Modesto, CA, MSA California Stanislaus

5190

013 015

Monmouth-Ocean, NJ, PMSA New Jersey Monmouth Ocean

5240

001 026 051

Montgomery, AL, MSA Alabama Autauga Elmore Montgomery

5345

011

Naples, FL, MSA Florida Collier

5360

011 019 022 074 075 083 094 095

Nashville, TN, MSA Tennessee Cheatham Davidson Dickson Robertson Rutherford Sumner Williamson Wilson

5380

028 048

Nassau-Suffolk, NY, PMSA New York Nassau Suffolk

5483

001 005

New Haven-Bridgeport-Stamford-Danbury-Waterbury, CT, NECMA Connecticut Fairfield New Haven

5523

006

New London-Norwich, CT, NECMA Connecticut New London

CA 186 NJ

188 AL

191 FL 192 TN

193 NY

194 CT

195 CT 196 LA 026 036 038 044 045 047 048 052

CA 099 NJ 025 029

AL 001 051 101

FL 021 TN 021 037 043 147 149 165 187 189 NY 059 103

New Orleans, LA, MSA Louisiana Jefferson Orleans Plaquemines St. Bernard St. Charles St. James St. John the Baptist St. Tammany

CT 001 009 CT 011 5560 LA 051 071 075 087 089 093 095 103

19

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

197

5600

029 038 040 056

New York, NY, PMSA New York New York city Putnam Rockland Westchester

5640

007 014 019 020 021

Newark, NJ, PMSA New Jersey Essex Morris Sussex Union Warren Newburgh, NY-PA, PMSA New York Orange Pennsylvania Pike

5660

5720

026 052 058 065 066 081 087 088 098 099 123 127 132 136

Norfolk-Virginia Beach-Newport News, VA-NC, MSA North Carolina Currituck Virginia Chesapeake city Gloucester Hampton city Isle of Wight James City Mathews Newport News city Norfolk city Poquoson city Portsmouth city Suffolk city Virginia Beach city Williamsburg city York

5775

001 007

Oakland, CA, PMSA California Alameda Contra Costa

5790

042

Ocala, FL, MSA Florida Marion

5880

009 014 042 044 055 063

Oklahoma City, OK, MSA Oklahoma Canadian Cleveland Logan McClain Oklahoma Pottawatomie

NY

198 NJ

199 NY 034 PA 052 200 NC 027 VA

201 CA

202 FL

204 OK

NY 005 079 087 119

NJ 013 027 037 039 041 NY 071 PA 103 NC 053 VA 550 073 650 093 095 115 700 710 735 740 800 810 830 199 CA 001 013 FL 083

OK 017 027 083 087 109 125

20

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con. 206

5920

013 028 077 089

Omaha, NE-IA, MSA Iowa Pottawattamie Nebraska Cass Douglas Sarpy Washington

5945

030

Orange County, CA, PMSA California Orange

5960

035 048 049 059

Orlando, FL, MSA Florida Lake Orange Osceola Seminole

5990

030

Owensboro, KY, MSA Kentucky Daviess

6080

017 057

Pensacola, FL, MSA Florida Escambia Santa Rosa

6120

072 090 102

Peoria-Pekin, IL, MSA Illinois Peoria Tazewell Woodford Philadelphia, PA-NJ, PMSA New Jersey Burlington Camden Gloucester Salem Pennsylvania Bucks Chester Delaware Montgomery Philadelphia

6160

6200

008 012

Phoenix-Mesa, AZ, MSA Arizona Maricopa Pinal

6240

035

Pine Bluff, AR, MSA Arkansas Jefferson

IA 078 NE

207 CA 208 FL

209 KY

212 FL

213 IL

214 NJ 003 004 008 017 PA 009 015 023 046 051 215 AZ

216 AR

IA 155 NE 025 055 153 177 CA 059 FL 069 095 097 117 KY 059

FL 033 113 IL 143 179 203 NJ 005 007 015 033 PA 017 029 045 091 101 AZ 013 021 AR 069

21

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

217

6280

002 004 010 026 063 065

Pittsburgh, PA, MSA Pennsylvania Allegheny Beaver Butler Fayette Washington Westmoreland

6323

002

Pittsfield, MA, NECMA Massachusetts Berkshire

6403

003

Portland, ME, NECMA Maine Cumberland

6440

006

Portland-Vancouver, OR-WA, PMSA Oregon Clackamas Columbia Multnomah Washington Yamhill Washington Clark

6483

001 002 004 005

Providence-Warwick-Pawtucket, RI, NECMA Rhode Island Bristol Kent Providence Washington

6520

025

Provo-Orem, UT, MSA Utah Utah

6640

019 032 035 051 068 092

Raleigh-Durham-Chapel Hill, NC, MSA North Carolina Chatham Durham Franklin Johnston Orange Wake

6660

051

Rapid City, SD, MSA South Dakota Pennington

PA

218 MA 219 ME 220 OR 003 005 026 034 036 WA 221 RI

222 UT

226 NC

227 SD

PA 003 007 019 051 125 129 MA 003 ME 005 OR 005 009 051 067 071 WA 011 RI 001 003 007 009 UT 049

NC 037 063 069 101 135 183 SD 103

22

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

228

6680

006

Reading, PA, MSA Pennsylvania Berks

6720

016

Reno, NV, MSA Nevada Washoe

6760

023 027 030 037 053 059 061 064 086 096 100 102 108

Richmond-Petersburg, VA, MSA Virginia Charles City Chesterfield Colonial Heights city Dinwiddie Goochland Hanover Henrico Hopewell city New Kent Petersburg city Powhatan Prince George Richmond city

6780

033 036

Riverside-San Bernardino, CA, PMSA California Riverside San Bernardino

6840

018 024 026 033 035 055

Rochester, NY, MSA New York Genesee Livingston Monroe Ontario Orleans Wayne

6880

004 071 101

Rockford, IL, MSA Illinois Boone Ogle Winnebago

PA

230 NV

232 VA

233 CA

236 NY

237 IL

PA 011

NV 031

VA 036 041 570 053 075 085 087 670 127 730 145 149 760 CA 065 071

NY 037 051 055 069 073 117

IL 007 141 201

23

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

239

6920

009 031 034

Sacramento, CA, PMSA California El Dorado Placer Sacramento

6960

009 056 073

Saginaw-Bay City-Midland, MI, MSA Michigan Bay Midland Saginaw

7040

036 050 057 092 095 096 110

St. Louis, MO-IL, MSA Illinois Clinton Jersey Madison Monroe St. Clair Missouri Franklin Jefferson Lincoln St. Charles St. Louis St. Louis city Warren

7080

024 027

Salem, OR, PMSA Oregon Marion Polk

7120

027

Salinas, CA, MSA California Monterey

7160

006 018 029

Salt Lake City-Ogden, UT, MSA Utah Davis Salt Lake Weber

CA

240 MI

243 MO 014 042 060 067 082 IL

244 OR

245 CA 246 UT

CA 017 061 067 MI 017 111 145

IL 027 083 119 133 163 MO 071 099 113 183 189 510 219 OR 047 053 CA 053

24

UT 011 035 057

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

248

7240

015 046 094 247

San Antonio, TX, MSA Texas Bexar Comal Guadalupe Wilson

7320

037

San Diego, CA, MSA California San Diego

TX

249 CA

250 CA 021 038 041 251

TX 029 091 187 493 CA 073

San Francisco, CA, PMSA California Marin San Francisco San Mateo

7360 CA 041 075 081 7400

043

San Jose, CA, PMSA California Santa Clara

7480

042

Santa Barbara-Santa Maria-Lompoc, CA, MSA California Santa Barbara

7485

044

Santa Cruz-Watsonville, CA, PMSA California Santa Cruz

7500

049

Santa Rosa, CA, PMSA California Sonoma

7510

041 058

Sarasota-Bradenton, FL, MSA Florida Manatee Sarasota

7520

015 025 051

Savannah, GA, MSA Georgia Bryan Chatham Effingham

7560

019 035 040 066

Scranton--Wilkes-Barre--Hazleton, PA, MSA Pennsylvania Columbia Lackawanna Luzerne Wyoming

7600

015 017 031

Seattle-Bellevue-Everett, WA, PMSA Washington Island King Snohomish

CA

253 CA 254 CA

256 CA 257 FL

258 GA

259 PA

260 WA

CA 085

CA 083 CA 087

CA 097 FL 081 115 GA 029 051 103

25

PA 037 069 079 131 WA 029 033 061

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

264

7680

008 009 060

Shreveport-Bossier City, LA, MSA Louisiana Bossier Caddo Webster

7800

071

South Bend, IN, MSA Indiana St. Joseph

7840

032

Spokane, WA, MSA Washington Spokane

7920

022 039 113

Springfield, MO, MSA Missouri Christian Greene Webster

8003

007 008

Springfield, MA, NECMA Massachusetts Hampden Hampshire

LA

267 IN 268 WA

270 MO

271 MA

LA 015 017 119 IN 141 WA 063

MO 043 077 225 MA 013 015

26

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

274

8120

039

Stockton-Lodi, CA, MSA California San Joaquin

8160

005 025 032 036

Syracuse, NY, MSA New York Cayuga Madison Onondaga Oswego

8200

027

Tacoma, WA, PMSA Washington Pierce

8240

020 037

Tallahassee, FL, MSA Florida Gadsden Leon

8280

027 029 051 052

Tampa-St. Petersburg-Clearwater, FL, MSA Florida Hernando Hillsborough Pasco Pinellas

8400

026 048 087

Toledo, OH, MSA Ohio Fulton Lucas Wood

8480

011

Trenton, NJ, PMSA New Jersey Mercer

8520

011

Tucson, AZ, MSA Arizona Pima

CA

276 NY

277 WA 278 FL

279 FL

282 OH

284 NJ 285 AZ

CA 077

NY 011 053 067 075 WA 053 FL 039 073 FL 053 057 101 103

39 051 095 173

NJ 021 AZ 019

27

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

286

8560

019 057 066 072 073

Tulsa, OK, MSA Oklahoma Creek Osage Rogers Tulsa Wagoner

8680

021 031

Utica-Rome, NY, MSA New York Herkimer Oneida

8720

028 048

Vallejo-Fairfield-Napa, CA, PMSA California Napa Solano

8735

056

Ventura, CA, PMSA California Ventura

8750

235

Victoria, TX, MSA Texas Victoria

8780

054

Visalia-Tulare-Porterville, CA, MSA California Tulare Washington, DC-MD-VA-WV, PMSA Dist. of Columbia District of Columbia Maryland Calvert Charles Frederick Montgomery Prince George's Virginia Alexandria city Arlington Clarke Culpeper Fairfax Fairfax city Falls Church city Fauquier Fredericksburg city King George

8840

OK

289 NY

290 CA

291 CA 292 TX

294 CA

296 DC 001 MD 005 009 011 016 017 VA 003 008 028 033 040 041 042 043 049 068

OK 037 113 131 143 145

NY 043 065 CA 055 095 CA 111 TX 469

28

CA 107

DC 001 MD 009 017 021 031 033 VA 510 013 043 047 059 600 610 061 630 099

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

073 078 079 103 120 121 128 WV 002 019 299 FL 050 301 KS 008 040 087 304 DE 002 MD 008

Loudoun Manassas city Manassas Park city Prince William Spotsylvania Stafford Warren West Virginia Berkeley Jefferson

107 683 685 153 177 179 187 WV 003 037

West Palm Beach-Boca Raton, FL, MSA Florida Palm Beach Wichita, KS, MSA Kansas Butler Harvey Sedgwick

8960 FL 099 9040 KS 015 079 173

Wilmington-Newark, DE-MD, PMSA Delaware New Castle Maryland Cecil

29

9160 DE 003 MD 015

Primary and Metropolitan Statistical Areas Established in 1990 Effective with 2002 and Adapted for Use by DVS United States - con.

308

9280

067

York, PA, MSA Pennsylvania York

9320

015 050 078

Youngstown-Warren, OH, MSA Ohio Columbiana Mahoning Trumbull

PA 309 OH

PA 133

30

OH 029 099 155

Tenth Revision 130 Selected Causes of Infant Death Adapted for use by DVS ST: 1 = Subtotal

Limited: Sex: 1 = Age: 1 = 4 = 7 =

Page 1

Males; 2 = Females 5 and over; 2 = 10-54; 3 = 28 days and over Under 1 year; 5 = 1-4 years; 6 = 1 year and over 10 years and over

***** Cause Subtotals are not identified in this file ***** 130 Recode

S Limited T Sex Age Cause Title and ICD-10 Codes Included

001 002 003 004 005 006 007 008 009 010 011 012 013 014 015 016 017 018 019 020 021 022

1

023 024 025 026 027 028

1 1

029

1

3 1

030 031 032 033 034 035 036 037

1

3

038 039 040 041 042 043 044 045 046 047 048 049 050 051 052 053 054 055

1

1

1 1

Certain infectious and parasitic diseases (A00-B99) Certain intestinal infectious diseases (A00-A08) Diarrhea and gastroenteritis of infectious origin (A09) Tuberculosis (A16-A19) Tetanus (A33,A35) Diphtheria (A36) Whooping cough (A37) Meningococcal infection (A39) Septicemia (A40-A41) Congenital syphilis (A50) Gonococcal infection (A54) Viral diseases (A80-B34) Acute poliomyelitis (A80) Varicella (chickenpox) (B01) Measles (B05) Human immunodeficiency virus (HIV) disease (B20-B24) Mumps (B26) Other and unspecified viral diseases (A81-B00,B02-B04,B06-B19,B25,B27-B34) Candidiasis (B37) Malaria (B50-B54) Pneumocystosis (B59) All other and unspecified infectious and parasitic diseases (A20-A32,A38,A42-A49,A51-A53,A55-A79,B35-B36,B38-B49,B55-B58,B60-B99) Neoplasms (C00-D48) Malignant neoplasms (C00-C97) Hodgkin's disease and non-Hodgkin's lymphomas (C81-C85) Leukemia (C91-C95) Other and unspecified malignant neoplasms (C00-C80,C88,C90,C96-C97) In situ neoplasms, benign neoplasms and neoplasms of uncertain or unknown behavior (D00-D48) Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism (D50-D89) Anemias (D50-D64) Hemorrhagic conditions and other diseases of blood and blood-forming organs (D65-D76) Certain disorders involving the immune mechanism (D80-D89) Endocrine, nutritional and metabolic diseases (E00-E88) Short stature, not elsewhere classified (E34.3) Nutritional deficiencies (E40-E64) Cystic fibrosis (E84) Volume depletion, disorders of fluid, electrolyte and acid-base balance (E86-E87) All other endocrine, nutritional and metabolic diseases (E00-E32,E34.0-E34.2,E34.4-E34.9,E65-E83,E85,E88) Diseases of the nervous system (G00-G98) Meningitis (G00,G03) Infantile spinal muscular atrophy, type I (Werdnig-Hoffman) (G12.0) Infantile cerebral palsy (G80) Anoxic brain damage, not elsewhere classified (G93.1) Other diseases of nervous system (G04,G06-G11,G12.1-G12.9,G20-G72,G81-G92,G93.0,G93.2-G93.9,G95-G98) Diseases of the ear and mastoid process (H60-H93) Diseases of the circulatory system (I00-I99) Pulmonary heart disease and diseases of pulmonary circulation (I26-I28) Pericarditis, endocarditis and myocarditis (I30,I33,I40) Cardiomyopathy (I42) Cardiac arrest (I46) Cerebrovascular diseases (I60-I69) All other diseases of circulatory system (I00-I25,I31,I34-I38,I44-I45,I47-I51, I70-I99) Diseases of the respiratory system (J00-J98) Acute upper respiratory infections (J00-J06) Influenza and pneumonia (J10-J18)

Tenth Revision 130 Selected Causes of Infant Death Adapted for use by DVS ST: 1 = Subtotal

Limited: Sex: 1 = Age: 1 = 4 = 7 =

Page 2

Males; 2 = Females 5 and over; 2 = 10-54; 3 = 28 days and over Under 1 year; 5 = 1-4 years; 6 = 1 year and over 10 years and over

***** Cause Subtotals are not identified in this file ***** 130 Recode

S Limited T Sex Age Cause Title and ICD-10 Codes Included

056 057 058 059 060 061 062 063 064 065 066 067 068 069 070 071

1

1

1 1

072 073 074 075 076 077 078

1

079 080 081 082 083

1

084 085 086 087 088 089 090 091 092 093 094 095 096 097 098 099 100

1 1

1

1

101 102 103 104 105 106 107

1

Influenza (J10-J11) Pneumonia (J12-J18) Acute bronchitis and acute bronchiolitis (J20-J21) Bronchitis, chronic and unspecified (J40-J42) Asthma (J45-J46) Pneumonitis due to solids and liquids (J69) Other and unspecified diseases of respiratory system (J22,J30-J39,J43-J44,J47-J68,J70-J98) Diseases of the digestive system (K00-K92) Gastritis, duodenitis, and noninfective enteritis and colitis (K29,K50-K55) Hernia of abdominal cavity and intestinal obstruction without hernia (K40-K46,K56) All other and unspecified diseases of digestive system (K00-K28,K30-K38,K57-K92) Diseases of the genitourinary system (N00-N95) Renal failure and other disorders of kidney (N17-N19,N25,N27) Other and unspecified diseases of genitourinary system (N00-N15,N20-N23,N26,N28-N95) Certain conditions originating in the perinatal period (P00-P96) Newborn affected by maternal factors and by complications of pregnancy, labor and delivery (P00-P04) Newborn affected by maternal hypertensive disorders (P00.0) Newborn affected by other maternal conditions which may be unrelated to present pregnancy (P00.1-P00.9) Newborn affected by maternal complications of pregnancy (P01) Newborn affected by incompetent cervix (P01.0) Newborn affected by premature rupture of membranes (P01.1) Newborn affected by multiple pregnancy (P01.5) Newborn affected by other maternal complications of pregnancy (P01.2-P01.4,P01.6-P01.9) Newborn affected by complications of placenta, cord and membranes (P02) Newborn affected by complications involving placenta (P02.0-P02.3) Newborn affected by complications involving cord (P02.4-P02.6) Newborn affected by chorioamnionitis (P02.7) Newborn affected by other and unspecified abnormalities of membranes (P02.8-P02.9) Newborn affected by other complications of labor and delivery (P03) Newborn affected by noxious influences transmitted via placenta or breast milk (P04) Disorders related to length of gestation and fetal malnutrition (P05-P08) Slow fetal growth and fetal malnutrition (P05) Disorders related to short gestation and low birthweight, not elsewhere classified (P07) Extremely low birthweight or extreme immaturity (P07.0,P07.2) Other low birthweight or preterm (P07.1,P07.3) Disorders related to long gestation and high birthweight (P08) Birth trauma (P10-P15) Intrauterine hypoxia and birth asphyxia (P20-P21) Intrauterine hypoxia (P20) Birth asphyxia (P21) Respiratory distress of newborn (P22) Other respiratory conditions originating in the perinatal period (P23-P28) Congenital pneumonia (P23) Neonatal aspiration syndromes (P24) Interstitial emphysema and related conditions originating in the perinatal period (P25) Pulmonary hemorrhage originating in the perinatal period (P26) Chronic respiratory disease originating in the perinatal period (P27) Atelectasis (P28.0-P28.1) All other respiratory conditions originating in the perinatal period (P28.2-P28.9) Infections specific to the perinatal period (P35-P39) Bacterial sepsis of newborn (P36) Omphalitis of newborn with or without mild hemorrhage (P38)

Tenth Revision 130 Selected Causes of Infant Death Adapted for use by DVS ST: 1 = Subtotal

Limited: Sex: 1 = Age: 1 = 4 = 7 =

Page 3

Males; 2 = Females 5 and over; 2 = 10-54; 3 = 28 days and over Under 1 year; 5 = 1-4 years; 6 = 1 year and over 10 years and over

***** Cause Subtotals are not identified in this file ***** 130 Recode 108 109 110 111 112

S Limited T Sex Age Cause Title and ICD-10 Codes Included

1

113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134

1

1

135 136 137 138 139 140 141

1 1 1

142

143 144 145 146 147 148 149 150 151 152 153 154 155 156 157

1

All other infections specific to the perinatal period (P35,P37,P39) Hemorrhagic and hematological disorders of newborn (P50-P61) Neonatal hemorrhage (P50-P52,P54) Hemorrhagic disease of newborn (P53) Hemolytic disease of newborn due to isoimmunization and other perinatal jaundice (P55-P59) Hematological disorders (P60-P61) Syndrome of infant of a diabetic mother and neonatal diabetes mellitus (P70.0-P70.2) Necrotizing enterocolitis of newborn (P77) Hydrops fetalis not due to hemolytic disease (P83.2) Other perinatal conditions (P29,P70.3-P70.9,P71-P76,P78-P81,P83.0-P83.1, P83.3-P83.9,P90-P96) Congenital malformations, deformations and chromosomal abnormalities (Q00-Q99) Anencephaly and similar malformations (Q00) Congenital hydrocephalus (Q03) Spina bifida (Q05) Other congenital malformations of nervous system (Q01-Q02,Q04,Q06-Q07) Congenital malformations of heart (Q20-Q24) Other congenital malformations of circulatory system (Q25-Q28) Congenital malformations of respiratory system (Q30-Q34) Congenital malformations of digestive system (Q35-Q45) Congenital malformations of genitourinary system (Q50-Q64) Congenital malformations and deformations of musculoskeletal system, limbs and integument (Q65-Q85) Down's syndrome (Q90) Edward's syndrome (Q91.0-Q91.3) Patau's syndrome (Q91.4-Q91.7) Other congenital malformations and deformations (Q10-Q18,Q86-Q89) Other chromosomal abnormalities, not elsewhere classified (Q92-Q99) Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) Sudden infant death syndrome (R95) Other symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R53,R55-R94,R96-R99) All other diseases (Residual) (F01-F99,H00-H57,L00-M99) External causes of mortality (*U01,V01-Y84) Accidents (unintentional injuries) (V01-X59) Transport accidents (V01-V99) Motor vehicle accidents(V02-V04,V09.0,V09.2,V12-V14,V19.0-V19.2, V19.4-V19.6,V20-V79,V80.3-V80.5,V81.0-V81.1,V82.0-V82.1,V83-V86, V87.0-V87.8,V88.0-V88.8,V89.0,V89.2) Other and unspecified transport accidents (V01,V05-V06,V09.1,V09.3-V09.9,V10-V11,V15-V18,V19.3, V19.8-V19.9,V80.0-V80.2,V80.6-V80.9,V81.2-V81.9,V82.2-V82.9, V87.9,V88.9,V89.1,V89.3,V89.9,V90-V99) Falls (W00-W19) Accidental discharge of firearms (W32-W34) Accidental drowning and submersion (W65-W74) Accidental suffocation and strangulation in bed (W75) Other accidental suffocation and strangulation (W76-W77,W81-W84) Accidental inhalation and ingestion of food or other objects causing obstruction of respiratory tract (W78-W80) Accidents caused by exposure to smoke, fire and flames (X00-X09) Accidental poisoning and exposure to noxious substances (X40-X49) Other and unspecified accidents (W20-W31,W35-W64,W85-W99,X10-X39,X50-X59) Assault (homicide) (*U01,X85-Y09) Assault (homicide) by hanging, strangulation and suffocation (X91) Assault (homicide) by discharge of firearms (*U01.4,X93-X95) Neglect, abandonment and other maltreatment syndromes (Y06-Y07) Assault (homicide) by other and unspecified means (*U01.0-*U01.3,*U01.5-*U01.9,X85-X90,X92,X96-X99,Y00-Y05,Y08-Y09) Complications of medical and surgical care (Y40-Y84)

Tenth Revision 130 Selected Causes of Infant Death Adapted for use by DVS ST: 1 = Subtotal

Limited: Sex: 1 = Age: 1 = 4 = 7 =

Males; 2 = Females 5 and over; 2 = 10-54; 3 = 28 days and over Under 1 year; 5 = 1-4 years; 6 = 1 year and over 10 years and over

***** Cause Subtotals are not identified in this file ***** 130 Recode 158

S Limited T Sex Age Cause Title and ICD-10 Codes Included Other external causes (X60-X84,Y10-Y36)

Page 4

11/16/06

Page 1

Documentation Table 1. Live births and infant deaths by state of occurrence of birth and by state of residence at birth United States, Puerto Rico, Virgin Islands, and Guam, 2004 Period Data. (Residence of birth is of the mother) ____________________________________________________________________________________________________________________________ Live births Infant deaths Unweighted Weighted 1/ State Occurence Residence Occurence Residence Occurence Residence ____________________________________________________________________________________________________________________________ United States /2 4118951 4112059 27612 27553 27920 27860 Alabama 58383 59510 515 516 516 517 Alaska 10268 10338 63 68 63 68 Arizona 93876 93663 622 624 628 630 Arkansas 37840 38573 296 323 296 323 California 545764 544845 2745 2736 2821 2812 Colorado 68797 68503 455 427 455 427 Connecticut 42545 42095 227 229 227 229 Delaware 12080 11369 104 98 104 98 Dist of Columbia 14794 7933 160 97 160 97 Florida 218218 218053 1548 1528 1550 1530 Georgia 140118 138850 1193 1183 1194 1184 Hawaii 18297 18281 99 104 101 106 Idaho 21949 22532 129 136 130 137 Illinois 177417 180778 1288 1344 1301 1357 Indiana 87942 87142 672 672 687 687 Iowa 38527 38438 179 194 180 195 Kansas 40449 39669 284 291 284 291 Kentucky 54085 55720 344 378 346 380 Louisiana 65582 65370 690 665 699 674 Maine 13733 13944 80 79 80 79 Maryland 70538 74629 580 631 580 631 Massachusetts 79405 78484 380 372 385 377 Michigan 128588 129776 985 982 986 983 Minnesota 70618 70625 348 325 349 326 Mississippi 41562 42827 397 420 401 424 Missouri 78591 77765 630 580 632 582 Montana 11526 11519 56 53 56 53 Nebraska 26446 26332 177 171 178 172 Nevada 34780 35200 214 215 218 219 New Hampshire 14198 14565 78 79 81 82 New Jersey 112233 115253 596 625 612 640 New Mexico 27798 28384 166 181 169 184 New York 127465 130879 782 795 803 815 New York City 124097 119068 727 721 727 722 North Carolina 120590 119847 1049 1046 1049 1046 North Dakota 9408 8189 43 48 43 48 Ohio 149502 148955 1147 1104 1164 1120 Oklahoma 50223 51306 403 405 405 407 Oregon 46454 45678 264 247 267 250 Pennsylvania 144498 144748 1067 1045 1072 1050 Rhode Island 13582 12779 75 68 76 69 South Carolina 54232 56590 497 525 497 525 South Dakota 11803 11338 97 90 97 90 Tennessee 84855 79642 758 684 760 686 Texas 387337 381293 2322 2310 2406 2393 Utah 51835 50670 278 263 280 265 Vermont 6262 6599 30 29 30 29 Virginia 101826 103933 746 764 746 764 Washington 81390 81747 435 449 436 450 West Virginia 21305 20880 160 158 160 158 Wisconsin 69014 70146 399 416 400 417 Wyoming 6326 6807 33 60 33 60 Foreign Residents 6896 59 59 Puerto Rico 51239 51146 410 406 410 406 Virgin Islands 1673 1593 9 12 9 12 Guam 3424 3407 40 39 40 39 ____________________________________________________________________________________________________________________________ 1/ Figures are based on weighted data rounded to the nearest infant, so categories may not add to totals 2/ Excludes data for Puerto Rico, Virgin Islands and Guam.

01/04/07

Page 1

Documentation Table 2. Live births,infant deaths and infant mortality rates by race of mother, sex and birthweight of child: United States, 2004 Period Data. [Infant death are weighted. Rates are per 1000 live births] ____________________________________________________________________________________________________________________________ 2500 Race of mother and sex Total <500 500-749 750-999 1000-1249 1250-1499 1500-1999 2000-2499 grams or Not grams grams grams grams grams grams grams more Stated ____________________________________________________________________________________________________________________________ All races Both sexes Live births.............. 4112055 Infant deaths............ 27,860 Infant mortality rate.... 6.78

6,953 5,907 849.56

11,659 5,602 480.49

12,321 1,921 155.91

14,245 966 67.81

16,805 758 45.11

65,821 1,800 27.35

205,623 2,264 11.01

3778051 8,528 2.26

577 113 195.84

3,571 3,086 864.18

5,897 3,253 551.64

6,417 1,202 187.31

7,264 543 74.75

8,459 434 51.31

31,997 961 30.03

94,615 1,177 12.44

1946137 4,926 2.53

306 72 235.29

3,382 2,822 834.42

5,762 2,349 407.67

5,904 719 121.78

6,981 422 60.45

8,346 325 38.94

33,824 838 24.78

111,008 1,087 9.79

1831914 3,602 1.97

271 42 154.98

3,927 3,353 853.83

6,914 3,430 496.09

7,800 1,215 155.77

9,360 631 67.41

11,418 513 44.93

45,976 1,291 28.08

143,361 1,535 10.71

2993755 6,213 2.08

418 77 184.21

1,996 1,734 868.74

3,575 2,016 563.92

4,099 778 189.80

4,820 343 71.16

5,855 295 50.38

22,624 677 29.92

66,202 809 12.22

1541312 3,578 2.32

215 47 218.60

1,931 1,619 838.43

3,339 1,413 423.18

3,701 437 118.08

4,540 288 63.44

5,563 219 39.37

23,352 613 26.25

77,159 726 9.41

1452443 2,635 1.81

203 30 147.78

2,728 2,306 845.31

4,199 1,908 454.39

3,893 599 153.87

4,108 282 68.65

4,406 202 45.85

15,912 408 25.64

48,006 586 12.21

532,699 1,839 3.45

125 32 256.00

1,442 1,242 861.30

2,059 1,087 527.93

1,975 351 177.72

2,032 168 82.68

2,115 115 54.37

7,441 225 30.24

21,684 300 13.84

275,077 1,072 3.90

72 21 291.67

1,286 1,064 827.37

2,140 821 383.64

1,918 248 129.30

2,076 114 54.91

2,291 88 38.41

8,471 183 21.60

26,322 286 10.87

257,622 767 2.98

53 11 *

Male Live births.............. 2104663 Infant deaths............ 15,653 Infant mortality rate.... 7.44 Female Live births.............. 2007392 Infant deaths............ 12,207 Infant mortality rate.... 6.08 White Both sexes Live births.............. 3222929 Infant deaths............ 18,257 Infant mortality rate.... 5.66 Male Live births.............. 1650698 Infant deaths............ 10,277 Infant mortality rate.... 6.23 Female Live births.............. 1572231 Infant deaths............ 7,981 Infant mortality rate.... 5.08 Black Both sexes Live births.............. 616,076 Infant deaths............ 8,162 Infant mortality rate.... 13.25 Male Live births.............. 313,897 Infant deaths............ 4,581 Infant mortality rate.... 14.59 Female Live births.............. 302,179 Infant deaths............ 3,581 Infant mortality rate.... 11.85

01/04/07

Page 2

Documentation Table 2. Live births,infant deaths and infant mortality rates by race of mother, sex and birthweight of child: United States, 2004 Period Data. [Infant death are weighted. Rates are per 1000 live births] ____________________________________________________________________________________________________________________________ 2500 Race of mother and sex Total <500 500-749 750-999 1000-1249 1250-1499 1500-1999 2000-2499 grams or Not grams grams grams grams grams grams grams more Stated ____________________________________________________________________________________________________________________________ American Indian /1 Both sexes Live births.............. Infant deaths............ Infant mortality rate....

43,927 371 8.45

54 43 796.30

107 45 420.56

105 22 209.52

143 11 *

172 4 *

653 22 33.69

2,061 45 21.83

40,622 178 4.38

10 0 *

22,293 212 9.51

23 16 *

49 24 489.80

61 19 *

75 7 *

81 2 *

337 14 *

962 20 20.79

20,700 110 5.31

5 0 *

21,634 158 7.30

31 27 870.97

58 21 362.07

44 3 *

68 4 *

91 2 *

316 8 *

1,099 25 22.75

19,922 68 3.41

5 0 *

Live births.............. 229,123 Infant deaths............ 1,070 Infant mortality rate.... 4.67

244 206 844.26

439 219 498.86

523 85 162.52

634 41 64.67

809 39 48.21

3,280 79 24.09

12,195 97 7.95

210,975 299 1.42

24 4 *

110 94 854.55

214 125 584.11

282 54 191.49

337 25 74.18

408 22 53.92

1,595 44 27.59

5,767 48 8.32

109,048 167 1.53

14 4 *

Male Live births.............. Infant deaths............ Infant mortality rate.... Female Live births.............. Infant deaths............ Infant mortality rate.... Asian or Pacific Islander Both sexes

Male Live births.............. 117,775 Infant deaths............ 583 Infant mortality rate.... 4.95 Female Live births.............. 111,348 134 225 241 297 401 1,685 6,428 101,927 10 Infant deaths............ 487 112 94 31 16 16 34 50 133 0 Infant mortality rate.... 4.37 835.82 417.78 128.63 * * 20.18 7.78 1.30 * ____________________________________________________________________________________________________________________________ * Figure does not meet standard of reliability or precision; based on fewer then 20 deaths in the numerator - Quantity zero /1 Includes Aleut and Eskimos

12/14/06

Page 1 Documentation Table 3

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and gestational age: United states, 2004 period data [Infant deaths weighted. Rates are per 1000 live births] ________________________________________________________________________________________________________________________________ Gestation ____________________________________________________________________________________________________ Birthweight <28 28-31 32-35 36 37-39 40 41 42 Weeks Not Total Weeks Weeks Weeks Weeks Weeks Weeks Weeks or more Stated ________________________________________________________________________________________________________________________________ All races Total Live births ............... 4,112,055 Infant deaths ............. 27,860 Infant mortality rate ..... 6.78

30,673 12,604 410.92

50,975 2,294 45.00

238,531 2,619 10.98

188,180 2,130,486 1,069 5,561 5.68 2.61

800,506 1,574 1.97

377,187 782 2.07

252,543 725 2.87

42,974 631 14.68

333,427 19,218 57.64

29,608 12,581 424.92

39,191 2,185 55.75

113,813 1,931 16.97

38,735 535 13.81

84,882 1,172 13.81

11,534 195 16.91

5,310 100 18.83

6,157 135 21.93

4,197 385 91.73

6,953 5,907 849.56

6,503 5,597 860.68

226 144 637.17

17 10 *

2 1 *

11 8 *

1 1 *

4 2 *

5 5 *

184 140 760.87

11,659 5,602 480.49

9,914 5,047 509.08

1,332 391 293.54

128 37 289.06

12 2 *

21 4 *

4 2 *

7 4 *

8 4 *

233 111 476.39

12,321 1,921 155.91

7,514 1,404 186.85

3,920 391 99.74

467 63 134.90

30 3 *

116 15 *

34 2 *

24 -

23 4 *

193 39 202.07

14,245 966 67.81

3,127 316 101.06

7,880 430 54.57

2,208 133 60.24

165 19 *

395 37 93.67

111 7 *

73 5 *

88 4 *

198 13 *

16,805 758 45.11

935 101 108.02

8,808 319 36.22

5,292 219 41.38

387 26 67.18

710 55 77.46

164 11 *

96 4 *

151 8 *

262 15 *

65,821 1,800 27.35

1,002 89 88.82

12,544 373 29.74

35,911 731 20.36

5,515 177 32.09

7,578 289 38.14

1,078 55 51.02

549 22 40.07

822 33 40.15

822 31 37.71

205,623 2,264 11.01

613 26 42.41

4,481 137 30.57

69,790 738 10.57

32,624 306 9.38

76,051 763 10.03

10,142 117 11.54

4,557 63 13.82

5,060 77 15.22

2,305 37 16.05

730,045 3,039 4.16

1,065 23 21.60

4,288 53 12.36

61,121 396 6.48

69,909 305 4.36

425,262 1,578 3.71

89,886 339 3.77

37,281 147 3.94

33,660 158 4.69

7,573 40 5.28

Live births ............... 1,573,831 Infant deaths ............. 3,272 Infant mortality rate ..... 2.08

-

5,049 42 8.32

41,674 204 4.90

55,315 164 2.96

904,716 1,756 1.94

315,088 565 1.79

137,616 257 1.87

98,471 235 2.39

15,902 49 3.08

Less then 2,500 grams Live births ............... Infant deaths ............. Infant mortality rate ..... Less then 500 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 500-749 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 750-999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 1,000-1,249 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 1,250-1,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 1,500-1,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 2,000-2,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 2,500-2,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 3,000-3,499 grams

See footnotes at end of table.

12/14/06

Page 2 Documentation Table 3

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and gestational age: United states, 2004 period data [Infant deaths weighted. Rates are per 1000 live births]-Cont ________________________________________________________________________________________________________________________________ Gestation ____________________________________________________________________________________________________ Birthweight <28 28-31 32-35 36 37-39 40 41 42 Weeks Not Total Weeks Weeks Weeks Weeks Weeks Weeks Weeks or more Stated ________________________________________________________________________________________________________________________________ All races 3,500-3,999 grams Live births ............... 1,125,055 Infant deaths ............. 1,699 Infant mortality rate ..... 1.51

-

2,447 13 *

17,517 67 3.82

19,537 49 2.51

563,573 828 1.47

286,621 366 1.28

140,410 206 1.47

83,823 141 1.68

11,127 30 2.70

299,196 424 1.42

-

-

3,763 16 *

3,952 12 *

131,287 195 1.49

83,781 91 1.09

47,760 60 1.26

25,629 43 1.68

3,024 8 *

44,917 69 1.54

-

-

550 5 *

642 3 *

18,488 23 1.24

12,446 15 *

7,973 10 *

4,337 9 *

481 3 *

5,007 24 4.79

-

-

93 -

90 2 *

2,278 10 *

1,150 3 *

837 3 *

466 3 *

93 3 *

577 113 195.84

-

-

-

-

-

-

-

-

577 113 195.84

Live births ............... 3,222,929 Infant deaths ............. 18,257 Infant mortality rate ..... 5.66

18,362 7,446 405.51

34,778 1,503 43.22

175,002 1,811 10.35

142,506 1,674,287 760 4,026 5.33 2.40

639,194 1,142 1.79

303,733 574 1.89

200,659 538 2.68

34,408 459 13.34

228,756 11,968 52.32

17,710 7,434 419.76

26,575 1,422 53.51

81,531 1,324 16.24

27,143 369 13.59

57,189 861 15.06

7,725 129 16.70

3,637 67 18.42

4,244 90 21.21

3,002 273 90.94

3,927 3,353 853.83

3,644 3,159 866.90

136 80 588.24

8 5 *

1 1 *

10 8 *

1 1 *

3 1 *

2 2 *

122 95 778.69

6,914 3,430 496.09

5,787 3,064 529.46

826 241 291.77

81 27 333.33

9 2 *

14 4 *

4 2 *

7 4 *

6 3 *

180 83 461.11

7,800 1,215 155.77

4,643 872 187.81

2,552 255 99.92

315 41 130.16

15 2 *

88 14 *

23 2 *

19 -

14 2 *

131 27 206.11

9,360 631 67.41

2,066 198 95.84

5,139 279 54.29

1,482 98 66.13

99 11 *

258 27 104.65

79 4 *

41 3 *

57 3 *

139 7 *

4,000-4,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 4,500-4,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 5,000 grams or more Live births ............... Infant deaths ............. Infant mortality rate ..... Not stated Live births ............... Infant deaths ............. Infant mortality rate ..... White Total

Less then 2,500 grams Live births ............... Infant deaths ............. Infant mortality rate ..... Less then 500 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 500-749 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 750-999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 1,000-1,249 grams Live births ............... Infant deaths ............. Infant mortality rate ..... See footnotes at end of table.

12/14/06

Page 3 Documentation Table 3

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and gestational age: United states, 2004 period data [Infant deaths weighted. Rates are per 1000 live births]-Cont ________________________________________________________________________________________________________________________________ Gestation ____________________________________________________________________________________________________ Birthweight <28 28-31 32-35 36 37-39 40 41 42 Weeks Not Total Weeks Weeks Weeks Weeks Weeks Weeks Weeks or more Stated ________________________________________________________________________________________________________________________________ White 1,250-1,499 grams Live births ............... Infant deaths ............. Infant mortality rate .....

11,418 513 44.93

587 68 115.84

6,021 207 34.38

3,578 150 41.92

270 19 *

482 38 78.84

122 7 *

71 4 *

93 6 *

194 14 *

45,976 1,291 28.08

593 58 97.81

8,944 262 29.29

25,222 522 20.70

3,822 129 33.75

5,119 220 42.98

726 38 52.34

390 16 *

580 23 39.66

580 23 39.66

143,361 1,535 10.71

390 14 *

2,957 98 33.14

50,845 481 9.46

22,927 204 8.90

51,218 550 10.74

6,770 75 11.08

3,106 38 12.23

3,492 51 14.60

1,656 24 14.49

522,822 2,109 4.03

652 12 *

2,736 42 15.35

45,365 275 6.06

52,323 226 4.32

302,827 1,069 3.53

62,851 237 3.77

26,445 103 3.89

23,965 112 4.67

5,658 32 5.66

Live births ............... 1,226,188 Infant deaths ............. 2,384 Infant mortality rate ..... 1.94

-

3,562 29 8.14

30,926 147 4.75

43,487 119 2.74

708,468 1,280 1.81

243,838 400 1.64

106,958 186 1.74

76,193 183 2.40

12,756 41 3.21

941,407 1,314 1.40

-

1,905 9 *

13,684 47 3.43

15,706 35 2.23

473,563 641 1.35

239,873 288 1.20

117,364 160 1.36

69,880 108 1.55

9,432 25 2.65

259,811 331 1.27

-

-

2,996 12 *

3,253 7 *

114,281 151 1.32

72,908 73 1.00

41,544 46 1.11

22,173 36 1.62

2,656 6 *

39,286 59 1.50

-

-

439 5 *

521 2 *

16,058 18 *

11,002 12 *

7,050 10 *

3,806 8 *

410 3 *

4,241 15 *

-

-

61 -

73 1 *

1,901 6 *

997 3 *

735 2 *

398 1 *

76 2 *

418 77 184.21

-

-

-

-

-

-

-

-

418 77 184.21

616,076 8,162 13.25

10,834 4,576 422.37

13,385 663 49.53

49,549 651 13.14

34,259 241 7.03

310,684 1,221 3.93

107,687 350 3.25

49,480 166 3.35

36,068 151 4.19

4,130 145 35.11

1,500-1,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 2,000-2,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 2,500-2,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 3,000-3,499 grams

3,500-3,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 4,000-4,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 4,500-4,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 5,000 grams or more Live births ............... Infant deaths ............. Infant mortality rate ..... Not stated Live births ............... Infant deaths ............. Infant mortality rate ..... Black Total Live births ............... Infant deaths ............. Infant mortality rate ..... See footnotes at end of table.

12/14/06

Page 4 Documentation Table 3

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and gestational age: United states, 2004 period data [Infant deaths weighted. Rates are per 1000 live births]-Cont ________________________________________________________________________________________________________________________________ Gestation ____________________________________________________________________________________________________ Birthweight <28 28-31 32-35 36 37-39 40 41 42 Weeks Not Total Weeks Weeks Weeks Weeks Weeks Weeks Weeks or more Stated ________________________________________________________________________________________________________________________________ Black Less then 2,500 grams Live births ............... Infant deaths ............. Infant mortality rate .....

83,252 6,291 75.57

10,492 4,567 435.28

10,519 639 60.75

25,641 493 19.23

8,922 129 14.46

21,004 250 11.90

3,026 59 19.50

1,344 26 19.35

1,526 32 20.97

778 95 122.11

2,728 2,306 845.31

2,581 2,202 853.16

83 59 710.84

8 5 *

1 -

-

-

-

3 3 *

52 37 711.54

4,199 1,908 454.39

3,678 1,748 475.26

433 126 290.99

39 9 *

3 -

4 -

-

-

1 -

41 25 609.76

3,893 599 153.87

2,501 454 181.53

1,166 113 96.91

125 19 *

12 1 *

20 -

10 -

4 -

9 2 *

46 9 *

4,108 282 68.65

898 99 110.24

2,320 131 56.47

602 28 46.51

56 7 *

121 9 *

29 3 *

22 1 *

25 -

35 4 *

4,406 202 45.85

296 26 87.84

2,323 95 40.90

1,378 58 42.09

86 3 *

185 14 *

33 3 *

21 -

45 2 *

39 1 *

15,912 408 25.64

341 26 76.25

2,946 90 30.55

8,574 159 18.54

1,331 43 32.31

1,958 54 27.58

277 16 *

136 4 *

181 7 *

168 8 *

48,006 586 12.21

197 11 *

1,248 26 20.83

14,915 215 14.42

7,433 75 10.09

18,716 172 9.19

2,677 37 13.82

1,161 21 18.09

1,262 18 *

397 11 *

148,523 753 5.07

342 9 *

1,279 9 *

12,177 96 7.88

13,109 61 4.65

86,515 413 4.77

19,121 83 4.34

7,758 33 4.25

7,318 41 5.60

904 8 *

234,900 709 3.02

-

1,195 12 *

8,177 46 5.63

8,828 36 4.08

131,382 376 2.86

47,522 128 2.69

20,853 59 2.83

15,563 46 2.96

1,380 4 *

119,908 291 2.43

-

392 2 *

2,866 13 *

2,809 10 *

58,835 141 2.40

30,077 62 2.06

15,021 37 2.46

9,155 23 2.51

753 2 *

Less then 500 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 500-749 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 750-999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 1,000-1,249 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 1,250-1,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 1,500-1,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 2,000-2,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 2,500-2,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 3,000-3,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 3,500-3,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... See footnotes at end of table.

12/14/06

Page 5 Documentation Table 3

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and gestational age: United states, 2004 period data [Infant deaths weighted. Rates are per 1000 live births]-Cont ________________________________________________________________________________________________________________________________ Gestation ____________________________________________________________________________________________________ Birthweight <28 28-31 32-35 36 37-39 40 41 42 Weeks Not Total Weeks Weeks Weeks Weeks Weeks Weeks Weeks or more Stated ________________________________________________________________________________________________________________________________ Black 4,000-4,499 grams Live births ............... Infant deaths ............. Infant mortality rate .....

25,271 72 2.85

-

-

584 2 *

493 2 *

11,071 34 3.07

6,920 16 *

3,880 10 *

2,168 6 *

155 2 *

3,602 5 *

-

-

84 -

85 1 *

1,625 3 *

926 1 *

555 -

301 -

26 -

495 8 *

-

-

20 -

13 1 *

252 4 *

95 -

69 -

37 2 *

9 1 *

125 32 256.00

-

-

-

-

-

-

-

-

125 32 256.00

43,927 371 8.45

325 101 310.77

616 29 47.08

2,897 53 18.29

2,110 24 11.37

21,811 98 4.49

8,263 32 3.87

4,217 15 *

3,312 14 *

376 3 *

3,295 193 58.57

297 101 340.07

390 28 71.79

1,086 36 33.15

369 12 *

892 10 *

107 -

52 2 *

72 3 *

30 -

54 43 796.30

52 42 807.69

2 1 *

-

-

-

-

-

-

-

107 45 420.56

90 40 444.44

15 5 *

-

-

-

-

-

-

2 -

105 22 209.52

63 14 *

36 7 *

4 1 *

-

1 -

1 -

-

-

-

143 11 *

44 5 *

68 5 *

18 1 *

1 -

5 -

-

2 -

2 -

3 -

172 4 *

20 -

83 2 *

41 -

11 1 *

11 1 *

2 -

1 -

2 -

1 -

4,500-4,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 5,000 grams or more Live births ............... Infant deaths ............. Infant mortality rate ..... Not stated Live births ............... Infant deaths ............. Infant mortality rate ..... American Indian¹ Total Live births ............... Infant deaths ............. Infant mortality rate ..... Less then 2,500 grams Live births ............... Infant deaths ............. Infant mortality rate ..... Less then 500 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 500-749 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 750-999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 1,000-1,249 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 1,250-1,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... See footnotes at end of table.

12/14/06

Page 6 Documentation Table 3

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and gestational age: United states, 2004 period data [Infant deaths weighted. Rates are per 1000 live births]-Cont ________________________________________________________________________________________________________________________________ Gestation ____________________________________________________________________________________________________ Birthweight <28 28-31 32-35 36 37-39 40 41 42 Weeks Not Total Weeks Weeks Weeks Weeks Weeks Weeks Weeks or more Stated ________________________________________________________________________________________________________________________________ American Indian¹ 1,500-1,999 grams Live births ............... Infant deaths ............. Infant mortality rate .....

653 22 33.69

23 -

121 4 *

345 14 *

51 1 *

87 -

12 -

5 2 *

4 1 *

5 -

2,061 45 21.83

5 -

65 4 *

678 20 29.50

306 10 *

788 9 *

92 -

44 -

64 2 *

19 -

7,180 52 7.24

28 -

82 1 *

752 10 *

707 8 *

3,909 23 5.88

868 7 *

379 2 *

395 1 *

60 -

16,271 70 4.30

-

89 -

663 5 *

644 2 *

9,078 39 4.30

3,035 14 *

1,397 5 *

1,220 2 *

145 2 *

12,571 39 3.10

-

55 -

310 1 *

297 1 *

6,005 17 *

3,057 9 *

1,610 4 *

1,149 6 *

88 1 *

3,802 11 *

-

-

67 1 *

75 1 *

1,585 7 *

1,005 -

659 1 *

376 1 *

35 -

696 4 *

-

-

13 -

15 -

292 1 *

165 2 *

110 -

93 1 *

8 -

102 1 *

-

-

6 -

3 -

50 -

26 -

10 1 *

7 -

-

10 -

-

-

-

-

-

-

-

-

10 -

229,123 1,070 4.67

1,152 481 417.53

2,196 99 45.08

11,083 104 9.38

9,305 45 4.84

123,704 216 1.75

45,362 51 1.12

19,757 27 1.37

12,504 22 1.76

4,060 25 6.16

18,124 766 42.26

1,109 479 431.92

1,707 95 55.65

5,555 77 13.86

2,301 25 10.86

5,797 51 8.80

676 7 *

277 5 *

315 10 *

387 18 *

2,000-2,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 2,500-2,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 3,000-3,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 3,500-3,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 4,000-4,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 4,500-4,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 5,000 grams or more Live births ............... Infant deaths ............. Infant mortality rate ..... Not stated Live births ............... Infant deaths ............. Infant mortality rate ..... Asian or Pacific Islander Total Live births ............... Infant deaths ............. Infant mortality rate ..... Less then 2,500 grams Live births ............... Infant deaths ............. Infant mortality rate ..... See footnotes at end of table.

12/14/06

Page 7 Documentation Table 3

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and gestational age: United states, 2004 period data [Infant deaths weighted. Rates are per 1000 live births]-Cont ________________________________________________________________________________________________________________________________ Gestation ____________________________________________________________________________________________________ Birthweight <28 28-31 32-35 36 37-39 40 41 42 Weeks Not Total Weeks Weeks Weeks Weeks Weeks Weeks Weeks or more Stated ________________________________________________________________________________________________________________________________ Asian or Pacific Islander Less then 500 grams Live births ............... Infant deaths ............. Infant mortality rate .....

244 206 844.26

226 194 858.41

5 4 *

1 -

-

1 -

-

1 1 *

-

10 7 *

439 219 498.86

359 195 543.18

58 19 *

8 1 *

-

3 -

-

-

1 1 *

10 3 *

523 85 162.52

307 64 208.47

166 16 *

23 1 *

3 -

7 1 *

-

1 -

-

16 3 *

634 41 64.67

119 14 *

353 15 *

106 6 *

9 1 *

11 1 *

3 -

8 1 *

4 1 *

21 2 *

809 39 48.21

32 7 *

381 15 *

295 11 *

20 3 *

32 1 *

7 1 *

3 -

11 -

28 -

3,280 79 24.09

45 4 *

533 17 *

1,770 35 19.77

311 4 *

414 15 *

63 1 *

18 -

57 2 *

69 -

12,195 97 7.95

21 1 *

211 8 *

3,352 22 6.56

1,958 17 *

5,329 32 6.00

603 5 *

246 3 *

242 6 *

233 2 *

51,520 125 2.43

43 2 *

191 1 *

2,827 15 *

3,770 9 *

32,011 73 2.28

7,046 12 *

2,699 8 *

1,982 4 *

951 -

96,472 110 1.14

-

203 1 *

1,908 6 *

2,356 6 *

55,788 61 1.09

20,693 23 1.11

8,408 7 *

5,495 4 *

1,621 2 *

51,169 55 1.07

-

95 2 *

657 5 *

725 2 *

25,170 29 1.15

13,614 7 *

6,415 5 *

3,639 4 *

854 1 *

10,312 9 *

-

-

116 1 *

131 2 *

4,350 2 *

2,948 2 *

1,677 2 *

912 -

178 -

500-749 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 750-999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 1,000-1,249 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 1,250-1,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 1,500-1,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 2,000-2,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 2,500-2,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 3,000-3,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 3,500-3,999 grams Live births ............... Infant deaths ............. Infant mortality rate ..... 4,000-4,499 grams Live births ............... Infant deaths ............. Infant mortality rate ..... See footnotes at end of table.

12/14/06

Page 8 Documentation Table 3

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and gestational age: United states, 2004 period data [Infant deaths weighted. Rates are per 1000 live births]-Cont ________________________________________________________________________________________________________________________________ Gestation ____________________________________________________________________________________________________ Birthweight <28 28-31 32-35 36 37-39 40 41 42 Weeks Not Total Weeks Weeks Weeks Weeks Weeks Weeks Weeks or more Stated ________________________________________________________________________________________________________________________________ Asian or Pacific Islander 4,500-4,999 grams Live births ............... Infant deaths ............. Infant mortality rate .....

1,333 1 *

-

-

14 -

21 -

513 1 *

353 -

258 -

137 -

37 -

169 -

-

-

6 -

1 -

75 -

32 -

23 -

24 -

8 -

24 4 *

-

-

-

-

-

-

-

-

24 4 *

5,000 grams or more Live births ............... Infant deaths ............. Infant mortality rate ..... Not stated Live births ............... Infant deaths ............. Infant mortality rate .....

__________________________________________________________________________________________________________________ -/ Quality zero. */Figure does not meet standard of reliability or precision; based on fewer than 20 death in the numerator. ¹/ Includes Aleuts and Eskimos.

12/20/06

Page 1 Documentation Table 4

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and age at death: United states, 2004 period data [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 1000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Birthweight and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ All races Total (all birthweights)................ Rate.................

4,112,055

27,860 6.78

18,602 4.52

14,836 3.61

3,766 0.92

9,258 2.25

Less than 2,500 grams................... Rate.................

333,427

19,218 57.64

15,582 46.73

13,028 39.07

2,554 7.66

3,637 10.91

Less than 500 grams..................... Rate.................

6,953

5,907 849.56

5,748 826.69

5,583 802.96

165 23.73

159 22.87

500-749 grams........................... Rate.................

11,659

5,602 480.49

4,784 410.33

3,851 330.30

933 80.02

819 70.25

750-999 grams........................... Rate.................

12,321

1,921 155.91

1,432 116.22

1,000 81.16

432 35.06

489 39.69

1,000-1,249 grams....................... Rate.................

14,245

966 67.81

697 48.93

478 33.56

219 15.37

269 18.88

1,250-1,499 grams....................... Rate.................

16,805

758 45.11

525 31.24

383 22.79

142 8.45

233 13.86

1,500-1,999 grams....................... Rate.................

65,821

1,800 27.35

1,195 18.16

924 14.04

271 4.12

605 9.19

2,000-2,499 grams....................... Rate.................

205,623

2,264 11.01

1,200 5.84

808 3.93

392 1.91

1,064 5.17

2,500-2,999 grams....................... Rate.................

730,045

3,039 4.16

1,176 1.61

688 0.94

487 0.67

1,864 2.55

3,000-3,499 grams....................... Rate.................

1,573,831

3,272 2.08

998 0.63

593 0.38

405 0.26

2,274 1.44

3,500-3,999 grams....................... Rate.................

1,125,055

1,699 1.51

551 0.49

302 0.27

249 0.22

1,149 1.02

4,000-4,499 grams....................... Rate.................

299,196

424 1.42

143 0.48

87 0.29

56 0.19

281 0.94

4,500-4,999 grams....................... Rate.................

44,917

69 1.54

34 0.76

23 0.51

11 *

34 0.76

5,000 grams or more..................... Rate.................

5,007

24 4.79

13 *

12 *

1 *

11 *

Not stated.............................. Rate.................

577

113 195.84

104 180.24

102 176.78

2 *

9 *

See footnotes at end of table.

12/20/06

Page 2 Documentation Table 4

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and age at death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 1000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Birthweight and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ White Total (all birthweights)................ Rate.................

3,222,929

18,257 5.66

12,178 3.78

9,674 3.00

2,504 0.78

6,080 1.89

Less than 2,500 grams................... Rate.................

228,756

11,968 52.32

9,879 43.19

8,276 36.18

1,603 7.01

2,089 9.13

Less than 500 grams..................... Rate.................

3,927

3,353 853.83

3,278 834.73

3,189 812.07

89 22.66

75 19.10

500-749 grams........................... Rate.................

6,914

3,430 496.09

3,003 434.34

2,462 356.09

541 78.25

427 61.76

750-999 grams........................... Rate.................

7,800

1,215 155.77

956 122.56

687 88.08

269 34.49

259 33.21

1,000-1,249 grams....................... Rate.................

9,360

631 67.41

487 52.03

341 36.43

145 15.49

144 15.38

1,250-1,499 grams....................... Rate.................

11,418

513 44.93

373 32.67

273 23.91

100 8.76

140 12.26

1,500-1,999 grams....................... Rate.................

45,976

1,291 28.08

901 19.60

711 15.46

191 4.15

389 8.46

2,000-2,499 grams....................... Rate.................

143,361

1,535 10.71

881 6.15

613 4.28

268 1.87

654 4.56

2,500-2,999 grams....................... Rate.................

522,822

2,109 4.03

868 1.66

520 0.99

348 0.67

1,241 2.37

3,000-3,499 grams....................... Rate.................

1,226,188

2,384 1.94

770 0.63

469 0.38

302 0.25

1,614 1.32

3,500-3,999 grams....................... Rate.................

941,407

1,314 1.40

438 0.47

241 0.26

197 0.21

876 0.93

4,000-4,499 grams....................... Rate.................

259,811

331 1.27

114 0.44

71 0.27

43 0.17

217 0.84

4,500-4,999 grams....................... Rate.................

39,286

59 1.50

31 0.79

22 0.56

9 *

27 0.69

5,000 grams or more..................... Rate.................

4,241

15 *

8 *

7 *

1 *

7 *

Not stated.............................. Rate.................

418

77 184.21

69 165.07

68 162.68

1 *

8 *

See footnotes at end of table.

12/20/06

Page 3 Documentation Table 4

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and age at death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 1000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Birthweight and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ Black Total (all birthweights)................ Rate.................

616,076

8,162 13.25

5,505 8.94

4,413 7.16

1,092 1.77

2,657 4.31

Less than 2,500 grams................... Rate.................

83,252

6,291 75.57

4,941 59.35

4,107 49.33

834 10.02

1,350 16.22

Less than 500 grams..................... Rate.................

2,728

2,306 845.31

2,227 816.35

2,156 790.32

71 26.03

79 28.96

500-749 grams........................... Rate.................

4,199

1,908 454.39

1,555 370.33

1,199 285.54

357 85.02

353 84.07

750-999 grams........................... Rate.................

3,893

599 153.87

399 102.49

261 67.04

139 35.71

199 51.12

1,000-1,249 grams....................... Rate.................

4,108

282 68.65

171 41.63

105 25.56

66 16.07

111 27.02

1,250-1,499 grams....................... Rate.................

4,406

202 45.85

117 26.55

84 19.06

33 7.49

86 19.52

1,500-1,999 grams....................... Rate.................

15,912

408 25.64

230 14.45

162 10.18

68 4.27

178 11.19

2,000-2,499 grams....................... Rate.................

48,006

586 12.21

242 5.04

142 2.96

100 2.08

345 7.19

2,500-2,999 grams....................... Rate.................

148,523

753 5.07

243 1.64

131 0.88

112 0.75

510 3.43

3,000-3,499 grams....................... Rate.................

234,900

709 3.02

176 0.75

89 0.38

88 0.37

532 2.26

3,500-3,999 grams....................... Rate.................

119,908

291 2.43

82 0.68

38 0.32

44 0.37

209 1.74

4,000-4,499 grams....................... Rate.................

25,271

72 2.85

23 0.91

11 *

12 *

49 1.94

4,500-4,999 grams....................... Rate.................

3,602

5 *

2 *

1 *

1 *

3 *

5,000 grams or more..................... Rate.................

495

8 *

5 *

5 *

-

3 *

Not stated.............................. Rate.................

125

32 256.00

31 248.00

30 240.00

1 *

1 *

See footnotes at end of table.

12/20/06

Page 4 Documentation Table 4

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and age at death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 1000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Birthweight and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ American Indian¹ Total (all birthweights)................ Rate.................

43,927

371 8.45

187 4.26

149 3.39

38 0.87

184 4.19

Less than 2,500 grams................... Rate.................

3,295

193 58.57

149 45.22

126 38.24

22 6.68

44 13.35

Less than 500 grams..................... Rate.................

54

43 796.30

43 796.30

42 777.78

1 *

-

500-749 grams........................... Rate.................

107

45 420.56

39 364.49

34 317.76

5 *

6 *

750-999 grams........................... Rate.................

105

22 209.52

19 *

14 *

5 *

3 *

1,000-1,249 grams....................... Rate.................

143

11 *

9 *

9 *

-

2 *

1,250-1,499 grams....................... Rate.................

172

4 *

2 *

1 *

1 *

2 *

1,500-1,999 grams....................... Rate.................

653

22 33.69

12 *

11 *

1 *

10 *

2,000-2,499 grams....................... Rate.................

2,061

45 21.83

24 11.64

15 *

9 *

21 10.19

2,500-2,999 grams....................... Rate.................

7,180

52 7.24

15 *

6 *

9 *

37 5.15

3,000-3,499 grams....................... Rate.................

16,271

70 4.30

13 *

9 *

4 *

57 3.50

3,500-3,999 grams....................... Rate.................

12,571

39 3.10

7 *

5 *

2 *

32 2.55

4,000-4,499 grams....................... Rate.................

3,802

11 *

2 *

2 *

-

9 *

4,500-4,999 grams....................... Rate.................

696

4 *

1 *

-

1 *

3 *

5,000 grams or more..................... Rate.................

102

1 *

-

-

-

1 *

Not stated.............................. Rate.................

10

-

-

-

-

-

See footnotes at end of table.

12/20/06

Page 5 Documentation Table 4

Live births, infant deaths, and infant mortality rates by birthweight, race of mother, and age at death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 1000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Birthweight and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ Asian or Pacific Islander Total (all birthweights)................ Rate.................

229,123

1,070 4.67

733 3.20

601 2.62

132 0.58

337 1.47

Less than 2,500 grams................... Rate.................

18,124

766 42.26

613 33.82

518 28.58

95 5.24

153 8.44

Less than 500 grams..................... Rate.................

244

206 844.26

200 819.67

196 803.28

4 *

6 *

500-749 grams........................... Rate.................

439

219 498.86

186 423.69

156 355.35

30 68.34

33 75.17

750-999 grams........................... Rate.................

523

85 162.52

58 110.90

39 74.57

19 *

27 51.63

1,000-1,249 grams....................... Rate.................

634

41 64.67

30 47.32

23 36.28

7 *

11 *

1,250-1,499 grams....................... Rate.................

809

39 48.21

33 40.79

25 30.90

8 *

5 *

1,500-1,999 grams....................... Rate.................

3,280

79 24.09

52 15.85

41 12.50

11 *

27 8.23

2,000-2,499 grams....................... Rate.................

12,195

97 7.95

54 4.43

39 3.20

15 *

44 3.61

2,500-2,999 grams....................... Rate.................

51,520

125 2.43

50 0.97

32 0.62

18 *

75 1.46

3,000-3,499 grams....................... Rate.................

96,472

110 1.14

39 0.40

27 0.28

12 *

71 0.74

3,500-3,999 grams....................... Rate.................

51,169

55 1.07

24 0.47

17 *

6 *

31 0.61

4,000-4,499 grams....................... Rate.................

10,312

9 *

4 *

3 *

1 *

5 *

4,500-4,999 grams....................... Rate.................

1,333

1 *

-

-

-

1 *

5,000 grams or more..................... Rate.................

169

-

-

-

-

-

Not stated.............................. Rate.................

24

4 *

4 *

4 *

-

-

See footnotes at end of table. __________________________________________________________________________________________________________________ */ Figure does not meet standard of reliability or precision; based on fewer than 20 death in the numerator -/ Quantity zero ¹/ Includes Aleuts and Eskimos

01/23/07

Page 1 Documentation Table 5

Infant deaths and infant mortality rates by age of death, birthweight, and race of mother for 10 major causes of infant death: United states, 2004 period data [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 100,000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Cause of death, birthweight, and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ All races All birthweights All causes ..............................................4,112,055

27,860 677.52

18,602 452.38

14,836 360.79

3,766 91.58

9,258 225.14

Congenital malformations (Q00-Q99).......................

5,636 137.06

4,023 97.83

3,110 75.63

913 22.20

1,613 39.23

Short gestation and low birthweight nec (P07)............

4,610 112.11

4,493 109.26

4,369 106.25

124 3.02

117 2.85

Sudden infant death syndrome (R95).......................

2,247 54.64

216 5.25

38 0.92

177 4.30

2,031 49.39

Maternal complications of pregnancy (P01)................

1,706 41.49

1,692 41.15

1,669 40.59

23 0.56

14 *

Accidents (unintentional injures) (V01-X59)..............

1,054 25.63

115 2.80

25 0.61

90 2.19

939 22.84

Complications of placenta, cord, membranes (P02).........

1,032 25.10

1,022 24.85

986 23.98

36 0.88

10 *

Respiratory distress of newborn (P22)....................

878 21.35

820 19.94

628 15.27

192 4.67

57 1.39

Bacterial sepsis of newborn (P36)........................

830 20.18

783 19.04

317 7.71

466 11.33

47 1.14

Neonatal hemorrhage (P50-P52, P54).......................

619 15.05

602 14.64

400 9.73

202 4.91

17 *

Diseases of the circulatory system (I00-I99).............

591 14.37

197 4.79

109 2.65

88 2.14

394 9.58

All other causes.........................................

8,657 210.53

4,639 112.81

3,185 77.46

1,454 35.36

4,018 97.71

19,218 5,763.78

15,582 4,673.29

13,028 3,907.30

Congenital malformations (Q00-Q99).......................

3,426 1,027.51

2,728 818.17

2,279 683.51

450 134.96

697 209.04

Short gestation and low birthweight nec (P07)............

4,501 1,349.92

4,391 1,316.93

4,270 1,280.64

121 36.29

110 32.99

Sudden infant death syndrome (R95).......................

490 146.96

53 15.90

8 *

45 13.50

436 130.76

Maternal complications of pregnancy (P01)................

1,666 499.66

1,652 495.46

1,631 489.16

21 6.30

14 *

Accidents (unintentional injures) (V01-X59)..............

171 51.29

30 9.00

12 *

18 *

141 42.29

Complications of placenta, cord, membranes (P02).........

927 278.02

920 275.92

896 268.72

24 7.20

7 *

Respiratory distress of newborn (P22)....................

850 254.93

799 239.63

611 183.25

188 56.38

51 15.30

Bacterial sepsis of newborn (P36)........................

756 226.74

711 213.24

282 84.58

429 128.66

44 13.20

Neonatal hemorrhage (P50-P52, P54).......................

568 170.35

555 166.45

369 110.67

185 55.48

13 *

Less then 2,500 grams All causes ..............................................

See footnotes at end of table.

333,427

2,554 3,637 765.98 1,090.79

01/23/07

Page 2 Documentation Table 5

Infant deaths and infant mortality rates by age of death, birthweight, and race of mother for 10 major causes of infant death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 100,000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Cause of death, birthweight, and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ All races Diseases of the circulatory system (I00-I99).............

316 94.77

112 33.59

66 19.79

46 13.80

204 61.18

All other causes.........................................

5,548 1,663.93

3,630 1,088.69

2,604 780.98

1,026 307.71

1,918 575.24

8,528 225.72

2,916 77.18

1,706 45.16

1,210 32.03

5,612 148.54

Congenital malformations (Q00-Q99).......................

2,205 58.36

1,290 34.14

827 21.89

463 12.25

915 24.22

Short gestation and low birthweight nec (P07)............

46 1.22

41 1.09

38 1.01

3 *

5 *

Sudden infant death syndrome (R95).......................

1,756 46.48

162 4.29

30 0.79

132 3.49

1,594 42.19

Maternal complications of pregnancy (P01)................

30 0.79

30 0.79

28 0.74

2 *

-

Accidents (unintentional injures) (V01-X59)..............

882 23.35

85 2.25

13 *

71 1.88

798 21.12

Complications of placenta, cord, membranes (P02).........

96 2.54

93 2.46

81 2.14

12 *

3 *

Respiratory distress of newborn (P22)....................

27 0.71

21 0.56

17 *

4 *

6 *

Bacterial sepsis of newborn (P36)........................

74 1.96

71 1.88

33 0.87

37 0.98

3 *

Neonatal hemorrhage (P50-P52, P54).......................

52 1.38

48 1.27

30 0.79

17 *

4 *

Diseases of the circulatory system (I00-I99).............

275 7.28

85 2.25

43 1.14

42 1.11

190 5.03

All other causes.........................................

3,086 81.68

991 26.23

565 14.95

426 11.28

2,094 55.43

113 104 102 19,584.06 18,024.26 17,677.64

2 *

9 *

4 *

-

1 *

63 61 61 10,918.54 10,571.92 10,571.92

-

2 *

2,500 grams or more All causes ..............................................3,778,051

Not stated birthweight All causes .............................................. Congenital malformations (Q00-Q99)....................... Short gestation and low birthweight nec (P07)............

577

5 *

4 *

Sudden infant death syndrome (R95).......................

1 *

-

-

-

1 *

Maternal complications of pregnancy (P01)................

11 *

11 *

11 *

-

-

Accidents (unintentional injures) (V01-X59)..............

-

-

-

-

-

Complications of placenta, cord, membranes (P02).........

9 *

9 *

9 *

-

-

Respiratory distress of newborn (P22)....................

-

-

-

-

-

See footnotes at end of table.

01/23/07

Page 3 Documentation Table 5

Infant deaths and infant mortality rates by age of death, birthweight, and race of mother for 10 major causes of infant death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 100,000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Cause of death, birthweight, and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ All races Bacterial sepsis of newborn (P36)........................

1 *

1 *

1 *

-

-

Neonatal hemorrhage (P50-P52, P54).......................

-

-

-

-

-

Diseases of the circulatory system (I00-I99).............

-

-

-

-

-

All other causes.........................................

23 3,986.14

18 *

16 *

2 *

5 *

All causes ..............................................3,222,929

18,257 566.47

12,178 377.86

9,674 300.16

2,504 77.69

6,080 188.65

Congenital malformations (Q00-Q99).......................

4,291 133.14

3,130 97.12

2,453 76.11

677 21.01

1,161 36.02

Short gestation and low birthweight nec (P07)............

2,617 81.20

2,557 79.34

2,495 77.41

62 1.92

61 1.89

Sudden infant death syndrome (R95).......................

1,500 46.54

152 4.72

29 0.90

123 3.82

1,348 41.83

Maternal complications of pregnancy (P01)................

1,003 31.12

995 30.87

981 30.44

13 *

8 *

Accidents (unintentional injures) (V01-X59)..............

726 22.53

89 2.76

20 0.62

68 2.11

637 19.76

Complications of placenta, cord, membranes (P02).........

682 21.16

677 21.01

654 20.29

23 0.71

5 *

Respiratory distress of newborn (P22)....................

561 17.41

527 16.35

414 12.85

113 3.51

34 1.05

Bacterial sepsis of newborn (P36)........................

510 15.82

481 14.92

199 6.17

282 8.75

29 0.90

Neonatal hemorrhage (P50-P52, P54).......................

410 12.72

398 12.35

263 8.16

135 4.19

12 *

Diseases of the circulatory system (I00-I99).............

390 12.10

144 4.47

80 2.48

64 1.99

247 7.66

All other causes.........................................

5,567 172.73

3,029 93.98

2,085 64.69

944 29.29

2,538 78.75

11,968 5,231.78

9,879 4,318.58

8,276 3,617.83

1,603 700.75

2,089 913.20

Congenital malformations (Q00-Q99).......................

2,604 1,138.33

2,128 930.25

1,799 786.43

329 143.82

476 208.08

Short gestation and low birthweight nec (P07)............

2,545 1,112.54

2,490 1,088.50

2,432 1,063.14

59 25.79

55 24.04

Sudden infant death syndrome (R95).......................

289 126.34

32 13.99

5 *

27 11.80

257 112.35

Maternal complications of pregnancy (P01)................

970 424.03

962 420.54

950 415.29

12 *

8 *

White All birthweights

Less then 2,500 grams All causes ..............................................

See footnotes at end of table.

228,756

01/23/07

Page 4 Documentation Table 5

Infant deaths and infant mortality rates by age of death, birthweight, and race of mother for 10 major causes of infant death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 100,000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Cause of death, birthweight, and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ White Accidents (unintentional injures) (V01-X59)..............

94 41.09

21 9.18

9 *

12 *

73 31.91

Complications of placenta, cord, membranes (P02).........

592 258.79

588 257.04

573 250.49

15 *

4 *

Respiratory distress of newborn (P22)....................

535 233.87

507 221.63

397 173.55

110 48.09

28 12.24

Bacterial sepsis of newborn (P36)........................

451 197.15

423 184.91

170 74.31

253 110.60

27 11.80

Neonatal hemorrhage (P50-P52, P54).......................

373 163.06

365 159.56

241 105.35

124 54.21

8 *

Diseases of the circulatory system (I00-I99).............

189 82.62

82 35.85

53 23.17

29 12.68

107 46.77

All other causes.........................................

3,326 1,453.95

2,281 997.13

1,648 720.42

633 276.71

1,046 457.26

6,213 207.53

2,230 74.49

1,330 44.43

900 30.06

3,983 133.04

Congenital malformations (Q00-Q99).......................

1,683 56.22

999 33.37

651 21.75

348 11.62

684 22.85

Short gestation and low birthweight nec (P07)............

34 1.14

30 1.00

27 0.90

3 *

4 *

Sudden infant death syndrome (R95).......................

1,210 40.42

120 4.01

24 0.80

96 3.21

1,090 36.41

Maternal complications of pregnancy (P01)................

24 0.80

24 0.80

23 0.77

1 *

-

Accidents (unintentional injures) (V01-X59)..............

632 21.11

67 2.24

11 *

56 1.87

565 18.87

Complications of placenta, cord, membranes (P02).........

83 2.77

82 2.74

74 2.47

8 *

1 *

Respiratory distress of newborn (P22)....................

26 0.87

20 0.67

17 *

3 *

6 *

Bacterial sepsis of newborn (P36)........................

59 1.97

57 1.90

27 0.90

29 0.97

2 *

Neonatal hemorrhage (P50-P52, P54).......................

37 1.24

33 1.10

22 0.73

11 *

4 *

Diseases of the circulatory system (I00-I99).............

201 6.71

62 2.07

27 0.90

35 1.17

139 4.64

All other causes.........................................

2,223 74.25

736 24.58

426 14.23

310 10.35

1,487 49.67

77 69 68 18,421.05 16,507.18 16,267.94

1 *

8 *

2,500 grams or more All causes ..............................................2,993,755

Not stated birthweight All causes ..............................................

418

Congenital malformations (Q00-Q99).......................

4 *

3 *

3 *

-

1 *

Short gestation and low birthweight nec (P07)............

39 9,330.14

37 8,851.67

37 8,851.67

-

2 *

See footnotes at end of table.

01/23/07

Page 5 Documentation Table 5

Infant deaths and infant mortality rates by age of death, birthweight, and race of mother for 10 major causes of infant death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 100,000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Cause of death, birthweight, and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ White Sudden infant death syndrome (R95).......................

-

-

-

-

-

Maternal complications of pregnancy (P01)................

9 *

9 *

9 *

-

-

Accidents (unintentional injures) (V01-X59)..............

-

-

-

-

-

Complications of placenta, cord, membranes (P02).........

7 *

7 *

7 *

-

-

Respiratory distress of newborn (P22)....................

-

-

-

-

-

Bacterial sepsis of newborn (P36)........................

1 *

1 *

1 *

-

-

Neonatal hemorrhage (P50-P52, P54).......................

-

-

-

-

-

Diseases of the circulatory system (I00-I99).............

-

-

-

-

-

All other causes.........................................

17 *

12 *

11 *

1 *

5 *

8,162 1,324.84

5,505 893.56

4,413 716.31

1,092 177.25

2,657 431.28

Congenital malformations (Q00-Q99).......................

1,018 165.24

669 108.59

478 77.59

191 31.00

349 56.65

Short gestation and low birthweight nec (P07)............

1,790 290.55

1,740 282.43

1,685 273.51

55 8.93

49 7.95

Sudden infant death syndrome (R95).......................

648 105.18

59 9.58

9 *

50 8.12

588 95.44

Maternal complications of pregnancy (P01)................

623 101.12

617 100.15

608 98.69

9 *

6 *

Accidents (unintentional injures) (V01-X59)..............

280 45.45

23 3.73

4 *

19 *

257 41.72

Complications of placenta, cord, membranes (P02).........

302 49.02

297 48.21

284 46.10

13 *

5 *

Respiratory distress of newborn (P22)....................

289 46.91

267 43.34

195 31.65

72 11.69

22 3.57

Bacterial sepsis of newborn (P36)........................

279 45.29

265 43.01

98 15.91

167 27.11

14 *

Neonatal hemorrhage (P50-P52, P54).......................

164 26.62

162 26.30

108 17.53

54 8.77

2 *

Diseases of the circulatory system (I00-I99).............

155 25.16

44 7.14

23 3.73

21 3.41

111 18.02

All other causes.........................................

2,614 424.30

1,361 220.91

921 149.49

440 71.42

1,254 203.55

6,291 7,556.58

4,941 5,934.99

4,107 4,933.21

Black All birthweights All causes ..............................................

616,076

Less then 2,500 grams All causes .............................................. See footnotes at end of table.

83,252

834 1,350 1,001.78 1,621.58

01/23/07

Page 6 Documentation Table 5

Infant deaths and infant mortality rates by age of death, birthweight, and race of mother for 10 major causes of infant death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 100,000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Cause of death, birthweight, and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ Black Congenital malformations (Q00-Q99).......................

624 749.53

451 541.73

355 426.42

95 114.11

173 207.80

Short gestation and low birthweight nec (P07)............

1,757 2,110.46

1,709 2,052.80

1,654 1,986.74

55 66.06

48 57.66

Sudden infant death syndrome (R95).......................

189 227.02

21 25.22

3 *

18 *

168 201.80

Maternal complications of pregnancy (P01)................

615 738.72

609 731.51

601 721.90

8 *

6 *

Accidents (unintentional injures) (V01-X59)..............

72 86.48

8 *

2 *

6 *

64 76.88

Complications of placenta, cord, membranes (P02).........

287 344.74

284 341.13

275 330.32

9 *

3 *

Respiratory distress of newborn (P22)....................

288 345.94

266 319.51

195 234.23

71 85.28

22 26.43

Bacterial sepsis of newborn (P36)........................

267 320.71

253 303.90

94 112.91

159 190.99

14 *

Neonatal hemorrhage (P50-P52, P54).......................

157 188.58

155 186.18

105 126.12

50 60.06

2 *

Diseases of the circulatory system (I00-I99).............

102 122.52

25 30.03

10 *

15 *

77 92.49

All other causes.........................................

1,933 2,321.87

1,160 1,393.36

814 977.75

346 415.61

773 928.51

1,839 345.22

532 99.87

275 51.62

257 48.24

1,306 245.17

Congenital malformations (Q00-Q99).......................

393 73.78

217 40.74

122 22.90

95 17.83

175 32.85

Short gestation and low birthweight nec (P07)............

11 *

10 *

10 *

-

1 *

Sudden infant death syndrome (R95).......................

458 85.98

38 7.13

6 *

32 6.01

419 78.66

Maternal complications of pregnancy (P01)................

6 *

6 *

5 *

1 *

-

Accidents (unintentional injures) (V01-X59)..............

209 39.23

15 *

2 *

13 *

194 36.42

Complications of placenta, cord, membranes (P02).........

13 *

11 *

7 *

4 *

2 *

Respiratory distress of newborn (P22)....................

1 *

1 *

-

1 *

-

Bacterial sepsis of newborn (P36)........................

12 *

12 *

4 *

8 *

-

Neonatal hemorrhage (P50-P52, P54).......................

7 *

7 *

3 *

4 *

-

Diseases of the circulatory system (I00-I99).............

53 9.95

19 *

13 *

6 *

34 6.38

All other causes.........................................

676 126.90

195 36.61

103 19.34

92 17.27

481 90.29

2,500 grams or more All causes ..............................................

See footnotes at end of table.

532,699

01/23/07

Page 7 Documentation Table 5

Infant deaths and infant mortality rates by age of death, birthweight, and race of mother for 10 major causes of infant death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 100,000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Cause of death, birthweight, and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ Black Not stated birthweight All causes ..............................................

125

Congenital malformations (Q00-Q99).......................

32 31 30 25,600.00 24,800.00 24,000.00

1 *

1 *

1 *

-

-

21 21 21 16,800.00 16,800.00 16,800.00

-

-

1 *

Short gestation and low birthweight nec (P07)............

1 *

Sudden infant death syndrome (R95).......................

1 *

-

-

-

1 *

Maternal complications of pregnancy (P01)................

2 *

2 *

2 *

-

-

Accidents (unintentional injures) (V01-X59)..............

-

-

-

-

-

Complications of placenta, cord, membranes (P02).........

2 *

2 *

2 *

-

-

Respiratory distress of newborn (P22)....................

-

-

-

-

-

Bacterial sepsis of newborn (P36)........................

-

-

-

-

-

Neonatal hemorrhage (P50-P52, P54).......................

-

-

-

-

-

Diseases of the circulatory system (I00-I99).............

-

-

-

-

-

All other causes.........................................

5 *

5 *

4 *

1 *

-

371 844.58

187 425.71

149 339.20

38 86.51

184 418.88

Congenital malformations (Q00-Q99).......................

89 202.61

57 129.76

47 107.00

10 *

31 70.57

Short gestation and low birthweight nec (P07)............

29 66.02

28 63.74

25 56.91

3 *

1 *

Sudden infant death syndrome (R95).......................

44 100.17

2 *

-

2 *

42 95.61

Maternal complications of pregnancy (P01)................

12 *

12 *

12 *

-

-

Accidents (unintentional injures) (V01-X59)..............

21 47.81

1 *

-

1 *

20 45.53

Complications of placenta, cord, membranes (P02).........

14 *

14 *

14 *

-

-

Respiratory distress of newborn (P22)....................

7 *

7 *

6 *

1 *

-

Bacterial sepsis of newborn (P36)........................

8 *

8 *

3 *

5 *

-

American Indian¹ All birthweights All causes ..............................................

See footnotes at end of table.

43,927

01/23/07

Page 8 Documentation Table 5

Infant deaths and infant mortality rates by age of death, birthweight, and race of mother for 10 major causes of infant death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 100,000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Cause of death, birthweight, and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ American Indian¹ Neonatal hemorrhage (P50-P52, P54).......................

8 *

8 *

6 *

2 *

-

Diseases of the circulatory system (I00-I99).............

8 *

1 *

-

1 *

7 *

All other causes.........................................

130 295.95

48 109.27

35 79.68

13 *

82 186.67

193 5,857.36

149 4,522.00

126 3,823.98

Congenital malformations (Q00-Q99).......................

49 1,487.10

40 1,213.96

36 1,092.56

4 *

9 *

Short gestation and low birthweight nec (P07)............

28 849.77

27 819.42

24 728.38

3 *

1 *

Sudden infant death syndrome (R95).......................

6 *

-

-

-

6 *

Maternal complications of pregnancy (P01)................

12 *

12 *

12 *

-

-

Accidents (unintentional injures) (V01-X59)..............

4 *

-

-

-

4 *

Complications of placenta, cord, membranes (P02).........

14 *

14 *

14 *

-

-

Respiratory distress of newborn (P22)....................

7 *

7 *

6 *

1 *

-

Bacterial sepsis of newborn (P36)........................

8 *

8 *

3 *

5 *

-

Neonatal hemorrhage (P50-P52, P54).......................

8 *

8 *

6 *

2 *

-

Diseases of the circulatory system (I00-I99).............

5 *

1 *

-

1 *

4 *

All other causes.........................................

51 1,547.80

31 940.82

25 758.73

6 *

20 606.98

178 438.19

38 93.55

22 54.16

16 *

139 342.18

Congenital malformations (Q00-Q99).......................

39 96.01

17 *

11 *

6 *

22 54.16

Short gestation and low birthweight nec (P07)............

1 *

1 *

1 *

-

-

Sudden infant death syndrome (R95).......................

38 93.55

2 *

-

2 *

36 88.62

Maternal complications of pregnancy (P01)................

-

-

-

-

-

Accidents (unintentional injures) (V01-X59)..............

17 *

1 *

-

1 *

16 *

Complications of placenta, cord, membranes (P02).........

-

-

-

-

-

Less then 2,500 grams All causes ..............................................

3,295

22 44 667.68 1,335.36

2,500 grams or more All causes ..............................................

See footnotes at end of table.

40,622

01/23/07

Page 9 Documentation Table 5

Infant deaths and infant mortality rates by age of death, birthweight, and race of mother for 10 major causes of infant death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 100,000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Cause of death, birthweight, and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ American Indian¹ Respiratory distress of newborn (P22)....................

-

-

-

-

-

Bacterial sepsis of newborn (P36)........................

-

-

-

-

-

Neonatal hemorrhage (P50-P52, P54).......................

-

-

-

-

-

Diseases of the circulatory system (I00-I99).............

3 *

-

-

-

3 *

All other causes.........................................

79 194.48

17 *

10 *

7 *

62 152.63

-

-

-

-

-

Congenital malformations (Q00-Q99).......................

-

-

-

-

-

Short gestation and low birthweight nec (P07)............

-

-

-

-

-

Sudden infant death syndrome (R95).......................

-

-

-

-

-

Maternal complications of pregnancy (P01)................

-

-

-

-

-

Accidents (unintentional injures) (V01-X59)..............

-

-

-

-

-

Complications of placenta, cord, membranes (P02).........

-

-

-

-

-

Respiratory distress of newborn (P22)....................

-

-

-

-

-

Bacterial sepsis of newborn (P36)........................

-

-

-

-

-

Neonatal hemorrhage (P50-P52, P54).......................

-

-

-

-

-

Diseases of the circulatory system (I00-I99).............

-

-

-

-

-

All other causes.........................................

-

-

-

-

-

1,070 467.00

733 319.92

601 262.30

132 57.61

337 147.08

Congenital malformations (Q00-Q99).......................

239 104.31

167 72.89

131 57.17

35 15.28

72 31.42

Short gestation and low birthweight nec (P07)............

174 75.94

168 73.32

164 71.58

4 *

6 *

Sudden infant death syndrome (R95).......................

55 24.00

2 *

-

2 *

53 23.13

Not stated birthweight All causes ..............................................

10

Asian or Pacific Islander All birthweights All causes ..............................................

See footnotes at end of table.

229,123

01/23/07

Page 10 Documentation Table 5

Infant deaths and infant mortality rates by age of death, birthweight, and race of mother for 10 major causes of infant death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 100,000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Cause of death, birthweight, and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ Asian or Pacific Islander Maternal complications of pregnancy (P01)................

69 30.11

69 30.11

68 29.68

1 *

-

Accidents (unintentional injures) (V01-X59)..............

26 11.35

2 *

1 *

1 *

24 10.47

Complications of placenta, cord, membranes (P02).........

34 14.84

34 14.84

34 14.84

-

-

Respiratory distress of newborn (P22)....................

20 8.73

19 *

13 *

6 *

1 *

Bacterial sepsis of newborn (P36)........................

33 14.40

29 12.66

17 *

12 *

4 *

Neonatal hemorrhage (P50-P52, P54).......................

37 16.15

34 14.84

23 10.04

11 *

3 *

Diseases of the circulatory system (I00-I99).............

37 16.15

8 *

6 *

2 *

29 12.66

All other causes.........................................

345 150.57

201 87.73

143 62.41

57 24.88

144 62.85

766 4,226.44

613 3,382.26

518 2,858.09

95 524.17

153 844.18

Congenital malformations (Q00-Q99).......................

148 816.60

110 606.93

89 491.06

21 115.87

38 209.67

Short gestation and low birthweight nec (P07)............

171 943.50

165 910.40

161 888.32

4 *

6 *

Sudden infant death syndrome (R95).......................

5 *

-

-

-

5 *

Maternal complications of pregnancy (P01)................

69 380.71

69 380.71

68 375.19

1 *

-

Accidents (unintentional injures) (V01-X59)..............

2 *

1 *

1 *

-

1 *

Complications of placenta, cord, membranes (P02).........

34 187.60

34 187.60

34 187.60

-

-

Respiratory distress of newborn (P22)....................

20 110.35

19 *

13 *

6 *

1 *

Bacterial sepsis of newborn (P36)........................

30 165.53

27 148.97

15 *

12 *

3 *

Neonatal hemorrhage (P50-P52, P54).......................

29 160.01

26 143.46

17 *

9 *

3 *

Diseases of the circulatory system (I00-I99).............

20 110.35

4 *

3 *

1 *

16 *

All other causes.........................................

237 1,307.66

157 866.25

117 645.55

40 220.70

80 441.40

299 141.72

116 54.98

79 37.45

37 17.54

184 87.21

90 42.66

57 27.02

43 20.38

14 *

34 16.12

Less then 2,500 grams All causes ..............................................

18,124

2,500 grams or more All causes .............................................. Congenital malformations (Q00-Q99)....................... See footnotes at end of table.

210,975

01/23/07

Page 11 Documentation Table 5

Infant deaths and infant mortality rates by age of death, birthweight, and race of mother for 10 major causes of infant death: United states, 2004 period data -Cont [Infant deaths are weighted. Infant deaths are under 1 year.Neonatal deaths are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Rates are per 100,000 live births] __________________________________________________________________________________________________________________ Live

Total

Early

Late

Post-

Cause of death, birthweight, and race of mother Births Infant Neonatal Neonatal Neonatal Neonatal __________________________________________________________________________________________________________________ Asian or Pacific Islander Short gestation and low birthweight nec (P07)............

-

-

-

-

-

Sudden infant death syndrome (R95).......................

50 23.70

2 *

-

2 *

48 22.75

Maternal complications of pregnancy (P01)................

-

-

-

-

-

Accidents (unintentional injures) (V01-X59)..............

24 11.38

1 *

-

1 *

23 10.90

Complications of placenta, cord, membranes (P02).........

-

-

-

-

-

Respiratory distress of newborn (P22)....................

-

-

-

-

-

Bacterial sepsis of newborn (P36)........................

3 *

2 *

2 *

-

1 *

Neonatal hemorrhage (P50-P52, P54).......................

7 *

7 *

5 *

2 *

-

Diseases of the circulatory system (I00-I99).............

17 *

4 *

3 *

1 *

13 *

All other causes.........................................

107 50.72

43 20.38

25 11.85

17 *

65 30.81

4 *

4 *

4 *

-

-

Congenital malformations (Q00-Q99).......................

-

-

-

-

-

Short gestation and low birthweight nec (P07)............

3 *

3 *

3 *

-

-

Sudden infant death syndrome (R95).......................

-

-

-

-

-

Maternal complications of pregnancy (P01)................

-

-

-

-

-

Accidents (unintentional injures) (V01-X59)..............

-

-

-

-

-

Complications of placenta, cord, membranes (P02).........

-

-

-

-

-

Respiratory distress of newborn (P22)....................

-

-

-

-

-

Bacterial sepsis of newborn (P36)........................

-

-

-

-

-

Neonatal hemorrhage (P50-P52, P54).......................

-

-

-

-

-

Diseases of the circulatory system (I00-I99).............

-

-

-

-

-

All other causes.........................................

1 *

1 *

1 *

-

-

Not stated birthweight All causes ..............................................

24

__________________________________________________________________________________________________________________ */Figure does not meet standard of reliability or precision; based on fewer than 20 death in the numerator. -/ Quality zero. ¹/ Includes Aleuts and Eskimos.

11/16/06

Page 1

Documentation Table 6. Unlinked infant deaths by race, age at death, and state of residence: United States and each state, 2004 [Infant deaths are under 1 year. Neonatal death are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Data in this table is for infant deaths in 2004 that are not included in the linked file because they were not linked with their corresponding birth certificates. See methodology section. Residence is of infant decedent; race is from death certificate] ________________________________________________________________________________________________________________________________ State and race of child 1/ Infant Total neonatal Early neonatal Late neonatal Postneonatal ________________________________________________________________________________________________________________________________ United States /2 Total White Black

308 191 100

226 144 72

199 132 60

27 12 12

82 47 28

Alabama Total White Black

-

-

-

-

-

Alaska Total White Black

-

-

-

-

-

Arizona Total White Black

8 5 1

3 2 -

1 1 -

2 1 -

5 3 1

Arkansas Total White Black

1 1 -

-

-

-

1 1 -

87 65 13

69 52 11

63 48 10

6 4 1

18 13 2

Colorado Total White Black

-

-

-

-

-

Connecticut Total White Black

-

-

-

-

-

Delaware Total White Black

-

-

-

-

-

Dist of Columbia Total White Black

-

-

-

-

-

Florida Total White Black

3 1 2

1 1

-

1 1

2 1 1

Georgia Total White Black

-

-

-

-

-

Hawaii Total White Black

-

-

-

-

-

California Total White Black

11/16/06

Page 2

Documentation Table 6. Unlinked infant deaths by race, age at death, and state of residence: United States and each state, 2004 [Infant deaths are under 1 year. Neonatal death are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Data in this table is for infant deaths in 2004 that are not included in the linked file because they were not linked with their corresponding birth certificates. See methodology section. Residence is of infant decedent; race is from death certificate] ________________________________________________________________________________________________________________________________ State and race of child 1/ Infant Total neonatal Early neonatal Late neonatal Postneonatal ________________________________________________________________________________________________________________________________ Idaho Total 1 1 White 1 1 Black Illinois Total White Black

31 13 17

15 8 7

11 6 5

4 2 2

16 5 10

Indiana Total White Black

4 3 1

2 2 -

2 2 -

-

2 1 1

Iowa Total White Black

-

-

-

-

-

Kansas Total White Black

-

-

-

-

-

Kentucky Total White Black

2 2 -

2 2 -

2 2 -

-

-

10 4 6

5 1 4

4 1 3

1 1

5 3 2

Maine Total White Black

-

-

-

-

-

Maryland Total White Black

-

-

-

-

-

12 9 3

6 5 1

5 5 -

1 1

6 4 2

Michigan Total White Black

-

-

-

-

-

Minnesota Total White Black

-

-

-

-

-

Mississippi Total White Black

3 1 2

-

-

-

3 1 2

Louisiana Total White Black

Massachusetts Total White Black

11/16/06

Page 3

Documentation Table 6. Unlinked infant deaths by race, age at death, and state of residence: United States and each state, 2004 [Infant deaths are under 1 year. Neonatal death are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Data in this table is for infant deaths in 2004 that are not included in the linked file because they were not linked with their corresponding birth certificates. See methodology section. Residence is of infant decedent; race is from death certificate] ________________________________________________________________________________________________________________________________ State and race of child 1/ Infant Total neonatal Early neonatal Late neonatal Postneonatal ________________________________________________________________________________________________________________________________ Missouri Total 1 1 1 White 1 1 1 Black Montana Total White Black

-

-

-

-

-

Nebraska Total White Black

1 1 -

1 1 -

1 1 -

-

-

Nevada Total White Black

1 1

-

-

-

1 1

New Hampshire Total White Black

-

-

-

-

-

New Jersey Total White Black

15 9 5

15 9 5

14 8 5

1 1 -

-

New Mexico Total White Black

-

-

-

-

-

17 9 6

14 8 5

13 8 5

1 -

3 1 1

New York City Total White Black

3 3 -

2 2 -

2 2 -

-

1 1 -

North Carolina Total White Black

-

-

-

-

-

North Dakota Total White Black

-

-

-

-

-

17 10 6

11 8 2

9 7 1

2 1 1

6 2 4

4 4 -

1 1 -

-

1 1 -

3 3 -

New York Total White Black

Ohio Total White Black Oklahoma Total White Black

11/16/06

Page 4

Documentation Table 6. Unlinked infant deaths by race, age at death, and state of residence: United States and each state, 2004 [Infant deaths are under 1 year. Neonatal death are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Data in this table is for infant deaths in 2004 that are not included in the linked file because they were not linked with their corresponding birth certificates. See methodology section. Residence is of infant decedent; race is from death certificate] ________________________________________________________________________________________________________________________________ State and race of child 1/ Infant Total neonatal Early neonatal Late neonatal Postneonatal ________________________________________________________________________________________________________________________________ Oregon Total 1 1 White 1 1 Black Pennsylvania Total White Black

4 1 3

3 1 2

3 1 2

-

1 1

Rhode Island Total White Black

-

-

-

-

-

South Carolina Total White Black

-

-

-

-

-

South Dakota Total White Black

-

-

-

-

-

Tennessee Total White Black

1 1 -

1 1 -

1 1 -

-

-

Texas Total White Black

80 46 33

73 40 33

66 38 28

7 2 5

7 6 -

Utah Total White Black

-

-

-

-

-

Vermont Total White Black

-

-

-

-

-

Virginia Total White Black

-

-

-

-

-

Washington Total White Black

1 1

1 1

1 1

-

-

West Virginia Total White Black

-

-

-

-

-

Wisconsin Total White Black

-

-

-

-

-

11/16/06

Page 5

Documentation Table 6. Unlinked infant deaths by race, age at death, and state of residence: United States and each state, 2004 [Infant deaths are under 1 year. Neonatal death are under 28 days; early neonatal, 0-6 days; late neonatal, 7-27 days; and postneonatal, 28 days through 11 months. Data in this table is for infant deaths in 2004 that are not included in the linked file because they were not linked with their corresponding birth certificates. See methodology section. Residence is of infant decedent; race is from death certificate] ________________________________________________________________________________________________________________________________ State and race of child 1/ Infant Total neonatal Early neonatal Late neonatal Postneonatal ________________________________________________________________________________________________________________________________ Wyoming Total White Black Foreign Residents Total White Black

-

-

-

-

-

Puerto Rico Total White Black

2 1 1

-

-

-

2 1 1

Virgin Islands Total White Black

-

-

-

-

-

Guam Total White Black ____________________________________________________________________________________________________________________________ 1/ Totals for geographic areas include races other than white and black. 2/ Excludes data for foreign residents, Puerto Rico, Virgin Islands and Guam.

Volume 55, Number 14

Revised as of June 13, 2007

May 2, 2007

Infant Mortality Statistics from the 2004 Period Linked Birth/Infant Death Data Set by T.J. Mathews, M.S., and Marian F. MacDorman, Ph.D., Division of Vital Statistics

Abstract Objectives—This report presents 2004 period infant mortality statistics from the linked birth/infant death data file by a variety of maternal and infant characteristics. The linked file differs from the mortality file, which is based entirely on death certificate data. Methods—Descriptive tabulations of data are presented and inter­ preted. Excluding rates by cause of death, the infant mortality rate is now published with two decimal places. Results—The U.S. infant mortality rate was 6.78 infant deaths per 1,000 live births in 2004 compared with 6.84 in 2003. Infant mortality rates ranged from 4.67 per 1,000 live births for Asian and Pacific

Non-Hispanic black

Islander mothers to 13.60 for non-Hispanic black mothers. Among Hispanics, rates ranged from 4.55 for Cuban mothers to 7.82 for Puerto Rican mothers. Infant mortality rates were higher for those infants whose mothers were born in the 50 states and the District of Columbia, were unmarried, or were born in multiple births. Infant mortality was also higher for male infants and infants born preterm or at low birthweight. The neonatal mortality rate declined from 4.63 in 2003 to 4.52 in 2004 while the postneonatal mortality rate was essentially unchanged. Infants born at the lowest gestational ages and birthweights have a large impact on overall U.S. infant mortality. More than one-half (55 per­ cent) of all infant deaths in the United States in 2004 occurred to the

Hispanic2

Non-Hispanic white

Total

American Indian or Alaska Native1

Asian or Pacific Islander1

Rate per 1,000 live births

15

12

9

6

0 1995 1 2

1996

1997

1998

1999 Year

Includes persons of Hispanic and Non-Hispanic origin. Persons of Hispanic origin may be of any race. SOURCE: National Vital Statistics System, NCHS, CDC.

Figure 1. Infant mortality rates by race and ethnicity, 1995–2004

2000

2001

2002

2003

2004

2

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

certificate to conduct more detailed analyses of infant mortality patterns. This report presents infant mortality data by race and Hispanic origin of the mother, birthweight, period of gestation, sex of infant, plurality, maternal age, live-birth order, mother’s marital status, mother’s place of birth, age at death, and underlying cause of death (Tables 1–8, A–E, and Figures 1–4). Other variables available in the linked file data set (1), but which are not discussed in this report, include: father’s age, race, and Hispanic origin; birth attendant; place of delivery; mother’s weight gain during pregnancy; and many medical and health measurements. Several states have implemented the 2003 revised birth certificate. Three key data items are consid­ ered noncomparable between the 1989 and 2003 revisions: trimester of pregnancy prenatal care began, maternal educational attainment, and maternal smoking during pregnancy (2). They are not shown or discussed in the same detail as in previous years. Another report, based on data from the vital statistics mortality file, provides further information on trends in infant mortality and on causes of infant death (3). Some rates calculated from the mortality file differ from those published using the linked birth/infant death file (linked file). The linked file is used for analysis and for calculating infant mortality rates by race and ethnicity, which are more accurately measured from the birth certificate. A more detailed discussion of the differences in the number of infant deaths and infant mortality rates between the linked file and the mortality file is presented in the ‘‘Technical Notes.’’

2 percent of infants born at less than 32 weeks of gestation. Still, infant mortality rates for late preterm (34–36 weeks of gestation) infants were three times those for term (37–41 week) infants. The three leading causes of infant death—Congenital malformations, low birthweight, and SIDS—taken together accounted for 45 percent all infant deaths. Results from a new analysis of preterm-related causes of death show that 36.5 percent of infant deaths in 2004 were due to preterm-related causes. The preterm-related infant mortality rate for non-Hispanic black mothers was 3.5 times higher, and the rate for Puerto Rican mothers was 75 percent higher than for non-Hispanic white mothers. Keywords: infant mortality c infant health c birthweight c gestational age c maternal characteristics

Introduction This report presents infant mortality data from the 2004 period linked file. In the linked file the information from the death certificate is linked to information from the birth certificate for each infant under 1 year of age who died in the 50 states, the District of Columbia, Puerto Rico, the Virgin Islands, or Guam during 2004. Linked birth/infant death data are not available for American Samoa and the Commonwealth of the Northern Marianas. The purpose of the linkage is to use the many additional variables available from the birth

WA MT

ME

ND MN

OR ID

VT

SD

WI

NY MI

WY IA

NV

PA

NE UT

IL CO

CA

KS

OH

IN

DE WV

MO

KY

OK

NM

AR

MD

SC MS

TX

VA NC

TN AZ

NJ

AL

GA

LA FL

AK

9.00 or more 8.00–8.99 7.00–7.99 HI

6.00–6.99 5.00–5.99 Less than 5.00 United States infant mortality rate=6.86 (2002–2004)

SOURCE: National Vital Statistics System, NCHS, CDC.

Figure 2. Infant mortality rates by state, 2002–2004

NH MA RI CT

DC

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

3

1,000 849.56 Rate per 1,000 live births

800

600 480.49 400

200

155.91 67.81

0

Less than 500

500–749

750–999

1,000– 1,249

45.11 1,250– 1,499

1,500– 1,749

1,750– 1,999

27.35 2,000– 2,249

11.01 2,250– 2,499

2.26 2,500 and over 2,499

Birthweight in grams SOURCE: National Vital Statistics System, NCHS, CDC.

Figure 3. Infant mortality rates by birthweight: United States, 2004

Methods Data shown in this report are based on birth and infant death certificates registered in all states, the District of Columbia, Puerto Rico, the Virgin Islands, and Guam. As part of the Vital Statistics Cooperative Program (VSCP), each state provided to the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) matching birth and death certificate numbers for each infant under 1 year of age who died in the state during 2004. When the birth and death occurred in different states, the state of death was responsible for contacting the state of birth identified on the death certificate to obtain the original birth certificate number. NCHS used the matching birth and death certificate numbers provided by the states to extract final edited data from the NCHS natality and mortality statistical files. These data were linked to form a single statistical record, thereby establishing a national linked record file. After the initial linkage, NCHS returned computer lists of unlinked infant death records and records with inconsistent data between the birth and death certificates to each state. State additions and correc­ tions were incorporated, and a final national linked file was produced. In 2004, 98.9 percent of all infant death records were successfully matched to their corresponding birth records. Records were weighted to adjust for the 1.1 percent of infant death records that were not linked to their corresponding birth certificates (see the ‘‘Technical Notes’’). Information on births by age, race, or marital status of mother is imputed if it is not reported on the birth certificate. These items were not reported for less than 1 percent of U.S. births in 2004 (2). Race and Hispanic origin are reported independently on the birth certificate. In tabulations of birth data by race and Hispanic origin, data for Hispanic persons are not further classified by race as the vast majority of women of Hispanic origin are reported as white. Data for

American Indian and Asian or Pacific Islander (API) births are not shown separately by Hispanic origin because the vast majority of these populations are non-Hispanic. Starting with data year 1999 cause-of-death statistics in this and similar publications are classified in accordance with the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD–10) (4). Issues of this report for data years previous to 1999 included causes of death classified according to the Manual of the International Statistical Classification of Diseases, Inju­ ries, and Causes of Death, Ninth Revision (ICD–9) (5). Issues related to comparability between ICD revisions are discussed in the ‘‘Technical Notes.’’ A new grouping of preterm-related causes of death was added to the report this year; see ‘‘Technical Notes.’’ This report includes data for seven states, Idaho, Kentucky, New York (but not New York City), Pennsylvania, South Carolina, Ten­ nessee, and Washington, that implemented the 2003 revision of the U.S. Standard Certificate of Live Birth on either January 1, 2003, or January 1, 2004, (revised). Two additional States, Florida and New Hampshire, implemented the revision in 2004 but after January 1. The remaining reporting areas include data that are based on the 1989 revision of the U.S. Standard Certificate of Live Birth (unrevised). Revised and unrevised data are combined when comparable. See Births: Final Data for 2004 for more information (2). Data for educational attainment, prenatal care, and tobacco use, although collected on both the revised and unrevised certificates are not considered to be comparable between revisions. For educational attainment and prenatal care, unrevised data for 41 States, New York City, and the District of Columbia are included in this report. For tobacco use, unrevised data for 40 states, New York City, and the District of Columbia are included as California did not report tobacco use in 2004; see ‘‘Technical Notes.’’

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National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Rate per 1,000 live births

15

Total

13.60

10

8.45

Preterm-related

7.82 6.78

6.29

5.66

5.47

4.67

5 3.19 1.89

0

Non-Hispanic black

American Indian or Alaska Native1

Puerto Rican

2.48

Total

1.82

Non-Hispanic white

1.76

Mexican

1.65

Asian or Pacific Islander1

Race and ethnicity 1

Includes persons of Hispanic and Non-Hispanic origin.

NOTE: Preterm-related deaths are those where the infant was born preterm (before 37 completed weeks of gestation) with underlying cause of death assigned to one of the following ICD–10

categories: K550, P000, P010, P011, P015, P020, P021, P027, P070–P073, P102, P220–P229, P250–279, P280, P281, P360–P369, P520–P523, P77; see “Technical Notes.”

SOURCE: National Vital Statistics System, NCHS, CDC.

Figure 4. Total and preterm-related infant mortality rates by race and ethnicity of mother: United States, 2004

Data by maternal and infant characteristics This report presents descriptive tabulations of infant mortality data by a variety of maternal and infant characteristics. These tabulations are useful for understanding the basic relationships between risk factors and infant mortality, unadjusted for the possible effects of other variables. In reality, women with one risk factor often have other risk factors as well. For example, teenage mothers are more likely to also be unmarried and of a low-income status and mothers who do not receive prenatal care are more likely to be of a low-income status and uninsured. The preferred method for disentan­ gling the multiple interrelationships among risk factors is multivariate analysis; however, an understanding of the basic relationships between risk factors and infant mortality is a necessary precursor to more sophisticated types of analyses, and is the aim of this publication. Race and Hispanic origin data—Infant mortality rates are pre­ sented here by race and detailed Hispanic origin of mother. The linked file is particularly useful for computing accurate infant mortality rates for this purpose because the race and Hispanic origin of the mother from the birth certificate is used in both the numerator and denominator of the infant mortality rate. In contrast, for the vital statistics mortality file, race information for the denominator is the race of the mother as reported on the birth certificate, whereas the race information for the numerator is the race of the decedent as reported on the death certificate (1,6). Thus, standard infant mortality rates can be based on inconsistent race information. In addition, race information from the birth certificate reported by the mother is generally considered to be more reliable than that from the death certificate where the race and ethnicity of the deceased infant is reported by the funeral director based on information provided by an informant or on observation. These different reporting methods can lead to differences in race and ethnic specific infant mortality rates between the two data files (3,6).

The 2003 revision of the U.S. Standard Certificate of Live Birth allows the reporting of more than one race (multiple races) for each parent (7). Information on this change is presented in a recent report (2). Fifteen states reported multiple race on their birth certificate for either part or all of 2004. To provide uniformity and comparability of the data, multiple race is imputed to a single race see ‘‘Technical Notes.’’ Statistical significance—Text statements have been tested for statistical significance, and a statement that a given infant mortality rate is higher or lower than another rate indicates that the rates are significantly different. Information on the methods used to test for statistical significance, as well as information on differences between period and cohort data, the weighting of the linked file, and a com­ parison of infant mortality data between the linked file and the vital statistics mortality file are presented in the ‘‘Technical Notes.’’ Additional information on maternal age, marital status, period of gestation, birthweight, and cause-of-death classification is also presented in the ‘‘Technical Notes.’’

Results and Discussion Trends in Infant mortality The overall 2004 infant mortality rate from the linked file was 6.78 infant deaths per 1,000 live births, lower but not significantly than the rate in 2003 (6.84) but the lowest rate ever reported (Table C) (the overall rate in 2004 was 6.79 from the mortality file). Infant mortality rates for race and Hispanic origin groups were not significantly different in 2004 compared with 2003 (Figure 1 and Table C). The neonatal mortality rate declined from 4.63 in 2003 to 4.52 in 2004. The postneonatal mortality rate was essentially unchanged over the same time period. Although the infant mortality rate was 10 percent lower in 2004 than in 1995 (7.57), the rate has not declined much since 2000 (6.89)

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

(Table C). During this 9-year period, decreases have been observed for all race and ethnic groups, although not all had significant declines. Significant declines were observed for infants of Central and South American (16 percent), Puerto Rican (12 percent), Asian or Pacific Islander (11 percent), non-Hispanic white (10 percent), Mexican (9 per­ cent), and non-Hispanic black mothers (7 percent).

Infant mortality by race and Hispanic origin of mother As in past years, there continues to be a wide variation in infant mortality rates by race and Hispanic origin of mother (8). The highest rate, 13.60 per 1,000 live births, was for infants of non-Hispanic black mothers, nearly three times greater than the lowest rate of 4.55 for infants of Cuban mothers. Rates were also fairly high for infants of American Indian (8.45) and Puerto Rican (7.82) mothers (Tables A–C). Rates were intermediate, but all below the U.S. rate, for infants of non-Hispanic white (5.66) and Mexican mothers (5.47). Central and South American (4.65) and Asian or Pacific Islanders mothers (4.67) also had low rates (Tables A–C).

Infant mortality by state Between 2003 and 2004 an equal number of states had decreases and increases in the infant mortality rate, although almost all these changes were not statistically significant. One state had a significant increase, Louisiana (12 percent), and two, Hawaii and Michigan, had significant declines of 24 and 12 percent, respectively (detailed data not shown). To obtain statistically reliable rates by race and Hispanic origin, 3 years of data were combined (Figure 2 and Table 3). Infant mortality rates ranged from 10.32 for Mississippi to 4.68 for Vermont. The highest rate noted (11.42) was for the District of Columbia (DC); however, the rate for the District of Columbia is more appropriately compared with rates for other large U.S. cities, because of the high concentrations of high-risk women in these areas. For infants of non-Hispanic black mothers, mortality rates ranged from 17.57 in Wisconsin to 8.75 in Minnesota. For infants of nonHispanic white mothers, West Virginia had the highest infant mortality rate (7.67) and New Jersey had the lowest rate (3.80). The rate for DC was 3.76. For infants of American Indian and Asian or Pacific Islander mothers, mortality rates could be reliably computed for only 15 and 29 states, respectively. For infants of American Indian mothers, mortality rates ranged from 13.51 in South Dakota to 6.29 in California. Overall, infant mortality rates for infants of Asian or Pacific Islander mothers were the lowest, ranging from 7.76 in South Carolina to 3.46 in Massachusetts.

Sex of infant In 2004, the overall infant mortality rate for female infants was 6.08 per 1,000, 18 percent lower than the rate for male infants (7.44). Infant mortality rates were higher for male than female infants in each race group (Table 1). Among Hispanics, this difference was not significant for infants of Central and South American mothers (Table 2).

5

Multiple births For multiple births, the infant mortality rate was 30.46, more than five times the rate of 5.94 for single births (Tables 1 and 2). Infant mortality rates for multiple births were higher than rates for single births for all race and Hispanic-origin groups, except for Cubans for whom rates could not be reliably computed due to small numbers of events. The risk of infant death increases with the increasing number of infants in the pregnancy. In 2004, the infant mortality rate for twins (28.70) was nearly five times the rate for single births (5.94). The rate for triplets (55.53) was nine times, and the rate for quadruplets (166.74) was 28 times higher than the rate for single births (tabular data not shown). A reliable infant mortality rate for quintuplet and higher order births could not be computed due to small numbers of infant deaths for that category. Changes in infant mortality rates from 2003–2004 for specific plurality categories were not statistically significant. Multiple pregnancy can lead to an accentuation of maternal risks and complications associated with pregnancy (2,9,10). For example, multiple births are much more likely to be born preterm and at low birthweight than single births (2,9,10). The higher risk profile of multiple births has a substantial impact on overall infant mortality (9,11,12). For example, in 2004 multiples accounted for 3 percent of all live births, but 15 percent of all infant deaths in the United States (Table 1).

Age at death In 2004, more than two-thirds of all infant deaths (18,602 out of 27,860) occurred during the neonatal period (from birth through 27 days of age). In 2004, the neonatal mortality rate of 4.52 deaths per 1,000 live births was more than 2 percent lower than the 2003 rate of 4.63. The 2004 postneonatal (28 days to under 1 year) mortality rate (2.25) was essentially unchanged from the previous year (2.22). The neonatal mortality rate for infants of non-Hispanic black mothers (9.13) was more than twice those for non-Hispanic white (3.70), Asian or Pacific Islander (3.20), Mexican (3.74), Central and South American (3.43), and Cuban women (2.81). Neonatal mortality rates for Puerto Rican (5.34) and American Indian (4.26) women were intermediate between these two groups. Infants of non-Hispanic black and American Indian mothers had the highest postneonatal mortality rates of any group (4.47 and 4.19, respectively)—more than twice those for non-Hispanic white, Asian or Pacific Islander, Mexican, and Central and South American women. Postneonatal mortality rates were inter­ mediate for Puerto Rican women (2.48) (Tables A and B).

Birthweight and period of gestation Birthweight and period of gestation are the two most important predictors of an infant’s subsequent health and survival. Infants born too small and/or too soon have a much greater risk of death and both short-term and long-term disability than those born at term (37–41 weeks of gestation) or with birthweights of 2,500 grams or more (13–17). Because of their much greater risk of death, infants born at the lowest birthweights and gestational ages have a large impact on overall U.S. infant mortality. For example, infants born weighing less than 1,000

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National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Table A. Infant, neonatal, and postneonatal deaths and mortality rates by race of mother: United States, 2004 linked file Number of deaths Race of mother All races . . . . . . . . . . White . . . . . . . . . . . . Black . . . . . . . . . . . . American Indian1 . . . . . Asian or Pacific Islander. 1

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

Mortality rate per 1,000 live births

Live births

Infant

Neonatal

Postneonatal

Infant

Neonatal

Postneonatal

4,112,055 3,222,929 616,076 43,927 229,123

27,860 18,257 8,162 371 1,070

18,602 12,178 5,505 187 733

9,258 6,080 2,657 184 337

6.78 5.66 13.25 8.45 4.67

4.52 3.78 8.94 4.26 3.20

2.25

1.89

4.31

4.19

1.47

Includes Aleuts and Eskimos.

NOTES: Infant deaths are weighted so numbers may not exactly add to totals due to rounding. Neonatal is less than 28 days and postneonatal is 28 days to under 1 year. Race and Hispanic origin are reported separately on birth certificates. Race categories are consistent with the 1977 Office of Management and Budget standards. Fifteen states reported multiple-race data on the birth certificate for 2004. The multiple-race data for these states were bridged to the single-race categories of the 1977 standards for comparability with other states; see reference 2.

Table B. Infant, neonatal, and postneonatal deaths and mortality rates by Hispanic origin of mother and by race of mother for mothers of non-Hispanic origin: United States, 2004 linked file Number of deaths Hispanic origin and race of mother All origins1 . . . . . . . . . . . . . Total Hispanic . . . . . . . . . . . Mexican . . . . . . . . . . . . . Puerto Rican . . . . . . . . . . Cuban . . . . . . . . . . . . . . Central and South American . Other and unknown Hispanic Non-Hispanic total2 . . . . . . . . Non-Hispanic white . . . . . . Non-Hispanic black . . . . . . Not stated . . . . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

Mortality rate per 1,000 live births

Live births

Infant

Neonatal

Postneonatal

Infant

Neonatal

Postneonatal

4,112,055 946,349 677,621 61,221 14,943 143,520 49,044 3,133,128 2,296,684 578,774 32,578

27,860 5,248 3,705 479 68 667 330 22,203 13,001 7,869 409

18,602 3,627 2,535 327 42 492 232 14,633 8,499 5,283 341

9,258 1,621 1,170 152 26 175 98 7,570 4,502 2,586 68

6.78 5.55 5.47 7.82 4.55 4.65 6.73 7.09 5.66 13.60 ...

4.52 3.83 3.74 5.34 2.81 3.43 4.73 4.67 3.70 9.13 ...

2.25 1.71 1.73 2.48 1.74 1.22 2.00 2.42 1.96 4.47 ...

. . . Category not applicable.

Origin of mother not stated included in ‘‘All origins’’ but not distributed among origins.

2 Includes races other than white or black.

1

NOTE: Infant deaths are weighted so numbers may not exactly add to totals due to rounding. Neonatal is less than 28 days and postneonatal is 28 days to under 1 year. Race and Hispanic origin are

reported separately on birth certificates. Race categories are consistent with the 1977 Office of Management and Budget standards. Persons of Hispanic origin may be of any race. In this table

Hispanic women are classified only by place of origin; non-Hispanic women are classified by race; see reference 2.

Table C. Infant mortality rates by race and Hispanic origin of mother: United States, 1995–2004 linked files Race and Hispanic origin of mother All races . . . . . . . . . . . . . . White . . . . . . . . . . . . . . . . Black . . . . . . . . . . . . . . . . American Indian1 . . . . . . . . . Asian or Pacific Islander. . . . . Hispanic . . . . . . . . . . . . . . Mexican . . . . . . . . . . . . . Puerto Rican . . . . . . . . . . Cuban . . . . . . . . . . . . . . Central and South American . Non-Hispanic white . . . . . . . . Non-Hispanic black . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

Percent Change 1995 to 2004

7.57 6.30 14.58 9.04 5.27 6.27 6.03 8.88 5.29 5.52 6.28 14.65

7.30 6.07 14.13 9.95 5.20 6.05 5.84 8.60 5.07 5.02 6.04 14.20

7.21 6.05 13.69 8.69 4.98 5.95 5.83 7.86 5.51 5.45 6.02 13.72

7.19 5.96 13.80 9.34 5.54 5.76 5.60 7.78 3.63 5.28 5.98 13.88

7.04 5.79 13.99 9.29 4.85 5.71 5.51 8.35 4.66 4.68 5.76 14.14

6.89 5.71 13.48 8.30 4.87 5.59 5.43 8.21 4.54 4.64 5.70 13.59

6.84 5.69 13.34 9.65 4.73 5.44 5.22 8.53 4.28 4.98 5.72 13.46

6.95 5.79 13.81 8.64 4.77 5.62 5.42 8.20 3.72 5.06 5.80 13.89

6.84 5.72 13.50 8.73 4.83 5.65 5.49 8.18 4.57 5.04 5.70 13.60

6.78 5.66 13.25 8.45 4.67 5.55 5.47 7.82 4.55 4.65 5.66 13.60

–10.4** –10.2** –9.1** –6.5 –11.4** –11.5** –9.3** –11.9** –14.0 –15.8** –9.9** –7.2**

Percent Change 2003 to 2004 –0.9 –1.0 –1.9 –3.2 –3.3 –1.8 –0.4 –4.4 –0.4 –7.7 –0.7 0.0

** Significant at p <.05. 1 Includes Aleuts and Eskimos. NOTES: Race and Hispanic origin are reported separately on birth certificates. Race categories are consistent with the 1977 Office of Management and Budget standards. Persons of Hispanic origin may be of any race. In this table Hispanic women are classified only by place of origin; non-Hispanic women are classified by race. Fifteen states reported multiple-race data on the birth certificate for 2004. The multiple-race data for these states were bridged to the single-race categories of the 1977 standards for comparability with other states; see reference 2.

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

grams accounted for only 0.8 percent of births, but nearly one-half (48.4 percent) of all infant deaths in the United States in 2004 (Table D). Conversely, 91.9 percent of infants born in the United States in 2004 weighed 2,500 grams or more, but these infants accounted for only 30.7 percent of infant deaths. A similar pattern is found when data by period of gestation were examined. Births at less than 28 weeks of gestation accounted for 0.8 percent of all live births, and 46.3 percent of all infant deaths in the United States in 2004 (tabular data not shown). The percent of preterm and low birthweight births has been increasing steadily since the mid-1980s (2). A portion of the increase is related to an increase in multiple births (in part due to increases in the use of assisted reproductive therapies (ART)), and to changes in the medical management of pregnancy (i.e., increases in cesarean section and induction of labor for preterm infants) (2, 18–20). The percentage of infants born at low birthweight (less than 2,500 grams) varied greatly by race and ethnicity, from a low of 6.5 percent for births to Mexican mothers to a high of 13.8 percent for births to non-Hispanic black mothers (Tables 4 and 5). The percent of preterm births (those born before 37 completed weeks of gestation) ranged from 10.5 percent for births to Asian or Pacific Islander mothers to 17.9 per­ cent for births to non-Hispanic black mothers. These differences in low birthweight and preterm births in turn are major factors in the differ­ ences in infant mortality rates. For all race and ethnic groups studied, infant mortality rates were much higher for low birthweight infants (57.64) than for infants with birthweights of 2,500 grams or more (2.26). Overall, the infant mortality rate for very low birthweight infants (those with birthweights of less than 1,500 grams) was 244.50, more than 100 times the rate for infants with birthweights of 2,500 grams or more (Table 6). At least 85 percent of infants with birthweights of less than 500 grams (1 lb. 1 oz. or less) died within the first year of life (Figure 3 and Table 6). Reporting of deaths among these very small infants may be incomplete (data not shown). An infant’s chances of survival increase rapidly with increasing birthweight. Infant mortality rates were lowest at birthweights of 3,000–4,999 grams (Table 6). The infant mortality rate for very low birthweight infants declined by 3 percent from 252.00 in 2003 to 244.50 in 2004. Previously, the infant mortality rate for very low birthweight infants had increased from 2000–2003. The rate in 2004 was similar to the rate in 2000 and 2001. The percentage of live births born at very low birthweight has been edging upwards, from 1.45 percent of live births in 2000 to 1.51 percent of births in 2004, as has the percentage of infant deaths (from 52.1 per­ cent in 2000 to 54.4 percent in 2004) (Table D). Trends in birthweight specific infant mortality rates for the period 1995 to 2004 are shown in Table 6. Overall rates have generally declined during this period; declines were larger for higher birthweights. For the total population, non-Hispanic white, non-Hispanic black, and Hispanic mothers, declines were generally largest for infants weighing 2,500–4,499 grams (Table 6). In 2004, the infant mortality rate for very preterm infants (less than 32 weeks of gestation) was 182.45, 76 times the rate of 2.39 for term infants (Tables 1 and 2). The infant mortality rate for very preterm infants declined by 3 percent from 188.24 in 2003. Previously, the infant mortality rate for very preterm infants had increased by 4 percent from 180.95 in 2000 (12). Although the highest risk of death is found for the most preterm infants, infants born shortly before term (at 34–36 weeks of gestation) have mortality rates three times those for term infants (37–41 weeks). Even within the term period, infants born at 37–39

7

weeks of gestation have mortality rates 30 percent higher than those born at 40–41 weeks of gestation.

Prenatal care This report includes data on the timing of prenatal care based on the 1989 Revision of the U.S. Standard Certificate of Live Birth (unrevised data) as reported by 41 States, New York City, and the District of Columbia; see ‘‘Technical Notes.’’ Although difficult to measure, the timing and quality of prenatal care received by the mother during pregnancy can be important to the infant’s subsequent health and survival (21–24). Early comprehensive prenatal care can promote healthier pregnancies by providing health behavior advice, early detection and treatment of risk factors and symptoms, and monitoring (21,22). The initiation and subsequent uti­ lization of prenatal care is also viewed as an indicator for access to care (24). In 2004, for the 41-state reporting area for which comparable data are available, the mortality rate for infants of mothers who began prenatal care after the first trimester of pregnancy or had no care at all, was 8.35 per 1,000 (Table E). This rate was 37 percent higher than the rate for infants of mothers whose care began in the first trimester (6.11).

Maternal age Infant mortality rates vary with maternal age; infants of teenage mothers and mothers aged 40 and over have the highest rates (9.75 and 8.81, respectively). The lowest rates are for infants of mothers in their late twenties and early thirties (Tables 1 and 2). In 2004, among births to teenagers, infants of the youngest mothers (under 15 years) had the highest rate (17.11). The rate for infants of mothers aged 15–17 years was 10.37; the rate for infants of mothers aged 18–19 years was 9.28 (tabular data not shown). Within racial and ethnic subgroups, among groups for which rates could be reliably computed, infant mortality rates for births to nonHispanic white mothers under 20 years of age were higher than for mothers aged 40 and over. In contrast, for Mexican mothers, rates for births to the oldest mothers were higher than rates for infants of teenagers. Studies suggest that the higher mortality risk for infants of younger mothers may be related to socioeconomic factors as well as biologic immaturity (25); young maternal age might be a marker for poverty (26). Among older mothers, especially for those having a first-time birth, infants are at an increased risk of prematurity and low birthweight and thus tend to have higher infant mortality rates (27). Multiple births are also a well known risk factor for infant mortality in older mothers (2).

Maternal education Information on educational attainment is reported on both the 2003 Standard Certificate of Live Birth (revised) and 1989 Standard Certificate of Live Birth (unrevised) (2). However, the format of the education item on the revised standard certificate substantively differs from that of the unrevised standard certificate leading to noncomparable data (see ‘‘Technical Notes’’). For 2004, unrevised data are available for 41 states, New York City, and the District of Columbia (80 percent of all 2004 births).

8

Table D. Selected perinatal events by birthweight: United States, 1999–2004 linked files Very low birthweight

Year

Total

Total low birthweight

Total very low birthweight

Less than 500 grams

500–749 grams

750–999 grams

Moderately low birthweight

1,000–1,249 grams

1,250–1,499 grams

Total moderately low birthweight

1,500–1,999 grams

2,000–2,499 grams

2,500 grams or more

Infant mortality rate1 2004. 2003. 2002. 2001. 2000. 1999. 2004. 2003. 2002. 2001. 2000. 1999. 2004. 2003. 2002. 2001. 2000. 1999. 2004. 2003. 2002. 2001. 2000. 1999. 2004. 2003. 2002. 2001. 2000. 1999. 1

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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.78 6.84 6.95 6.84 6.89 7.04 27,860 27,995 27,970 27,523 27,960 27,864 100.0 100.0 100.0 100.0 100.0 100.0 4,112,055 4,090,007 4,021,825 4,026,036 4,058,882 3,959,417 100.0 100.0 100.0 100.0 100.0 100.0

57.64 59.04 59.54 58.60 59.40 60.48 19,218 19,223 18,758 18,151 18,299 18,273 68.98 68.67 67.97 66.88 66.40 66.52 333,427 325,619 315,028 309,760 308,074 302,113 8.11 7.96 7.84 7.70 7.60 7.64

244.50 252.00 250.75 244.37 244.26 246.96 15,155 15,247 14,885 14,345 14,365 14,380 54.40 54.46 53.93 52.86 52.13 52.35 61,983 60,505 59,361 58,702 58,810 58,227 1.51 1.48 1.48 1.46 1.45 1.47

849.56 865.44 861.95 855.04 846.08 855.97 5,907 6,110 5,844 5,515 5,420 5,408 21.20 21.83 21.17 20.32 19.67 19.69 6,953 7,060 6,780 6,450 6,406 6,318 0.17 0.17 0.17 0.16 0.16 0.16

480.49 476.68 489.64 476.76 476.25 485.45 5,602 5,489 5,528 5,283 5,325 5,507

155.91 163.72 155.13 154.13 155.84 151.56

20.11 19.61 20.03 19.47 19.32 20.05

Percent distribution 6.90 6.95 6.63 6.73 6.75 6.48

11,659 11,515 11,290 11,081 11,181 11,344

Number 12,321 11,892 11,803 11,847 11,942 11,738

0.28 0.28 0.28 0.28 0.28 0.29

45.11 46.03 45.69 45.64 45.59 48.73

14.97 14.99 15.15 15.16 15.78 15.96

27.35 27.88 26.51 27.24 28.28 28.76

11.01 10.90 11.53 11.29 11.74 11.82

2.26 2.29 2.39 2.42 2.47 2.52

758 755 726 719 726 756

4,064 3,975 3,873 3,806 3,933 3,893

1,800 1,781 1,636 1,658 1,721 1,714

2,264 2,194 2,237 2,148 2,212 2,179

8,528 8,603 8,840 8,989 9,259 9,197

of infant deaths3 3.47 2.72 3.38 2.70 3.46 2.63 3.69 2.65 3.75 2.63 3.39 2.75

14.59 14.20 14.03 14.02 14.27 14.17

6.46 6.36 5.93 6.11 6.25 6.24

8.13 7.84 8.11 7.91 8.03 7.93

30.61 30.73 32.03 33.12 33.60 33.48

16,805 16,403 15,889 15,752 15,926 15,513

271,444 265,114 255,667 251,058 249,264 243,886

65,821 63,891 61,705 60,858 60,864 59,599

205,623 201,223 193,962 190,200 188,400 184,287

3,778,051 3,763,758 3,705,556 3,714,965 3,748,046 3,654,764

0.41 0.40 0.40 0.39 0.39 0.39

6.60 6.48 6.36 6.24 6.15 6.16

1.60 1.56 1.53 1.51 1.50 1.51

5.00 4.92 4.82 4.73 4.64 4.66

91.88 92.02 92.16 92.30 92.40 92.36

Number of infant deaths2 1,921 966 1,947 945 1,831 956 1,826 1,001 1,861 1,033 1,779 930

of births2 14,245 13,635 13,599 13,572 13,355 13,314

Percent distribution of births3 0.30 0.35 0.29 0.33 0.29 0.34 0.29 0.34 0.29 0.33 0.30 0.34

Infant mortality rates are deaths less than 1 year per 1,000 live births in specified group.

Infant deaths and births with not stated birthweight included in totals.

3 Infant deaths and births with not stated birthweight are subtracted from the total number of events used as denominators for percentage computations.

2

67.81 69.31 70.30 73.75 77.35 69.85

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Low birthweight

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

For the 41-state reporting area described previously, the infant mortality rate for mothers who completed 16 or more years of school was 4.17 in 2004. This rate was 49 percent lower than the rate for mothers who completed less than 12 years of education (8.12) (Table E). Infant mortality rates generally decreased with increasing edu­ cational level. This pattern may reflect the effects of more education as well as socioeconomic differences; women with more education tend to have higher income levels (28).

9

infants of mothers who smoked was 11.14, 70 percent higher than the rate of 6.54 for nonsmokers (Table E). Tobacco use during pregnancy causes the passage of substances such as nicotine, hydrogen cyanide, and carbon monoxide from the placenta into the fetal blood supply. These substances restrict the growing infant’s access to oxygen and can lead to adverse pregnancy and birth outcomes such as low birthweight, preterm delivery, intrau­ terine growth retardation, and infant mortality (36,37). Maternal smoking has also been shown to increase the risk of respiratory infections and inhibit allergic immune responses in infants (38,39).

Live birth order Infant mortality rates were generally higher for first births than for second births, and then generally increased as birth order increased (Tables 1 and 2). Overall, the infant mortality rate for first births (6.74) was 13 percent higher than for second births (5.99). The rate for fifth and higher order births (10.64) was 72 percent higher than the rate for second births. The higher parities and therefore the highest order births (5th child and above) are more likely to be associated with older maternal age, multiple births, and lower socioeconomic status (2,29).

Marital status Marital status may be a marker for the presence or absence of social, emotional, and financial resources (30, 31). Infants of mothers who are not married have been shown to be at higher risk for poor outcomes (32,33). In 2004, infants of married mothers had an infant mortality rate of 5.30 per 1,000, 44 percent lower than the rate for infants of unmarried mothers (9.43) (Tables 1 and 2). Within each race and Hispanic origin group, infants of unmarried mothers had higher rates of mortality and with the exception of Cuban and Central and South American infants, these differences were significant.

Nativity In 2004 the infant mortality rate for mothers born in the 50 states and the District of Columbia (7.14) was 39 percent higher than the rate for mothers born elsewhere (5.12). Among race and Hispanic origin groups for whom infant mortality rates could be calculated all had higher infant mortality rates for mothers born in the 50 states and the District of Columbia (the difference was not significant for Puerto Rican, Cuban, and Central and South American mothers—the latter two have almost no difference) (Tables 1 and 2). A variety of different hypotheses have been advanced to account for the lower infant mortality rate among infants of mothers born outside the 50 states and the District of Columbia, including possible differ­ ences in migration selectivity, social support, and risk behaviors (34). Also, women born outside the 50 states and the District of Columbia have been shown to have different characteristics than their U.S. born counterparts with regard to socioeconomic and educational status (35).

Maternal smoking Data on maternal smoking during pregnancy are shown for 40 states, New York City, and the District of Columbia (unrevised data); see ‘‘Technical Notes.’’ For this area, the infant mortality rate for

Leading causes of infant death Infant mortality rates for the five leading causes of infant death are presented in Table 7 by race and Hispanic origin of mother. The leading cause of infant death in the United States in 2004 was Congenital malformations, deformations and chromosomal abnormali­ ties (congenital malformations), accounting for 20 percent of all infant deaths. Disorders relating to short gestation and low birthweight, not elsewhere classified (low birthweight) was second, accounting for 17 percent of all infant deaths, followed by Sudden infant death syndrome (SIDS) accounting for 8 percent of infant deaths. The fourth and fifth leading causes—Newborn affected by maternal complications of pregnancy (maternal complications), and Accidents (unintentional injuries), accounted for 6 and 4 percent, respectively, of all infant deaths in 2004. Together the five leading causes accounted for 55 percent of all infant deaths in the United States in 2003. The order of the top four leading causes was the same as in 2003. The fifth leading cause of death in 2004 was unintentional injuries, which was ranked sixth in 2003. Complications of placenta, cord and membranes (cord complications) was the fifth leading cause in 2003, but dropped to sixth in 2004. The rank order of leading causes of infant death varied substan­ tially by race and Hispanic origin of the mother. Congenital malfor­ mations was the leading cause of infant death for all groups except for non-Hispanic black and Puerto Rican women, for whom low birthweight was the leading cause. Infant mortality rates for Congenital malformations, SIDS, and maternal complications were basically unchanged from 2003–2004. The rate for low birthweight decreased by 5 percent, while the rate for unintentional injuries increased by 11 percent from 2003 to 2004. Much of the increase for unintentional injuries was in the accidental suffo­ cation subcategories, although changes in reporting might have also had an impact on these categories (40–42). When examined by race and ethnicity, none of the race and ethnic groups shown in Table 7 had significant changes in cause-specific infant mortality rates from 2003–2004, except for unintentional injuries, which increased for infants of Mexican mothers, although their rates were still substantially lower than those for non-Hispanic white women. When differences between cause-specific infant mortality rates were examined by race and ethnicity, infant mortality rates from Con­ genital malformations were 30 percent higher for non-Hispanic black, 57 percent higher for American Indian, and 11 percent higher for Mexican than for non-Hispanic white women, while the rate for Asian or Pacific Islander women was 19 percent lower. Infants of non-Hispanic black mothers had the highest mortality rates from low birthweight. The rate for non-Hispanic black mothers was

10 National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Table E. Infant mortality rates for trimester of pregnancy prenatal care began, smoking status during pregnancy, and education of mother: 41 states, the District of Columbia, and New York City for 2003 and 2004 Characteristic Prenatal care: Prenatal care beginning in the 1st trimester . . . . . . . . . Prenatal care beginning after the 1st trimester or no care . Prenatal care beginning in the 2nd or 3rd trimester . . . No prenatal care . . . . . . . . . . . . . . . . . . . . . . . . Smoking status:1 Smoker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nonsmoker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Education of mother: 0–11 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13–15 years . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 or more years . . . . . . . . . . . . . . . . . . . . . . . . . 1

2004

2003

. . . .

6.11 8.35 6.62 33.68

6.13 8.67 7.01 33.15

..................... .....................

10.95 6.47

11.14 6.54

8.12 7.55 6.21 4.17

8.36 7.58 6.19 4.23

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Excludes data for California, which did not report smoking status on the birth certificate.

NOTE: Data are based on the 1989 Revision of the U.S. Standard Certificate of Live Birth and exclude data from Florida, Idaho, Kentucky, New Hampshire, New York State, (excluding New York City), Pennsylvania, South Carolina, Tennessee and Washington.

nearly four times the rate for non-Hispanic white mothers. The rate for Puerto Rican mothers was nearly double the rate for non-Hispanic white mothers. SIDS rates were highest for non-Hispanic black and American Indian mothers—2.1 and 1.9 times those for non-Hispanic white mothers, respectively. As most SIDS deaths occur during the post­ neonatal period, the high SIDS rates for infants of non-Hispanic black and American Indian mothers accounted for much of their elevated risk of postneonatal mortality. Compared with non-Hispanic white mothers, SIDS rates were 49 percent lower for Asian or Pacific Islander mothers, 51 percent lower for Mexican mothers, and 70 percent lower for Central and South American mothers. For maternal complications (which include incompetent cervix, premature rupture of membranes, and multiple pregnancy, for example), infants of non-Hispanic black mothers had the highest mortality rates—3.2 times those for non-Hispanic white mothers. The higher percent of non-Hispanic black infants born at low birthweight may help to explain their higher infant mortality rates from these causes, which occur predominantly among low birthweight infants. Infant mor­ tality rates from maternal complications were 23 percent lower for Mexican than for non-Hispanic white women. Compared with non-Hispanic white women, infant mortality rates from unintentional injuries were 87 percent and 83 percent higher for American Indian and non-Hispanic black women, respectively, while infant mortality rates from unintentional injuries were 44 percent and 36 percent lower for Asian or Pacific Islander and Mexican women, respectively. An examination of cause-specific differences in infant mortality rates among race and Hispanic origin groups can help the researcher to understand overall differences in infant mortality rates among these groups. For example, 28 percent of the elevated infant mortality rate for non-Hispanic black mothers, when compared with non-Hispanic white mothers, can be accounted for by their higher rate from low birthweight, 9 percent by differences in maternal complications, and 7 percent by differences in SIDS. In other words, if non-Hispanic black infant mortality rates for these three causes could be reduced to the levels for non-Hispanic white infants, the difference in the infant

mortality rate between non-Hispanic black and non-Hispanic white mothers would be reduced by 44 percent. For American Indian mothers, 26 percent of their elevated infant mortality rate, when compared with non-Hispanic white mothers, can be accounted for by their higher rate of Congenital malformations, 17 percent by differences in SIDS, and 8 percent by differences in unintentional injuries. Thus, if American Indian infant mortality rates for these three causes could be reduced to non-Hispanic white levels, the difference in the infant mortality rate between American Indian and non-Hispanic white mothers would be reduced by 51 percent. Similarly, 35 percent of the difference between Puerto Rican and non-Hispanic white infant mortality rates can be accounted for by differences in low birthweight. Thus, if Puerto Rican infant mortality from low birthweight could be reduced to non-Hispanic white levels, the difference in the infant mortality rate between Puerto Rican and nonHispanic white infants would be reduced by 35 percent. In addition to helping to explain differences in infant mortality rates between various groups, comparisons such as these can be helpful in targeting pre­ vention efforts.

Preterm-related causes of death A new table has been added to this report to monitor infant mortality for preterm-related causes of death (Table 8). It is difficult, using traditional analyses of the leading causes of infant death, to assess the overall impact of preterm related infant deaths on infant mortality. In particular, the category ‘‘Disorders related to short gestation and low birthweight, not elsewhere classified’’ includes the phrase ‘‘not elsewhere classified’’ thereby indicating that many other preterm-related infant deaths are classified to other ICD categories. In 2006, CDC authors published an article that attempted to capture this impact by examining the 20 leading causes of infant death and identifying and grouping together causes with a direct, etiological connection to preterm birth (43). For an underlying cause of death to be considered preterm-related, 75 percent or more of infants whose deaths were attributed to that cause had to be born at less than 37

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

weeks of gestation, and the cause of death had to be a direct consequence of preterm birth based on a clinical evaluation and review of the literature (43). For the purposes of this report, the previous analysis was extended by examining all of the remaining categories of infant death (outside of the 20 leading causes) to develop a comprehensive list of preterm-related causes of death. The comprehensive list of preterm­ related ICD codes is shown in Table 8. Please note that even this more comprehensive listing is probably an underestimate of the total impact of preterm-related infant death, as some ICD categories (notably those beginning with the words ‘‘Other’’ and ‘‘All other’’) had a high per­ centage of preterm infant deaths but lacked sufficient specificity to be able to establish the etiologic connection to prematurity with any degree of certainty. Table 8 shows trends in preterm-related infant mortality by race and Hispanic origin of mother from 1999 (the first year that ICD–10 was implemented in the United States) to 2004. In 2004, 36.5 percent of all infant deaths in the United States were preterm related. Preterm-related infant deaths accounted for 10,180 of the total of 27,860 infant deaths that year. In 1999, 35.4 percent of all infant deaths in the United States were preterm-related. The impact of preterm-related infant deaths varied considerably by maternal race and ethnicity. In 2004, nearly one-half (46 percent) of infant deaths to non-Hispanic black women, and 41 percent of infant deaths to Puerto Rican women were due to preterm-related causes, while the percentage was somewhat lower for other race and ethnic groups (Table 8). Preterm-related infant mortality rates varied considerably by race and ethnicity of the mother (Figure 4 and Table 8). Preterm-related infant mortality rates were 3.5 times higher for non-Hispanic black (6.29) than for non-Hispanic white (1.82) mothers. It is important to note that, in 2004, the preterm-related infant mortality rate for non-Hispanic black mothers was higher than the total infant mortality rate for nonHispanic white, Mexican, and Asian or Pacific Islander women. The preterm-related infant mortality rate for Puerto Rican (3.19) mothers was 75 percent higher than for non-Hispanic white mothers. Preterm­ related infant mortality rates for American Indian (1.89), Mexican (1.76), and Asian or Pacific Islander (1.65) women were not significantly different from those for non-Hispanic white women.

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research, 1999. National Center for Health Statistics. Vital Health Stat 2(128). 1999. National Center for Health Statistics. U.S. Certificate of Live Birth. Available from: http://www.cdc.gov/nchs/data/dvs/birth11–03final­ ACC.pdf. 2003. Tomashek KM, Qin C, Hsia J, Iyasu S, Barfield WD, Flowers LM. Infant mortality trends and differences between American Indian/Alaska Native infants and white infants in the United States, 1989–1991 and 1998–2000. Am J Public Health 96:2222–7. 2006. American College of Obstetricians and Gynecologists. Multiple Gesta­ tion: Complicated twin, triplet, and high order multifetal pregnancy. ACOG Practice Bulletin no. 56, Washington, DC: American College of Obstetricians and Gynecologists. 2004. Ayres A, Johnson TRB. Management of multiple pregnancy: Prenatal care–Part 1. Obstet Gynecol 60;527–37. 2005. Blondel B, Kogan MD, Alexander GR, 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 Public Health 92:1323–30. 2002. MacDorman MF, Martin JA, Hoyert DL, Mathews TJ, Ventura SJ. Explaining the 2001–02 infant mortality increase: Data from the linked birth/infant death data set. National vital statistics reports; vol 53 no 12. Hyattsville, MD: National Center for Health Statistics. 2005. Marlow N, Wolke D, Bracewell MA, Samara M. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med 352:9–19. 2005. Hack M, Taylor HG, Drotar D, et al. Chronic conditions, functional limitations, and special health care needs of school-aged children born with extremely low-birth-weight in the 1990s. JAMA 294:318–25. 2005. Wilson-Costello D, Friedman H, Minich N, et al. Improved survival rates with increased neurodevelopmental disability for extremely low birth weight infants in the 1990s. Pediatrics 115:997–1003. 2005. Meadow W, Lee G, Lin K, Lantos J. Changes in mortality for extremely low birth weight infants in the 1990s: Implications for treatment decisions and resource use. Pediatrics 113:1223–9. 2004. van Barr AL, van Wassenaer AG, Briet JM, et.al. Very preterm birth is associated with disabilities in multiple developmental domains. J Ped Psych 30:247–55. 2005. Davidoff MJ, Dias T, Damus K, et al. Changes in the gestational age distribution among U.S. singleton births: Impact on rates of late preterm birth, 1992 to 2002. Semin Perinatol 30:8–15. 2006. MacDorman MF, Mathews TJ, Martin JA, Malloy MH. Trends and characteristics of induced labour in the United States, 1989–98. Paediatri Perinat Epidemiol 16:263–73. 2002. Ananth CV, Joseph KS, Oyelese Y, et al. Trends in preterm birth and perinatal mortality among singletons: United States, 1989 through 2000. Obstet Gynecol 105(5 Pt 1):1084–91. 2005. Kirkham C, Harris S, Grzybowski S. Evidence-based prenatal care: Part 1. General prenatal care and counseling issues. Am Fam Physician 71:1307–16. 2005. Kirkham C, Harris S, Grzybowski S. Evidence-based prenatal care: Part II. Third-trimester care and prevention of infectious diseases. Am Fam Physician 71:1555–60. 2005. Conway KS, Deb P. Is prenatal care really ineffective? Or, is the ‘devil’ in the distribution? J Health Economics 24:489–513. 2005. Vintzileos AM, Ananth CV, Smulian JC, Scorza WE, Knuppel RA. The impact of prenatal care on neonatal deaths in the presence and absence of antenatal high-risk conditions. Am J Obstet and Gynecol 186(5):1011–6. 2002. Kirchengast S, Hartmann B. Impact of maternal age and maternal somatic characteristics on newborn size. Am J Hum Biology 15:220–8. 2003.

12 National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007 26. Phipps MG, Blume JD, DeMonner SM. Young maternal age associated with increased risk of postneonatal death. Obstet Gynecol 100:481–6. 2002. 27. Nabukera S, Wingate MS, Alexander GR, Salihu HM. First-time births among women 30 years and older in the United States: Patterns and risk of adverse outcomes. J Reprod Med 51 (9):676–82. 2006. 28. U.S. Bureau of the Census. Table 8. Income in 2004 by Educational Attainment of the Population 18 Years and Over, by Age, Sex, Race Only, And Hispanic Origin: 2005. Available from: http://www. census.gov/population/socdemo/education/cps2005/tab08–1.xls 29. Bai J, Wong FWS, Bauman A, Mohsin M. Parity and pregnancy outcomes. Am J Obstet Gynecol 186(2):274–8. 2002. 30. McNamara TK, Orav EJ, Wilkins-Haug L, Chang G. Social support and prenatal alcohol use. J Women’s Health 15(1):70–6. 2006. 31. Feldman PJ, Dunkel-Schetter C, Sandman CA, Wadhwa, P. Maternal social support predicts birth weight and fetal growth in human pregnancy. Psychosomatic Medicine 67:715–25. 2000. 32. Jooma N, Borstell J, Shenkang Y, Tahner A, Vu H. Infant mortality in Louisiana-Identifying the risks. J La State Med Soc 153: 85–91. 2001. 33. Raatikainen K, Heiskanen N, Heinonen S. Marriage still protects pregnancy. Br J Obstet Gynaecol 112(10):1411–6. 2005. 34. Singh GK, Miller BA. Health, life expectancy, and mortality patterns among immigrant populations in the United States. Can J Public Health 95(3):I14–21. 2004. 35. Acevedo-Garcia D, Soobader M, Berkman LF. The differential effect of foreign-born status on low birth weight by race/ethnicity and education. Pediatrics 115:20–30. 2005. 36. U.S. Department of Health and Human Services. The health conse­ quences of smoking: A report of the Surgeon General. Atlanta, GA: Centers for Disease Control and Prevention, Office on Smoking and Health. 2004. 37. Delpisheh A, Attia E, Drammond S, Brabin BJ. Adolescent smoking in pregnancy and birth outcomes. Eur J Public Health Advance Access published on November 22, 2005. Available from http://eurpub.oxfordjournals.org 38. Noakes PS, Hale J, Thomas R, Lane C, Devadason SG, Prescott SL. Maternal smoking is associated with impaired neonatal toll-like­ receptor-mediated immune responses. Eur Respir J 28:721–9. 2006. 39. Le Souëf PN. Adverse effects of maternal smoking during pregnancy on innate immunity in infants. Eur Respir J 28:675–7. 2006. 40. Malloy MH, MacDorman MF. Changes in the classification of sudden unexpected infant deaths: United States, 1992–2001. Pediatrics 115:1247–53. 2005. 41. Tomashek KM, Hsia J, Iyasu S. Trends in postneonatal mortality attributable to injury, United States, 1988–1998. Pediatrics 111:1219–25. 2003. 42. Shapiro-Mendoza CK, Tomashek KM, Anderson RN, Wingo J. Recent national trends in sudden unexpected infant deaths: More evidence supporting a change in classification or reporting. Am J Epidemiol 163:762–9. 2006. 43. Callaghan WD, MacDorman MF, Rasmussen SA, et al. The contribu­ tion of preterm birth to infant mortality rates in the United States. Pediatrics 118:1566–73. 2006. 44. Buehler JW, Prager K, Hogue CJR. The role of linked birth and infant death certificates in maternal and child health epidemiology in the United States. Am J Prev Med 19(1S):3–11. 2000. 45. National Center for Health Statistics. 2003 revision of the U.S. Standard Certificate of Live Birth. 2003. Available from: http://www.cdc.gov/nchs/vital_certs_rev.htm 46. National Center for Health Statistics. Report of the Panel to Evaluate the U.S. Standard Certificates and Reports. National Center for Health Statistics. 2000. Available from: http://www.cdc.gov/nchs/data/dvs/ pan­ elreport_acc.pdf

47. National Center for Health Statistics. Technical appendix. Vital statistics of the United States, 2003, vol I natality. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics. Hyattsville, MD: Available from: http://www.cdc.gov/nchs/data/TechApp03_1–09.pdf 48. Office of Management and Budget. Race and ethnic standards for federal statistics and administrative reporting. Statistical Policy Direc­ tive 15. May 12, 1977. 49. Office of Management and Budget. Revisions to the standards for the classification of federal data on race and ethnicity. Federal Register 62FR58781–58790. October 30, 1997. Available from: http://www.whitehouse.gov/omb/fedreg/ombdir15.html 50. Alexander GR, Allen MC. Conceptualization, measurement, and use of gestational age. I. Clinical and Public Health Practice. J Perinatol 16(1):53B9. 1996. 51. National Center for Health Statistics. Computer edits for natality data, effective 1993. Instruction manual, part 12. Hyattsville, MD: National Center for Health Statistics. 1995. 52. National Center for Health Statistics. Vital statistics, instructions for classifying the underlying cause of death. NCHS instruction manual; part 2a. Hyattsville, MD: Public Health Service. Published annually. 53. National Center for Health Statistics. Vital Statistics, instructions for classifying multiple causes of death. NCHS instruction manual; part 2b. Hyattsville, MD: Public Health Service. Published annually. 54. Israel RA, Rosenberg HM, Curtin LR. Analytical potential for multiple cause-of-death data. Am J Epidemiol 124(2):161–79. 1986. 55. National Center for Health Statistics. Public use data file documenta­ tion: Multiple cause of death for ICD–10, 2001 data. Hyattsville, MD: Public Health Service. Forthcoming. 56. Anderson RN, Miniño AM, Hoyert DL, Rosenberg HM. Comparability of cause of death between ICD–9 and ICD–10: Preliminary estimates. National vital statistics reports; vol 49 no 2. Hyattsville, MD: National Center for Health Statistics. 2001. 57. National Center for Health Statistics. Updated comparability ratios. Available from: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Datasets/ Comparability/icd9_icd10/Comparability_Ratio_tables.xls 58. National Center for Health Statistics. ICD–10 cause-of-death lists for tabulating mortality statistics, effective 1999. NCHS instruction manual: part 9. Hyattsville, MD: Public Health Service. 1999. 59. MacDorman MF, Callaghan WM, Mathews TJ, et al. Trends in preterm-related infant mortality by race and ethnicity: United States, 1999–2004. NCHS Health E-stat. 2007. 60. Brillinger DR. The natural variability of vital rates and associated statistics. Biometrics 42:693–734. 1986.

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

List of detailed tables 1. Infant mortality rates, live births, and infant deaths by selected characteristics and race of mother: United States, 2004 linked file . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

15

2. Infant mortality rates, live births, and infant deaths by selected characteristics and Hispanic origin of mother and by race of mother for mothers of non-Hispanic origin: United States, 2004 linked file . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

18

3. Infant mortality rates by race and Hispanic origin of mother: United States and each state, Puerto Rico, Virgin Islands, and Guam, 2002–2004 linked files . . . . . . . . . . . . . . . . . . . . . . .

21

4. Percent of live births with selected maternal and infant character­ istics by race of mother: United States, 2004 linked file . . . . . .

22

5. Percent of live births with selected maternal and infant character­ istics by Hispanic origin of mother and race of mother for mothers of non-Hispanic origin: United States, 2004 linked file. . . . . . . .

22

6. Live births, infant, neonatal, and postneonatal deaths and mor­ tality rates by race and Hispanic origin of mother and birthweight: United States, 2004 linked file, and percent change in birthweight­ specific infant mortality, 1995–2004 linked files . . . . . . . . . . . .

23

7. Infant deaths and mortality rates for the five leading causes of infant death by race and Hispanic origin of mother: United States, 2004 linked file . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

26

8. Number of and percent of preterm-related infant deaths and preterm-related infant mortality rates by race and Hispanic origin of mother: United States, 1999–2004 linked files . . . . . . . . . . .

27

13

14 National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Table 1. Infant mortality rates, live births, and infant deaths, by selected characteristics and race of mother: United States, 2004 linked file Race of mother All races

Characteristics

White

Black

American Indian1

Asian or Pacific Islander

Infant mortality rates per 1,000 live births in specified group Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

6.78

5.66

13.25

8.45

4.67

Age at death: Total neonatal . . . . . . . . . . . . . Early neonatal (less than 7 days) Late neonatal (7–27 days) . . . . Postneonatal . . . . . . . . . . . . . .

. . . .

4.52 3.61 0.92 2.25

3.78 3.00 0.78 1.89

8.94 7.16 1.77 4.31

4.26 3.39 0.87 4.19

3.20

2.62

0.58

1.47

Sex: Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Female . . . . . . . . . . . . . . . . . . . . . . . . . . . .

7.44 6.08

6.23 5.08

14.59 11.85

9.51 7.30

4.95 4.37

Plurality: Single births . . . . . . . . . . . . . . . . . . . . . . . . . Plural births . . . . . . . . . . . . . . . . . . . . . . . . .

5.94 30.46

4.96 25.77

11.67 55.35

7.68 37.00

4.14 23.13

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

Birthweight: Less than 2,500 grams. . Less than 1,500 grams 1,500–2,499 grams. . . 2,500 grams or more . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

57.64 244.50 14.97 2.26

52.32 231.92 14.93 2.08

75.57 273.97 15.55 3.45

58.57 216.87 24.69 4.38

42.26

222.73

11.37

1.42

Period of gestation:

Less than 32 weeks 32–33 weeks . . . . 34–36 weeks . . . . 37–41 weeks . . . . 37–39 weeks . . . 40–41 weeks . . . 42 weeks or more .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

182.45 16.06 7.32 2.39 2.61 2.00 2.87

168.40 15.52 6.83 2.19 2.40 1.82 2.68

216.28 17.37 9.19 3.71 3.93 3.28 4.19

139.21 24.45 13.61 4.23 4.49 3.77 *

173.24

15.90

5.85

1.56

1.75

1.20

1.76

Age of mother:

Under 20 years 20–24 years . . 25–29 years . . 30–34 years . . 35–39 years . . 40–54 years . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

9.75 7.69 5.95 5.47 6.24 8.81

8.31 6.45 4.89 4.62 5.43 7.72

13.90 12.81 12.89 13.30 13.85 16.14

8.80 8.86 7.74 7.86 7.35 *

9.84

5.51

4.32

3.90

4.38

8.29

Live-birth order:

1. . . . . . . . 2. . . . . . . . 3. . . . . . . . 4. . . . . . . . 5 or more . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

6.74 5.99 6.48 8.17 10.64

5.69 5.06 5.52 6.59 8.38

13.41 11.94 11.82 14.89 17.79

7.07 8.47 6.75 12.83 11.16

4.69

4.49

4.58

4.34

7.03

Marital status: Married . . . . . . . . . . . . . . . . . . . . . . . . . . . . Unmarried . . . . . . . . . . . . . . . . . . . . . . . . . .

5.30 9.43

4.86 7.49

11.26 14.15

6.71 9.50

4.28 6.78

Mother’s place of birth: Born in the 50 states and DC. . . . . . . . . . . . . . . Born elsewhere . . . . . . . . . . . . . . . . . . . . . . .

7.14 5.12

5.76 4.88

13.77 8.50

8.58 *

5.94 4.33

. . . . .

See footnotes at end of table.

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Table 1. Infant mortality rates, live births, and infant deaths, by selected characteristics and race of mother: United States, 2004 linked file—Con. Race of mother Characteristics

All races

White

Black

American Indian1

Asian or Pacific Islander

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4,112,055

3,222,929

616,076

Sex: Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Female . . . . . . . . . . . . . . . . . . . . . . . . . . . .

43,927

229,123

2,104,663 2,007,392

1,650,698 1,572,231

313,897 302,179

22,293 21,634

117,775 111,348

Plurality: Single births . . . . . . . . . . . . . . . . . . . . . . . . . Plural births . . . . . . . . . . . . . . . . . . . . . . . . .

3,972,560 139,495

3,113,164 109,765

593,853 22,223

42,819 1,108

222,724 6,399

Birthweight: Less than 2,500 grams . Less than 1,500 grams 1,500–2,499 grams . . 2,500 grams or more . . Not stated . . . . . . . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

333,427 61,983 271,444 3,778,051 577

228,756 39,419 189,337 2,993,755 418

83,252 19,334 63,918 532,699 125

3,295 581 2,714 40,622 10

18,124

2,649

15,475

210,975

24

Period of gestation:

Less than 32 weeks 32–33 weeks . . . . 34–36 weeks . . . . 37–41 weeks . . . . 37–39 weeks . . . 40–41 weeks . . . 42 weeks or more . Not stated . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

81,648 64,766 361,945 3,308,179 2,130,486 1,177,693 252,543 42,974

53,140 46,258 271,250 2,617,214 1,674,287 942,927 200,659 34,408

24,219 14,734 69,074 467,851 310,684 157,167 36,068 4,130

941 818 4,189 34,291 21,811 12,480 3,312 376

3,348

2,956

17,432

188,823

123,704

65,119

12,504

4,060

Age of mother:

Under 20 years 20–24 years . 25–29 years . 30–34 years . 35–39 years . 40–54 years .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

422,043 1,034,455 1,104,486 965,663 475,607 109,801

300,858 788,264 880,871 780,368 384,917 87,651

105,620 200,399 147,858 99,083 50,044 13,072

7,843 15,130 10,717 6,488 2,994 755

7,722

30,662

65,040

79,724

37,652

8,323

Live-birth order:

1 ....... 2 ....... 3 ....... 4 ....... 5 or more . . Not stated . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

1,630,923 1,319,426 693,933 273,589 175,551 18,633

1,276,937 1,050,100 549,428 209,194 124,065 13,205

233,028 177,850 108,509 51,113 41,585 3,991

15,270 12,036 7,849 4,287 4,213 272

105,688

79,440

28,147

8,995

5,688

1,165

Marital status: Married . . . . . . . . . . . . . . . . . . . . . . . . . . . Unmarried . . . . . . . . . . . . . . . . . . . . . . . . . .

2,641,864 1,470,191

2,239,470 983,459

192,124 423,952

16,551 27,376

193,719 35,404

Mother’s place of birth: Born in the 50 states and DC . . . . . . . . . . . . . . Born elsewhere . . . . . . . . . . . . . . . . . . . . . . . Not stated . . . . . . . . . . . . . . . . . . . . . . . . . .

3,103,356 992,227 16,472

2,506,578 706,019 10,332

515,905 95,413 4,758

41,470 2,317 140

39,403 188,478 1,242

Live births

. . . . . .

See footnotes at end of table.

15

16 National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Table 1. Infant mortality rates, live births, and infant deaths, by selected characteristics and race of mother: United States, 2004 linked file—Con. Race of mother Characteristics

All races

White

Black

American Indian1

Asian or Pacific Islander

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27,860

18,257

8,162

Age at death:. . . . . . . . . . . . . . . Total neonatal . . . . . . . . . . . . Early neonatal (less than 7 days) Late neonatal (7–27 days) . . . . Postneonatal . . . . . . . . . . . . .

. . . . .

371

1,070

18,602 14,836 3,766 9,258

12,178 9,674 2,504 6,080

5,505 4,413 1,092 2,657

187 149 38 184

733 601 132 337

Sex: Male . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Female . . . . . . . . . . . . . . . . . . . . . . . . . . .

15,653 12,207

10,277 7,981

4,581 3,581

212 158

583 487

Plurality: Single births . . . . . . . . . . . . . . . . . . . . . . . . Plural births . . . . . . . . . . . . . . . . . . . . . . . . .

23,611 4,249

15,428 2,829

6,932 1,230

329 41

922 148

Birthweight: Less than 2,500 grams . Less than 1,500 grams 1,500–2,499 grams . . 2,500 grams or more . . Not stated . . . . . . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

19,218 15,155 4,064 8,528 113

11,968 9,142 2,826 6,213 77

6,291 5,297 994 1,839 32

193 126 67 178 –

766 590 176 299 4

Period of gestation: Less than 32 weeks 32–33 weeks . . . . 34–36 weeks . . . . 37–41 weeks . . . . 37–39 weeks . . . 40–41 weeks . . . 42 weeks or more . Not stated . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

14,897 1,040 2,648 7,918 5,561 2,357 725 631

8,949 718 1,853 5,741 4,026 1,715 538 459

5,238 256 635 1,737 1,221 516 151 145

131 20 57 145 98 47 14 3

580 47 102 294 216 78 22 25

Age of mother: Under 20 years 20–24 years . 25–29 years . 30–34 years . 35–39 years . 40–54 years .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

4,114 7,953 6,576 5,281 2,969 967

2,501 5,082 4,307 3,602 2,089 677

1,468 2,568 1,906 1,318 693 211

69 134 83 51 22 11

76 169 281 311 165 69

Live-birth order: 1 ....... 2 ....... 3 ....... 4 ....... 5 or more . . Not stated . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

10,994 7,898 4,498 2,234 1,867 368

7,265 5,317 3,033 1,379 1,040 224

3,126 2,123 1,283 761 740 129

108 102 53 55 47 5

496 357 129 39 40 10

Marital status: Married . . . . . . . . . . . . . . . . . . . . . . . . . . . Unmarried . . . . . . . . . . . . . . . . . . . . . . . . . .

13,999 13,861

10,894 7,364

2,164 5,998

111 260

830 240

Mother’s place of birth: Born in the 50 states and DC . . . . . . . . . . . . . . Born elsewhere . . . . . . . . . . . . . . . . . . . . . . . Not stated . . . . . . . . . . . . . . . . . . . . . . . . . .

22,143 5,083 634

14,449 3,447 362

7,105 811 247

356 10 5

234 816 20

Infant deaths

. . . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

* Figure does not meet standards of reliability or precision; based on fewer than 20 deaths in the numerator.

– Quanity zero.

1 Includes Aleuts and Eskimos.

NOTE: Infant deaths are weighted so numbers may not exactly add to totals due to rounding. Not stated responses were included in totals but not distributed among group for rate computations. Race and Hispanic origin are reported separately on birth certificates. Race categories are consistent with the 1977 Office of Management and Budget standards. In this table all women (including Hispanic women) are classified only according to their race. Fifteen states reported multiple-race data on the birth certificate for 2004. The multiple-race data for these states were bridged to the single-race categories of the 1977 standards for comparability with other states; see reference 2.

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

17

Table 2. Infant mortality rates, live births, and infant deaths, by selected characteristics and Hispanic origin of mother and by race of mother for mothers of non-Hispanic origin: United States, 2004 linked file Hispanic All origins1

Characteristics

Total

Mexican

Puerto Rican

Non-Hispanic

Cuban

Central and South American

Other and unknown Hispanic

Total2

White

Black

Infant mortality rates per 1,000 live births in specified group Total . . . . . . . . . . . . . . . . . . . . . . . . . .

6.78

5.55

5.47

7.82

4.55

4.65

6.73

7.09

5.66

13.60

Age at death: Total neonatal . . . . . . . . . Early neonatal (less than 7 Late neonatal (7–27 days) Postneonatal . . . . . . . . . .

. . . .

4.52 3.61 0.92 2.25

3.83 3.04 0.80 1.71

3.74 2.98 0.76 1.73

5.34 4.02 1.32 2.48

2.81 2.28 * 1.74

3.43 2.71 0.72 1.22

4.73 3.83 0.90 2.00

4.67 3.72 0.95 2.42

3.70 2.93 0.77 1.96

9.13 7.31 1.82 4.47

Sex: Male . . . . . . . . . . . . . . . . . . . . . . . . . Female . . . . . . . . . . . . . . . . . . . . . . .

7.44 6.08

6.04 5.03

5.96 4.95

9.09 6.48

4.51 4.60

4.99 4.29

6.93 6.51

7.79 6.35

6.24 5.05

15.00 12.14

Plurality: Single births . . . . . . . . . . . . . . . . . . . . Plural births . . . . . . . . . . . . . . . . . . . .

5.94 30.46

5.01 28.90

4.95 29.85

7.06 32.22

3.41 *

4.13 25.23

6.35 21.26

6.18 30.48

4.89 24.89

12.00 55.71

.... days) .... ....

. . . .

. . . .

. . . .

. . . .

. . . .

Birthweight: Less than 2,500 grams . . Less than 1,500 grams 1,500–2,499 grams . . . 2,500 grams or more . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

57.64 244.50 14.97 2.26

56.45 245.41 15.16 1.81

58.25 251.93 16.36 1.80

55.92 229.94 12.25 2.56

45.89 235.90 * *

50.20 224.22 12.26 1.35

55.63 255.49 15.67 2.52

57.38 242.04 14.89 2.39

50.05 222.98 14.79 2.18

76.01 274.34 15.67 3.54

Period of gestation: Less than 32 weeks 32–33 weeks . . . . 34–36 weeks . . . . 37–41 weeks . . . 37–39 weeks . . . 40–41 weeks . . . . 42 weeks or more. .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

182.45 16.06 7.32 2.39 2.61 2.00 2.87

162.52 14.65 6.20 1.96 2.18 1.60 2.41

163.32 15.16 6.38 1.95 2.16 1.59 2.47

172.65 * 7.57 2.82 2.92 2.64 *

181.47 * * * * * *

150.52 12.68 4.72 1.60 1.79 1.28 2.07

161.01 * 7.21 2.44 2.70 1.88 *

185.81 16.42 7.60 2.52 2.73 2.11 3.03

168.29 15.73 7.05 2.28 2.50 1.89 2.80

217.31 17.60 9.25 3.82 4.04 3.39 4.35

Age of mother: Under 20 years 20–24 years . . 25–29 years . . 30–34 years . . 35–39 years . . 40–54 years . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

9.75 7.69 5.95 5.47 6.24 8.81

6.67 5.34 4.82 5.28 6.26 10.02

6.41 5.31 4.60 5.39 6.50 9.94

9.85 7.42 7.75 6.86 5.92 *

* * * * * *

4.96 4.25 4.46 4.34 5.33 8.45

8.18 5.93 5.93 6.67 7.55 *

11.17 8.49 6.26 5.45 6.15 8.58

9.56 6.94 4.88 4.37 5.15 7.12

14.19 13.15 13.31 13.66 14.08 16.49

Live-birth order: 1. . . . . . . . 2. . . . . . . . 3. . . . . . . . 4. . . . . . . . 5 or more. . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

6.74 5.99 6.48 8.17 10.64

5.80 4.81 4.89 6.09 8.63

5.84 4.81 4.77 5.68 8.15

8.86 6.01 6.14 8.38 14.32

3.58 4.77 * * *

4.16 4.39 4.49 6.55 8.24

7.21 4.62 6.37 9.45 10.44

6.94 6.28 7.02 9.01 11.44

5.61 5.13 5.79 6.83 8.20

13.77 12.28 12.18 15.39 18.11

Marital status: Married . . . . . . . . . . . . . . . . . . . . . . . Unmarried . . . . . . . . . . . . . . . . . . . . .

5.30 9.43

5.08 6.08

5.16 5.85

6.70 8.54

4.01 5.65

4.36 4.95

4.97 8.70

5.30 10.78

4.76 8.42

11.58 14.49

Mother’s place of birth: Born in the 50 states and DC . . . . . . . . . . Born elsewhere . . . . . . . . . . . . . . . . . .

7.14 5.12

6.19 5.05

6.02 5.10

8.08 7.05

4.55 4.56

4.57 4.64

6.32 4.66

7.25 5.12

5.69 3.96

13.91 9.40

. . . . .

See footnotes at end of table.

18 National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Table 2. Infant mortality rates, live births, and infant deaths, by selected characteristics and Hispanic origin of mother and by race of mother for mothers of non-Hispanic origin: United States, 2004 linked file—Con. Hispanic All origins1

Non-Hispanic

Cuban

Central and South American

Other and unknown Hispanic

Total2

White

Black

Not stated

Total

Mexican

Puerto Rican

Total . . . . . . . . . . . . . . . . . . . . . . . . . . 4,112,055

946,349

677,621

61,221

14,943

143,520

49,044

3,133,128

2,296,684

578,774

32,578

Sex: Male . . . . . . . . . . . . . . . . . . . . . . . . . 2,104,663 Female . . . . . . . . . . . . . . . . . . . . . . . 2,007,392

482,923 463,426

345,241 332,380

31,448 29,773

7,765 7,178

73,371 70,149

25,098 23,946

1,605,129 1,527,999

1,178,139 1,118,545

294,732 284,042

16,611 15,967

Plurality: Single births . . . . . . . . . . . . . . . . . . . . 3,972,560 Plural births . . . . . . . . . . . . . . . . . . . . 139,495

925,275 21,074

663,653 13,968

59,359 1,862

14,363 580

140,032 3,488

47,868 1,176

3,015,920 117,208

2,207,747 88,937

557,592 21,182

31,365 1,213

Birthweight: Less than 2,500 grams . . Less than 1,500 grams 1,500–2,499 grams . . . 2,500 grams or more . . . Not stated . . . . . . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. 333,427 . 61,983 . 271,444 . 3,778,051 . 577

64,443 11,556 52,887 881,852 54

43,792 7,788 36,004 633,800 29

6,026 1,209 4,817 55,184 11

1,155 195 960 13,788 *

9,641 1,726 7,915 133,871 8

3,829 638 3,191 45,209 6

266,141 49,777 216,364 2,866,694 293

166,029 28,114 137,915 2,130,476 179

79,911 18,641 61,270 498,773 90

2,843 650 2,193 29,505 230

Period of gestation: Less than 32 weeks 32–33 weeks . . . . 34–36 weeks . . . . 37–41 weeks . . . . 37–39 weeks . . . 40–41 weeks . . . 42 weeks or more. . Not stated . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. 81,648 . 64,766 . 361,945 . 3,308,179 . 2,130,486 . 1,177,693 . 252,543 . 42,974

16,355 14,406 80,177 749,757 473,195 276,562 63,916 21,738

11,211 10,157 56,439 535,127 336,871 198,256 45,821 18,866

1,587 1,113 5,812 48,296 30,865 17,431 4,201 212

259 235 1,413 12,138 8,100 4,038 859 39

2,385 2,130 12,072 115,200 72,162 43,038 9,670 2,063

913 771 4,441 38,996 25,197 13,799 3,365 558

64,523 49,871 279,066 2,533,153 1,641,418 891,735 186,762 19,753

37,246 32,295 193,103 1,883,739 1,211,397 672,342 138,457 11,844

23,294 14,038 65,637 438,385 292,300 146,085 33,564 3,856

770 489 2,702 25,269 15,873 9,396 1,865 1,483

Age of mother: Under 20 years 20–24 years . . 25–29 years . . 30–34 years . . 35–39 years . . 40–54 years . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. 422,043 . 1,034,455 . 1,104,486 . 965,663 . 475,607 . 109,801

135,400 279,746 254,358 177,762 81,021 18,062

103,423 207,535 182,306 121,408 51,985 10,964

10,764 19,552 15,235 9,917 4,728 1,025

1,168 2,758 3,875 4,341 2,243 558

12,100 35,073 40,624 33,399 17,829 4,495

7,945 14,828 12,318 8,697 4,236 1,020

283,789 747,380 841,593 779,789 390,138 90,439

170,272 517,148 631,727 604,040 304,085 69,412

100,019 188,762 138,093 92,646 46,946 12,308

2,854 7,329 8,535 8,112 4,448 1,300

Live-birth order: 1. . . . . . . . 2. . . . . . . . 3. . . . . . . . 4. . . . . . . . 5 or more. . . Not stated . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. 1,630,923 . 1,319,426 . 693,933 . 273,589 . 175,551 . 18,633

338,736 288,730 183,929 81,237 50,422 3,295

232,512 203,589 137,421 62,828 39,262 2,009

23,695 18,962 10,750 4,535 3,002 277

6,989 5,238 1,885 502 252 77

56,267 45,800 25,402 9,774 5,702 575

19,273 15,141 8,471 3,598 2,204 357

1,279,649 1,021,378 505,052 190,311 123,568 13,170

946,010 767,723 369,822 129,847 74,793 8,489

218,586 166,674 101,861 48,341 39,751 3,561

12,538 9,318 4,952 2,041 1,561 2,168

Marital status: Married . . . . . . . . . . . . . . . . . . . . . . . 2,641,864 Unmarried . . . . . . . . . . . . . . . . . . . . . 1,470,191

506,808 439,541

371,553 306,068

23,864 37,357

9,985 4,958

75,241 68,279

26,165 22,879

2,113,768 1,019,360

1,734,145 562,539

177,792 400,982

21,288 11,290

Mother’s place of birth: Born in the 50 states and DC . . . . . . . . . . 3,103,356 Born elsewhere . . . . . . . . . . . . . . . . . . 992,227 Not stated . . . . . . . . . . . . . . . . . . . . . 16,472

347,781 596,489 2,079

246,022 430,701 898

40,989 19,858 374

7,029 7,895 19

18,161 125,161 198

35,580 12,874 590

2,731,272 388,924 12,932

2,156,291 132,788 7,605

502,041 72,628 4,105

24,303 6,814 1,461

Characteristics

Live births

. . . . . .

See footnotes at end of table.

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

19

Table 2. Infant mortality rates, live births, and infant deaths, by selected characteristics and Hispanic origin of mother and by race of mother for mothers of non-Hispanic origin: United States, 2004 linked file—Con. Hispanic All origins1

Total

27,860

. . . .

Non-Hispanic Central and South American

Mexican

Puerto Rican

Cuban

5,248

3,705

479

68

667

18,602 14,836 3,766 9,258

3,627 2,874 753 1,621

2,535 2,018 517 1,170

327 246 81 152

42 34 8 26

Sex: Male . . . . . . . . . . . . . . . . . . . . . . . . Female . . . . . . . . . . . . . . . . . . . . . . .

15,653 12,207

2,918 2,329

2,058 1,646

286 193

Plurality: Single births . . . . . . . . . . . . . . . . . . . . Plural births . . . . . . . . . . . . . . . . . . . .

23,611 4,249

4,639 609

3,288 417

Birthweight: Less than 2,500 grams . Less than 1,500 grams 1,500–2,499 grams . . 2,500 grams or more . . Not stated . . . . . . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

19,219 15,155 4,064 8,528 113

3,638 2,836 802 1,593 17

Period of gestation: Less than 32 weeks 32–33 weeks . . . . 34–36 weeks . . . . 37–41 weeks . . . . 37–39 weeks . . . 40–41 weeks . . . 42 weeks or more . Not stated . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

14,897 1,040 2,648 7,918 5,561 2,357 725 631

Age of mother: Under 20 years 20–24 years . . 25–29 years . . 30–34 years . . 35–39 years . . 40–54 years . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

Live-birth order: 1 ....... 2 ....... 3 ....... 4 ....... 5 or more . . Not stated . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

Other and unknown Hispanic

Total2

White

Black

Not stated

330

22,203

13,001

7,869

409

492 389 103 175

232 188 44 98

14,634 11,652 2,982 7,570

8,499 6,727 1,772 4,502

5,283 4,230 1,053 2,586

341 310 31 68

35 33

366 301

174 156

12,502 9,701

7,349 5,651

4,420 3,449

233 176

419 60

49 19

579 88

304 25

18,630 3,573

10,787 2,214

6,689 1,180

342 67

2,551 1,962 589 1,142 11

337 278 59 141 1

53 46 7 15 –

484 387 97 181 2

213 163 50 114 3

15,270 12,048 3,222 6,854 79

8,309 6,269 2,040 4,642 50

6,074 5,114 960 1,768 26

310 271 39 82 17

2,658 211 497 1,472 1,030 443 154 254

1,831 154 360 1,044 729 315 113 203

274 12 44 136 90 46 8 4

47 2 4 14 13 1 1 –

359 27 57 184 129 55 20 20

147 16 32 95 68 26 12 27

11,989 819 2,121 6,373 4,489 1,884 566 336

6,268 508 1,362 4,297 3,024 1,273 388 178

5,062 247 607 1,675 1,180 495 146 133

250 10 30 73 42 30 5 41

4,114 7,953 6,576 5,281 2,969 967

903 1,493 1,225 938 507 181

663 1,102 838 654 338 109

106 145 118 68 28 14

9 9 15 14 14 7

60 149 181 145 95 38

65 88 73 58 32 13

3,170 6,344 5,267 4,246 2,401 776

1,628 3,590 3,085 2,637 1,567 494

1,419 2,482 1,838 1,266 661 203

41 116 83 97 61 10

. . . . . .

10,994 7,898 4,498 2,234 1,867 368

1,966 1,389 900 495 435 62

1,358 979 655 357 320 36

210 114 66 38 43 8

25 25 12 2 2 2

234 201 114 64 47 7

139 70 54 34 23 9

8,879 6,413 3,547 1,715 1,414 236

5,304 3,936 2,140 887 613 121

3,011 2,046 1,241 744 720 107

149 97 51 24 18 69

Marital status: Married . . . . . . . . . . . . . . . . . . . . . . . Unmarried . . . . . . . . . . . . . . . . . . . . .

13,999 13,861

2,574 2,673

1,916 1,789

160 319

40 28

328 338

130 199

11,213 10,990

8,263 4,738

2,059 5,810

211 198

Mother’s place of birth: Born in the 50 states and DC . . . . . . . . . Born elsewhere . . . . . . . . . . . . . . . . . . Not stated . . . . . . . . . . . . . . . . . . . . .

22,143 5,083 634

2,152 3,015 81

1,481 2,198 26

331 140 7

32 36 –

83 581 3

225 60 45

19,791 1,993 420

12,274 526 201

6,985 683 202

200 76 133

Characteristics

Infant deaths Total . . . . . . . . . . . . . . . . . . . . . . . . Age at death: Total neonatal . . . . . . . . . Early neonatal (less than 7 Late neonatal (7–27 days) Postneonatal . . . . . . . . .

. . . . . .

.... days) .... ....

. . . .

. . . .

. . . .

. . . .

. . . .

* Figure does not meet standards of reliability or precision; based on fewer than 20 deaths in the numerator.

– Quantity zero.

1 Includes origin not stated.

2 Includes races other than black or white.

NOTES: Infant deaths are weighted so numbers may not exactly add to totals due to rounding. Not stated responses were included in totals but not distributed among groups for rate computations. Race and Hispanic origin are reported separately on birth certificates. Race categories are consistent with the 1977 Office of Management and Budget standards. Persons of Hispanic origin may be of any race. In this table Hispanic women are classified only by place of origin; non-Hispanic women are classified by race. See reference 2.

20 National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Table 3. Infant mortality rates by race and Hispanic origin of mother: United States and each state, Puerto Rico, Virgin Islands, and Guam, 2002–2004 linked files [By place of residence] Race and Hispanic origin of mother Race

State

Total

White

Black

Hispanic origin

American Indian1

Asian or Pacific Islander

Hispanic

Non-Hispanic white

Non-Hispanic black

Infant mortality rates per 1,000 live births in specified group 2

United States . . . . . . . . . . . . . . . .

6.86

5.73

13.51

8.60

4.76

5.60

5.72

13.70

Alabama . . . . . . . Alaska . . . . . . . . Arizona . . . . . . . . Arkansas . . . . . . . California. . . . . . . Colorado . . . . . . . Connecticut . . . . . Delaware. . . . . . . District of Columbia Florida . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

8.82 6.36 6.55 8.47 5.25 6.11 5.75 8.88 11.42 7.33

6.74 4.93 6.22 7.37 4.84 5.58 4.98 6.92 5.08 5.67

13.50 * 10.62 13.11 11.32 16.52 12.00 14.91 14.81 12.79

* 9.41 8.25 * 6.29 * * * * 8.27

* * 6.69 * 4.21 6.39 * * * 5.99

7.94 * 6.46 6.02 5.05 6.67 7.13 6.16 7.93 5.11

6.67 5.11 6.00 7.56 4.59 5.14 4.39 7.07 3.76 5.84

13.49 * 11.06 13.17 11.33 16.30 12.14 15.03 15.49 13.12

Georgia . Hawaii . . Idaho . . . Illinois . . Indiana . . Iowa . . . Kansas . . Kentucky . Louisiana. Maine. . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

8.65 6.95 6.14 7.53 7.78 5.36 7.04 6.94 9.95 5.01

6.32 5.06 6.09 5.87 6.78 5.14 6.44 6.46 6.96 4.95

13.70 14.82 * 15.52 14.94 10.47 13.91 11.52 14.03 *

* * * * * * * * * *

5.80 7.34 * 4.58 5.36 * 6.20 * 6.99 *

6.17 7.06 6.15 6.04 6.93 5.83 6.22 6.25 5.09 *

6.32 4.60 6.08 5.90 6.93 5.11 6.57 6.51 7.20 4.91

13.64 15.04 * 15.51 15.00 10.37 14.05 11.57 14.01 *

Maryland . . . . . Massachusetts . Michigan . . . . . Minnesota . . . . Mississippi . . . . Missouri . . . . . Montana . . . . . Nebraska. . . . . Nevada. . . . . . New Hampshire.

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

8.09 4.80 8.09 4.85 10.32 7.95 6.42 6.34 6.00 4.93

5.51 4.24 6.33 4.46 6.82 6.77 6.00 5.70 5.27 4.79

13.33 9.53 16.81 8.86 14.69 14.72 * 15.86 13.22 *

* * * 8.81 * * 8.39 * * *

4.16 3.46 5.05 3.55 * 6.83 * * 5.16 *

5.67 6.59 7.31 4.97 * 8.23 * 6.18 4.52 *

5.46 3.87 6.21 4.39 6.93 6.68 5.79 5.46 5.78 4.75

13.62 10.23 16.76 8.75 14.69 14.79 * 16.18 12.98 *

New Jersey . . New Mexico . . New York . . . North Carolina. North Dakota . Ohio . . . . . . Oklahoma . . . Oregon . . . . . Pennsylvania . Rhode Island .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

5.62 6.11 6.08 8.35 6.48 7.74 7.95 5.59 7.40 6.40

4.31 5.82 4.89 6.15 6.00 6.31 7.21 5.37 6.25 5.83

11.48 * 11.18 15.44 * 15.50 13.98 9.98 14.04 10.41

* 6.96 11.03 11.10 8.69 * 7.81 11.07 * *

4.23 * 3.77 5.20 * 4.66 * 5.28 4.69 *

5.76 5.52 5.52 6.63 * 7.92 6.06 4.55 7.46 6.27

3.80 6.46 4.71 6.06 5.94 6.27 7.46 5.58 5.98 5.41

12.22 * 11.72 15.37 * 15.57 13.79 10.06 13.89 11.57

South Carolina South Dakota . Tennessee . . . Texas . . . . . . Utah . . . . . . Vermont . . . . Virginia . . . . . Washington . . West Virginia . Wisconsin . . . Wyoming . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

8.98 7.11 9.05 6.37 5.26 4.68 7.48 5.62 7.98 6.43 6.99

6.24 5.79 6.91 5.51 5.07 4.67 5.77 5.28 7.74 5.16 6.65

14.26 * 17.02 12.22 * * 13.67 9.20 14.02 17.56 *

* 13.51 * * * * * 10.53 * 9.66 *

7.76 * 6.16 4.22 7.33 * 4.83 5.23 * 6.47 *

6.36 * 5.96 5.51 6.58 * 5.15 5.44 * 6.05 *

6.25 5.84 7.02 5.87 4.83 4.71 5.82 5.07 7.67 5.09 6.77

14.40 * 17.34 12.21 * * 13.86 9.24 13.61 17.57 *

Puerto Rico . . . . . . . . . . . . . . . . . Virgin Islands . . . . . . . . . . . . . . . . Guam. . . . . . . . . . . . . . . . . . . . .

9.05 6.13 9.63

8.88 * *

10.54 5.95 *

––– * *

––– * 10.03

––– * *

––– * *

––– * *

* Figure does not meet standards of reliability or precision; based on fewer than 20 deaths in the numerator. 1 2 Includes Aleuts and Eskimos. Excludes data for Puerto Rico, Virgin Islands, and Guam.

- - -Data not available.

NOTES: Race and Hispanic origin are reported separately on birth certificates. Race categories are consistent with the 1977 Office of Management and Budget standards. Persons of Hispanic origin may be of any race. In this table Hispanic women are classified only by place of origin; non-Hispanic women are classified by race. Fifteen states reported multiple-race data on the birth certificate for 2004. The multiple-race data for these states were bridged to the single-race catergories of the 1977 standards for comparability with other states; see reference 2.

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

21

Table 4. Percent of live births with selected maternal and infant characteristics by race of mother: United States, 2004 linked file Characteristic Birthweight: . . . . . . . . . . . . . . . . Less than 1,500 grams . . . . . . . . Less than 2,500 grams . . . . . . . . Preterm births2 . . . . . . . . . . . . . . Births to mothers under 20 years . . . Fourth and higher order births . . . . . Births to unmarried mothers. . . . . . . Mothers born in the 50 states and DC 1 2

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

. . . . . . . .

.

. . . . . . .

All races

White

Black

American Indian1

1.5 8.1 12.5 10.3 11.0 35.8 75.8

1.2 7.1 11.6 9.3 10.3 30.2 79.1

3.2 13.7 17.8 17.2 15.2 69.2 86.3

1.3 7.5 13.7 17.9 19.6 62.6 96.2

Asian or Pacific Islander 1.2

7.9

10.5

3.2

6.3

14.8

16.9

Includes births to Aleuts and Eskimos. Born prior to 37 completed weeks of gestation.

NOTE: Fifteen states reported multiple-race data on the birth certificate for 2004. The multiple-race data for these states were bridged to the single-race categories of the 1977 standards for comparability with other states; see reference 2.

Table 5. Percent of live births with selected maternal and infant characteristics by Hispanic origin of mother and race of mother for mothers of non-Hispanic origin: United States, 2004 linked file Hispanic

Characteristic Birthweight: Less than 1,500 grams . . . . . . . . Less than 2,500 grams . . . . . . . . Preterm births3 . . . . . . . . . . . . . . Births to mothers under 20 years . . . Fourth and higher order births . . . . . Births to unmarried mothers. . . . . . . Mothers born in the 50 states and DC 1

. . . . . . .

. . . . . . .

Includes origin not stated

Includes races other than black or white.

3 Born prior to 37 completed weeks of gestation.

2

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

All origins1

Total

1.5 8.1 12.5 10.3 11.0 35.8 75.8

1.2 6.8 12.0 14.3 14.0 46.4 36.8

Mexican

Puerto Rican

1.1 6.5 11.8 15.3 15.1 45.2 36.4

2.0 9.8 14.0 17.6 12.4 61.0 67.4

Non-Hispanic

Cuban

Central and South American

Other and unknown Hispanic

Total2

White

Black

1.3 7.7 12.8 7.8 5.1 33.2 47.1

1.2 6.7 11.7 8.4 10.8 47.6 12.7

1.3 7.8 12.6 16.2 11.9 46.6 73.4

1.6 8.5 12.6 9.1 10.1 32.6 87.4

1.2 7.2 11.5 7.4 8.9 24.5 94.2

3.2

13.8

17.9

17.3

15.3

69.3

87.4

22 National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Table 6. Live births, infant, neonatal, and postneonatal deaths and mortality rates by race and Hispanic origin of mother and birthweight: United States, 2004 linked file, and percentage change in birthweight-specific infant mortality, 1995–2004 linked files Number in 2004 Race and birthweight

Live births

1

Infant deaths

Neonatal deaths

Postneonatal

Percent change in infant mortality rate 1995–2004

4.52

2.25

–10.4**

46.73 212.74 826.69 410.33 116.22 48.93 31.24 18.16 5.84 0.77 1.61 0.63 0.49 0.48 0.76 * ...

10.91 31.77 22.87 70.25 39.69 18.88 13.86 9.19 5.17 1.49 2.55 1.44 1.02 0.94 0.76 * ...

–10.8** –8.9** –6.0** –9.0** –14.4** –20.7** –17.4** –17.5** –18.7** –23.6** –23.5** –27.5** –24.9** –22.0** –29.0** –42.6 *

Mortality rate per 1,000 live births in 2004 Postneonatal deaths

Infant

Neonatal

All races . . . . . . . . . . . . . . . . . .

4,112,055

27,860

18,602

9,258

6.78

Less than 2,500 grams . . Less than 1,500 grams . Less than 500 grams . 500–749 grams . . . . . 750–999 grams . . . . . 1,000–1,249 grams . . . 1,250–1,499 grams . . . 1,500–1,999 grams . . . 2,000–2,499 grams . . . 2,500 grams or more . . . 2,500–2,999 grams . . . 3,000–3,499 grams . . . 3,500–3,999 grams . . . 4,000–4,499 grams . . . 4,500–4,999 grams . . . 5,000 grams or more . . Not stated . . . . . . . . . .

. . . . . . . . . . . . . . . . .

333,427 61,983 6,953 11,659 12,321 14,245 16,805 65,821 205,623 3,778,051 730,045 1,573,831 1,125,055 299,196 44,917 5,007 577

19,218 15,155 5,907 5,602 1,921 966 758 1,800 2,264 8,528 3,039 3,272 1,699 424 69 24 113

15,582 13,186 5,748 4,784 1,432 697 525 1,195 1,200 2,916 1,176 998 551 143 34 13 104

3,637 1,969 159 819 489 269 233 605 1,064 5,612 1,864 2,274 1,149 281 34 11 9

57.64 244.50 849.56 480.49 155.91 67.81 45.11 27.35 11.01 2.26 4.16 2.08 1.51 1.42 1.54 4.79 ...

White . . . . . . . . . . . . . . . . . . . . .

3,222,929

18,257

12,178

6,080

5.66

3.78

1.89

–10.2**

Less than 2,500 grams . . Less than 1,500 grams . Less than 500 grams . 500–749 grams . . . . . 750–999 grams . . . . . 1,000–1,249 grams . . . 1,250–1,499 grams . . . 1,500–1,999 grams . . . 2,000–2,499 grams . . . 2,500 grams or more . . . 2,500–2,999 grams . . . 3,000–3,499 grams . . . 3,500–3,999 grams . . . 4,000–4,499 grams . . . 4,500–4,999 grams . . . 5,000 grams or more . . Not stated . . . . . . . . . .

. . . . . . . . . . . . . . . . .

228,756 39,419 3,927 6,914 7,800 9,360 11,418 45,976 143,361 2,993,755 522,822 1,226,188 941,407 259,811 39,286 4,241 418

11,968 9,142 3,353 3,430 1,215 631 513 1,291 1,535 6,213 2,109 2,384 1,314 331 59 15 77

9,879 8,096 3,278 3,003 956 487 373 901 881 2,230 868 770 438 114 31 8 69

2,089 1,046 75 427 259 144 140 389 654 3,983 1,241 1,614 876 217 27 7 8

52.32 231.92 853.83 496.09 155.77 67.41 44.93 28.08 10.71 2.08 4.03 1.94 1.40 1.27 1.50 * ...

43.19 205.38 834.73 434.34 122.56 52.03 32.67 19.60 6.15 0.74 1.66 0.63 0.47 0.44 0.79 * ...

9.13 26.54 19.10 61.76 33.21 15.38 12.26 8.46 4.56 1.33 2.37 1.32 0.93 0.84 0.69 * ...

–12.4** –11.0** –6.3 –9.2** –19.2** –25.9** –19.0** –15.4** –21.8** –22.4** –23.7** –27.1** –23.1** –20.1** –26.1 * *

Black . . . . . . . . . . . . . . . . . . . . .

616,076

8,162

5,505

2,657

13.25

8.94

4.31

–9.1**

Less than 2,500 grams . . Less than 1,500 grams . Less than 500 grams . 500–749 grams . . . . . 750–999 grams . . . . . 1,000–1,249 grams . . . 1,250–1,499 grams . . . 1,500–1,999 grams . . . 2,000–2,499 grams . . . 2,500 grams or more . . . 2,500–2,999 grams . . . 3,000–3,499 grams . . . 3,500–3,999 grams . . . 4,000–4,499 grams . . . 4,500–4,999 grams . . . 5,000 grams or more . . Not stated . . . . . . . . . .

83,252 19,334 2,728 4,199 3,893 4,108 4,406 15,912 48,006 532,699 148,523 234,900 119,908 25,271 3,602 495 125

6,291 5,297 2,306 1,908 599 282 202 408 586 1,839 753 709 291 72 5 8 32

4,941 4,470 2,227 1,555 399 171 117 230 242 532 243 176 82 23 2 5 31

1,350 827 79 353 199 111 86 178 345 1,306 510 532 209 49 3 3 1

75.57 273.97 845.31 454.39 153.87 68.65 45.85 25.64 12.21 3.45 5.07 3.02 2.43 2.85 * * ...

59.35 231.20 816.35 370.33 102.49 41.63 26.55 14.45 5.04 1.00 1.64 0.75 0.68 0.91 * * ...

16.22 42.77 28.96 84.07 51.12 27.02 19.52 11.19 7.19 2.45 3.43 2.26 1.74 1.94 * * ...

–4.6** –4.1 –5.5 –9.0** –5.6 –7.8 –5.6 –20.8** –9.2 –24.0** –18.5** –26.3** –30.2** –34.5 * * *

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See footnotes at end of table.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . .

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

23

Table 6. Live births, infant, neonatal, and postneonatal deaths and mortality rates by race and Hispanic origin of mother and birthweight: United States, 2004 linked file, and percentage change in birthweight-specific infant mortality, 1995–2004 linked files—Con. Number in 2004 Race and birthweight

Live births

2

Infant deaths

Neonatal deaths

Postneonatal

Percent change in infant mortality rate 1995–2004

Mortality rate per 1,000 live births in 2004 Postneonatal deaths

Infant

Neonatal

American Indian . . . . . . . . . . . . . .

43,927

371

187

184

8.45

4.26

4.19

–6.5

Less than 2,500 grams . . Less than 1,500 grams . Less than 500 grams . 500–749 grams . . . . . 750–999 grams . . . . . 1,000–1,249 grams . . . 1,250–1,499 grams . . . 1,500–1,999 grams . . . 2,000–2,499 grams . . . 2,500 grams or more . . . 2,500–2,999 grams . . . 3,000–3,499 grams . . . 3,500–3,999 grams . . . 4,000–4,499 grams . . . 4,500–4,999 grams . . . 5,000 grams or more . . Not stated . . . . . . . . . .

. . . . . . . . . . . . . . . . .

3,295 581 54 107 105 143 172 653 2,061 40,622 7,180 16,271 12,571 3,802 696 102 10

193 126 43 45 22 11 4 22 45 178 52 70 39 11 4 1 –

149 112 43 39 19 9 2 12 24 38 15 13 7 2 1 – –

44 13 – 6 3 2 2 10 21 139 37 57 32 9 3 1 –

58.57 216.87 796.30 420.56 209.52 * * 33.69 21.83 4.38 7.24 4.30 3.10 * * * ...

45.22 192.77 796.30 364.49 * * * * 11.64 0.94 * * * * * * ...

13.35 * * * * * * * 10.19 3.42 5.15 3.50 2.55 * * * ...

1.7 –8.4 –10.4 –31.0 * * * * 13.5 –18.1 –31.4 –11.2 –24.2 * * * ...

Asian or Pacific Islander. . . . . . . . . .

229,123

1,070

733

337

4.67

3.20

1.47

–11.6**

Less than 2,500 grams . . Less than 1,500 grams . Less than 500 grams . 500–749 grams . . . . . 750–999 grams . . . . . 1,000–1,249 grams . . . 1,250–1,499 grams . . . 1,500–1,999 grams . . . 2,000–2,499 grams . . . 2,500 grams or more . . . 2,500–2,999 grams . . . 3,000–3,499 grams . . . 3,500–3,999 grams . . . 4,000–4,499 grams . . . 4,500–4,999 grams . . . 5,000 grams or more . . Not stated . . . . . . . . . .

. . . . . . . . . . . . . . . . .

18,124 2,649 244 439 523 634 809 3,280 12,195 210,975 51,520 96,472 51,169 10,312 1,333 169 24

766 590 206 219 85 41 39 79 97 299 125 110 55 9 1 – 4

613 508 200 186 58 30 33 52 54 116 50 39 24 4 – – 4

153 83 6 33 27 11 5 27 44 184 75 71 31 5 1 – –

42.26 222.73 844.26 498.86 162.52 64.67 48.21 24.09 7.95 1.42 2.43 1.14 1.07 * * * ...

33.82 191.77 819.67 423.69 110.90 47.32 40.79 15.85 4.43 0.55 0.97 0.40 0.47 * * * ...

8.44 31.33 * 75.17 51.63 * * 8.23 3.61 0.87 1.46 0.74 0.61 * * * ...

–8.8 –7.1 –6.6 –3.4 –15.0 –28.9 –34.9 –41.6** –23.7 –34.3** –30.6** –40.9** –23.0 * * * *

Hispanic . . . . . . . . . . . . . . . . . . .

946,349

5,248

3,627

1,621

Less than 2,500 grams . . Less than 1,500 grams . Less than 500 grams . 500–749 grams . . . . . 750–999 grams . . . . . 1,000–1,249 grams . . . 1,250–1,499 grams . . . 1,500–1,999 grams . . . 2,000–2,499 grams . . . 2,500 grams or more . . . 2,500–2,999 grams . . . 3,000–3,499 grams . . . 3,500–3,999 grams . . . 4,000–4,499 grams . . . 4,500–4,999 grams . . . 5,000 grams or more . . Not stated . . . . . . . . . .

64,443 11,556 1,194 2,257 2,362 2,656 3,087 12,333 40,554 881,852 166,211 381,777 259,067 64,010 9,561 1,226 54

3,638 2,836 978 1,109 396 195 158 372 430 1,593 531 634 329 75 19 5 17

3,000 2,487 954 982 296 141 114 262 251 610 238 208 119 29 13 2 17

638 349 24 127 100 55 43 110 179 982 293 426 209 45 6 3 –

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

See footnotes at end of table.

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . .

5.55

3.83

1.71

–11.5**

56.45 245.41 819.10 491.36 167.65 73.42 51.18 30.16 10.60 1.81 3.19 1.66 1.27 1.17 * * ...

46.55 215.21 798.99 435.09 125.32 53.09 36.93 21.24 6.19 0.69 1.43 0.54 0.46 0.45 * * ...

9.90 30.20 20.10 56.27 42.34 20.71 13.93 8.92 4.41 1.11 1.76 1.12 0.81 0.70 * * ...

–8.0** –6.8** –6.3 –9.2 –11.5 –14.0 –5.9 –10.7 –18.4** –27.6** –28.8** –27.2** –31.0** –22.5 * * *

24 National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Table 6. Live births, infant, neonatal, and postneonatal deaths and mortality rates by race and Hispanic origin of mother and birthweight: United States, 2004 linked file, and percentage change in birthweight-specific infant mortality, 1995–2004 linked files—Con. Number in 2004 Race and birthweight

Postneonatal deaths

Infant deaths

Non-Hispanic white . . . . . . . . . . . . .

2,296,684

13,001

8,499

4,502

5.66

3.70

1.96

–9.9**

Less than 2,500 grams . . Less than 1,500 grams . Less than 500 grams . 500–749 grams . . . . . 750–999 grams . . . . . 1,000–1,249 grams . . . 1,250–1,499 grams . . . 1,500–1,999 grams . . . 2,000–2,499 grams . . . 2,500 grams or more . . . 2,500–2,999 grams . . . 3,000–3,499 grams . . . 3,500–3,999 grams . . . 4,000–4,499 grams . . . 4,500–4,999 grams . . . 5,000 grams or more . . Not stated . . . . . . . . . .

. . . . . . . . . . . . . . . . .

166,029 28,114 2,687 4,717 5,512 6,780 8,418 33,966 103,949 2,130,476 361,064 853,288 686,773 196,528 29,796 3,027 179

8,309 6,269 2,326 2,318 823 444 358 929 1,111 4,642 1,595 1,752 989 255 39 10 50

6,828 5,559 2,276 2,015 660 349 260 642 628 1,624 634 562 320 84 18 6 47

1,481 711 51 304 163 95 98 287 483 3,018 961 1,191 669 172 21 4 3

50.05 222.98 865.65 491.41 149.31 65.49 42.53 27.35 10.69 2.18 4.42 2.05 1.44 1.30 1.31 * ...

41.13 197.73 847.04 427.18 119.74 51.47 30.89 18.90 6.04 0.76 1.76 0.66 0.47 0.43 * * ...

8.92 25.29 18.98 64.45 29.57 14.01 11.64 8.45 4.65 1.42 2.66 1.40 0.97 0.88 0.70 * ...

–14.9** –13.5** –6.1 –10.3** –22.0** –28.9** –23.5** –17.0** –23.0** –20.4** –20.4** –26.0** –21.3** –18.2** –29.6 * *

Non-Hispanic black . . . . . . . . . . . . .

578,774

7,869

5,283

2,586

13.60

9.13

4.47

–7.2**

Less than 2,500 grams . . Less than 1,500 grams . Less than 500 grams . 500–749 grams . . . . . 750–999 grams . . . . . 1,000–1,249 grams . . . 1,250–1,499 grams . . . 1,500–1,999 grams . . . 2,000–2,499 grams . . . 2,500 grams or more . . . 2,500–2,999 grams . . . 3,000–3,499 grams . . . 3,500–3,999 grams . . . 4,000–4,499 grams . . . 4,500–4,999 grams . . . 5,000 grams or more . . Not stated. . . . . . . . .

79,911 18,641 2,628 4,054 3,756 3,964 4,239 15,313 45,957 498,773 141,296 220,220 110,552 22,991 3,254 460 90

6,075 5,114 2,221 1,846 579 271 196 393 567 1,768 723 684 278 70 5 8 26

4,759 4,307 2,145 1,499 386 165 113 222 230 499 228 168 74 21 2 5 25

1,316 807 77 348 193 106 84 171 338 1,269 495 515 204 49 3 3 1

76.02 274.34 845.13 455.35 154.15 68.37 46.24 25.66 12.34 3.54 5.12 3.11 2.51 3.04 * * ...

59.55 231.05 816.21 369.76 102.77 41.62 26.66 14.50 5.00 1.00 1.61 0.76 0.67 0.91 * * ...

16.47 43.29 29.30 85.84 51.38 26.74 19.82 11.17 7.35 2.54 3.50 2.34 1.85 2.13 * * ...

–3.8** –3.8 –5.6 –8.4** –5.8 –8.1 –4.2 –20.5** –8.0 –22.5** –17.8** –24.5** –28.7** –31.4 * * *

. . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . .

Infant

Neonatal

Postneonatal

Percent change in infant mortality rate 1995–2004

Live births

. . . . . . . . . . . . . . . . .

Neonatal deaths

Mortality rate per 1,000 live births in 2004

* Figure does not meet standards of reliability or precision; based on fewer than 20 deaths in the numerator.

** Significant at p <.05.

. . . Category not applicable.

– Quantity zero.

1 Includes races other than white or black.

2 Includes Aleuts and Eskimos.

NOTES: Infant deaths are weighted so numbers may not exactly add to totals due to rounding. Neonatal is less than 28 days and postneonatal is 28 days to under 1 year. Race and Hispanic origin are reported separately on birth certificates. Race categories are consistent with the 1977 Office of Management and Budget standards. Persons of Hispanic origin may be of any race. In this table Hispanic women are classified only by place of origin; non-Hispanic women are classified by race. Fifteen states reported multiple-race data on the birth certificate for 2004. The multiple-race data for these states were bridged to the single-race catergories of the 1977 standards for comparability with other states; see reference 2.

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

25

Table 7. Infant deaths and mortality rates for the five leading causes of infant death, by race and Hispanic origin of mother: United States, 2004 linked file [Rates per 100,000 live births in specified group] Cause of death (Based on the Tenth Revision International Classification of Diseases, 1992)

All races

Rank Number Rate Rank Number Rate Rank Number

All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . Congenital malformations, deformations, and chromosomal abnormalities. . . . . . . (Q00–Q99) 1 Disorders related to short gestation and low birth weight, not elsewhere classified . . . . . (P07) 2 Sudden infant death syndrome . . . . . . . . . (R95) 3 Newborn affected by maternal complications of pregnancy. . . . . . . . . . . . . . . . . . . . . (P01) 4 Accidents (unintentional injuries) . . . . . (V01–X59) 5 Cause of death (Based on the Tenth Revision International Classification of Diseases, 1992) All causes . . . . . . . . . . . . . . . . . . . . . . . . Congenital malformations, deformations, and chromosomal abnormalities. . . . . . . (Q00–Q99) Disorders related to short gestation and low birth weight, not elsewhere classified . . . . . . . . (P07) Sudden infant death syndrome . . . . . . . . . (R95) Newborn affected by maternal complications of pregnancy. . . . . . . . . . . . . . . . . . . . . (P01) Accidents (unintentional injuries) . . . . . (V01–X59)

Non-Hispanic black1

Non-Hispanic white

27,860 677.5 . . .

13,001 566.1 . . .

American Indian2,3 Asian and Pacific Islander4

Rate

Rank Number Rate

7,869 1,359.6 . . .

Rank

Number

Rate

371

844.6

...

1,070

467.0

5,636 137.1

1

2,969 129.3

2

969

167.4

1

89

202.6

1

239

104.3

4,610 112.1 2,247 54.6

2 3

1,770 1,240

77.1 54.0

1 3

1,720 642

297.2 110.9

3 2

29 44

66.0 100.2

2 4

174 55

75.9 24.0

1,706 1,054

4 5

739 589

32.2 25.6

4 7

597 271

103.1 46.8

6 4

12 21

* 47.8

3 9

69 26

30.1 11.4

41.5 25.6

Total Hispanic5

Mexican6

Central and South American8

Puerto Rican7

Rank

Number

Rate

Rank

Number

Rate

Rank

Number

Rate

Rank

Number

Rate

...

5,248

554.6

...

3,705

546.8

...

479

782.4

...

667

464.7

1

1,308

138.2

1

976

144.0

2

78

127.4

1

157

109.4

2 3

816 261

86.2 27.6

2 3

540 181

79.7 26.7

1 3

93 36

151.9 58.8

2 7

108 23

75.3 16.0

4 8

256 150

27.1 15.9

4 8

168 112

24.8 16.5

4 13

31 8

50.6 *

3 8

37 15

25.8 *

. . . Category not applicable. * Figure does not meet standards of reliability or precision; based on fewer than 20 deaths in the numerator.

1 For Non-Hispanic black women, Newborn affected by complications of placenta, cord and membranes was the fifth leading cause of death with 288 deaths and a rate of 49.8.

2 Includes Aleuts and Eskimos.

3 For American Indians, Newborn affected by complications of placenta, cord and membranes was the fifth leading cause of death; however with only 14 deaths, a reliable infant mortality rate could not

be computed.

4 For Asian or Pacific Islanders, Diseases of the circulatory system and Neonatal hemorrhage were tied for the fifth leading cause of death, with 37 deaths each and rates of 16.1.

5 For Total Hispanic, Newborn affected by complications of placenta, cord and membranes was the fifth leading cause of death with 184 deaths and a rate of 19.4.

6 For Mexicans, Newborn affected by complications of placenta, cord and membranes was the fifth leading cause of death with 130 deaths and a rate of 19.2.

7 For Puerto Ricans, Respiratory distress of newborn was the fifth leading cause of death; however, with only 16 deaths, a reliable infant morality rate could not be computed.

8 For Central and South Americans Respiratory distress of newborn was the fourth leading cause of death with 28 deaths and a rate of 19.5. Bacterial sepsis of newborn was the fifth leading cause of

death with 27 deaths and a rate of 18.8. NOTES: Reliable cause-specific infant mortality rates cannot be computed for Cubans because of the small number of infant deaths (68). Race and Hispanic origin are reported separately on birth certificates. Race categories are consistent with the 1977 Office of Management and Budget standards. Persons of Hispanic origin may be of any race. In this table Hispanic women are classified only by place of origin; non-Hispanic women are classified by race. Fifteen states reported multiple-race data on the birth certificate for 2004. The multiple-race data for these states were bridged to the single-race catergories of the 1977 standards for comparability with other states; see reference 2.

26 National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Table 8. Number of and percent of preterm-related infant deaths and preterm-related infant mortality rates by race and Hispanic origin of mother: United States, 1999–2004 linked files Central All races Non-Hispanic Non-Hispanic American Asian or Total Puerto and South and origins white black Indian Pacific Islander Hispanic1 Mexican Rican American

Year

Number of preterm-related infant deaths

2004. 2003. 2002. 2001. 2000. 1999.

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. 10,180 . 10,331 . 9,965 . 9,767 . 9,673 . 9,865

2004. 2003. 2002. 2001. 2000. 1999.

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

4,171 4,358 4,342 4,289 4,141 4,285

3,641 3,615 3,581 3,561 3,586 3,669

83 91 90 79 96 100

378 364 321 280 298 260

1,752 1,761 1,540 1,436 1,411 1,408

1,192 1,163 1,018 951 929 879

195 200 190 196 189 216

238

256

192

189

170

153

Percent of total infant deaths that are preterm-related

2004. 2003. 2002. 2001. 2000. 1999. 1 2

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

. . . . . .

36.5 36.9 35.6 35.5 34.6 35.4 2.48 2.53 2.48 2.43 2.38 2.49

32.1 32.9 32.6 32.2 30.8 31.7 1.82 1.88 1.89 1.84 1.75 1.83

46.3 46.1 44.6 44.9 43.7 44.1

22.4 24.2 24.6 19.6 27.7 26.8

35.3 34.1 31.9 29.6 30.5 29.7

Preterm-related infant mortality rate2 6.29 1.89 1.65 6.28 2.11 1.65 6.19 2.12 1.52 6.04 1.89 1.40 5.93 2.30 1.49 6.23 2.49 1.44

33.4 34.2 31.3 31.0 30.9 32.3 1.85 1.93 1.76 1.69 1.73 1.84

32.2 32.4 29.9 29.8 29.4 29.5 1.76 1.78 1.62 1.56 1.60 1.63

40.7 41.8 40.3 39.9 39.6 45.3 3.19 3.42 3.31 3.40 3.25 3.78

35.7

37.4

30.1

31.3

32.3

31.7

1.66

1.89

1.52

1.56

1.50

1.48

Includes Cuban and other and unknown Hispanic. Cuban data was not shown separately because of small numbers of infant deaths. Rate per 1,000 live births in specified group.

NOTES: Preterm-related deaths are those where the infant was born preterm (before 37 completed weeks of gestation) with the underlying cause of death assigned to one of the following ICD-10

categories: K550, P000, P010, P011, P015, P020, P021, P027, P070-P073, P102, P220–229, P250–279, P280, P281, P360-P369, P520-P523, P77; see Technical Notes. Fifteen states reported

multiple-race data on the birth certificate for 2004. The multiple-race data for these states were bridged to the single-race catergories of the 1977 standards for comparability with other states; see

reference 2.

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Technical Notes Differences between period and cohort data From 1983 to 1991, NCHS produced linked files in a birth cohort format (44). Beginning with 1995 data, linked files are produced first using a period format and then subsequently using a birth cohort format. The 2004 period linked file contains a numerator file that consists of all infant deaths occurring in 2004 that have been linked to their corresponding birth certificates, whether the birth occurred in 2003 or in 2004. In contrast, the 2004 birth cohort linked file will contain a numerator file that consists of all infant deaths to babies born in 2004 whether the death occurred in 2004 or 2005. While the birth cohort format has methodological advantages, it creates delays in data availability, since it is necessary to wait until the close of the following data year to include all infant deaths in the birth cohort. Beginning with 1995 data, the period linked file is the basis for all official NCHS linked file statistics. For the 2004 file, NCHS accepted birth records that could be linked to infant deaths even if registered after the closure of the 2004 birth file (less than 100 cases). This improved the infant birth/death linkage and made the denominator file distinctly different from the official 2004 birth file.

Weighting A record weight is added to the linked file to compensate for the 1.1 percent (in 2004) of infant death records that could not be linked to their corresponding birth certificates. This procedure was initiated in 1995. Records for Puerto Rico, the Virgin Islands, and Guam are not weighted. The percent of records linked varied by registration area (from 96.7–100.0 percent with all but four areas—California, Massachusetts, New Jersey, and Texas at 97.5 percent or higher) (Table I). The number of infant deaths in the linked file for the 50 states and the District of Columbia was weighted to equal the sum of the linked plus unlinked infant deaths by state of occurrence at birth and age at death (less than 7 days, 7–27 days, and 28 days to under 1 year). The addition of the weight greatly reduced the potential for bias in comparing infant mortality rates by characteristics. The 2004 linked file started with 27,920 infant death records. Of these 27,920 records, 27,612 were linked; 308 were unlinked because corresponding birth certificates could not be identified. The 27,920 linked and unlinked records contained 60 records of infants whose mother’s usual place of residence was outside of United States. These 60 records were excluded to derive a weighted total of 27,860 infant deaths. Thus, all total calculations for 2004 in this report used a weighted total of 27,860 infant deaths (Tables A–C, 1,2, and 6–8).

Comparison of infant mortality data between the linked file and the vital statistics mortality file The overall infant mortality rate from the 2004 period linked file of 6.78 is nearly the same as the 2004 vital statistics mortality file (6.79)(3). The number of infant deaths differs slightly; the number in the mortality file was 27,936 (3). Differences in numbers of infant deaths between the two data sources are primarily due to geographic coverage differences, as for the vital statistics mortality file, all deaths occurring in the 50 states and the District of Columbia are included

27

Table I. Percentage of infant death records which were linked to their corresponding birth records: United States and each state, Puerto Rico, Virgin Islands, and Guam, 2004 linked file Percent linked by state of occurrence of death

State United States1. . . . . . . . . . . . . . . .

98.9

Alabama . . . . . . . Alaska . . . . . . . . Arizona . . . . . . . . Arkansas . . . . . . . California. . . . . . . Colorado . . . . . . . Connecticut . . . . . Delaware. . . . . . . District of Columbia Florida . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

100.0

100.0

98.7

99.7

96.9

100.0

100.0

100.0

100.0

99.8

Georgia . Hawaii . . Idaho . . . Illinois . . Indiana . . Iowa . . . Kansas . . Kentucky . Louisiana. Maine. . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

100.0

100.0

99.2

97.6

99.4

100.0

100.0

99.4

98.6

100.0

Maryland . . . . . Massachusetts . Michigan . . . . . Minnesota . . . . Mississippi . . . . Missouri . . . . . Montana . . . . . Nebraska. . . . . Nevada. . . . . . New Hampshire.

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

100.0

97.0

100.0

100.0

99.2

99.9

100.0

99.5

99.5

100.0

New Jersey . . New Mexico . . New York . . . North Carolina. North Dakota . Ohio . . . . . . Oklahoma . . . Oregon . . . . . Pennsylvania . Rhode Island .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

97.3

100.0

98.7

100.0

100.0

98.5

99.0

99.6

99.6

100.0

South Carolina South Dakota . Tennessee . . . Texas . . . . . . Utah . . . . . . Vermont . . . . Virginia . . . . . Washington . . West Virginia . Wisconsin . . . Wyoming . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

100.0

100.0

99.9

96.7

100.0

100.0

100.0

99.8

100.0

100.0

100.0

Puerto Rico . . . . . . . . . . . . . . . . . Virgin Islands . . . . . . . . . . . . . . . . Guam. . . . . . . . . . . . . . . . . . . . .

99.5

100.0

100.0

1

. . . . . . . . . .

. . . . . . . . . .

. . . . . . . . . .

Excludes data for Puerto Rico, Virgin Islands, and Guam.

regardless of the place of birth of the infant. In contrast, to be included in the U.S. linked file, both the birth and death must occur in the 50 states and the District of Columbia (the territory linked file is a

28 National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

separate file). Also, although every effort has been made to design weights that will accurately reflect the distribution of deaths by characteristics, weighting may contribute to small differences in numbers and rates by specific variables between these two data sets.

The 1989 and 2003 Revisions of the U.S. Standard Certificates of Live Birth This report includes 2004 data on items that are collected on both the 1989 Revision of the U.S. Standard Certificate of Live Birth (unrevised) and the 2003 Revision of the U.S. Standard Certificate of Live Birth (revised) (2). The 2003 revision is described in detail elsewhere (45–47). Seven states, Idaho, Kentucky, New York (excluding New York City), Pennsylvania, South Carolina, Tennessee, and Washington implemented the revised birth certificate as of January 1, 2004, or in 2003. Two additional states, Florida and New Hampshire, implemented the revised birth certificate in 2004, but after January 1. The nine revised states represent 20 percent of all 2004 births; the seven revised states that implemented as of January 1, 2004, represent 14 percent of all births. Data for educational attainment, prenatal care, and tobacco use, although collected on both the revised and unrevised certificates, are not considered comparable between revisions. As discussed above, the 2004 period linked file contains all infant deaths in 2004 linked to their corresponding birth certificates, whether the birth occurred in 2003 or 2004. Therefore, complete revised data for these variables were only available from the two states (Pennsylvania and Washington) that revised as of January 1, 2003. Revised data for educational attainment, prenatal care, and tobacco use are not shown in this report as data from two states was deemed insufficient for national-level analysis. Future reports will include revised data for these items. Data items exclusive to either the 1989 or the 2003 birth certificate revision are not shown in this report.

Marital status National estimates of births to unmarried women are based on two methods of determining marital status. In 2004, marital status was based on a direct question in 48 states and the District of Columbia. In the two States (Michigan and New York), which used inferential procedures to compile birth statistics by marital status, a birth is inferred as nonmarital if either of these factors, listed in priority-of-use order, is present: a paternity acknowledgment was received or the father’s name is missing. For more information on the inferential procedures and on the changes in reporting, see ‘‘Tech­ nical Notes’’ in Births: Final Data for 2004 (2).

Multiple race For the birth certificates in the 2004 data year, multiple race was reported by California, Florida (for births occurring from March 1, 2004, only), Hawaii, Idaho, Kentucky, Michigan (for births at selected facilities only), Minnesota, New Hampshire (for births occurring from July 19, 2004, only), New York State (excluding New York City), Ohio, Pennsylvania, South Carolina, Tennessee, Utah, and Washington (2). Data from the vital records of the remaining states, the District of

Columbia, and New York City followed the 1977 OMB standards in which a single race is reported (48,49). In addition, these areas also report the minimum set of four races as stipulated in the 1977 standards, compared with the minimum of five races for the 1997 standards (2). To provide uniformity and comparability of the data during the transition period, before multiple-race data are available for all reporting areas, it is necessary to bridge the responses of those who reported more than one race to a single race. Multiple race is imputed to a single race (one of the following: AIAN, API, black, or white) according to the combination of races, Hispanic origin, sex, and age indicated on the birth certificate (2).

Period of gestation and birthweight The primary measure used to determine the gestational age of the newborn is the interval between the first day of the mother’s last normal menstrual period (LMP) and the date of birth. It is subject to error for several reasons, including imperfect maternal recall or misidentification of the LMP because of postconception bleeding, delayed ovulation, or intervening early miscarriage. These data are edited for LMP-based gestational ages that are clearly inconsistent with the infant’s plurality and birthweight (see below), but reporting problems for this item persist and many occur more frequently among some subpopulations and among births with shorter gestations (50,51). The U.S. Standard Certificate of Live Birth contains an item, ‘‘clinical estimate of gestation,’’ which is compared with length of gestation computed from the date the LMP began when the latter appears to be inconsistent with birthweight. This is done for normal weight births of apparently short gestations and very low birthweight births reported to be full term. The clinical estimate was also used if the LMP date was not reported. The period of gestation for 5.9 percent of the births in 2004 was based on the clinical estimate of gestation. For 97 percent of these records, the clinical estimate was used because the LMP date was not reported. For the remaining 3 percent, the clinical estimate was used because it was consistent with the reported birthweight, whereas the LMP-based gestation was not. In cases where the reported birthweight was inconsistent with both the LMP-computed gestation and the clinical estimate of gestation, the LMP-computed gestation was used and birthweight was reclassified as ‘‘not stated.’’ This was necessary for about 0.04 percent of all birth records in 2004 (2). For the linked file, not stated birthweight was imputed for 3,244 records or 0.08 percent of the birth records in 2004 when birthweight was not stated but the period of gestation was known. In this case, birthweight was assigned the value from the previous record with the same period of gestation, maternal race, sex, and plurality. If birthweight and period of gestation were both unknown the not stated value for birthweight was retained. This imputation was done to improve the accuracy of birthweight-specific infant mortality rates, since the percent of records with not stated birthweight was higher for infant deaths (4.10 percent before imputation) than for live births (0.09 percent before imputation). The imputation reduced the percent of not stated records to 0.44 percent for infant deaths, and 0.01 percent for births. The not

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

stated birthweight cases in the natality/birth file, as distinct from the linked file, are not imputed (2).

Cause-of-death classification The mortality statistics presented in this report were compiled in accordance with the World Health Organization (WHO) regulations, which specify that member nations classify and code causes of death in accordance with the current revision of the International Statistical Classification of Diseases and Related Health Problems. The ICD provides the basic guidance used in virtually all countries to code and classify causes of death. The ICD not only details disease classifica­ tion but also provides definitions, tabulation lists, the format of the death certificate, and the rules for coding cause of death. Cause-of­ death data presented in this report were coded by procedures outlined in annual issues of the NCHS Instruction Manual (52,53). In this report, tabulations of cause-of-death statistics are based solely on the underlying cause of death. The underlying cause is defined by WHO as ‘‘the disease or injury which initiated the train of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury’’ (4). It is selected from the conditions entered by the physician in the cause-of-death section of the death certificate. When more than one cause or condition is entered by the physician, the underlying cause is determined by the sequence of conditions on the certificate, provisions of the ICD, and associated selection rules and modifications. Generally, more medical information is reported on death certificates than is directly reflected in the under­ lying cause of death. This is captured in NCHS multiple cause-of-death statistics (54,55). About every 10–20 years, the International Classification of Dis­ eases is revised to take into account advances in medical knowledge. Effective with deaths occurring in 1999, the United States began using the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) (4); during the period 1979–98, causes were coded and classified according to the Ninth Revision (ICD-9) (5). Changes in classification of causes of death due to these revisions may result in discontinuities in cause-of-death trends. Measures of this discontinuity are essential to the interpretation of mortality trends, and are discussed in detail in other NCHS publications (3, 56,57).

Tabulation lists and cause-of-death ranking The cause-of-death rankings for ICD-10 are based on the List of 130 Selected Causes of Infant Death. The tabulation lists and rules for ranking leading causes of death are published in the NCHS Instruction Manual, Part 9, ICD-10 Cause-of-Death Lists for Tabu­ lating Mortality Statistics, Effective 1999 (58). Briefly, category titles that begin with the words ‘‘Other’’ and ‘‘All other’’ are not ranked to determine the leading causes of death. When one of the titles that represents a subtotal is ranked (for example, Influenza and pneu­ monia (J10–J18)), its component parts are not ranked (in this case, Influenza (J10–J11) and Pneumonia (J12–18)).

Preterm-related causes of death This year, a new grouping of preterm-related causes of death was added to the report. This grouping attempts to identify causes of

29

death that have a direct etiological connection to preterm birth, and does not include causes that are incidental to preterm birth (for example, a Motor vehicle accident to a preterm infant). For an underlying cause of death to be considered preterm-related, 75 per­ cent or more of infants whose deaths were attributed to that cause had to be born preterm, and the cause of death had to be a direct consequence of preterm birth based on a clinical evaluation and review of the literature. Further detail on the development of this cause-of-death grouping is available in a related publication (59).

Computation of rates Infant mortality rates are the most commonly used index for measuring the risk of dying during the first year of life. For the linked birth/infant death data set they are calculated by dividing the number of infant deaths in a calendar year by the number of live births registered for the same period and are presented as rates per 1,000 or per 100,000 live births. Both the mortality file and the linked birth/infant death file use this computation method but due to unique numbers of infant deaths, as explained in the section above on the comparison of these two files, the rates will often differ for specific variables (particularly for race and ethnicity). Infant mortality rates use the number of live births in the denominator to approximate the population at risk of dying before the first birthday. In contrast to the infant mortality rates based on live births, infant death rates, used only in age-specific death rates with the mortality file, use the estimated population of persons under 1 year of age as the denominator. For all variables, not stated responses were shown in tables of frequencies, but were dropped before rates were computed. Rates per 1,000 live births display two digits after the decimal place to provides a more precise and sensitive measurement. For rates per 100,000 live births (by cause of death) the infant mortality rate is shown for one decimal place. Adding an additional decimal for rates per 100,000 does not increase precision as it does for rates per 1,000. As stated previously, infant death records for the 50 states and the District of Columbia in the U.S. linked file are weighted so that the infant mortality rates are not underestimated for those areas that did not successfully link all records.

Random variation in infant mortality rates The number of infant deaths and live births reported for an area represent complete counts of such events. As such, they are not subject to sampling error, although they are subject to nonsampling error in the registration process. However, when the figures are used for analytic purposes, such as the comparison of rates over time, for different areas, or among different subgroups, the number of events that actually occurred may be considered as one of a large series of possible results that could have arisen under the same circumstances (60). As a result, numbers of births, deaths, and infant mortality rates are subject to random variation. The probable range of values may be estimated from the actual figures according to certain statistical assumptions. In general, distributions of vital events may be assumed to follow the binomial distribution. When the number of events is large, the relative standard error is usually small. When the number of events is small (perhaps less than 100) and the probability of such an event is

30 National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

small, considerable caution must be observed in interpreting the data. Such infrequent events may be assumed to follow a Poisson probability distribution (3). Estimates of relative standard errors (RSE’s) and 95-percent confidence intervals are shown below. The formula for the RSE of infant deaths and live births is: RSE(D) = 100 c

Œ

Œ

where Dadj is the adjusted number of infant deaths (rounded to the nearest integer) used to take into account the RSE of the number of infant deaths and live births, and is computed as follows:

1 B

Dadj =

For example, let us say that for group A the number of infant deaths was 497 while the number of live births was 81,555 yielding an infant mortality rate of 6.09 infant deaths per 1,000 live births. The RSE of the deaths = 100 c

Œ

while the RSE of the births = 100 c

1 = 4.49, 497

Œ

1 = 0.35. 81,555

The formula for the RSE of the infant mortality rate (IMR) is:

Œ

1 1 + D B

The RSE of the IMR for the example above = 100 c

Œ

1 1 + = 4.50. 497 81,555

Binomial distribution—When the number of events is greater than 100, the binomial distribution is used to estimate the 95 percent confidence intervals as follows: Lower: R1 – 1.96 c R1 c Upper: R1 + 1.96 c R1 c

D c B

D + B

L (.95, Dadj) and U (.95, Dadj) refer to the values in Table II corresponding to the value of Dadj.

where B is the number of births.

RSE(IMR) = 100 c

Lower: IMR c L (.95, Dadj) Upper: IMR c U (.95, Dadj)

1 D

where D is the number of deaths and RSE (B) = 100 c

Poisson distribution—When the number of events in the numerator is less than 100, the confidence interval for the rate can be estimated based on the Poisson distribution using the values in Table II.

RSE(R1)

100

RSE(R1)

For example, let us say that for group B the number of infant deaths was 53, the number of live births was 9,241, and the infant mortality rate was 5.74. Dadj =

(53 c 9,241)

= 53

(53 + 9,241)

Therefore the 95 percent confidence interval (using the formula in Table II for 1–99 infant deaths) = Lower: 5.74 c 0.74907 = 4.30 Upper: 5.74 c 1.30802 = 7.51 Comparison of two infant mortality rates—If either of the two rates to be compared is based on less than 100 deaths, compute the confidence intervals for both rates and check to see if they overlap. If so, the difference is not statistically significant at the 95 percent level. If they do not overlap, the difference is statistically significant. If both of the two rates (R1 and R2) to be compared are based on 100 or more deaths, the following z-test may be used to define a signifi­ cance test statistic: R1 – R2 z=

Œ

R 12

(

)

RSE(R1) 2 100

+ R 22

(

)

RSE(R2) 2 100

If ?z? ≥ 1.96, then the difference is statistically significant at the 0.05 level and if ?z? < 1.96, the difference is not significant.

100

Availability of linked file data Thus, for group A:

( ) 4.50 = 6.63 Upper: 6.09 + (1.96 c 6.09 c 100 )

4.50 Lower: 6.09 – 1.96 c 6.09 c = 5.55 100

Thus the chances are 95 out of 100 that the true IMR for Group A lies somewhere in the 5.55–6.63 interval.

Linked file data are available on CD-ROM from the National Center for Health Statistics (NCHS) at 1–866-441–6247. Data are also available in selected issues of the Vital and Health Statistics, Series 20 reports, the National Vital Statistics Reports (formerly the Monthly Vital Statistics Report) through NCHS. Additional unpub­ lished tabulations are available from NCHS or through our Internet site at http://www.cdc.gov/nchs.

National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Table II. Values of L and U for calculating 95 percent confidence limits for numbers of events and rates when the number of events is less than 100 N 1. 2. 3. 4. 5. 6. 7. 8. 9. 10 . 11 . 12 . 13 . 14 . 15 . 16 . 17 . 18 . 19 . 20 . 21 . 22 . 23 . 24 . 25 . 26 . 27 . 28 . 29 . 30 . 31 . 32 . 33 . 34 . 35 . 36 . 37 . 38 . 39 . 40 . 41 . 42 . 43 . 44 . 45 . 46 . 47 . 48 . 49 . 50 .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

L

U

N

L

U

0.02532 0.12110 0.20622 0.27247 0.32470 0.36698 0.40205 0.43173 0.45726 0.47954 0.49920 0.51671 0.53246 0.54671 0.55969 0.57159 0.58254 0.59266 0.60207 0.61083 0.61902 0.62669 0.63391 0.64072 0.64715 0.65323 0.65901 0.66449 0.66972 0.67470 0.67945 0.68400 0.68835 0.69253 0.69654 0.70039 0.70409 0.70766 0.71110 0.71441 0.71762 0.72071 0.72370 0.72660 0.72941 0.73213 0.73476 0.73732 0.73981 0.74222

5.57164 3.61234 2.92242 2.56040 2.33367 2.17658 2.06038 1.97040 1.89831 1.83904 1.78928 1.74680 1.71003 1.67783 1.64935 1.62394 1.60110 1.58043 1.56162 1.54442 1.52861 1.51401 1.50049 1.48792 1.47620 1.46523 1.45495 1.44528 1.43617 1.42756 1.41942 1.41170 1.40437 1.39740 1.39076 1.38442 1.37837 1.37258 1.36703 1.36172 1.35661 1.35171 1.34699 1.34245 1.33808 1.33386 1.32979 1.32585 1.32205 1.31838

51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

0.74457 0.74685 0.74907 0.75123 0.75334 0.75539 0.75739 0.75934 0.76125 0.76311 0.76492 0.76669 0.76843 0.77012 0.77178 0.77340 0.77499 0.77654 0.77806 0.77955 0.78101 0.78244 0.78384 0.78522 0.78656 0.78789 0.78918 0.79046 0.79171 0.79294 0.79414 0.79533 0.79649 0.79764 0.79876 0.79987 0.80096 0.80203 0.80308 0.80412 0.80514 0.80614 0.80713 0.80810 0.80906 0.81000 0.81093 0.81185 0.81275

1.31482

1.31137

1.30802

1.30478

1.30164

1.29858

1.29562

1.29273

1.28993

1.28720

1.28454

1.28195

1.27943

1.27698

1.27458

1.27225

1.26996

1.26774

1.26556

1.26344

1.26136

1.25933

1.25735

1.25541

1.25351

1.25165

1.24983

1.24805

1.24630

1.24459

1.24291

1.24126

1.23965

1.23807

1.23652

1.23499

1.23350

1.23203

1.23059

1.22917

1.22778

1.22641

1.22507

1.22375

1.22245

1.22117

1.21992

1.21868

1.21746

31

32 National Vital Statistics Reports, Vol. 55, No. 14, May 2, 2007

Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Methods. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Results and Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . 4

References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

List of Detailed Tables . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Technical Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27

Copyright information All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

Suggested citation Mathews TJ, MacDorman MF. Infant mortality statistics from the 2004 period linked birth/infant death data set. National vital statistics reports; vol 55 no 15. Hyattsville, MD: National Center for Health Statistics. 2007.

National Center for Health Statistics Acknowledgments This report was prepared in the Division of Vital Statistics under the general direction of Stephanie J. Ventura, Chief of the Reproductive Statistics Branch (RSB). Nicholas Pace, Chief of Systems, Programming, and Statistical Resources Branch (SPSRB), Steve Steimel, Candace Cosgrove, Annie Liu, Jordan Sacks, Manju Sharma, and Sergey Yagodin (SPSRB) provided computer programming support and statistical tables. Yashu Patel of RSB provided assistance with content review. Bill Callaghan of the Division of Reproductive Health of the National Center for Chronic Disease Prevention and Health Promotion and Donna Hoyert and Ken Kochanek of the Mortality Statistics Branch contributed to the analysis of preterm-related causes of death. The Registration Methods staff and the Data Acquisition and Evalua­ tion Branch provided consultation to State vital statistics offices regarding collection of the birth and death certificate data on which this report is based. This report was edited by Gail V. Johnson, Writer Editor Services Branch; typeset by Annette F. Holman; and graphics were produced by Zorica Tomic-Whalen, CoCHIS/NCHM/Division of Creative Services.

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics 3311 Toledo Road Hyattsville, MD 20782 OFFICIAL BUSINESS PENALTY FOR PRIVATE USE, $300 To receive this publication regularly, contact the National Center for Health Statistics by calling 1-800-232-4636 E-mail: [email protected] Internet: www.cdc.gov/nchs CS110485 (5/2007) T28175 DHHS Publication No. (PHS) 2007–1120

Director

Edward J. Sondik, Ph.D.

Acting Co-Deputy Directors

Jennifer H. Madans, Ph.D.

Michael H. Sadagursky

Division of Vital Statistics Director, Charles J. Rothwell

MEDIA MAIL

POSTAGE & FEES PAID

CDC/NCHS

PERMIT NO. G-284

TECHNICAL APPENDIX FROM

VITAL STATISTICS OF THE UNITED STATES 2004 NATALITY

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION NATIONAL CENTER FOR HEALTH STATISTICS Hyattsville, Maryland: September 2006 Version 9-12-06

ACKNOWLEDGMENTS The technical appendix preparation was coordinated by Sharon Kirmeyer in the Division of Vital Statistics (DVS) under the general direction of Joyce A. Martin, Lead Statistician, Reproductive Statistics Branch (RSB), DVS, and Stephanie J. Ventura, Chief of the Reproductive Statistics Branch. The vital statistics computer file on which it is based was prepared by DVS staff. The Division of Vital Statistics, Charles J. Rothwell, Director, and James A. Weed, Deputy Director, managed the Vital Statistics Cooperative Program, through which the vital registration offices of all states, the District of Columbia, New York City, Puerto Rico, Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands provided the data to the National Center for Health Statistics (NCHS). This Division also processed computer edits, designed and programmed the tabulations, reviewed the data, prepared documentation for this publication, and was responsible for receipt and processing of the basic data file. The following management staff provided overall direction: Rajesh Virkar, Nicholas F. Pace, and Delton Atkinson. Important contributors were Judy M. Barnes, Faye Cavalchire, Candace Cosgrove, Connie M. Gentry, Brenda A. Green, Bonita Gross, Brady E. Hamilton, Kathy B. Holiday, Christina K. Jarman, Millie B. Johnson, David W. Justice, Virginia J. Justice, Julia L. Kowaleski, Kryn Krautheim, Annie Liu, Marian MacDorman, T.J. Mathews, Susan L. McBroom, Fay Menacker, Jaleh Mousavi, Martha Munson, Yashu Patel, Adrienne L. Rouse, Jordan Sacks, Manju Sharma, Steven Steimel, Pam Stephenson, Charles Sirc, Paul Sutton, George C. Tolson, James G. Williams, Jiaquan Xu and Serguey Yagodin. Thomas D. Dunn reviewed and verified the report. Senior Editor was Demarius Miller. NCHS acknowledges the essential role of the vital registration offices of all states and territories in maintaining the system through which vital statistics data are obtained and their cooperation in providing the information on which this publication is based.

2

For a list of reports published by the National Center for Health Statistics, contact: Information Dissemination Branch National Center for Health Statistics Centers for Disease Control and Prevention 3311 Toledo Road, Room 5420 Hyattsville, MD 20782 (301) 458–4636 Internet: www.cdc.gov/nchs

3

Table of Contents Introduction

7

Definition of Live Birth

7

History of Birth-Registration Area

8

Sources of Data

8

Natality statistics

8

Standard certificates of live birth

9

1989 revision

9

2003 revision

9

The 2004 Natality Data File

11

Occurrence and residence

12

Geographic classification

13

Demographic Characteristics

13

Hispanic origin, race and national origin

13

Age of mother

17

Age of father

19

Live birth order and parity

19

Marital Status

20

Educational attainment

21

Maternal and Infant Characteristics

22

Weight gain during pregnancy

22

Pregnancy risk factors

23

Tobacco use during pregnancy

23

Alcohol use during pregnancy

24

Prenatal care

24

Obstetric procedures

25

Characteristics of labor and/or delivery

26

Place of delivery and attendant at birth

27

Method of Delivery

27

4

Period of gestation

28

Birthweight

30

Apgar score

31

Plurality

31

Abnormal conditions of the newborn

32

Congenital anomalies of child

32

Quality of Data

33

Completeness of registration

33

Completeness of reporting

33

Quality control procedures

33

Computation of Rates and Other Measures

34

Population bases

34

Cohort fertility tables

37

Total fertility rates

38

Seasonal adjustment of rates

38

Computation of percentages, percentage distributions, and means

38

Computation of measures of variability

38

Random variation and significance testing for natality data

38

Random variation and significance testing for population subgroups

48

References

53

5

Figure 4-A. U.S. Standard Certificate of Live Birth: 1989 Revision 4-B. U.S. Standard Certificate of Live Birth: 2003 Revision Text Tables A.

Percentage of birth records on which specified items were not stated: United States and each state and territory, 2004

B.

Births by place of occurrence and residence for births occurring in the 50 states, the District of Columbia, U.S. territories, and other countries, 2004

C.

Lower and upper 95 percent and 96 percent confidence limit factors for a birth rate based on a Poisson variable of 1 through 99 births, B

D.

Sources for the resident population and population including Armed Forces abroad: Birth-and death-registration states, 1900–1932, and United States, 1900–2004

E.

Percentage net undercount, by age, sex, and race/Hispanic origin: United States, April 1, 2000

Population Tables 4-1. Population of birth-and death-registration states, 1900–1932, and United States, 1900–2004 4-2. Estimated total population by race and estimated female population by age and race: United States, 2004 4-3. Estimated total population by specified Hispanic origin and estimated female population by age and specified Hispanic origin and by race for women of nonHispanic origin: United States, 2004 4-4. Estimated total population and female population aged 15–44 years: United States, each state, and territory, July 1, 2004

6

Introduction This Technical Appendix, published by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS), is reprinted from “Vital Statistics of the United States, 2004, Volume I, Natality” [1]. Reference will be made to the “1999 Technical Appendix” for historical context and a more lengthy discussion of some variables, as well as the quality and completeness of the birth data [2]. This report supplements the “Technical Notes” section of “Births: Final data for 2004” [3] and is recommended for use with the public-use file for 2004 births, available on CD-ROM from NCHS [4], and the tabulated data of “Vital Statistics of the United States, 2004 Volume I, Natality” [1], in addition to the Internet publication of tables for variables not included in the 2004 natality report.

Definition of Live Birth Every product of conception that gives a sign of life after birth, regardless of the length of the pregnancy, is considered a live birth. This concept is included in the definition set forth by the World Health Organization in 1950 [5]. A slightly expanded definition of live birth was recommended by the 1992 revision of the Model State Vital Statistics Act and Regulations [6], based on recommendations of a 1988 working group formed by the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists [7] and is consistent with that currently used by the WHO in the ICD-10 [8] and the United Nations: “Live birth” means the complete expulsion or extraction from its mother of a product of human conception, irrespective of the duration of pregnancy, which, after such expulsion or extraction, breathes, or shows any other evidence of life, such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles, whether or not the umbilical cord has been cut or the placenta is attached. Heartbeats are to be distinguished from transient cardiac contractions; respirations are to be distinguished from fleeting respiratory efforts or gasps.

7

This definition distinguishes in precise terms a live birth from a fetal death [9,10]. Forty-eight registration areas use definitions of live births similar to this definition; five areas use a shortened definition; four have no formal definition of live birth. [9]. All states require the reporting of live births regardless of length of gestation or birth weight.

History of Birth-Registration Area Currently the birth-registration system of the United States includes the 50 states, the District of Columbia, the independent registration area of New York City, and Puerto Rico, the U.S. Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands (referred to as Northern Marianas). However, in the statistical tabulations, “United States” refers only to the aggregate of the 50 states (including New York City) and the District of Columbia. Information on the history and development of the birth-registration area is available elsewhere [2, 11].

Sources of Data Natality statistics Since 1985, natality statistics for all states and the District of Columbia have been based on information from the total file of records. The information is received on electronic files consisting of individual records processed by the states, the District of Columbia, New York City, Puerto Rico, the Virgin Islands, American Samoa, and the Northern Marianas. NCHS receives these files from the registration offices of all states, the two cities and four territories through the Vital Statistics Cooperative Program. Information for Guam is obtained from paper copies of original birth certificates which is coded and keyed by NCHS. Data from American Samoa first became available in 1997; data from the Northern Marianas in 1998. U.S. natality data are limited to births occurring within the United States, including those occurring to U.S. residents and nonresidents. Births to nonresidents of the United States have been excluded from all tabulations by place of residence beginning in 1970 (for further discussion see “Classification by occurrence and residence”). Births occurring to U.S. citizens outside the United States are not included in the natality file. Data for Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern

8

Marianas are limited to births registered in these areas. Standard certificates of live birth The U.S. Standard Certificate of Live Birth, issued by the U.S. Department of Health and Human Services, has served for many years as the principal means for attaining uniformity in the content of the documents used to collect information on births in the United States. Every 10-15 years, the U.S. Standard Certificate of Live Birth is revised. Most state certificates conform closely in content to the standard certificate, but are modified to the extent required by the particular state's needs or by special provisions of the state's vital statistics law. 1989 revision—Effective January 1, 1989, a revised U.S. Standard Certificate of Live Birth (figure 4-A) replaced the 1978 revision. This revision provided a wide variety of new information on maternal and infant health characteristics, representing a significant departure from previous versions in both content and format. The most significant format change was the use of checkboxes to obtain detailed medical and health information about the mother and child. Details of the nature and content of the 1989 revision are available elsewhere [2, 11]. 2003 revision — In 2003, a revised U.S. Standard Certificate of Live Birth was adopted, with initial implementation in two states (Pennsylvania and Washington). Five states, Idaho, Kentucky, New York (excluding New York City), South Carolina, and Tennessee implemented the revised birth certificate as of January 1, 2004. Two additional states, Florida and New Hampshire, implemented the revised birth certificate in 2004, but after January 1. The nine revised states represent 20 percent of all 2004 births; the seven states which revised as of January 1, 2004 represent 14 percent of all 2004 births. Full implementation in all states of the revised certificate will be phased in over several years. There are numerous new items on the 2003 certificate and modifications of old items. Examples of modified items include multiple race, educational attainment, smoking during pregnancy, and prenatal care. A few examples of new checkbox categories for old items are infertility treatment, NICU admission, and trial of labor prior to a cesarean delivery. The process of the 2003 revision and the revision contents are described elsewhere. [12,13].

9

A key aspect of the 2003 Revision of the United States Standard Certificate has been the re-engineering of the data collection and transmission system. The intent of the re-engineering is to improve data quality, speed of data collection and transmission, and to enhance standardization of data [14]. To encourage collection of data from the best sources, two worksheets have been developed: the Mother’s Worksheet and the Facility Worksheet. In the Mother’s Worksheet, data are directly obtained from the mother and include such data as race, Hispanic origin, educational attainment, etc. In the Facility Worksheet, data are obtained directly from medical records of the mother and infant for items such as date of last normal menses, risk factors, method of delivery, etc. To assist hospital staff in completing the Facility Worksheet, a comprehensive instruction manual was developed: Guide to Completing the Facility Worksheets for the Certificate of Live Birth and Report of Fetal Death (2003 Revision) [15]. The medical and health check boxes -- Both the 1989 and 2003 Standard Certificates of Live Birth use a checkbox format for collecting much of the medical and health information available on the birth certificate. This information includes items on pregnancy/medical risk factors, method of delivery, obstetric procedures, characteristics of labor and/or delivery, abnormal conditions of the newborn, and congenital anomalies of the child. However, a number of individual checkbox items included on the 1989 certificate were dropped from the revised certificate in 2003 (such as Rh sensitization, incompetent cervix, and amniocentesis). In addition, specifications for some check box items were modified for the 2003 revision resulting in data which are not comparable across revisions (for example: premature rupture of membranes and prolonged labor.) See table A and 2004 file documentation for reporting areas [4]. The report “Births: Final Data for 2004” includes items which are reported in both the 1989 and the 2003 Standard Certificate of Live Birth. Data items exclusive to either the 1989 (e.g. maternal anemia, ultrasound, and alcohol use) or the 2003 birth certificate revision (e.g. such as the use of infertility treatment and NICU admission) are not shown. Supplemental 2004 tables for data exclusive to the 1989 Revision are available on the NCHS website (www.cdc.gov/nchs). A forthcoming report will present selected information exclusive to the 2003 Revision.

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The 2004 Natality Data File The 2004 data file includes data items which are comparable between the 1989 and 2003 revisions of the U.S. Standard Certificate of Live Birth. The file also includes all data which are exclusive to the 1989 revision, such as febrile infant and cord prolapse. Additionally, the 2004 file also includes new checkbox response categories for selected items, such as number of previous cesarean deliveries and surfactants to newborn. Certain new data items exclusive to the 2003 revised certificate are not available on the file: -

date of last prenatal care visit

-

matching number for plural births

-

10-minute Apgar score

-

source of payment for delivery

-

mother’s height

-

WIC food receipt

-

infections present (5 items)

-

maternal morbidity (7 items)

-

whether infant was alive at time

-

whether infant was breastfed at

of report

discharge.

The 1989 certificate was used in 41 states, the District of Columbia and the territories for all of 2004. Seven states used the 2003 certificate throughout the 2004 data year: Idaho, Kentucky, New York (excluding New York City), Pennsylvania, South Carolina, Tennessee and Washington. Florida used the 1989 revision during January and February, 2004; New Hampshire used the 1989 revision until July 19; starting March 1, Florida implemented the 2003 revision; New Hampshire did so on July 20. One of the principal values of vital statistics data is realized through the presentation of rates that are computed by relating the vital events of a class to the population of a similarly defined class. Vital statistics and population statistics, therefore, must be tabulated in comparable groups. Even when the variables common to both, such as geographic area, age, race, and sex, have been similarly classified and tabulated, significant discrepancies may result from differences between the enumeration method of obtaining population data and the registration method of obtaining vital statistics data. The general rules used to classify characteristics of live births are set forth in two NCHS manuals [16, 17]. The instruction materials are for states to use in coding the data items; they do not include NCHS recodes. Therefore, the file layout [4] is a better source of information on the code structure because it provides the exact codes, recodes and reporting flags that are available. Classification of certain important items is discussed in

11

the following pages. Information on the completeness of reporting of birth certificate data is shown in table A, which presents a listing of items and the percentage of records that were not stated for each state, Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Marianas. Occurrence and residence In tabulations by place of residence, births occurring within the United States to U.S. citizens and to resident aliens are allocated to the usual place of residence of the mother in the United States, as reported on the birth certificate. Beginning in 1970, births to nonresidents of the United States occurring in the United States are excluded from these tabulations. Births to U.S. residents occurring outside this country are not included in tabulations by place of residence. The total count of births for the United States by place of residence and by place of occurrence will not be identical. Births to nonresidents of the United States are included in data by place of occurrence but excluded from data by place of residence, as previously indicated. See table B for the number of births by residence and occurrence for the 50 states and the District of Columbia for 2004. Residence error—A nationwide test of birth-registration completeness in 1950 provided measures of residence error for natality statistics. According to the 1950 test (which has not been repeated), errors in residence reporting for the country as a whole tend to overstate the number of births to residents of urban areas and to understate the number of births to residents of other areas [18]. Recent experience suggests that this is still a concern based on anecdotal evidence from the states. This tendency has assumed special importance because of a concomitant development—the increased utilization of hospitals in cities by residents of nearby places—with the result that a number of births are erroneously reported as having occurred to residents of urban areas. Another factor that contributes to this overstatement of urban births is the customary practice of using city addresses for persons living outside the city limits. Residence error should be taken into consideration in interpreting data for small areas and for cities. Both birth and infant mortality patterns can be affected. Incomplete residence—Beginning in 1973, where only the state of residence is reported with no city or county specified and the state named is different from the state of

12

occurrence, the birth is allocated to the largest city of the state of residence. Before 1973, such births were classified according to the exact place of occurrence. Geographic classification The rules followed in the classification of geographic areas for live births are contained in the instruction manual mentioned previously. The geographic code structure for the 2004 file is given in two manuals, “Vital Records Geographic Classification, 2003,” and “Vital Records Geographic Classification, 2004. Federal Information Processing Standards (FIPS).” NCHS Instruction Manual, Part 8, [17] and [19]. The geographic code structure on the 2004 file is based on results of the 2000 Census of Population. United States— In the statistical tabulations “United States” refers only to the aggregate of the 50 states and the District of Columbia. Alaska has been included in the U.S. tabulations since 1959 and Hawaii since 1960. Details of the classification of births for metropolitan statistical areas, metropolitan and non-metropolitan counties, and population size groups for cities and urban places are presented elsewhere [2]. Places with a population of less than 100,000 are not separately identified on the public-use file because of confidentiality limitations.

Demographic Characteristics Hispanic origin, and race Hispanic origin—Hispanic origin and race are reported separately on the birth certificate. Data for Hispanic subgroups are shown in most cases for five specific groups: Mexican, Puerto Rican, Cuban, Central and South American, and “other and unknown Hispanic.” In tabulations of birth data by race and Hispanic origin, data for persons of Hispanic origin are not further classified by race because the vast majority of births to Hispanic women in 2004 are reported as white as in previous years. In tabulations of birth data by race only, data for persons of Hispanic origin are included in the data for each race group according to the mother’s reported race. In tabulations that include Hispanic origin, data for non-Hispanic persons are classified according to the race of the mother because there are substantial differences in fertility and maternal and infant health

13

between Hispanic and non-Hispanic white women. A recode variable is available that provides cross tabulations of race by Hispanic origin. Items asking for the Hispanic origin of the mother and the father have been included on the birth certificates of all states and the District of Columbia, the Virgin Islands, and Guam since 1993 [3]. Puerto Rico, American Samoa, and the Northern Marianas do not collect this information. In addition, Florida (for births occurring from March 1, 2004 only), Idaho, Kentucky, New Hampshire (for births occurring as of July 19, 2004 only), New York State (excluding New York City), Pennsylvania, South Carolina, Tennessee, and Washington, which used the 2003 revision of the U.S. Standard Certificate of Live Birth, permitted respondents to select one or more Hispanic origin categories [Figure 4-B]. Minnesota, which used the 1989 revised certificate, also allowed reporting of multiple Hispanic groups. These 10 revised states accounted for 13 percent of Hispanic births in the United States in 2004. The percentage of records for which Hispanic origin of the parents was not reported in 2004 is shown by state in table A. The new Hispanic origin question asks that the respondent "check the box that best describes whether the mother or father is Spanish/Hispanic/Latina/o." Although only one response is asked for, multiple responses to this item are sometimes given. Therefore, the electronic State birth registration systems are designed to capture multiple responses to this item. If more than one box is checked, or if there is a literal entry and one or more boxes checked, the code for "Multiple Hispanic" is applied. These records are classified as "Other Hispanic" in NCHS data. The percentage of Hispanic mothers in the 10 revised states reporting more than one Hispanic origin group was 1.5 percent in 2004. In computing birth and fertility rates for the Hispanic population, births with origin of mother not stated are included with non-Hispanic births rather than being distributed. Thus, rates for the Hispanic population are underestimates of the true rates [20] to the extent that the births with Hispanic origin of mother not stated (0.8 percent in 2004) were actually to Hispanic mothers. The population with origin not stated was imputed. The effect on the rates is believed to be small. Single, Multiple and “Bridged” race of mother and father—In 1997, the Office of Management and Budget (OMB) issued ‘‘Revisions to the Standards for the

14

Classification of Federal Data on Race and Ethnicity’’ which revised the ‘‘1977 Statistical Policy Directive 15, Race and Ethnic Standards for Federal Statistics and Administrative Reporting’’ [21, 22, 23]. These documents specify guidelines for collection, tabulation, and presentation of race and ethnicity data within the Federal statistical system. The 1997 revised standards incorporated two major changes designed to reflect the changing racial profile of the United States. First, the revision increased from four to five the minimum set of categories to be used by Federal agencies for identification of race. The 1977 standards required Federal agencies to report racespecific tabulations using a minimum set of four single-race categories: American Indian or Alaska Native (AIAN), Asian or Pacific Islander (API), Black, and White. The five categories for race specified in the 1997 standards are: American Indian or Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, and White. The revised standards called for reporting of Asians separately from Native Hawaiians or Other Pacific Islanders. Collection of additional detail on race and ethnicity is permitted, as before, so long as the additional categories can be aggregated into the minimum categories. The revised standards also require Federal data collection programs to allow respondents to select one or more race categories. For the 2000 decennial census, the U.S. Census Bureau collected race and ethnicity data in accordance with the 1997 revised standards. However, the National Vital Statistics System, which is based on data collected by the states, will not be fully compliant with the new standards until all of the states revise their birth certificates to reflect the new standards. Thus, beginning with the 2000 data year, the numerators (births) for birth rates are incompatible with the denominators (populations) (see “Population denominators”). In order to compute rates, it is necessary to ‘‘bridge’’ population data for multiple-race persons to single-race categories. This has been done for birth rates by race presented in this report. Once all states revise their birth registration systems to be compliant with the 1997 OMB standards, the use of ‘‘bridged’’ populations can be discontinued. For the 2004 data year, multiple-race was reported by Florida (for births occurring from March 1, 2004 only), Idaho, Kentucky, New Hampshire (for births occurring from

15

July 19, 2004 only), New York State (excluding New York City), Pennsylvania, South Carolina, Tennessee and Washington, which used the 2003 revision of the U.S. Standard Certificate of Live Birth, as well as by California, Hawaii, Michigan (for births at selected facilities only), Minnesota, Ohio, and Utah, which used the 1989 revision of the U.S. Standard Certificate of Live Birth. These 15 states, which account for 43.0 percent of U.S. births in 2004, reported 1.8 percent of mothers as multiracial, with levels varying from 0.5 percent (New Hampshire) to 34.4 percent (Hawaii). Data from the vital records of the remaining 35 states and the District of Columbia followed the 1977 OMB standards in which a single race is reported [21]. In addition, these areas also report the minimum set of four races as stipulated in the 1977 standards [21], compared with the minimum of five races for the 1997 [22] standards. In order to provide uniformity and comparability of the data during the transition period, before multiple-race data are available for all reporting areas, it is necessary to “bridge” the responses of those who reported more than one race to a single-race. The bridging procedure for multiple-race mothers and fathers is based on the procedure used to bridge the multiracial population estimates (see “Population denominators”) [23, 24]. Multiple-race is imputed to a single race (one of the following: AIAN, API, Black, or White) according to the combination of races, Hispanic origin, sex, and age indicated on the birth certificate of the mother or father. The imputation procedure is described in detail elsewhere [25, 26]. As noted previously, the bridging procedure imputes multiple-race of mothers to one of the four minimum races stipulated in the 1977 OMB standards, that is, AIAN, API, Black, or White. Mothers of a specified Asian or Pacific Islander subgroup (that is, Chinese, Japanese, Hawaiian, or Filipino) in combination with another race (that is, AIAN, Black, and/or White) or another API subgroup cannot be imputed to a single API subgroup. API mothers are disproportionately represented in the 15 states reporting multiple-race (54.8 percent in 2004.) For both reports: “Births: Final Data for 2003” and “Births: Final Data for 2004”, data are not shown for the specified API subgroups because the bridging technique cannot be applied in this detail [3, 23, 24]. However, data for the API subgroups, reported alone or in combination with other races and/or API subgroups, are available in the 2004 natality public-use data file. A forthcoming [27]

16

report describes characteristics of births in 2003 to single and multiple-race women Race of mother is reported by 35 states and the District of Columbia in at least eight single-race categories: White, Black, American Indian or Alaska Native, Chinese, Japanese, Hawaiian, Filipino, and “other Asian or Pacific Islander” (API). Of these, six states (Illinois, Missouri, New Jersey, Texas, Virginia, and West Virginia) report data on the expanded API subgroups included in the “other API category” (Asian Indian, Korean, Samoan, Vietnamese, Guamanian, and remaining API). Finally, the fifteen states which report multiple-race data (California, Hawaii, Ohio, Pennsylvania, Utah, and Washington) report a minimum of fourteen categories (White, Black, American Indian or Alaska Native, Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, other Asian, Hawaiian, Guamanian, Samoan, and other Pacific Islander). For this report, as discussed above, the multiple-race combinations (for example, White and AIAN or Black and Chinese) were bridged to one of four broad categories (bridged White, bridged Black, bridged AIAN, and bridged API). Detailed data on race (single or multiple) as reported in these 15 states are available from the 2004 natality public use file. In 2004, race of mother was not reported for 0.9 percent of births. In these cases, if the race of the father was known, the race of the father was assigned to the mother. When information was not available for either parent, the race of the mother was imputed according to the specific race of the mother on the preceding record with a known race of mother. This was necessary for just 0.7 percent of births in 2004. Beginning with the 1989 data year, NCHS started tabulating its birth data primarily by race of the mother. In 1988 and prior years, births were tabulated by the race of the child, which was determined from the race of the parents as entered on the birth certificate. The reasons for this change are summarized in the 1999 Technical Appendix [2]. Trend data by race shown in this report are by race of mother for all years beginning with the 1980 data year. Text references to white births and white mothers or black births and black mothers are used interchangeably for ease in writing. Age of mother Beginning in 1989 a “Date of birth” item on the birth certificate replaced the “Age (at time of this birth)” item. Not all states revised this item, and, therefore, the age of mother either is derived from the reported month and year of birth or coded as stated on

17

the certificate. In 2004 age of mother was reported directly by four states (Nevada, North Dakota, Virginia, and Wyoming) and American Samoa. From 1964 to 1996, births reported to occur to mothers younger than age 10 or older than age 49 years had age imputed according to the age of mother from the previous record with the same race and total birth order (total of live births and fetal deaths). Beginning in 1997, age of mother is imputed for ages 9 years or under and 55 years and over. A review and verification of unedited birth data for 1996 showed that the vast majority of births reported as occurring to women aged 50 years and older were to women aged 50-54 years. The numbers of births to women aged 50-54 years are too small for computing age-specific birth rates. These births have been included with births to women aged 45-49 years for computing birth rates [2]. Age–specific birth rates are based on populations of women by age, prepared by the U.S. Census Bureau. In census years the decennial census counts are used. In intercensal years, estimates of the population of women by age are published by the U.S. Census Bureau in Current Population Reports. The 2000 Census of Population derived age in completed years as of April 1, 2000, from responses to questions on age at last birthday and month and year of birth, with the latter given preference. In the 1960, 1970, 1980, and 1990 Census of Population, age was also derived from month and year of birth. Age in completed years was asked in censuses before 1960. This was nearly the equivalent of the former birth certificate question, which the 1950 test of matched birth and census records confirmed by showing a high degree of consistency in reporting age in these two sources [28]. More recently, reporting of maternal age on the birth certificate was compared with reporting of age in a survey of women who had recently given birth. Reporting of age was very consistent between the two sources [29]. Median age of mother—Median age is the value that divides an age distribution into two equal parts, one-half of the values being less and one-half being greater. Median ages of mothers for 1960 to the present have been computed from birth rates for 5–year age groups rather than from birth frequencies. This method eliminates the effects of changes in the age composition of the childbearing population over time. Changes in the median ages from year to year can thus be attributed solely to changes in the age–specific birth rates. Trend data on the median age are shown in table 1-5 of “Vital Statistics of the

18

United States, 2001, Volume 1, Natality” [30], which is available on the Internet at: http://www.cdc.gov/nchs/datawh/statab/unpubd/natality/natab2001.htm Not stated age or date of birth of mother— In 2004, age of mother was not reported on 0.02 percent of the records. Beginning in 1964 birth records with date of birth of mother and/or age of mother not stated have had age imputed according to the age of mother from the previous birth record of the same race and total-birth order (total of fetal deaths and live births). (See NCHS Instruction Manual, Part 12, page 9) [31]. Editing procedures for 1963 and earlier years are described elsewhere [2]. Age of father Age of father is derived from the reported date of birth or coded as stated on the birth certificate. If the age is under 10 years, it is considered not stated and grouped with those cases for which age is not stated on the certificate. Information on age of father is often missing on birth certificates of children born to unmarried mothers, greatly inflating the number in the “Not stated” category in all tabulations by age of father. In computing birth rates by age of father, births tabulated as age of father not stated are distributed in the same proportions as births with known age within each 5–year-age classification of the mother. This procedure is followed because, while father’s age is missing on 13.6 percent of the birth certificates in 2004, one-quarter of these were on records where the mother is a teenager. This distribution procedure is done separately by race. The resulting distributions are summed to form a composite frequency distribution that is the basis for computing birth rates by age of father. This procedure avoids the distortion in rates that would result if the relationship between age of mother and age of father were disregarded. Births with age of father not stated are distributed only for rates, not for frequency tabulations [3]. Live-birth order and parity Live-birth order and parity classifications refer to the total number of live births the mother has had including the 2004 birth. Fetal deaths are excluded. Live-birth order indicates what number the present birth represents; for example, a baby born to a mother who has had two previous live births (even if one or both are not now living) has a live-birth order of three. Parity indicates how many live births a mother has had. Before delivery, a mother having her first baby has a parity of zero, and a mother

19

having her third baby has a parity of two. After delivery the mother of a baby who is a first live birth has a parity of one, and the mother of a baby who is a third live birth has a parity of three. Live-birth order and parity are determined from two items on the birth certificate, “Live births now living” and “Live births now dead.” Editing procedures for live birth order are summarized elsewhere [2, 14, 31]. Not stated birth order—All births tabulated in the “Not stated birth order” category are excluded from the computation of percentages. In computing birth rates by live-birth order, births tabulated as birth order not stated are distributed in the same proportion as births of known live-birth order. Marital status National estimates of births to unmarried women are based on two methods of determining marital status. For 1994 through 1996 birth certificates in 45 states and the District of Columbia included a question about the mother's marital status. For the other states, marital status is inferred from information on the birth certificate. Beginning in 1997, the marital status of women giving birth in California and Nevada was determined by a direct question in the birth registration process. New York City also changed its procedures for inferring marital status in 1997. Beginning June 15, 1998, Connecticut discontinued inferring the mother’s marital status and added a direct question on mother’s marital status to the state’s birth certificate. In the two states (Michigan and New York) which used inferential procedures to compile birth statistics by marital status in 2004, a birth is inferred as nonmarital if either of these factors, listed in priority-of-use order, is present: a paternity acknowledgment was received or the father’s name is missing. In recent years, a number of states have extended their efforts to identify the fathers when the parents are not married in order to enforce child support obligations. The presence of a paternity acknowledgment, therefore, is the most reliable indicator that the birth is nonmarital in the states not reporting this information directly; this is now the key indicator in the nonreporting states. Details of the changes in reporting procedures and the impact of the procedures on the data are described in previous reports [32, 33]. The mother’s marital status was not reported in 2004 on 0.04 percent of the birth

20

records in the 48 states and the District of Columbia where this information is obtained by a direct question. Marital status was imputed for these records. If status was unknown and the father’s age was known, then the mother was considered married. If the status was unknown, and the father’s age unknown, then the mother was considered unmarried. This represents a change from the procedures in effect for 2002 and previous years. Prior to 2003, marital status for records with marital status not reported was imputed as “married.” Because of the small number of records affected (2,216 births in 2004), the change in imputation procedures had essentially no impact on measures of nonmarital births. When births to unmarried women are reported as second or higher order births, it is not known whether the mother was married or unmarried when the previous deliveries occurred because her marital status at the time of these earlier births is not available from the birth record. Educational attainment Information on educational attainment is reported on both the 2003 Standard Certificate of Live Birth (revised) and 1989 Standard Certificate of Live Birth (unrevised). However, the format of the education item on the revised standard certificate substantively differs from that of the unrevised standard certificate. The 2003 Certificate item asks for the highest degree or level of school completed at the time of the birth (e.g., high school diploma, some college credit but no degree, bachelor degree, etc.). By contrast, the 1989 Certificate asks for the highest grade of school completed by the mother. Only those years completed in regular schools are counted, that is, a formal educational system of public schools or the equivalent in accredited private or parochial schools. Business or trade schools, such as beauty and barber schools, are not considered regular schools for the purposes of this item. No attempt has been made to convert years of school completed in foreign school systems, ungraded school systems, and so forth, to equivalent grades in the American school system. Such entries are included in the “Not stated” category. Women who have completed only a partial year in high school or college are tabulated as having completed the highest preceding grade or level. For those certificates on which a specific degree is stated, years of school completed is coded to the level at

21

which the degree is most commonly attained; for example, women reporting B.A., A.B., or B.S. degrees are considered to have completed 16 years of school In sum, education data for the states that have implemented the revised certificates are not directly comparable with the data for the states that are not yet using the revised certificate. For 2004, unrevised data are available for 41 states, New York City and the District of Columbia and part of the year for Florida and New Hampshire. Revised data are available for all of 2004 for 7 states (Idaho, Kentucky, New York State (excluding New York City), Pennsylvania, South Carolina, Tennessee, and Washington) and part of the year for Florida and New Hampshire. “Births: Final Data for 2004,” provides separate tabulations for the revised and unrevised educational attainment items; see table D. Table A of this Appendix indicates that education was not stated in 2.0 percent of the unrevised states; among the revised states, levels ranged from 0.8 to 7.5%. Data on educational attainment are currently available only for the mother [2]. Beginning in 1995, NCHS discontinued collecting information on the educational attainment of the father.

Maternal and Infant Health Characteristics Weight gain during pregnancy Information on maternal weight gain is available from both the 1989 (unrevised) and the 2003 (revised) Standard Certificate of Live Birth. However, the item was modified. The unrevised question asks for “weight gained during pregnancy ____ lbs.”, compared with the revised question, which asks for the pre-pregnancy weight of the mother and her weight at delivery. In the 2004 file, unrevised data are available through the data year for 40 states, New York City, and the District of Columbia, while revised data are available for 7 states. Two states which had mid-year revisions, reported both revised and unrevised data. California did not report weight gain information. The data from the revised certificate were combined with the data based on the 1989 revision to produce tabulations shown in tables 22 and 23 of the report “Birth: Final Data 2004” [3].

22

Weight gain in pregnancy is reported in pounds. A reported loss of weight is recorded as zero gain. Pregnancy risk factors Both the 2003 and 1989 certificates collect pregnancy risk information in the check box format. Ten medical risks which can affect pregnancy outcome are separately identified on the 2003 Standard Certificate of Live Birth (revised); sixteen on the 1989 Standard Certificate of Live Birth (unrevised). The format allows for the designation of more than one risk factor and includes a choice of “None.” Accordingly, if the item is not completed, it is classified as not stated. Four risk factors are comparable between certificates: diabetes, chronic hypertension, gestational hypertension, and eclampsia. Selected risk factors are shown in tables 23 to 25 of the report “Births: Final Data for 2004” [3]. Supplemental 2004 tables for risk factor data exclusive to the 1989 Revision are available on the NCHS website (www.cdc.gov/nchs); a forthcoming report will present risk factor information exclusive to the 2003 Revision. The percent of birth records in which pregnancy risk factor items were not stated was 0.4. Definitions for revised and unrevised items are available elsewhere [3, 15]. Tobacco use during pregnancy Information on smoking during pregnancy was reported on both the 2003 Certificate of Live Birth (revised) and the 1989 Certificate of Live Birth (unrevised). The format of the tobacco use item differs between certificates. Briefly stated, the 1989 revision asks a simple “yes/no” question on tobacco use during pregnancy and the average number of cigarettes per day with no specificity on timing during the pregnancy. In contrast, the 2003 revision asks for number of cigarettes smoked at different intervals before and during the pregnancy. If the mother reported smoking in any of the three trimesters of pregnancy she was recorded as a smoker. In the file, for 40 States, New York City, and the District of Columbia, smoking status was based on the 1989 U.S. Standard Certificate (unrevised), while data for 6 states are drawn from the 2003 revision of the birth certificate (revised). Florida had a unique smoking use question in its 2003 revision which differed from both the standard revised

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and unrevised version; resulting data were not comparable to either version. Florida used the standard 1989 revision question during January and February, 2004; New Hampshire used the 1989 revision until July 19; starting March 1, Florida implemented its own revised question; New Hampshire implemented the standard revised tobacco use question on July 20. California did not report tobacco use in 2004. The births occurring where the unrevised question was used accounted for 67 percent of US births in 2004. The overall percent of birth records where tobacco use was not stated for the unrevised item was 1.1 percent. In the report, Births: Final Data for 2004” [3] data are shown separately in table E for the areas using the unrevised certificate and for the areas using the revised certificate. Alcohol use during pregnancy Data on alcohol use are not collected in the 2003 Standard Certificate of Live Birth. Data on alcohol use during pregnancy from the 1989 Standard Certificate are available for 40 states for the full data year of 2004 and the initial months of 2004 for Florida and New Hampshire. Alcohol use data are not collected on California’s birth certificate. Supplemental 2004 tables for data exclusive to the 1989 Revision, including alcohol use during pregnancy, are available on the NCHS website (www.cdc.gov/nchs). Alcohol use during pregnancy is a major, independent risk factor and it is implicated as well in delayed infant and child development [34, 35]. Unfortunately, alcohol use is substantially underreported on the birth certificate, compared with data collected in nationally representative surveys of pregnant women. The birth certificate question on alcohol use from the 1989 revision is evidently not sensitive enough to measure this behavior accurately. The question’s wording as well as the lack of specific time reference for the birth certificate questions are probable factors contributing to the underreporting. In addition, the stigma of maternal alcohol use likely contributes to the underreporting [36, 37]. Prenatal care Information on the timing of prenatal care is available for both the revised and unrevised Certificates of Live Birth. However, the 2003 revision of the birth certificate introduced substantive changes in item wording and also to the sources of prenatal

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information. The wording of the prenatal care item was modified to “Date of first prenatal visit” from “Month prenatal care began.” In addition, the 2003 revision process resulted in recommendations that the prenatal care information be gathered from the prenatal care or medical records, whereas the 1989 revision did not recommend a source for these data. Accordingly, prenatal care data for the two revisions are not directly comparable. For the complete data year 2004, unrevised data on prenatal care are available for 41 states, New York City and the District of Columbia. Revised data for 7 states (Idaho, Kentucky, New York State (excluding New York City), Pennsylvania, South Carolina, Tennessee, and Washington) are available for all of 2004. Florida and New Hampshire implemented the revised certificate after January 1, 2004. As noted above, the revised prenatal care item is substantively different from the unrevised question. One result is that levels of utilization of prenatal care based on revised data are substantially lower than those based on unrevised data. For example, unrevised 2003 data for Kentucky indicate that 87.0 of residents began care in the first trimester of pregnancy in 2003. This compares with a level of 74.5 percent based on 2004 revised data. Much, if not all of the difference between 2003 and 2004 for Kentucky and other revised states, is related to changes in reporting and not to changes in prenatal care utilization. Prenatal care utilization results are shown separately according to the two revisions in tables E, 26(a) and 26(b) of the report “Birth: Final Data for 2004” [3]. The 2004 natality data file includes a variable, The Adequacy of Prenatal Care Utilization Index (APNCU). The APNCU is an alternative measure of prenatal care timing which takes into account the number of prenatal care visits and gestational age of the newborn at delivery [38, 39]. The index in the file is a 4 point scale ranging from “inadequate” to “adequate plus care”. See table G of the report “Birth: Final Data for 2004” [3]. Tabulations of the number of prenatal visits were presented for the first time in 1972. Beginning in 1989, these data were collected from the birth certificates of all states.

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Obstetric procedures The 2003 Standard Certificate of Live Birth (revised) includes three specific check boxes for obstetric procedures; the 1989 certificate includes six procedures. Both certificates have a format which permits the selection of multiple procedures. Birth records with “Obstetric procedures” left blank are considered “not stated.” Definitions for the unrevised procedures are adapted and abbreviated from a set of definitions compiled by a committee of Federal and State health statistics officials for the National Association for Public Health Statistics and Information Systems (NAPHSIS) [3]. Definitions for the revised items are included in the detailed facility worksheet guidebook for the 2003 revised certificate only [15]. Reporting areas and reporting completeness for obstetric procedures are indicated in table A of this Appendix. Tables H and 25 of the report: “Births: Final Data for 2004” [3] provide data for the two procedures comparable to both certificates – tocolysis and induction of labor. Supplemental 2004 tables for obstetric procedures exclusive to the 1989 Revision are available on the NCHS website (www.cdc.gov/nchs). A forthcoming report will present selected obstetric procedure tables exclusive to the 2003 Revision. Characteristics of labor and of delivery The 2003 Standard Certificate of Live Birth (revised) includes nine specific check boxes for characteristics of labor and delivery; fifteen characteristics are reported on the 1989 (unrevised) certificate. Both certificates have a format which allows for the reporting of more than one characteristic and includes a choice of “none”. Birth records with “characteristics” left blank are considered “not stated.” Three characteristics: precipitous labor, breech position, and meconium staining are comparable between the two certificates. The percent of records on which labor and delivery items were not stated and notes on reporting areas are found in table A. The complication rates for selected labor/delivery characteristics and their respective reporting areas are given in table 25 in the report “Birth: Final Data for 2004” [3]. Supplemental 2004 tables for characteristics of labor and delivery exclusive to the 1989 revision are available on the NCHS website (www.cdc.gov/nchs). A forthcoming report will present selected labor and delivery information exclusive to the 2003 revision.

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Definitions for revised and unrevised items are available elsewhere [3, 15]. Place of delivery and attendant at birth Both the 1989 and 2003 revisions of the U.S. Standard Certificate of Live Birth include separate categories for hospitals, freestanding birthing centers, residence, and clinic or doctor's office as the place of birth. In addition, the 2003 certificate queries whether the home birth was planned to be a home delivery. For both the revised and unrevised certificates, four professional categories of attendants are medical doctors, doctors of osteopathy, certified nurse midwives, and other midwives. Procedures in some hospitals may require that a physician be listed as the attendant for every birth and that a physician sign each birth certificate, even if the birth is attended by a midwife and no physician is physically present. Therefore, the number of live births attended by midwives may be understated. Additional information on births occurring outside of hospitals, and on birth attendants can be found elsewhere [2]. Tabulations of place of birth and birth attendant are found in table 27 of the report: “Births Final Data for 2004” [3]. Method of delivery Information on the method of delivery is collected on both the 2003 Standard Certificate of Live Birth (revised) and the 1989 Standard Certificate of Live Birth (unrevised). However, the 2003 revised item is substantially modified from the 1989 item. The 1989 certificate includes, among others, direct questions on vaginal birth after previous cesarean section (VBAC), and primary or repeat cesarean delivery. In contrast, the revised certificate includes a direct question on previous cesarean delivery; whether the delivery was a primary cesarean or was a VBAC must be derived from a question on previous cesarean deliveries under the separate item “Risk Factors in this Pregnancy”. Despite substantive changes to the method of delivery item, the total numbers and percents of vaginal and cesarean deliveries appear to be very consistent between revisions. (See tables 28-30 from the report: “Birth: Final Data for 2004” [3]). However, information on whether the delivery is a VBAC, primary cesarean, or repeat cesarean appears to be less comparable. In brief, data for the revised states show higher- than-

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expected VBAC and primary cesarean rates, and lower- than- expected repeat cesarean rates. These discontinuities are likely due to wording and formatting changes to the method of delivery item on the 2003 Revision of the U.S. Standard certificate of live birth. The changes to the method of delivery item appear to have a small impact (2-3 percent) on the national primary and VBAC rates shown in the 2004 natality report [3]. Measures which incorporate these data to compare changes across revisions for individual states should be interpreted with caution. Information on forceps and vacuum delivery are also available from both revisions of the birth certificate; these data appear to be comparable between revisions. The 2003 revision item was also expanded to include questions on whether attempted forceps or vacuum deliveries were successful, and whether a trial of labor was attempted prior to cesarean delivery. These and other new data on method of delivery are available on the 2004 file and will be presented in a forthcoming report. Several rates are computed for method of delivery. The overall cesarean section rate or total cesarean rate is computed as the proportion of all births that were delivered by cesarean section. The primary cesarean rate is a measure that relates the number of women having a primary cesarean birth to all women giving birth who have never had a cesarean delivery. The denominator for this rate is the sum of women with a vaginal birth excluding VBACs and women with a primary cesarean birth. The VBAC delivery rate is computed by relating all VBAC deliveries to the sum of VBAC and repeat cesarean deliveries, that is, to women with a previous cesarean section. Period of gestation The period of gestation is defined as beginning with the first day of the last normal menstrual period (LMP) and ending with the day of the birth. The LMP is used as the initial date because it can be more accurately determined than the date of conception, which usually occurs 2 weeks after the LMP. LMP measurement is subject to error for several reasons, including imperfect maternal recall or misidentification of the LMP because of post-conception bleeding, delayed ovulation, or intervening early miscarriage. Births occurring before 37 completed weeks of gestation are considered to be preterm for purposes of classification. At 37–41 weeks gestation, births are considered to be term, and at 42 completed weeks and over, post-term. These distinctions are according

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to the ICD–9 and ICD–10 [8] definitions. See tables 31 and 32 in the 2004 natality report. Before 1981, the period of gestation was computed only when there was a valid month, day, and year of LMP. However, length of gestation could not be determined from a substantial number of live-birth certificates each year because the day of LMP was missing. Beginning in 1981, weeks of gestation have been imputed for records with missing day of LMP when there is a valid month and year. The imputation procedure and its effect on the data are described elsewhere [2, 40]. But reporting problems for this item persist and may occur more frequently among some subpopulations and among births with shorter gestations. Changes in reporting of this measure over time have apparently affected trends in preterm birth rates, particularly by race [41]. The 1989 revision of the U.S. Standard Certificate of Live Birth includes an item, “Clinical estimate of gestation” (CE); in the 2003 revision of the certificate, the item is “Obstetric estimate of gestation” (OE) – see definitions [15]. Both measures are in completed weeks. The OE and the CE are compared with length of gestation computed from the LMP date when the latter appears to be inconsistent with birthweight. This is done for normal weight births of apparently short gestations and very low birthweight births reported to be full term. The procedures are described in the NCHS instruction manuals, part 12, (see NCHS [31] for the 1989 revision; NCHS [42] for the 2003 revision). The clinical/obstetric estimate is reported by all areas except California for 2004. The period of gestation for 5.9 percent of the births in 2004 was based on the clinical estimate of gestation. For 97 percent of these records, the clinical/obstetric estimate was used because the LMP date was not reported. For the remaining 3 percent, the clinical/obstetric estimate was used because it was compatible with the reported birthweight, whereas the LMP-based gestation was not. In cases where the reported birthweight was inconsistent with both the LMP-computed gestation and the clinical estimate of gestation, the LMP-computed gestation was used and birthweight was reclassified as "not stated." This was necessary for 1,302 births or 0.04 percent of all birth records in 2004, significantly higher than for 2003. Despite these edits, substantial incongruities in these data persist; research is ongoing to address these data deficiencies. Gestational age data are shown in tables 31 and 32 of the report: “Births: Final Data for

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2004.” Birthweight In some areas birthweight is reported in pounds and ounces rather than in grams. However, the metric system has been used in tabulating and presenting the statistics to facilitate comparison with data published by other groups. The categories for birthweight are consistent with the recommendations in the International Classification of Diseases, Ninth Revision (ICD–9) and the International Classification of Diseases, Tenth Revision (ICD–10) [8]. The categories in gram intervals and their equivalents in pounds and ounces are as follows: Less than 500 grams = 1 lb 1 oz or less 500–999 grams = 1 lb 2 oz–2 lb 3 oz 1,000–1,499 grams = 2 lb 4 oz–3 lb 4 oz 1,500–1,999 grams = 3 lb 5 oz–4 lb 6 oz 2,000–2,499 grams = 4 lb 7 oz–5 lb 8 oz 2,500–2,999 grams = 5 lb 9 oz–6 lb 9 oz 3,000–3,499 grams = 6 lb 10 oz–7 lb 11 oz 3,500–3,999 grams = 7 lb 12 oz–8 lb 13 oz 4,000–4,499 grams = 8 lb l4 oz–9 lb l4 oz 4,500–4,999 grams = 9 lb 15 oz–11 lb 0 oz 5,000 grams or more = 11 lb l oz or more ICD–9 and ICD–10 define low birthweight as less than 2,500 grams. This is a shift of 1 gram from the previous criterion of 2,500 grams or less, which was recommended by the American Academy of Pediatrics in 1935 and adopted in 1948 by the World Health Organization in the International Lists of Diseases and Causes of Death, Sixth Revision [43]. Very low birthweight is defined as less than 1,500 grams. To establish the continuity of class intervals needed to convert pounds and ounces to grams, the end points of these intervals are assumed to be half an ounce less at the lower end and half an ounce more at the upper end. For example, 2 lb 4 oz–3 lb 4 oz is interpreted as 2 lb 3 ½ oz–3 lb 4 ½ oz. Births for which birthweights are not reported are excluded from the computation of percentages. The panel that proposed the 2003 Revised Certificate recommended that birthweight be reported in grams rather than pounds for data entry [12]. Birthweight data are shown in tables 31, 32, 34-36 of the 2004 natality report [3].

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Apgar score The 1– and 5–minute Apgar scores were added to the U.S. Standard Certificate of Live Birth in 1978 to evaluate the condition of the newborn infant at 1 and 5 minutes after birth. The 2003 revised certificate asks for a 10 minute score if the 5 minute score was less than 6. The Apgar score is a measure of the need for resuscitation and a predictor of the infant's chances of surviving the first year of life. It is a summary measure of the infant's condition based on heart rate, respiratory effort, muscle tone, reflex irritability, and color. Each of these factors is given a score of 0, 1, or 2; the sum of these 5 values is the Apgar score, which ranges from 0 to 10. A score of 0 to 3 indicates an infant in need of resuscitation; a score of 4 to 6 is considered intermediate; a score of 7 or greater indicates that the neonate is in good to excellent physical condition. Beginning in 1995, NCHS collected information only on the 5–minute Apgar score. Since 1991, the reporting area for the 5–minute Apgar score has been comprised of 48 states and the District of Columbia. California and Texas did not collect information on Apgar scores on their birth certificates. For 0.5 percent of the births in the reporting area, there were no Apgar scores reported. Five minute Apgar sores are given in Table L of the report: “Birth: Final Data for 2004” [3]. Revised data for the 10 minute score are not available in the 2004 file. Plurality Comparable plurality data are reported in the 2003 and 1989 Standard Certificates of Live Birth. In this file, plurality is classified as single, twin, triplet, quadruplet, and quintuplet and higher order births. Each record in the natality file represents an individual birth. For example, a record coded as a twin represents one birth in a twin delivery. Pairs or sets of twins or higher order multiple births are not identified in this file. The Matched Multiple Birth File 1995-2000 [44] includes information on sets of twin, triplet and quadruplets, thus allowing for the analysis of characteristics of sets of births and fetal deaths in multiple deliveries. Numbers and rates of births by plurality are given in tables 37 -- 39 of the report: “Birth: Final Data for 2004” [3]. Records for which plurality is unknown are imputed as singletons. This occurred for 0.003 percent of all records for 2004.

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Abnormal conditions of the newborn Information on abnormal conditions of the newborn is obtained from the checkboxes on the 1989 and 2003 certificate revisions. There are seven specific abnormal conditions included on the 2003 revised birth certificate; eight are included on the 1989 certificate. More than one abnormal condition may be reported for a given birth or “None” may be selected. If the item is not completed it is tabulated as not stated. There are no comparable abnormal conditions between the 1989 and 2003 certificate. However, both unrevised and revised items are included in the 2004 Natality Public Use File. Supplemental 2004 tables for abnormal conditions of the newborn exclusive to the 1989 Revision are available on the NCHS website (www.cdc.gov/nchs). A forthcoming report will present selected abnormal conditions information exclusive to the 2003 Revision. Definitions are available elsewhere [3, 15]. For information on reporting areas and for percent of birth records with conditions not stated, see table A. Congenital anomalies of the newborn Twelve specific anomalies or anomaly groups are collected on the 2003 Standard Certificate of Live Birth, 21 anomalies are collected on the 1989 Standard Certificate of Live Birth. The checkbox format allows for the identification of more than one anomaly including a choice of “None” should no anomalies be evident. The “not stated” category includes birth records for which the item is not completed. There are five congenital anomalies in common to the two revisions of the birth certificate: anencephalus, spina bifida/meningocele, omphalocele/gastroschisis, cleft lip/palate and Downs syndrome; see table 25 of the report “Births: Final Data for 2004” [3]. It is well documented that congenital anomalies, except for the most visible and most severe, are incompletely reported on birth certificates [45]. The completeness of reporting specific anomalies depends on how easily they are recognized in the short time between birth and birth-registration. For 1.2 of the birth records, there were incomplete check boxes for congenital anomalies. Definitions for the revised and unrevised congenital anomalies are available elsewhere [3,15]. See table A for reporting areas and for percent of records for which data on congenital anomalies is not stated. 32

Quality of Data Although vital statistics data are useful for a variety of administrative and scientific purposes, they cannot be correctly interpreted unless various qualifying factors and methods of classification are taken into account. The factors to be considered depend on the specific purposes for which the data are to be used. It is not feasible to discuss all the pertinent factors in the use of vital statistics tabulations, but some of the more important ones should be mentioned. Most of the factors limiting the use of data arise from imperfections in the original records or from the impracticability of tabulating these data in very detailed categories. These limitations should not be ignored, but their existence does not lessen the value of the data for most general purposes. Completeness of registration It is estimated that more than 99 percent of all births occurring in the United States in 2004 were registered. These estimates are based on the results of a national 1964–68 test of birth-registration completeness according to place of delivery (in or out of hospital) and race (white and non-white). This test has not been conducted more recently. A detailed discussion of the method and results of the 1964–68 birth-registration test is available [46]. Information on procedures for adjusting births for under registration (for cohort fertility tables) is presented elsewhere [2]. Completeness of reporting Interpretation of these data must include evaluation of item completeness. The “Not stated” percentage is one measure of the quality of the data. Completeness of reporting varies among items and states. See table A for the percentage of birth records on which specified items were not stated. Data users should note that levels of incomplete or inaccurate reporting for some of the items are quite high in some states. The 2004 data for Alaska and the District of Columbia are of particular concern. Quality control procedures As electronic files are received at NCHS, they are automatically checked for completeness, individual item code validity, and unacceptable inconsistencies between data items. The registration area is notified of any problems. In addition, NCHS staff

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reviews the files on an ongoing basis to detect problems in overall quality such as inadequate reporting for certain items, failure to follow NCHS coding rules, and systems and software errors. Traditionally, quality assurance procedures were limited to the review and analysis of differences between NCHS and registration area code assignments for a small sample of records. In recent years, as electronic birth registration became prevalent, this procedure was augmented by analyses of year-to-year and area-to-area variations in the data. These analyses are based on preliminary tabulations of the data that are cumulated by state on a year-to-date basis each month. NCHS investigates all differences that are judged to have consequences for quality and completeness. In the review process, statistical tests are used to call initial attention to differences for possible follow-up. As necessary, registration areas are informed of differences encountered in the tables and asked to verify the counts or to determine the nature of the differences. Missing records (except those permanently voided) and other problems detected by NCHS are resolved, and corrections are transmitted to NCHS in the same manner as for those corrections identified by the registration area.

Computation of Rates and Other Measures Population bases Estimation by age, sex, race and Hispanic origin—Birth and fertility rates for 2004 shown in tables 1, 3–5, 7-9, 11, 14-15, 21, A, and B in the report: “Births: Final Data for 2004” [3] are computed using 2000 census-based post-censal (population) estimates as of July 1, 2004. These populations are shown in tables 4-2 and 4-3. The population estimates have been provided by the U.S. Census Bureau [47] and are based on the 2000 census counts by age, sex, race, and Hispanic origin, which have been modified to be consistent with Office of Management and Budget racial categories as of 1977 and historical categories for birth data. The modification procedures are described in detail elsewhere [48]. Birth and fertility rates by state shown in table 10 of the report: “Births: Final Data for 2004” [3] use 2000 census-based state-level post-censal population estimates provided by the U.S. Census Bureau [47]. Rates by state shown in this report may differ from rates computed on the basis of other population estimates. Birth and fertility rates

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by month shown in table 16 of the 2004 natality final report [3] are based on monthly population estimates. Rates for unmarried women shown in tables 18 and 19 of the 2004 natality final report [3] are based on distributions of the population by marital status as of March 2004 as reported by the U.S. Census Bureau in the March Current Population Survey (CPS) [49], which have been adjusted to July 2004 population levels [47] by the Division of Vital Statistics, NCHS [3]. Birth and fertility rates for the Hispanic population, shown in tables 5, 7, 8, 9, and 15 of the 2004 natality final report [3], are based on estimates of the total Hispanic population as of July 1, 2004 [47]. Rates for Hispanic subgroups are based on special population estimates that are presented in table 4-3. Information about allocation to Hispanic subgroups is presented elsewhere [50]. The populations by race used in this report were produced under a collaborative arrangement with the U.S. Census Bureau and are 2000 census-based post-censual estimates. Reflecting the new guidelines issued in 1997 by the Office of Management and Budget (OMB), the 2000 census included an option for individuals to report more than one race as appropriate for themselves and household members [22]. In addition, the 1997 OMB guidelines called for reporting of Asian persons separately from Native Hawaiians or other Pacific Islanders. In the 1977 OMB guidelines, data for Asian or Pacific Islander persons were collected as a single group [21]. Except for fifteen states, birth certificates currently report only one race for each parent in the categories specified in the 1977 OMB guidelines (see “Hispanic origin, race and national origin”). In addition, unrevised birth certificate data do not report Asians separately from Native Hawaiians or other Pacific Islanders. Thus, birth certificate data by race (the numerators for birth and fertility rates) currently are incompatible with the population data collected in the 2000 census (the denominators for the rates). To produce birth and fertility rates for 2000 through 2004, it was necessary to ‘‘bridge’’ the population data for multiple race persons back to single race categories. In addition, the postcensal estimates were modified to be consistent with the 1977 OMB racial categories, that is, to report the data for Asian persons and Native Hawaiians or other Pacific Islanders as a combined category Asian or Pacific Islanders [51]. The procedures used to produce the ‘‘bridged’’ populations are described in separate publications [23,24]. In 2003, six states began reporting multiple race data; and in 2004,

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15 states. Once all states revise their birth certificates to be compliant with the 1997 OMB standards, the use of ‘‘bridged’’ populations can be discontinued. Populations used to calculate the rates for 1991–99 are based on population estimates as of July 1 of each year and were produced by the U.S. Census Bureau, with support from the National Cancer Institute [23, 47, 52, 53]. These intercensal population estimates for 1991-99 are based on the April 1, 2000 Census. The bridged rates for 1990 and 2000 are based on populations from the censuses in those years as of April 1. Readers should keep in mind that the population data used to compile birth and fertility rates by race and ethnicity shown in this report are based on special estimation procedures, and are not actual counts. This is the case even for the 2000 populations that are based on the 2000 census. As a result, the estimation procedures used to develop these populations may contain some errors. Smaller populations, for example, American Indians, are likely to be affected much more than larger populations by potential measurement error [23]. While the nature and magnitude of error is unknown, the potential for error should be kept in mind when evaluating trends and differentials. As more accurate information becomes available, further revisions of the estimates may be necessary. Additional information on the revised populations is available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm . Residential population base— Birth rates for the United States, individual states, and metropolitan areas are based on the total resident populations of the respective areas (table 4-4). Except as noted, these populations exclude the Armed Forces abroad but include the Armed Forces stationed in each area. The residential population of the birthand death-registration states for 1900–1932 and for the United States for 1900–2004 is shown in table 4-1. In addition, the population including Armed Forces abroad is shown for the United States. Table D shows the sources for these populations. A detailed discussion of historical population bases is presented elsewhere [2]. Small populations as denominators— An asterisk (*) is shown in place of any derived rate based on fewer than 20 births in the numerator, or a population denominator of less than 50 (unweighted) for decennial years and 75,000 (weighted) for all other years for the Hispanic subgroups. Rates based on populations below these minimum levels lack

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sufficient reliability for analytic purposes. Net census undercounts and overcounts— Studies conducted by the U.S. Census Bureau indicate that some age, race, and sex groups are more completely enumerated than others. Census miscounts can have consequences for vital statistics measures. For example, an adjustment to increase the population denominator would result in a smaller rate compared to the unadjusted rate. A more detailed discussion of census undercounts and overcounts can be found in the “1999 Technical Appendix” [2]. Adjusted rates for 2000 can be computed by multiplying the reported rates by ratios from the 2000 censuslevel population adjusted for the estimated age-specific census over- and undercounts, which are shown in table E. Cohort fertility tables Various fertility measures for cohorts of women are computed from births adjusted for underregistration and population estimates corrected for under enumeration and misstatement of age. Data published after 1974 use revised population estimates prepared by the U.S. Census Bureau and have been expanded to include data for the two major racial groups. Heuser [54] has prepared a detailed description of the methods used in deriving these measures as well as more detailed data for earlier years. The series of cohort fertility tables are being revised to incorporate rates for black women and the revised intercensal population estimates of the 1990s. A publication is forthcoming. Parity distribution—The percentage distribution of women by parity (number of children ever born alive to mother) is derived from cumulative birth rates by order of birth. The percentage of 0-parity women is found by subtracting the cumulative first birth rate from 1,000 and dividing by 10. The proportions of women at parities one through six are found from the following formula: Percent at N parity = ((cum. rate, order N)-(cum. rate, order N + 1))/10 The percentage of women at seventh and higher parities is found by dividing the cumulative rate for seventh-order births by 10. Birth probabilities—Birth probabilities indicate the likelihood that a woman of a certain parity and age at the beginning of the year will have a child during the year. Birth probabilities differ from central birth rates in that the denominator for birth probabilities is specific for parity as well as for age.

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Total fertility rates The total fertility rate is the sum of the birth rates by age of mother (in 5–year age groups) multiplied by 5. It is an age–adjusted rate because it is based on the assumption that there is the same number of women in each age group. The rate of 2,045.5 in 2004, for example, means that if a hypothetical group of 1,000 women were to have the same birth rates in each age group that were observed in the actual childbearing population in 2004, they would have a total of 2,046 children by the time they reached the end of the reproductive period (taken here to be age 50 years), assuming that all of the women survived to that age. Seasonal adjustment of rates The seasonally adjusted birth and fertility rates are computed from the X–11 variant of Census Method II [55]. This method, used since 1964, differs slightly from the U.S. Bureau of Labor Statistics (BLS) Seasonal Factor Method, which was used for Vital Statistics of the United States, 1964. The fundamental technique is the same in that it is an adaptation of the ratio-to-moving-average method. Before 1964, the method of seasonal adjustment was based on the X–9 variant and other variants of Census Method II. A comparison of the Census Method II with the BLS Seasonal Factor Method shows the differences in the seasonal patterns of births to be negligible. Computations of percentages, percentage distributions, and means Births for which a particular characteristic is unknown were subtracted from the figures for total births that were used as denominators before percentages, percentage distributions, and means were computed. The percentage of records with missing information for each item is shown by state in table A. The mean age of mother is the arithmetic average of the age of mothers at the time of birth, computed directly from the frequency of births by age of mother. An asterisk is shown in place of any derived statistic based on fewer than 20 births in the numerator or denominator.

Computation of Measures of Variability Random variation and significance testing for natality data This detailed discussion of random variation and significance testing for natality

38

data is similar to that in the “Technical Notes” of “Births: Final data for 2004” [3]. The number of births reported for an area is essentially a complete count, because more than 99 percent of all births are registered. Although this number is not subject to sampling error, it may be affected by nonsampling errors such as mistakes in recording the mother’s residence or age during the registration process. When the number of births is used for analytic purposes (that is, for the comparison of numbers, rates, and percents over time, for different areas, or between different groups), the number of events that actually occurred can be thought of as one outcome in a large series of possible results that could have occurred under the same (or similar) circumstances. When considered in this way, the number of births is subject to random variation and a probable range of values estimated from the actual figures, according to certain statistical assumptions. The confidence interval is the range of values for the number of births, birth rates, or percent of births that you could expect in 95 out of 100 cases. The confidence limits are the end points of this range of values (the highest and lowest values). Confidence limits tell you how much the number of events or rates could vary under the same (or similar) circumstances. Confidence limits for numbers, rates, and percents can be estimated from the actual number of vital events. Procedures differ for rates and percents and also differ depending on the number of births on which these statistics are based. Below are detailed procedures and examples for each type of case. When the number of vital events is large, the distribution is assumed to follow a normal distribution (where the relative standard error is small). When the number of events is small and the probability of the event is small, the distribution is assumed to follow a Poisson probability distribution. Considerable caution should be observed in interpreting the occurrence of infrequent events. 95-percent confidence limits for numbers less than 100 -- When the number of births is less than 100 and the rate is small, the data are assumed to follow a Poisson probability distribution [56]. Confidence limits are estimated using the following formulas:

39

Lower limit = B × L Upper limit = B × U

where: B

=

number of births

L

=

the value in table C that corresponds to the number B

U

=

the value in table C that corresponds to the number B

Example Suppose that the number of first births to American Indian women 40-44 years of age was 47. The confidence limits for this number would be: Lower limit = 47 × 0 . 73476 = 35 Upper limit = 47 × 1 . 32979 = 63

This means that the chances are 95 out of 100 that the actual number of first births to American Indian women 40-44 years of age would lie between 35 and 63. 95-percent confidence limits for numbers of 100 or more –– When the number of events is greater than 100, the data are assumed to approximate a normal distribution. Formulas for 95-percent confidence limits are:

(

)

(

)

Lower limit = B − 1.96 × B

Upper limit = B + 1.96 × B

where: B

=

number of births

Example Suppose that the number of first births to white women 40-44 years of age was 40

14,108. The 95-percent confidence limits for this number would be:

(

Lower limit = 14,108 − 1.96 × 14,108

)

= 14,108 − 233 = 13,875

(

Lower limit = 14,108 + 1.96 × 14,108

)

= 14,108 + 233 = 14,341

This means that the chances are 95 out of 100 that the actual number of first births to white women 40-44 years of age would fall between 13,875 and 14,341. Computing confidence intervals for rates -- The same statistical assumptions can be used to estimate the variability in birth rates. Again, one formula is used for rates based on numbers of events less than 100, and another formula for rates based on numbers of 100 or greater. For our purposes, assume that the denominators of these rates (the population estimates) have no error. While this assumption is technically correct only for denominators based on the census that occurs every 10 years, the error in intercensal population estimates is usually small, difficult to measure, and therefore not considered. (See, however, earlier discussion of population denominators in the section on “population bases”.) 95-percent confidence limits for rates based on fewer than 100 events –– As stated earlier, when the number of events in the numerator is less than 20 (or the population denominator is less than 50 for decennial years and 75,000 for all other years for an estimated subgroups), an asterisk (*) is shown in place of the rate because there were too few births or the population is too small to compute a statistically reliable rate. When the number of events in the numerator is greater than 20 but less than 100 (and the population denominator for the subgroups is above the minimum), the confidence interval for a rate can be estimated using the two formulas which follow and the values in table C.

Lower limit = R × L

41

Upper limit = R × U

where: R

=

birth rate

L

=

the value in table C that corresponds to the number of events B

U

=

the value in table C that corresponds to the number of events B

Example Suppose that the first birth rate for American Indian women 40-44 years of age was 0.50 per thousand, based on 47 births in the numerator. Using table C:

Lower limit = 0.50 × 0.73476 = 0.37 Upper limit = 0.50 × 1.32979 = 0.66 This means that the chances are 95 out of 100 that the actual first birth rate for American Indian women 40-44 years of age would be between 0.37 and 0.66. 95-percent confidence limits for rates when the numerator is 100 or more -- In this case, use the following formula for the birth rate R based on the number of births B:

(

(

))

(

(

))

Lower limit = R − 1.96 × R / B

Upper limit = R + 1.96 × R / B

where: R

=

birth rate

B

=

number of births

Example 42

Suppose that the first birth rate for white women 40-44 years of age was 1.55 per thousand, based on 14,108 births in the numerator. Therefore, the 95-percent confidence interval would be:

(

(

))

(

))

Lower limit = 1.55 − 1.96 × 1.55 / 14,108 = 1.55 − 0.026 = 1.52

(

Upper limit = 1.55 + 1.96 × 1.55 / 14,108 = 1.55 + 0.026 = 1.58

This means that the chances are 95 out of 100 that the actual first birth rate for white women 40-44 years of age lies between 1.52 and 1.58. Computing 95-percent confidence intervals for percents -- In many instances we need to compute the confidence intervals for percents. Percents derive from a binomial distribution. As with birth rates, an asterisk (*) will be shown for any percent which is based on fewer than 20 births in the numerator. We easily compute a 95-percent confidence interval for a percent when the following conditions are met: B × p ≥ 5 and B × q ≥ 5

where: B

=

number of births in the denominator

p

=

percent divided by 100

q

=

1-p

For natality data, these conditions will be met except for very rare events in small subgroups. If the conditions are not met, the variation in the percent will be so large as to render the confidence intervals meaningless. When these conditions are met the 95percent confidence interval can be computed using the normal approximation of the

43

binomial. The 95-percent confidence intervals are computed by the following formulas:

(

(

p•q/B

))

(

(

p•q/B

))

Lower limit = p − 1.96 •

Upper limit = p + 1.96 •

where: p

=

percent divided by 100

q

=

1- p

B

=

number of births in the denominator

Example Suppose that the percent of births to Hispanic women in Arizona that were to unmarried women was 49.7 percent. This was based on 14,751 births in the numerator and 29,682 births in the denominator. First we test to make sure we can use the normal approximation of the binomial: 29,682 × 0.497 = 14,752 29,682 × (1 − 0.497) = 29,682 × 0.503 = 14,930

Both 14,752 and 14,930 are greater than 5 so we can proceed. The 95-percent confidence interval would be:

(

Lower limit = 0.497 − 1.96 •

(

0.497 • 0.503 / 29,682

))

= 0.497 − 0.006 = 0.491 or 49.1 percent

(

(

Upper limit = 0.497 + 1.96• 0.497 • 0.503 / 29,682 = 0.497 + 0.006 = 0.503 or 50.3 percent

44

))

This means that the chances are 95 out of 100 that the actual percent of births to unmarried Hispanic women in Arizona is between 49.1 and 50.3 percent. Significance testing when one or both of the rates is based on fewer than 100 cases -- To compare two rates, when one or both of those rates are based on less than 100 cases, you first compute the confidence intervals for both rates. Then you check to see if those intervals overlap. If they do overlap, the difference is not statistically significant at the 95-percent level. If they do not overlap, the difference is indeed statistically significant. Example Suppose that the first birth rate for American Indian women 40-44 years of age was 0.70 per 1,000 in year X and 0.57 in year Y. Is the rate for year X significantly higher than the rate for year Y? The two rates are based on 63 events in year X and 54 events in year Y. Both rates are based on fewer than 100 events; therefore, the first step is to compute the confidence intervals for both rates. Lower Limit

Upper Limit

Year X

0.54

0.90

Year Y

0.43

0.74

These two confidence intervals overlap. Therefore, the first birth rate for American women 40-44 in year X is not significantly higher (at the 95-percent confidence level) than the rate in year Y. This method of comparing confidence intervals is a conservative test for statistical significance. That is, the difference between two rates may, in fact, be statistically significant even though confidence intervals for the two rates overlap [57]. Thus, caution should be observed when interpreting a non-significant difference between two rates, especially when the lower and upper limits being compared overlap only slightly. Significance testing when both rates are based on 100 or more events -- When both rates are based on 100 or more events, the difference between the two rates, irrespective of sign (+/-), is considered statistically significant if it exceeds the statistic in the formula below. This statistic equals 1.96 times the standard error for the difference between two rates.

45

1.96 ×

R12 R22 + N1 N 2

where: R1

=

first rate

R2

=

second rate

N1

=

first number of births

N2

=

second number of births

If the difference is greater than this statistic, then the difference would occur by chance less than 5 times out of 100. If the difference is less than or equal to this statistic, the difference might occur by chance more than 5 times out of 100. We say that the difference is not statistically significant at the 95-percent confidence level. Example Is the first birth rate for black women 40-44 years of age (1.08 per 1,000) significantly lower than the comparable rate for white women (1.55)? Both rates are based on more than 100 births (1,535 for black women and 14,108 for white women). The difference between the rates is 1.55 - 1.08 = 0.47. The statistic is then calculated as follows:

= 1.96 ×

1.08 2 1.55 2 + 1,535 14,108

= 1.96 ×

((1.166 / 1,535) + (2.403 / 14,108))

= 1.96 × 0.00076 + 0.00017 = 1.96 × 0.00093 = 1.96 × 0.03 = 0.06 The difference between the rates (0.47) is greater than this statistic (0.06). Therefore, the difference is statistically significant at the 95-percent confidence level. Significance testing differences between two percents -- When testing the

difference between two percents, both percents must meet the following conditions:

46

B × p ≥ 5 and B × q ≥ 5

where: B

=

number of births in the denominator

p

=

percent divided by 100

q

=

1-p

When both percents meet these conditions then the difference between the two percents is considered statistically significant if it is greater than the statistic in the formula below. This statistic equals 1.96 times the standard error for the difference between two percents.

⎛ 1 1 ⎞ 1.96 × p × (1 − p )× ⎜⎜ + ⎟⎟ ⎝ B1 B2 ⎠ where: B1

=

number of births in the denominator of the first percent

B2

=

number of births in the denominator of the second percent

B

B

p

=

B1 × p1 + B2 × p2 B1 + B2

p1

=

the first percent divided by 100

p2

=

the second percent divided by 100

Example Is the percent of births to Hispanic women that were to unmarried women higher in New Mexico (50.2) than in Arizona (49.7)? Suppose that the number in the denominator was 13,714 in New Mexico and 29,682 in Arizona. The necessary conditions are met for both percents (calculations not shown). The difference between the two percents is 0.502 - 0.497 = 0.005. The statistic is then calculated as follows:

47

1.96 × 0.499 × (0.501)× (0.000106609) = 1.96 × 0.000026652 = 1.96 × 0.005162563 = 0.010 The difference between the percents (0.005) is less than this statistic (0.010). Therefore, the difference is not statistically significant at the 95-percent confidence level.

Random variation and significance testing for population subgroups

This section presents information relevant to Hispanic subgroups (or generally speaking, any subgroup of the population for which survey data has been used for estimation of the denominator.) Birth and fertility rates for Mexicans, Puerto Ricans, Cubans, and “Other” Hispanic subgroups for 2004 are shown in tables 5,6, 8, and 15 of 2004 natality final report [3] and in tables 1-4 and 1-12 of “Vital Statistics of the United States, 2004, Part 1, Natality” (in preparation). Population estimates for Hispanic subgroups are derived from the U.S. Census Bureau’s Current Population Survey (CPS) and adjusted to resident population control totals as shown in table 4-3 [47, 50]. As a result, the rates are subject to the variability of the denominator as well as the numerator. For these Hispanic subgroups (but not for all origin, total Hispanic, total non-Hispanic, non-Hispanic white, or non-Hispanic black populations), the following formulas are used for testing statistical significance in trends and differences: Approximate 95-percent confidence interval: 100 or more births -- When the

number of events in the numerator is greater than 100, the confidence interval for the birth rate can be estimated from the following formulas: For crude and age–specific birth rates,

b⎞ ⎛1⎞ ⎛ Lower limit = R − 1.96 * R * ⎜ ⎟ + f ⎜ a + ⎟ P⎠ ⎝ B⎠ ⎝ b⎞ ⎛1⎞ ⎛ Upper limit = R + 1.96 * R * ⎜ ⎟ + f ⎜ a + ⎟ P⎠ ⎝ B⎠ ⎝

48

where:

R = rate (births per 1,000 population) B = total number of births upon which rate is based f = the factor which depends on whether an entire or a sampled population (like one from a Current Population Survey – CPS) is used, and the span of years represented. f equals 0.670 for a single year a and b of the example are single year averages of the 2002 and 2003 CPS standard error parameters [58, 59] a = -0.000096 b = 3,809 P = total estimated population upon which rate is based

Example Suppose that the fertility rate of Cuban women 15–44 years of age was 51.2 per 1,000 based on 13,088 births in the numerator and an estimated resident population of 255,399 in the denominator. The 95-percent confidence interval would be: ⎡ ⎛ 1 ⎞ ⎛ 3,809 ⎞⎤ Lower limit = 51.2 − 1.96 * 51.2 * ⎜ ⎟ + 0.670 * ⎢− 0.000096 + ⎜ ⎟⎥ ⎝ 13,088 ⎠ ⎝ 255,399 ⎠⎦ ⎣ = 51.2 − 1.96 * 51.2 * 0.000076406 + (0.670 * 0.014914) = 51.2 − 1.96 * 51.2 * 0.01000475 = 51.2 − 1.96 * 51.2 * 0.100024 = 41.16 ⎡ ⎛ 3,809 ⎞ ⎤ ⎛ 1 ⎞ Upper limit = 51 .2 + 1.96 * 51 .2 * ⎜⎜ ⎟⎟ ⎥ ⎟⎟ + 0.670 * ⎢ − 0.000096 + ⎜⎜ ⎝ 255,399 ⎠ ⎦ ⎝ 13,088 ⎠ ⎣ = 51 .2 + 1.96 * 51 .2 * 0.000076406 + (0.670 * 0.014914 ) = 51 .2 + 1.96 * 51 .2 * 0.01000475 = 51 .2 + 1.96 * 51 .2 * 0.100024 = 61 .24

This means that the chances are 95 out of 100 that the actual fertility rate of Cuban women 15–44 years of age is between 41.16 and 61.24. Approximate 95-percent confidence interval: less than 100 births -- When the

number of events in the numerator is less than 20, an asterisk is shown in place of the rate. When the number of events in the numerator is greater than 20 but less than 100, the

49

confidence interval for the birth rate can be estimated using the formulas that follow and the values in table C. For crude and age–specific birth rates, ⎛ b ⎞⎞ ⎛ Lower limit = R * L(1 − α = .96, B ) * ⎜1 − 2.576 f ⎜ a + ⎟ ⎟ ⎜ P ⎠ ⎟⎠ ⎝ ⎝ ⎛ b ⎞⎞ ⎛ Upper limit = R *U (1 − α = .96, B ) * ⎜1 + 2.576 f ⎜ a + ⎟ ⎟ ⎜ P ⎠ ⎟⎠ ⎝ ⎝ where:

R = rate (births per 1,000 population) B = total number of births upon which rate is based L = the value in table C that corresponds to the number B, using the 96 percent CI column U = the value in table C that corresponds to the number B, using the 96 percent CI column f = the factor which depends on whether an entire or a sampled population (like one from a Current Population Survey – CPS) is used, and the span of years represented. f equals 0.670 for a single year a and b are CPS standard error parameters (see previous section on 95-percent confidence interval for 100 or more births for description and specific values) P = total estimated population upon which the rate is based

NOTE: In the formulas above, the confidence limits are estimated from the nonsampling error in the number of births, the numerator, and the sampling error in the population estimate, the denominator. A 96 percent standard error is computed for the numerator and a 99 percent standard error is computed for the denominator in order to compute a 95-percent confidence interval for the rate. Example Suppose that the birth rate of Puerto Rican women 45–49 years of age was 0.4 per 1,000, based on 35 births in the numerator and an estimated resident population of 87,892 in the denominator. Using table C, the 95-percent confidence interval would be:

50

⎛ ⎛ ⎛ 3,809 ⎞ ⎞ ⎞⎟ Lower limit = 0.4 * 0.68419 * ⎜1 − 2.576 0.670⎜⎜ − 0.000096 + ⎜ ⎟ ⎟⎟ ⎜ 87 , 892 ⎝ ⎠ ⎠ ⎟⎠ ⎝ ⎝

(

)

= 0.4 * 0.68419 * 1 − 2.576 0.028972 = 0.4 * 0.68419 * (1 − (2.576 * 0.170211) ) = 0.4 * 0.68419 * 0.561536 = 0.154 ⎛ ⎛ ⎛ 3,809 ⎞ ⎞ ⎞⎟ Upper limit = 0.4 * 1.41047 * ⎜1 + 2.576 0.670⎜⎜ − 0.000096 + ⎜ ⎟⎟ ⎜ 87,892 ⎠ ⎟⎠ ⎟ ⎝ ⎝ ⎝ ⎠

(

)

= 0.4 * 1.41047 * 1 + 2.576 0.028972 = 0.4 * 1.41047 * (1 + (2.576 * 0.170211) ) = 0.4 * 1.41047 * 1.438464 = 0.812

This means that the chances are 95 out of 100 that the actual birth rate of Puerto Rican women 45–49 years of age lies between 0.15 and 0.81. Significance testing for subgroups -- When both rates are based on 100 or more

events, the difference between the two rates is considered statistically significant if it exceeds the value given by the formula below. This statistic equals 1.96 times the standard error for the difference between two rates. ⎡⎛ 1 ⎞ z = 1.96 * R12 * ⎢⎜⎜ ⎟⎟ + ⎣⎝ B1 ⎠

⎡⎛ 1 ⎞ ⎛ b ⎞⎤ f ⎜⎜ a + ⎟⎟⎥ + R22 * ⎢⎜⎜ ⎟⎟ + P1 ⎠⎦ ⎝ ⎣⎝ B2 ⎠

⎛ b ⎞⎤ f ⎜⎜ a + ⎟⎟⎥ P2 ⎠⎦ ⎝

If the difference is greater than this statistic, then the difference would occur by chance less than 5 times out of 100. If the difference is less than this statistic, the difference might occur by chance more than 5 times out of 100. We would therefore conclude that the difference is not statistically significant at the 95-percent confidence level. Example Suppose the birth rate for Mexican mothers 15–19 years of age (R1) is 94.5, based on 97,744 births and an estimated population of 1,033,878, and the birth rate for Puerto Rican mothers 15–19 years of age (R2) is 61.4, based on 10,006 births and an estimated population of 162,899. Using the above formula, the z score is computed as follows:

51

⎡⎛ 1 ⎞ ⎡⎛ 1 ⎞ 3,809 ⎞⎤ 3,809 ⎞⎤ ⎛ ⎛ = 1.96 * 94.5 2 * ⎢⎜ ⎟ + 0.670⎜ − 0.000096 + ⎟⎥ + 61.4 2 * ⎢⎜ ⎟ + 0.670⎜ − 0.000096 + ⎟⎥ 1,033,878 ⎠⎦ 162,899 ⎠⎦ ⎝ ⎝ ⎣⎝ 97,744 ⎠ ⎣⎝ 10,006 ⎠ = 1.96 * 8930.25 * (0.000010231 + 0.670 * 0.003589 ) + 3769.96(0.00009994 + 0.670 * 0.023287 ) = 1.96 *

(8930.25 * 0.0024147 ) + (3769.96 * 0.015702 )

= 1.96 * 21.563 + 59.20 = 1.96 * 8.99 = 17.61

Since the difference between the two rates 33.1 is greater than the value above, the two rates are statistically significantly different at the 0.05 level of significance.

52

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23. Ingram DD, Parker JD, Schenker N, Weed JA, Hamilton B, Arias E, Madans JH. United States Census 2000 with bridged race categories. National Center for Health Statistics. Vital Health Stat 2(135). 2003. 24. Schenker N, Parker JD. From single-race reporting to multiple-race reporting: Using imputation methods to bridge the transition. Stat Med 22(9):1571–87. 2003. 25. Johnson D. Coding and editing multiple race and ethnicity. Presented at the 2004 Joint Meeting of NAPHSIS and VSCP. Portland, Oregon. June 6-10, 2004. Available on the Internet at: http://www.naphsis.org/events/index.asp?bid=699 . 26. Weed JA. NCHS procedures for multiple-race and Hispanic origin data: Collecting, coding, editing and transmitting. Presented at the 2004 Joint Meeting of NAPHSIS and VSCP. Portland, Oregon. June 6-10, 2004. Available on the Internet at: http://www.cdc.gov/nchs/data/dvs/Multiple_race_docu_5-10-04.pdf . 27. Hamilton BE, Ventura SJ, Martin JA. Characteristics of births to single-race and multiple-race women, 2003. National vital statistics reports; vol 54 no ??. Hyattsville, Maryland: National Center for Health Statistics. 2006. 28. Schachter J. Matched record comparison of birth certificate and census information in the United States, 1950. Vital statistics—Special Reports; vol 47 no 12. Washington: Public Health Service. 1962. 29. Schoendorf KC, Parker JD, Batkhan LZ, Kiely JL. Comparability of the birth certificate and 1988 maternal and infant health survey. Vital Health Statistics 2 (116). Hyattsville, Maryland: National Center for Health Statistics. 1993. 30. National Center for Health Statistics. Vital statistics of the United States, 2001, volume I, natality. Available on the Internet at: http://www.cdc.gov/nchs/datawh/statabunpubd/natality/natab2001.htm and on CDROM from Hyattsville, Maryland: National Center for Health Statistics. 2006. 31. Division of Vital Statistics. Instruction manual part 12: Computer edits for natality data, effective 1993.Vital statistics, data preparation. Hyattsville, Maryland: National Center for Health Statistics. 1995. Available on the Internet at: www.cdc.gov/nchs/data/dvs/instr12.pdf . 32. Ventura SJ, Bachrach CA. Nonmarital childbearing in the United States, 1940–99. National vital statistics reports; vol 48 no 16. Hyattsville, Maryland: National Center for Health Statistics. 2000. 33. Ventura SJ. Births to unmarried mothers: United States, 1980–92. National Center for Health Statistics. Vital Health Stat 21(53). 1995.

55

34. Sampson PD, Bookstein FL, Barr HM, Steissguth AP. Prenatal alcohol exposure, birthweight, and measures of child size from birth to 14 years. Am J Public Health 84(9):1421-28. 1994. 35. Roeleveld N, Vingerhoets E, Zielhuis GA, Gabreels F. Mental retardation associated with parental smoking and alcohol consumption before, during, and after pregnancy. Prev Medicine 21(1):110-19. 1992. 36. Ebrahim SH, Luman ET, Floyd RL, et al. Alcohol consumption by pregnant women in the United States during 1988-1995. Obstet Gynecol 92(2):187-192. 1998. 37. Chomitz VR, Cheung LWY, Lieberman E. The role of lifestyle in preventing low birth weight. In: The future of children: Low birthweight. Vol 5(1):121-138. Los Altos, California: Center for the Future of Children, The David and Lucile Packard Foundation. 1995. 38. Kotelchuck M. An evaluation of the Kessner adequacy of prenatal care index and a proposed adequacy of prenatal care utilization index. Am J Public Health 84 (9):1414-20. 1994. 39. Kogan MD, Martin JA, Alexander GR, et al. The changing pattern of prenatal care utilization in the United States, 1981-1995, using different prenatal care indices. JAMA 279(20):1623-8. 1998. 40. Taffel S, Johnson D, Heuser R. A method for imputing length of gestation on birth certificates. National Center for Health Statistics. Vital Health Stat 2(93). Hyattsville, Maryland: National Center for Health Statistics. 1982. 41. Vahratian A, Buekens P, Bennett TA, et al. Preterm delivery rates in North Carolina: Are they really declining among non-Hispanic African Americans? Am J Epidemiology 159(1):59-63. 2004. 42. Division of Vital Statistics. Instruction manual part 12: Computer edits for natality data -- 2003 Revised Certificate. Hyattsville, Maryland: National Center for Health Statistics.. Forthcoming on the Internet . 43. World Health Organization. Manual of the international statistical classification of diseases, injuries and causes of death. Sixth revision. Geneva. 1949. Referenced in: http://www.who.int/classifications/icd/en/HistoryOfICD.pdf . 44. National Center for Health Statistics. Matched Multiple Birth file 1995-2000. Public use CD-ROM. Hyattsville, Maryland: National Center for Health Statistics. CD Rom series 21. no.17. 2004. 45. Watkins ML, Edmonds L, McClearn A, et al. The surveillance of birth defects: The usefulness of the revised U.S. standard birth certificate. Am J Public Health

56

86(5):731–4. 1996. 46. U.S. Census Bureau. Test of birth-registration completeness, 1964 to 1968. 1970 census of population and housing; PHC (E)–2. Evaluation and Research Program. Washington: U.S. Department of Commerce. 1973. 47. National Center for Health Statistics. Postcensal estimates of the resident population of the United States as of July 1, 2004, by year, state and county, age, bridged race, sex, and Hispanic origin (vintage 2004). File pcen_v2004.txt (ASCII). Released September 8, 2005. Available on the Internet at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/datadoc.htm 48. U.S. Census Bureau. Age, sex, race, and Hispanic origin information from the 1990 census: A comparison of census results with results where age and race have been modified. 1990 CPH–L–74. Washington, DC: U.S. Department of Commerce. 1991. Available on the Internet at : http://www.wnjpin.net/OneStopCareerCenter/LaborMarketInformation/lmi02/cphl-74.htm . 49

U.S. Census Bureau. Unpublished data from the March 2004 current population survey. U.S. Census Bureau. 2004.

50. U.S. Census Bureau. Unpublished tabulations prepared by the Housing and Household Economic Statistics Division. 2005. 51. U.S. Census Bureau. Census 2000 modified race data summary file. Available on the Internet at: http://www.census.gov/popest/archives/files/MR-CO.txt . 52. Hamilton BE, Sutton PD, Ventura SJ. Revised birth and fertility rates for the 1990s and new rates for Hispanic populations, 2000 and 2001: United States. National vital statistics reports; vol 51 no 12. Hyattsville, Maryland. 2003. 53. Ventura SJ, Hamilton BE, Sutton PD. Revised birth and fertility rates for the United States, 2000 and 2001. National vital statistics reports; vol 51 no 4. Hyattsville, Maryland: National Center for Health Statistics. 2003. 54. Heuser R. Fertility tables for birth cohorts by color: United States, 1917–73. Available on the Internet at http://www.cdc.gov/nchs/data/misc/fertiltbacc.pdf and on CD from Hyattsville, Maryland: National Center for Health Statistics. 1976. 55. Shiskin J, Young A, Musgrove J. The X–11 variant of the Census Method II Seasonal Adjustment Program. Technical paper; no 15, 1967 rev. Washington: U.S. Census Bureau. 1967. 56. Bailer JC, Ederer F. Significance factors for the ratio of a Poisson variable to its expectations. Biometrics. 20:639-43. 1964.

57

57. Schenker N, Gentleman JF. On judging the significance of differences by examining the overlap between confidence intervals. Amer Stat 55:182-86. 2001. 58. U.S. Census Bureau, Demographic Statistical Methods Division. Source and accuracy of the data for the March 2002 Current Population Survey microdata file. Available on the Internet at: http://www.bls.census.gov/cps/ads/2002/S&A_02.pdf . 59. U.S. Census Bureau, Demographic Statistical Methods Division. Source and accuracy of the data for the March 2003 Current Population Survey microdata file.

58

Figure 4–A. U.S. Standard Certificate of Live Birth: 1989 Revision

24

Figure 4–A. U.S. Standard Certificate of Live Birth: 1989 Revision - Con.

25 24

U.S. STANDARD CERTIFICATE OF LIVE BIRTH LOCAL FILE NO.

BIRTH NUMBER:

C H I L D

1. CHILD’S NAME (First, Middle, Last, Suffix)

2. TIME OF BIRTH 3. SEX (24hr)

5. FACILITY NAME (If not institution, give street and number)

MOTHER

6. CITY, TOWN, OR LOCATION OF BIRTH

8a. MOTHER’S CURRENT LEGAL NAME (First, Middle, Last, Suffix)

7. COUNTY OF BIRTH

8b. DATE OF BIRTH (Mo/Day/Yr)

8c. MOTHER’S NAME PRIOR TO FIRST MARRIAGE (First, Middle, Last, Suffix) 9a. RESIDENCE OF MOTHER-STATE

4. DATE OF BIRTH (Mo/Day/Yr)

8d. BIRTHPLACE (State, Territory, or Foreign Country)

9b. COUNTY

9c. CITY, TOWN, OR LOCATION

9d. STREET AND NUMBER

9e. APT. NO.

9f. ZIP CODE

9g. INSIDE CITY LIMITS? 9 Yes 9 No

10a. FATHER’S CURRENT LEGAL NAME (First, Middle, Last, Suffix)

10b. DATE OF BIRTH (Mo/Day/Yr)

10c. BIRTHPLACE (State, Territory, or Foreign Country)

FATHER 11. CERTIFIER’S NAME: _________________________________________

CERTIFIER TITLE: 9 MD 9

9

DO

9

HOSPITAL ADMIN.

9

9

CNM/CM

12. DATE CERTIFIED

13. DATE FILED BY REGISTRAR

______/ ______ / __________ MM DD YYYY

OTHER MIDWIFE

______/ ______ / __________ MM DD YYYY

OTHER (Specify)_____________________________

INFORMATION FOR ADMINISTRATIVE USE 14. MOTHER’S MAILING ADDRESS:

MOTHER

9 Same as residence, or:

State:

City, Town, or Location:

Street & Number:

Apartment No.:

15. MOTHER MARRIED? (At birth, conception, or any time between) IF NO, HAS PATERNITY ACKNOWLEDGMENT BEEN SIGNED IN THE HOSPITAL? 18. MOTHER’S SOCIAL SECURITY NUMBER:

9 Yes 9 No 9 Yes 9 No

Zip Code:

16. SOCIAL SECURITY NUMBER REQUESTED 17. FACILITY ID. (NPI) FOR CHILD?

9 Yes 9

No

19. FATHER’S SOCIAL SECURITY NUMBER:

INFORMATION FOR MEDICAL AND HEALTH PURPOSES ONLY

MOTHER

20. MOTHER’S EDUCATION (Check the box that best describes the highest degree or level of school completed at the time of delivery)

9

8th grade or less

9

9th - 12th grade, no diploma

9

High school graduate or GED

completed

9

Associate degree (e.g., AA, AS)

9

Bachelor’s degree (e.g., BA, AB, BS)

Mother’s Medical Record No._________________

Mother’s Name______________________

FATHER

9

Yes, Mexican, Mexican American, Chicana

9

Yes, Puerto Rican

9

Yes, Cuban

9

Yes, other Spanish/Hispanic/Latina

(Specify)_____________________________

Doctorate (e.g., PhD, EdD) or

Professional degree (e.g., MD, DDS, DVM, LLB, JD)

23. FATHER’S EDUCATION (Check the box that best describes the highest degree or level of school completed at the time of delivery)

9

8th grade or less

9

9th - 12th grade, no diploma

9

High school graduate or GED completed

9

Some college credit but no degree

9 9

Associate degree (e.g., AA, AS)

9

Master’s degree (e.g., MA, MS, MEng,

24. FATHER OF HISPANIC ORIGIN? (Check the box that best describes whether the father is Spanish/Hispanic/Latino. Check the “No” box if father is not Spanish/Hispanic/Latino)

Bachelor’s degree (e.g., BA, AB, BS)

MEd, MSW, MBA)

9

No, not Spanish/Hispanic/Latina

Master’s degree (e.g., MA, MS, MEng, MEd, MSW, MBA)

9

9

Some college credit but no degree

9

9

21. MOTHER OF HISPANIC ORIGIN? (Check the box that best describes whether the mother is Spanish/Hispanic/Latina. Check the “No” box if mother is not Spanish/Hispanic/Latina)

Doctorate (e.g., PhD, EdD) or Professional degree (e.g., MD, DDS, DVM, LLB, JD)

9

No, not Spanish/Hispanic/Latino

9

Yes, Mexican, Mexican American, Chicano

9

Yes, Puerto Rican

9 9

Yes, Cuban

Yes, other Spanish/Hispanic/Latino

(Specify)_____________________________

26. PLACE WHERE BIRTH OCCURRED (Check one) 9 Hospital

22. MOTHER’S RACE (Check one or more races to indicate what the mother considers herself to be)

9 9 9 9 9 9 9 9 9 9 9 9 9 9 9

White Black or African American American Indian or Alaska Native (Name of the enrolled or principal tribe)____________________________ Asian Indian

Chinese Filipino

Japanese Korean

Vietnamese

Other Asian (Specify)__________________________________________ Native Hawaiian Guamanian or Chamorro Samoan

Other Pacific Islander (Specify)___________________________________ Other (Specify)_________________________________________________

25. FATHER’S RACE (Check one or more races to indicate what the father considers himself to be) 9 White

9 9 9 9 9 9 9 9 9 9 9 9 9 9

Black or African American American Indian or Alaska Native (Name of the enrolled or principal tribe)____________________________ Asian Indian

Chinese Filipino

Japanese

Korean

Vietnamese Other Asian (Specify)__________________________________________ Native Hawaiian Guamanian or Chamorro Samoan Other Pacific Islander (Specify)___________________________________ Other (Specify)_________________________________________________

27. ATTENDANT’S NAME, TITLE, AND NPI NAME: _______________________ NPI:_______

9 Freestanding birthing center 9 Home Birth: Planned to deliver at home? 9 Yes 9 No

9 Clinic/Doctor’s office

9 Other (Specify)_______________________ REV. 11/2003

TITLE: 9 MD 9 DO 9 CNM/CM 9 OTHER MIDWIFE 9 OTHER (Specify)___________________

28. MOTHER TRANSFERRED FOR MATERNAL MEDICAL OR FETAL INDICATIONS FOR DELIVERY? 9 Yes 9 No IF YES, ENTER NAME OF FACILITY MOTHER TRANSFERRED FROM: ____________________________________________

MOTHER

29a. DATE OF FIRST PRENATAL CARE VISIT ______ /________/ __________ 9 No Prenatal Care MM DD YYYY 31. MOTHER’S HEIGHT

29b. DATE OF LAST PRENATAL CARE VISIT

30. TOTAL NUMBER OF PRENATAL VISITS FOR THIS PREGNANCY ______ /________/ __________ ___________________________ (If none, enter “0".) MM DD YYYY 33. MOTHER’S WEIGHT AT DELIVERY 34. DID MOTHER GET WIC FOOD FOR HERSELF 32. MOTHER’S PREPREGNANCY WEIGHT

_______ (feet/inches)

35a.Now Living

Number ____

Number __________

9 None

9 None

9 None

35c. DATE OF LAST LIVE BIRTH

36b. DATE OF LAST OTHER PREGNANCY OUTCOME

_______/________

MEDICAL AND HEALTH INFORMATION

MM

39. DATE LAST NORMAL MENSES BEGAN

Hypertension 9 Prepregnancy (Chronic) 9 Gestational (PIH, preeclampsia) 9 Eclampsia

9

No

9 Private Insurance

40. MOTHER’S MEDICAL RECORD NUMBER

M M

DD

YYYY 46. METHOD OF DELIVERY

43. OBSTETRIC PROCEDURES (Check all that apply)

Diabetes 9 Prepregnancy (Diagnosis prior to this pregnancy) 9 Gestational (Diagnosis in this pregnancy)

Yes

_____ /_____/ __________

YYYY

41. RISK FACTORS IN THIS PREGNANCY (Check all that apply)

9

38. PRINCIPAL SOURCE OF PAYMENT FOR THIS DELIVERY

Average number of cigarettes or packs of cigarettes smoked per day. 9 Medicaid # of cigarettes # of packs 9 Self-pay Three Months Before Pregnancy _________ OR ________ First Three Months of Pregnancy _________ OR ________ 9 Other Second Three Months of Pregnancy _________ OR ________ (Specify) ____________________ Third Trimester of Pregnancy _________ OR ________

_______/_______

YYYY

DURING THIS PREGNANCY?

37. CIGARETTE SMOKING BEFORE AND DURING PREGNANCY For each time period, enter either the number of cigarettes or the number of packs of cigarettes smoked. IF NONE, ENTER “0".

35b. Now Dead 36a. Other Outcomes

Number _____

MM

_________ (pounds)

_________ (pounds)

36. NUMBER OF OTHER PREGNANCY OUTCOMES LIVE BIRTHS (Do not include (spontaneous or induced this child) losses or ectopic pregnancies)

35. NUMBER OF PREVIOUS

9 Cervical cerclage 9 Tocolysis

A. Was delivery with forceps attempted but unsuccessful?

External cephalic version: 9 Successful 9 Failed

9 Yes 9 No B. Was delivery with vacuum extraction attempted but unsuccessful?

9 None of the above

9 Yes

9 No

44. ONSET OF LABOR (Check all that apply)

9 Previous preterm birth

9 Premature Rupture of the Membranes (prolonged, ≥12 hrs.)

9 Other previous poor pregnancy outcome (Includes perinatal death, small-for-gestational age/intrauterine growth restricted birth) 9 Pregnancy resulted from infertility treatment-If yes, check all that apply: 9 Fertility-enhancing drugs, Artificial insemination or Intrauterine insemination 9 Assisted reproductive technology (e.g., in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT))

C. Fetal presentation at birth 9 Cephalic 9 Breech 9 Other

9 Precipitous Labor (<3 hrs.) 9 Prolonged Labor

(≥ 20

hrs.)

9 None of the above

D. Final route and method of delivery (Check one)

45. CHARACTERISTICS OF LABOR AND DELIVERY (Check all that apply)

9 Vaginal/Spontaneous 9 Vaginal/Forceps

9 Induction of labor

9 Vaginal/Vacuum

9 Augmentation of labor 9 Non-vertex presentation

9 Mother had a previous cesarean delivery If yes, how many __________

9 Cesarean If cesarean, was a trial of labor attempted? 9 Yes 9 No

9 Steroids (glucocorticoids) for fetal lung maturation received by the mother prior to delivery

9 None of the above 42. INFECTIONS PRESENT AND/OR TREATED DURING THIS PREGNANCY (Check all that apply)

9 Antibiotics received by the mother during labor 47.MATERNAL MORBIDITY (Check all that apply) (Complications associated with labor and delivery)

9 Gonorrhea

9 Clinical chorioamnionitis diagnosed during labor or maternal temperature >38°C (100.4°F)

9 Syphilis

9 Moderate/heavy meconium staining of the amniotic fluid

9 Chlamydia 9 Hepatitis B

9 Fetal intolerance of labor such that one or more of the following actions was taken: in-utero resuscitative measures, further fetal assessment, or operative delivery

9 Hepatitis C

9 Epidural or spinal anesthesia during labor

9 None of the above

9 None of the above

9

Admission to intensive care unit

9

Unplanned operating room procedure

9

None of the above

9

Maternal transfusion

9

Third or fourth degree perineal laceration

9

Ruptured uterus

9

Unplanned hysterectomy

following delivery

NEWBORN INFORMATION

REV. 11/2003

Mother’s Medical Record No. _______

Mother’s Name __________________

NEWBORN

48. NEWBORN MEDICAL RECORD NUMBER:

54. ABNORMAL CONDITIONS OF THE NEWBORN (Check all that apply)

49. BIRTHWEIGHT (grams preferred, specify unit) 9 Assisted ventilation required immediately following delivery ______________________ 9 Assisted ventilation required for more than 9 grams 9 lb/oz six hours 50. OBSTETRIC ESTIMATE OF GESTATION: _________________ (completed weeks) 51. APGAR SCORE:

9 Anencephaly 9 Meningomyelocele/Spina bifida 9 Cyanotic congenital heart disease 9 Congenital diaphragmatic hernia 9 Omphalocele 9 Gastroschisis

9 NICU admission 9 Newborn given surfactant replacement therapy

Score at 5 minutes:_________________________ If 5 minute score is less than 6,

55. CONGENITAL ANOMALIES OF THE NEWBORN (Check all that apply)

9 Antibiotics received by the newborn for suspected neonatal sepsis

Score at 10 minutes: _______________________

9 Seizure or serious neurologic dysfunction

52. PLURALITY - Single, Twin, Triplet, etc. (Specify)________________________

9 Significant birth injury (skeletal fracture(s), peripheral nerve injury, and/or soft tissue/solid organ hemorrhage which requires intervention)

53. IF NOT SINGLE BIRTH - Born First, Second,

9 None of the above

9 Limb reduction defect (excluding congenital amputation and dwarfing syndromes) 9 Cleft Lip with or without Cleft Palate 9 Cleft Palate alone 9 Down Syndrome 9 Karyotype confirmed 9 Karyotype pending 9

Suspected chromosomal disorder 9 Karyotype confirmed 9 Karyotype pending

9

Hypospadias

9

None of the anomalies listed above

Third, etc. (Specify)____________________

56. WAS INFANT TRANSFERRED WITHIN 24 HOURS OF DELIVERY? 9 Yes 9 No

57. IS INFANT LIVING AT TIME OF REPORT?

IF YES, NAME OF FACILITY INFANT TRANSFERRED TO:________________________

9 Yes 9 No 9 Infant transferred, status unknown

58. IS THE INFANT BEING BREASTFED AT DISCHARGE? 9 Yes 9 No

NOTE: This recommended standard birth certificate is the result of an extensive evaluation process. Information on the process and resulting recommendations as well as plans for future activities is available on the Internet at: http://www.cdc.gov/nchs/vital_certs_rev.htm.

Table A. Percent of birth records on which specified items were not stated: United States and each State and territory, New York City and the District of Columbia, 2004 [By place of residence] Items common to both the 1989 and 2003 revisions of the U.S. Standard Certificate of Live Birth Area Total of reporting areas

All births 1

Place of birth

Attendant at birth

Mother's birthplace

Hispanic Origin Father's age

Father's race

Mother

Father

4,112,052

0.0

0.2

0.4

13.6

16.0

0.8

14.1

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia

59,510 10,338 93,663 38,573 544,843 68,503 42,095 11,369 7,933

0.0 0.0 0.0 0.0 -

0.0 0.9 0.0 0.0 0.0 0.0 0.1 0.1 0.0

0.0 0.5 0.1 0.5 0.4 0.5 0.5 0.3 0.0

20.8 9.2 14.7 19.0 7.3 8.1 10.6 32.6 35.7

21.1 14.2 18.2 20.3 8.1 8.8 11.8 33.6 44.1

0.1 11.6 1.9 0.3 1.4 0.0 0.3 0.7 0.4

20.8 20.9 16.8 19.1 7.7 8.8 10.9 32.6 35.7

Florida 2 Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada

218,053 138,849 18,281 22,532 180,778 87,142 38,438 39,669 55,720 65,369 13,944 74,628 78,484 129,776 70,624 42,827 77,765 11,519 26,332 35,200

0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -

0.1 0.0 0.1 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.0 0.1 0.1 0.1 0.0 0.1 0.0

0.2 0.2 0.2 0.4 0.2 0.0 0.0 0.1 0.6 0.0 0.0 0.1 0.9 0.2 0.3 0.1 0.3 0.0 0.5

15.8 17.0 8.6 9.2 13.7 13.2 14.0 10.6 20.1 19.6 9.2 13.4 7.9 14.6 12.1 20.7 18.0 9.2 13.2 22.4

24.5 17.7 12.3 15.2 15.2 13.2 15.5 11.1 24.7 19.7 12.7 19.4 9.4 16.9 18.2 20.7 19.9 10.6 14.9 24.0

0.3 1.6 0.2 1.3 0.1 0.4 0.3 1.4 0.1 0.2 0.5 0.1 0.7 2.7 1.4 0.1 0.1 1.6 2.5 1.0

18.4 18.4 8.6 12.1 15.0 13.4 15.7 12.1 23.3 19.7 12.8 15.5 8.5 18.6 13.9 20.7 18.5 11.9 15.6 22.8

New Hampshire 2 New Jersey New Mexico New York(excluding NYC) New York City North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

14,565 115,253 28,384 130,879 119,068 119,847 8,189 148,954 51,306 45,678 144,748 12,779 56,590 11,338 79,642 381,293 50,670 6,599 103,933 81,747 20,880 70,146 6,807

0.0 0.0 0.0 0.0 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 -

0.0 0.1 0.0 0.0 0.0 0.0 0.0 4.6 0.0 0.0 1.2 0.0 0.0 0.0 0.1 0.0 0.0 0.0

0.2 0.1 1.6 0.1 0.5 0.0 0.5 0.0 0.1 3.9 0.2 0.1 0.1 0.3 0.4 0.2 0.4 0.1 0.3 0.1 0.1 0.1

6.4 7.6 19.7 10.8 15.4 16.2 9.3 16.2 14.6 10.2 6.6 13.0 29.5 10.4 16.0 14.3 9.9 7.6 15.3 9.7 13.0 30.8 16.0

8.6 9.0 19.6 16.1 16.1 16.3 9.5 19.9 17.2 4.9 11.0 14.3 33.8 11.0 22.2 14.7 12.9 10.0 17.0 23.6 13.5 30.9 16.4

3.5 0.1 0.0 0.2 0.4 0.1 2.8 0.5 0.3 0.3 1.2 13.8 0.1 0.1 0.2 0.3 0.6 1.1 0.1 2.9 0.2 0.1 0.3

7.6 7.8 19.6 10.9 15.6 16.3 12.1 16.9 16.8 4.9 5.9 24.1 0.7 13.4 15.9 14.5 10.8 10.7 15.3 15.5 13.4 30.9 16.2

51,127 1,574 3,410 1,714 1,355

0.1 0.2 -

0.1 0.3 0.4 0.5

0.4 3.9 -

3.2 21.0 22.3 36.4 8.9

4.3 22.1 22.6 36.5 9.0

--4.3 1.5 -----

--60.7 27.8 -----

Puerto Rico Virgin Islands Guam American Samoa Northern Marianas See footnotes at end of table.

Table A. Percent of birth records on which specified items were not stated: United States and each State and territory, 2004 -- Con. [By place of residence] Items common to both the 1989 and 2003 revisions of the U.S. Standard Certificate of Live Birth Area

Educational attainment of mother Live-birth order Unrevised

Total of reporting areas

1

3

Revised

Length of gestation

4

Month prenatal care began Unrevised

3

Revised

4

Number of prenatal visits

Weight gain

2.0

---

0.5

1.0

2.5

---

3.6

5.9

Alabama Alaska Arizona Arkansas

0.7 6.7 1.4 1.9

---------

0.0 10.4 0.1 0.2

0.1 0.4 0.1 0.2

0.7 6.8 0.1 2.7

---------

0.2 10.6 0.7 2.2

1.6 8.7 12.5 8.9

California 5 Colorado Connecticut Delaware District of Columbia

2.9 1.1 1.2 3.1 8.0

-----------

0.1 0.1 0.0 0.2 0.2

6.8 0.0 0.0 0.1 0.2

1.7 1.8 1.5 2.7 11.1

-----------

2.7 2.0 1.0 0.6 15.8

--3.0 1.1 1.1 13.7

Florida 2 Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada

--3.3 1.2 --1.6 1.6 0.2 0.4 --0.1 1.5 1.5 0.4 2.6 1.9 4.3 1.2 0.6 0.1 2.7

------5.1 --------4.4 -----------------------

0.7 0.1 0.0 0.2 0.3 0.1 0.1 0.0 0.1 0.1 0.2 0.1 0.2 0.4 0.5 0.1 0.5 0.1 0.0 1.3

0.1 0.1 0.2 0.1 0.2 0.0 0.1 0.1 0.0 0.1 0.1 0.1 0.2 0.1 0.2 0.2 0.2 0.1 0.0 0.6

--2.6 3.4 --5.6 2.3 0.2 0.8 --0.3 1.2 1.9 2.0 3.7 4.2 5.2 2.3 0.8 0.2 7.7

------1.3 --------1.9 -----------------------

4.5 1.4 2.8 1.6 5.9 1.8 0.3 0.8 1.6 0.3 0.3 2.3 0.7 4.8 5.3 3.6 4.0 0.5 0.3 10.3

8.5 6.5 13.3 8.1 6.4 2.2 0.7 0.2 2.0 4.4 0.9 3.1 0.9 7.1 10.4 5.7 4.2 1.3 3.1 8.9

New Hampshire 2 New Jersey New Mexico New York(excluding NYC) New York City North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

--2.2 3.2 --4.5 0.5 0.3 2.4 0.5 2.9 --2.5 --0.1 --1.4 1.8 5.9 2.3 --2.5 0.4 1.1

------7.5 ------------3.0 --5.3 --0.8 --------3.2 -------

0.5 0.1 1.0 2.0 0.0 0.0 0.1 0.3 0.2 0.0 1.3 2.0 0.0 0.0 0.9 0.7 0.3 0.2 0.0 2.8 0.0 0.0 0.0

0.3 0.1 0.3 0.1 0.0 0.0 0.2 0.1 0.2 0.0 0.8 0.1 0.1 0.0 0.5 0.3 0.0 0.0 0.0 0.3 0.1 0.0 0.0

--2.0 6.0 --5.9 1.0 1.1 4.9 2.2 1.6 --6.0 --0.4 --1.5 2.6 8.3 1.2 --3.8 0.3 0.8

------4.5 ------------6.7 --1.2 --9.6 --------17.1 -------

2.8 1.0 6.3 6.0 0.7 0.8 0.8 9.1 2.2 0.2 9.6 10.7 0.8 0.4 8.2 3.8 2.8 0.6 1.7 16.2 0.7 0.5 0.5

8.7 0.9 11.2 6.8 2.0 2.6 2.3 3.8 3.6 1.9 13.0 13.7 1.8 0.8 8.4 8.1 4.0 2.0 3.2 16.6 2.2 2.2 1.9

Puerto Rico Virgin Islands Guam American Samoa Northern Marianas

0.3 1.0 1.4 --8.1

-----------

0.1 1.3 2.3 5.4

0.0 0.1 --0.7

0.2 0.1 1.1 --4.4

-----------

0.1 2.6 1.5 --4.0

0.0 13.0 2.8 -----

See footnotes at end of table.

Table A. Percent of birth records on which specified items were not stated: United States and each State and territory, 2004 -- Con. [By place of residence] Items common to both the 1989 and 2003 revisions of the U.S. Standard Certificate of Live Birth Tobacco use

Area Birthweight

Total of reporting areas

1

5-minute apgar score

Unrevised

3

Revised

4

Method of Delivery 6

0.1

0.5

1.1

---

0.4

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia

0.1 0.3 0.1 0.1 0.0 0.0 0.0 0.1 0.1

0.2 0.9 0.4 3.2 --0.3 0.2 0.2 0.6

0.6 1.4 1.7 1.5 --0.2 0.7 2.5 0.1

-------------------

0.7 0.3 0.4 0.5 0.0 0.0 0.2 0.0 0.1

Florida 2,7 Georgia Hawaii Idaho Illinois

0.0 0.0 0.1 0.0 0.0

0.3 0.4 0.5 0.6 0.3

--1.4 0.1 --0.3

------3.8 ---

0.2 0.6 0.5 0.2 0.6

Indiana 8 Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada

0.4 0.1 0.0 0.2 0.1 0.1 0.0 0.2 0.1 0.0 0.1 0.0 0.1 0.0 0.0

0.3 0.3 0.8 0.6 0.4 0.2 0.3 0.2 0.3 0.3 0.4 0.6 0.1 0.1 1.5

1.2 0.1 0.1 --0.2 1.2 0.4 0.3 2.9 2.3 0.4 4.1 1.0 0.1 2.2

------4.3 -----------------------

0.6 0.8 0.3 0.3 0.2 0.3 0.4 0.3 0.6 0.9 0.6 0.8 0.3 0.3 0.9

New Hampshire 2 New Jersey New Mexico New York(excluding NYC) New York City North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina

0.2 0.0 0.3 0.1 0.0 0.0 0.2 0.0 0.1 0.0 0.4 0.1 0.0

0.4 0.2 3.7 0.5 0.2 0.3 0.3 0.2 0.9 0.4 1.2 0.4 0.2

--1.8 1.7 --4.2 0.4 0.5 0.9 0.9 2.5 --2.7 ---

------6.8 ------------4.1 --5.1

0.5 0.8 0.4 0.5 0.2 0.6 2.3 0.8 1.9 0.7 0.1 0.2 0.0

South Dakota 9 Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

0.0 0.4 0.1 0.0 0.3 0.1 0.4 0.0 0.0 0.0

0.2 3.2 --0.2 0.2 0.1 0.4 0.2 0.4 0.3

0.1 --0.2 1.0 6.2 1.1 --1.9 0.2 0.5

--1.0 --------3.2 -------

0.6 0.0 0.9 0.5 0.1 0.6 0.0 0.3 0.0 0.3

Puerto Rico Virgin Islands Guam American Samoa

0.0 0.6 0.1 -

0.1 1.6 0.6 ---

1.5 1.0 ---

---------

0.0 1.7 0.2 ---

0.4

1.5

6.4

---

3.4

Northern Marianas

9

See footnotes at end of table.

Table A. Percent of birth records on which specified items were not stated: United States and each State and territory, 2004 -- Con. Items common to both the 1989 and 2003 revisions of the U.S. Standard Certificate of Live Birth Risk Factors in this Pregnancy

Characteristics of Labor and Delivery

Area P.A. Hypertension

Diabetes

Total of reporting areas

1

Chronic Hypertension

Eclampsia

Menconium

Breech

Precipitous Labor

0.4

0.4

0.4

0.4

0.3

0.5

0.4

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia

0.0 9.5 0.0 0.1 0.0 0.0 0.1 0.0

0.0 9.5 0.0 0.1 0.0 0.0 0.1 0.0

0.0 9.5 0.0 0.1 0.0 0.0 0.1 0.0

0.0 9.5 0.0 0.1 0.0 0.0 0.1 0.0

0.0 9.5 0.0 0.0 0.0 0.0 -

0.0 9.5 0.0 0.0 0.0 0.0 -

0.0 9.5 0.0 0.0 0.0 0.0 -

Florida 2 Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada

0.2 0.4 0.0 0.8 0.0 0.0 0.0 0.1 0.4 0.1 0.1 0.0 0.3 0.0 3.0 0.1 0.1 0.0 2.8

0.2 0.4 0.0 0.8 0.0 0.0 0.0 0.1 0.4 0.1 0.1 0.0 0.3 0.0 3.0 0.1 0.1 0.0 2.8

0.2 0.4 0.0 0.8 0.0 0.0 0.0 0.1 0.4 0.1 0.1 0.0 0.3 0.0 3.0 0.1 0.1 0.0 2.8

0.2 0.4 0.0 0.8 0.0 0.0 0.0 0.1 0.4 0.1 0.1 0.0 0.3 0.0 3.0 0.1 0.1 0.0 2.8

0.2 0.0 0.5 0.0 0.0 0.0 0.0 0.4 0.1 0.1 0.0 0.3 0.0 2.9 0.1 0.1 0.0 0.0 2.9

2.9 0.0 1.9 0.0 0.0 0.0 0.0 0.9 0.1 0.1 0.0 0.3 0.0 2.9 0.1 0.1 0.0 0.0 2.9

0.3 0.0 0.6 0.0 0.0 0.0 0.0 0.8 0.1 0.1 0.0 0.3 0.0 2.9 0.1 0.1 0.0 0.0 2.9

New Hampshire 2 New Jersey New Mexico New York(excluding NYC) New York City North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

0.0 0.3 0.0 1.5 0.1 0.0 0.3 0.0 4.8 0.7 0.0 1.9 0.0 0.0 0.9 0.1 0.0 0.0 2.9 0.1 0.0 -

0.0 0.3 0.0 1.5 0.1 0.0 0.3 0.0 4.8 0.7 0.0 1.9 0.0 0.0 0.9 0.1 0.0 0.0 2.9 0.1 0.0 -

0.0 0.3 0.0 1.5 0.1 0.0 0.3 0.0 4.8 0.7 0.0 1.9 0.0 0.0 0.9 0.1 0.0 0.0 2.9 0.1 0.0 -

0.0 0.3 0.0 1.5 0.1 0.0 0.3 0.0 4.8 0.7 0.0 1.9 0.0 0.0 0.9 0.1 0.0 0.0 2.9 0.1 0.0 -

0.5 0.1 0.0 0.1 0.0 0.3 0.0 5.4 0.0 0.0 1.8 0.0 0.0 0.0 0.0 0.0 0.1 3.2 0.1 0.0 -

1.7 0.1 1.1 0.1 0.0 0.3 0.0 5.4 0.0 0.1 1.8 0.0 0.0 0.0 0.0 0.0 0.3 0.0 4.9 0.1 0.0 -

1.1 0.1 2.9 0.1 0.0 0.3 0.0 5.4 0.0 0.1 1.8 0.0 0.0 0.0 0.0 0.0 0.1 0.0 3.6 0.1 0.0 -

Puerto Rico Virgin Islands Guam American Samoa Northern Marianas

0.0 4.5 1.1

0.0 4.5 1.1

0.0 4.5 1.1

0.0 4.5 1.1

0.0

0.0

0.0

0.0

0.0 5.7 0.5 --6.0

0.0 5.7 0.5 --6.0

0.0 5.7 0.5 --6.0

See footnotes at end of table.

Table A. Percent of birth records on which specified items were not stated: United States and each State and territory, 2004 -- Con. Items common to both the 1989 and 2003 revisions of the U.S. Standard Certificate of Live Birth Obstetric Procedures

Area

Induction of Labor 1

Congenital Anomalies

Tocolysis

Anen-cephalus

Spina Bifida

Omphalocele/Gastioschisis

Cleft Lip/ Palate

Down Syndrome

0.2

0.3

1.2

1.2

1.2

1.2

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia

0.0 6.4 0.0 0.0 0.0 0.0 -

0.0 6.5 0.0 0.0 0.0 0.0 -

0.0 11.9 0.3 0.0 0.0 0.1 0.4 -

0.0 11.9 0.3 0.0 0.0 0.1 0.4 -

0.0 11.9 0.3 0.0 0.0 0.1 0.4 -

0.0 11.9 0.3 0.0 0.0 0.1 0.4 -

0.0 11.9 0.3 0.0 0.0 0.1 0.4 -

Florida 2 Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada

0.2 0.0 0.0 0.5 0.0 0.0 0.0 0.0 0.4 0.1 0.0 0.0 0.2 0.0 1.6 0.0 0.1 0.0 2.2

0.0 0.0 0.0 0.6 0.0 0.0 0.0 0.0 0.6 0.1 0.0 0.0 0.2 0.0 1.6 0.0 0.1 0.0 2.2

0.5 0.0 1.3 0.0 0.0 0.1 0.1 0.0 0.1 0.1 0.0 0.6 0.0 4.6 0.1 0.1 0.0 4.5

0.5 0.0 1.3 0.0 0.0 0.1 0.1 0.0 0.1 0.1 0.0 0.6 0.0 4.6 0.1 0.1 0.0 4.5

0.5 0.0 1.3 0.0 0.0 0.1 0.1 0.0 0.1 0.1 0.0 0.6 0.0 4.6 0.1 0.1 0.0 4.5

0.5 0.0 1.3 0.0 0.0 0.1 0.1 0.0 0.1 0.1 0.0 0.6 0.0 4.6 0.1 0.1 0.0 4.5

0.5 0.0 1.3 0.0 0.0 0.1 0.1 0.0 0.1 0.1 0.0 0.6 0.0 4.6 0.1 0.1 0.0 4.5

New Hampshire 2 New Jersey New Mexico New York (excluding NYC) New York City North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

0.5 0.0 0.0 0.0 0.0 0.0 0.4 0.0 1.8 0.0 2.0 0.0 0.0 0.1 0.0 0.1 3.2 0.1 0.0 -

0.8 0.0 0.0 1.8 0.0 0.0 0.4 0.0 1.8 0.0 0.0 2.0 0.0 0.0 0.1 0.0 0.2 0.0 3.6 0.2 0.0 -

1.0 0.4 2.5 0.2 0.0 0.4 0.0 8.6 0.0 0.0 3.9 0.0 0.0 0.0 0.1 0.1 0.2 0.0 2.9 0.1 0.1 0.0

1.0 0.4 2.5 0.2 0.0 0.4 0.0 8.6 0.0 0.0 3.9 0.0 0.0 0.0 0.1 0.1 0.2 0.0 2.9 0.1 0.1 0.0

1.0 0.4 2.5 0.2 0.0 0.4 0.0 8.6 0.0 0.0 3.9 0.0 0.0 0.0 0.1 0.1 0.2 0.0 2.9 0.1 0.1 0.0

1.0 0.4 2.5 0.2 0.0 0.4 0.0 8.6 0.0 0.0 3.9 0.0 0.0 0.0 0.1 0.1 0.2 0.0 2.9 0.1 0.1 0.0

1.0 0.4 2.5 0.2 0.0 0.4 0.0 8.6 0.0 0.0 3.9 0.0 0.0 0.0 0.1 0.1 0.2 0.0 2.9 0.1 0.1 0.0

Puerto Rico Virgin Islands Guam American Samoa Northern Marianas

0.0 1.9 0.7 --3.8

0.0 1.9 0.7 --3.8

0.0 6.0 0.8 --6.0

0.0 6.0 0.8 --6.0

0.0 6.0 0.8 --6.0

0.0 6.0 0.8 --6.0

0.0 6.0 0.8 --6.0

Total of reporting areas

See footnotes at end of table.

Table A. Percent of birth records on which specified items were not stated: United States and each State and territory, 2004 -- Con. Items based on the 2003 US. Standard Certificate of Live Birth Area

Total of reporting areas

Pregnancy Risk Factors 1

Obstetric Procedures

Onset of Labor

Characteristics of Labor and Delivery

Method of Delivery

Congenital Anomalies

---

---

---

---

---

---

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia

-------------------

-------------------

-------------------

-------------------

-------------------

-------------------

Florida 2 Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada

------3.9 --------4.7 -----------------------

------3.7 --------4.9 -----------------------

------3.7 --------5.1 -----------------------

------3.6 --------4.7 -----------------------

------3.3 --------4.6 -----------------------

------4.4 --------4.3 -----------------------

New Hampshire 2 New Jersey New Mexico New York(excluding NYC) New York City North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

------8.3 ------------2.2 --5.0 --0.6 --------4.5 -------

------8.6 ------------2.2 --5.0 --0.6 --------5.1 -------

------9.7 ------------2.2 --5.0 --0.6 --------5.1 -------

------6.8 ------------2.2 --5.0 --0.6 --------4.7 -------

------7.3 ------------2.3 --5.0 --0.6 --------1.5 -------

------9.3 ------------2.2 --5.0 --0.6 --------4.4 -------

Puerto Rico Virgin Islands Guam American Samoa Northern Marianas

-----------

-----------

-----------

-----------

-----------

-----------

See footnotes at end of table.

Table A. Percent of birth records on which specified items were not stated: United States and each State and territory, 2004 -- Con. Item based on the 1989 U.S. Standard Certificate of Live Birth Area Alcohol use

Total of reporting areas

1

Medical Risk Factors

Complica-tions of Labor/ Delivery

Obstetric Procedures

Abnormal Conditions of the Newborn

Congenital Anomalies

0.5

0.9

0.7

0.8

0.3

1.7

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia

0.0 1.1 1.8 0.4 --0.2 0.1 0.0

0.6 9.9 0.0 1.3 0.0 0.0 0.8 2.5 0.1

0.6 6.8 0.0 1.3 0.0 0.0 0.7 2.5 0.1

0.6 9.9 0.0 1.3 0.0 0.0 0.7 2.5 0.1

0.0 11.5 0.0 0.0 0.0 0.3 -

0.6 12.3 0.3 1.3 0.0 0.1 1.0 2.5 0.1

Florida 2 Georgia Hawaii Idaho Illinois Indiana Iowa

0.1 --0.3 0.1 --0.1 0.1

--1.6 0.0 --0.1 1.0 0.1

--1.1 0.0 --0.1 1.0 0.0

--1.1 0.0 --0.1 1.0 0.1

--0.0 --0.0 0.0 0.1

--1.1 0.0 --0.1 1.0 0.1

Kansas 10 Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana

0.1 0.1 --0.2 0.2 0.1 0.2 3.0 2.4 0.2 0.4

0.1 --0.1 1.1 0.3 0.4 0.0 3.0 4.0 0.1 0.3

0.0 --0.2 1.1 0.3 0.4 0.0 1.6 4.0 0.1 0.3

0.1 --0.2 1.1 0.3 0.4 0.0 3.0 4.0 0.1 0.3

0.0 --0.1 0.0 0.0 0.2 0.0 4.5 0.1 0.1 -

0.1 --0.2 1.1 0.3 0.8 0.0 4.6 4.0 0.1 0.3

0.9 0.0

0.1 3.0

0.0 2.3

0.1 3.0

0.0 2.4

0.0 4.7

2.2 --0.2 1.8

--1.9 0.1 ---

--1.7 0.0 ---

--1.8 0.0 ---

--0.1 0.0 ---

--2.0 ---

New York City 12 North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee

--0.1 0.1 0.8 0.5 0.9 1.0 --2.9 --0.1

4.2 0.3 0.4 0.6 4.9 2.3 --1.9 --0.0 ---

4.1 0.3 0.4 0.6 1.8 1.6 --2.0 --0.0 ---

4.2 0.3 0.4 0.6 5.4 1.6 --1.9 --0.0 ---

0.2 0.0 0.5 0.0 8.2 0.0 --4.1 --0.0 ---

4.3 0.3 0.4 0.6 8.6 1.6 --3.9 --0.0 ---

Texas 11,13,14 Utah Vermont Virginia Washington West Virginia

--0.2 1.0 0.5 0.0 ---

0.9 0.2 5.5 1.1 --1.7

0.1 0.1 5.5 1.1 --1.7

0.0 0.1 5.5 1.1 --1.7

0.1 0.1 0.0 0.1 --0.2

0.1 0.2 5.5 1.1 --1.7

0.4 0.2 0.3

0.0 0.3

0.0 0.3

0.0 0.3

0.1 -

0.1 0.3

0.0 4.5 1.1 ---

0.0 1.9 0.7 --3.8

0.0 5.7 0.5 --6.0

0.0 6.7 0.6 --6.1

0.0 6.0 0.8 --6.0

Nebraska Nevada New New New New

11

2

Hampshire Jersey Mexico York(excluding NYC)

Wisconsin Wyoming

15

Puerto Rico Virgin Islands Guam American Samoa Northern Marianas See footnotes at end of table.

0.0 1.6 1.7 ---

0.0 Quantity more than zero but less than 0.05. ---Data not available. - Quantity zero. 1

Excludes data for Puerto Rico, Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Marianas.

2

Florida and New Hampshire implemented the 2003 U.S. Standard Certificate of Live Birth in 2004, but after January 1, 2004.

3

Includes data for states based on the 1989 U.S. Standard Certificate of Live birth; excludes data for states based on the 2003 U.S. Standard Certificate of Live Birth.

4

Includes data for states based on the 2003 U.S. Standard Certificate of Live birth; excludes data from states based on the 1989 U.S. Standard Certificate of Live Birth.

5

California reports date last normal menses began but does not report the clinical estimate of gestation.

6 7

Not stated levels for states which implemented the 2003 U.S. Standard Certificate of Live Birth are derived from

the item "Final route and method of delivery" only.

The Florida tobacco use item is not consistent with the tobacco use items on either the 1989 or 2003 U.S Standard Certificates of Live Birth.

8

Indiana reports tobacco use but does not report the average number of cigarettes smoked

9

South Dakota and the Commonwealth of the Northern Marianas report tobacco use but do not report the average number of cigarettes smoked per day.

10 11 12

per day in standard categories.

Kansas does not report the Medical Risk Factor "Rh sensitization." Nebraska and Texas do not report the abnormal condition of the newborn "birth injury." New York City does not report the Abnormal Conditions of the Newborn "assisted ventilation less then 30 minutes and assisted ventilation of 30 minutes or more."

13

Texas does not report the Medical Risk Factors "genital herpes and uterine bleeding."

14

Texas does not report the Abnormal Conditions of the Newborn "anesthetic complications and fetal distress."

15

Wisconsin does not report the Abnormal Condition of the Newborn "fetal alcohol syndrome."

Table B. Births by place of occurrence and residence for births occurring in the 50 states, the District of Columbia, and U.S. territories, 2004

Area

Number live births Occurrence 4,118,907

Residence 4,112,052

Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida

58,383 10,268 93,876 37,840 545,758 68,797 42,545 12,080 14,794 218,218

59,510 10,338 93,663 38,573 544,843 68,503 42,095 11,369 7,933 218,053

Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine

140,117 18,297 21,949 177,417 87,942 38,527 40,449 54,085 65,572 13,733

138,849 18,281 22,532 180,778 87,142 38,438 39,669 55,720 65,369 13,944

Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire

70,538 79,405 128,585 70,618 41,562 78,591 11,526 26,446 34,780 14,198

74,628 78,484 129,776 70,624 42,827 77,765 11,519 26,332 35,200 14,565

New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island

112,232 27,798 251,562 120,588 9,408 149,481 50,223 46,454 144,498 13,582

115,253 28,384 249,947 119,847 8,189 148,954 51,306 45,678 144,748 12,779

South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

54,232 11,803 84,855 387,337 51,835 6,262 101,826 81,390 21,305 69,014 6,326

56,590 11,338 79,642 381,293 50,670 6,599 103,933 81,747 20,880 70,146 6,807

United States 1/

Births occurring to US territorial residents Puerto Rico Virgin Islands Guam American Samoa Northern Marianas -

` 51127 1574 3410 1714 1355

--- Data not available. 1/ Excludes data for the territories and foreign residents

Table C. Lower and upper 95 percent and 96 percent confidence limit factors for a birth rate based on a Poisson variable of 1 through 99 births, B B

L(1- a=.95,B )

U(1- a =.95,B )

L(1- a =.96,B )

U(1- a =.96,B )

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50

0.02532 0.12110 0.20622 0.27247 0.32470 0.36698 0.40205 0.43173 0.45726 0.47954 0.49920 0.51671 0.53246 0.54671 0.55969 0.57159 0.58254 0.59266 0.60207 0.61083 0.61902 0.62669 0.63391 0.64072 0.64715 0.65323 0.65901 0.66449 0.66972 0.67470 0.67945 0.68400 0.68835 0.69253 0.69654 0.70039 0.70409 0.70766 0.71110 0.71441 0.71762 0.72071 0.72370 0.72660 0.72941 0.73213 0.73476 0.73732 0.73981 0.74222

5.57164 3.61234 2.92242 2.56040 2.33367 2.17658 2.06038 1.97040 1.89831 1.83904 1.78928 1.74680 1.71003 1.67783 1.64935 1.62394 1.60110 1.58043 1.56162 1.54442 1.52861 1.51401 1.50049 1.48792 1.47620 1.46523 1.45495 1.44528 1.43617 1.42756 1.41942 1.41170 1.40437 1.39740 1.39076 1.38442 1.37837 1.37258 1.36703 1.36172 1.35661 1.35171 1.34699 1.34245 1.33808 1.33386 1.32979 1.32585 1.32205 1.31838

0.02020 0.10735 0.18907 0.25406 0.30591 0.34819 0.38344 0.41339 0.43923 0.46183 0.48182 0.49966 0.51571 0.53027 0.54354 0.55571 0.56692 0.57730 0.58695 0.59594 0.60435 0.61224 0.61966 0.62666 0.63328 0.63954 0.64549 0.65114 0.65652 0.66166 0.66656 0.67125 0.67575 0.68005 0.68419 0.68817 0.69199 0.69568 0.69923 0.70266 0.70597 0.70917 0.71227 0.71526 0.71816 0.72098 0.72370 0.72635 0.72892 0.73142

5.83392 3.75830 3.02804 2.64510 2.40540 2.23940 2.11666 2.02164 1.94553 1.88297 1.83047 1.78566 1.74688 1.71292 1.68289 1.65610 1.63203 1.61024 1.59042 1.57230 1.55563 1.54026 1.52602 1.51278 1.50043 1.48888 1.47805 1.46787 1.45827 1.44922 1.44064 1.43252 1.42480 1.41746 1.41047 1.40380 1.39743 1.39134 1.38550 1.37991 1.37454 1.36938 1.36442 1.35964 1.35504 1.35060 1.34632 1.34218 1.33818 1.33431

Table C. Lower and upper 95 percent and 96 percent confidence limit factors for a birth rate based on a Poisson variable of 1 through 99 births, B --Con. B

L(1- a=.95,B )

U(1- a =.95,B )

L(1- a =.96,B )

U(1- a =.96,B )

51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99

0.74457 0.74685 0.74907 0.75123 0.75334 0.75539 0.75739 0.75934 0.76125 0.76311 0.76492 0.76669 0.76843 0.77012 0.77178 0.77340 0.77499 0.77654 0.77806 0.77955 0.78101 0.78244 0.78384 0.78522 0.78656 0.78789 0.78918 0.79046 0.79171 0.79294 0.79414 0.79533 0.79649 0.79764 0.79876 0.79987 0.80096 0.80203 0.80308 0.80412 0.80514 0.80614 0.80713 0.80810 0.80906 0.81000 0.81093 0.81185 0.81275

1.31482 1.31137 1.30802 1.30478 1.30164 1.29858 1.29562 1.29273 1.28993 1.28720 1.28454 1.28195 1.27943 1.27698 1.27458 1.27225 1.26996 1.26774 1.26556 1.26344 1.26136 1.25933 1.25735 1.25541 1.25351 1.25165 1.24983 1.24805 1.24630 1.24459 1.24291 1.24126 1.23965 1.23807 1.23652 1.23499 1.23350 1.23203 1.23059 1.22917 1.22778 1.22641 1.22507 1.22375 1.22245 1.22117 1.21992 1.21868 1.21746

0.73385 0.73621 0.73851 0.74075 0.74293 0.74506 0.74713 0.74916 0.75113 0.75306 0.75494 0.75678 0.75857 0.76033 0.76205 0.76373 0.76537 0.76698 0.76856 0.77011 0.77162 0.77310 0.77456 0.77598 0.77738 0.77876 0.78010 0.78143 0.78272 0.78400 0.78525 0.78648 0.78769 0.78888 0.79005 0.79120 0.79233 0.79344 0.79453 0.79561 0.79667 0.79771 0.79874 0.79975 0.80074 0.80172 0.80269 0.80364 0.80458

1.33057 1.32694 1.32342 1.32002 1.31671 1.31349 1.31037 1.30734 1.30439 1.30152 1.29873 1.29601 1.29336 1.29077 1.28826 1.28580 1.28340 1.28106 1.27877 1.27654 1.27436 1.27223 1.27014 1.26810 1.26610 1.26415 1.26223 1.26036 1.25852 1.25672 1.25496 1.25323 1.25153 1.24987 1.24824 1.24664 1.24507 1.24352 1.24201 1.24052 1.23906 1.23762 1.23621 1.23482 1.23345 1.23211 1.23079 1.22949 1.22822

Table D. Sources for resident population and population including Armed Forces abroad: Birth and death-registration states, 1900-1932, and United States, 1900-2004 [2004] National Center for Health Statistics. Postcensal estimates of the resident

population of the United States as of July 1, 2004, by year, state and county, age, bridged race, sex, and Hispanic origin (vintage 2004). File pcen_v2004.txt (ASCII). Released September 8, 2005. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/datadoc.htm [2004] US Census Bureau. Monthly postcensal resident population plus Armed Forces overseas, by single year of age, sex, race, and Hispanic origin. Available at: http://www.census.gov/popest/national/asrh/2004_nat_af.html

[2003] National Center for Health Statistics. Postcensal estimates of the resident population of the United States as of July 1, 2003, by year, state and county, age, bridged race, sex, and Hispanic origin (vintage 2003). File pcen_v2003_y03.txt (ASCII). Released September 14, 2004. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/datadoc.htm [2002] National Center for Health. Postcensal estimates of the resident population of the United States as of July 1, 2002, by state and county, age, bridged race, sex, and Hispanic origin. File pcen v2002.txt. Internet released, August 1, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. [2001] National Center for Health. Postcensal estimates of the resident population of the United States as of July 1, 2001, by state and county, age, bridged race, sex, and Hispanic origin. File pcen v2002.txt. Internet released, August 1, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. [2001] National Center for Health. Postcensal estimates of the resident population of the United States as of July 1, 2001, by age, bridged race, sex, and Hispanic origin. File pcen v2001.txt. Internet released, January 12, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. [2000] National Center for Health Statistics. Estimates of the April 1, 2000, United States resident population by state and county, age, sex, bridged race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. File br040100.txt. Internet released, January 12, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. [1999] National Center for Health Statistics. Intercensal estimates of the July 1, 1999, United States resident population by state and county, age, sex, bridged race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. File icen1999.txt. Internet released, April 15, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. [1998] National Center for Health Statistics. Intercensal estimates of the July 1,

1998, United States resident population by state and county, age, sex, bridged race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. File icen1999.txt. Internet released, April 15, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. [1997] National Center for Health Statistics. Intercensal estimates of the July 1, 1997, United States resident population by state and county, age, sex, bridged race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. File icen1997.txt. Internet released, April 15, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. [1996] National Center for Health Statistics. Intercensal estimates of the July 1, 1996, United States resident population by state and county, age, sex, bridged race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. File icen1996.txt. Internet released, April 15, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. [1995] National Center for Health Statistics. Intercensal estimates of the July 1, 1995, United States resident population by state and county, age, sex, bridged race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. File icen1995.txt. Internet released, April 15, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. [1994] National Center for Health Statistics. Intercensal estimates of the July 1, 1994, United States resident population by state and county, age, sex, bridged race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. File icen1994.txt. Internet released, April 15, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. [1993] National Center for Health Statistics. Intercensal estimates of the July 1, 1993, United States resident population state and county, by age, sex, bridged race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. File icen1993.txt. Internet released, April 15, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. [1992] National Center for Health Statistics. Intercensal estimates of the July 1, 1992, United States resident population by state and county, age, sex, bridged race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. File icen1992.txt. Internet released, April 15, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm. [1991] National Center for Health Statistics. Intercensal estimates of the July 1, 1991, United States resident population by state and county, age, sex, bridged race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. File icen1991.txt. Internet released, April 15, 2003. Available at: http://www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm.

.

Table E. Percentage net undercount, by age, sex, and race/Hispanic origin: United States, April 1, 2000 Characteristic

Estimate (%)

Total

-0.49

Age/sex 10–17 Male and female 18–29 Male 18–29 Female 30–49 Male 30–49 Female 50 years and over male 50 years and over female

-1.32 1.12 -1.39 2.01 -0.60 -0.80 -2.53

Race/Hispanic origin Non-Hispanic white Non-Hispanic black Hispanic

-1.13 1.84 0.71

SOURCE: Fenstermaker D, Haines D. Summary of estimated net coverage. DSSD A.C.E. Revision II Memorandum Series #PP-54. Washington: U.S. Census Bureau. 2002.

Table 4–1. Population of birth- and death-registration states, 1900–1932, and United States, 1900–2004 [Population enumerated as of April 1 for 1940, 1950, 1960, 1970, 1980, 1990, and 2000 and estimated as of July 1 for all other years] United States 1/

United States 1/ Population Year

2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974

including Armed Forces abroad

293,906,517 291,028,156 288,600,204 285,024,000 281,652,000 279,294,713 276,115,288 272,911,760 269,667,391 266,557,091 263,435,673 260,255,352 256,894,189 253,492,503 249,225,000 247,342,000 245,021,000 242,804,000 240,651,000 238,466,000 236,348,000 234,307,000 232,188,000 229,966,000 227,061,000 225,055,000 222,585,000 220,239,000 218,035,000 215,973,000 213,854,000

Population residing in area

293,655,404 290,810,789 288,368,706 284,796,887 281,421,906 279,040,168 275,854,104 272,646,925 269,394,284 266,278,393 263,125,821 259,918,588 256,514,224 252,980,941 248,709,873 246,819,000 244,499,000 242,289,000 240,133,000 237,924,000 235,825,000 233,792,000 231,664,000 229,466,000 226,545,805 224,567,000 222,095,000 219,760,000 217,563,000 215,465,000 213,342,000

Birth-registration States

Death-registration States

Population Year

1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921

including Armed Forces abroad 151,132,000 149,188,000 146,631,000 144,126,000 141,389,000 139,928,000 138,397,000 136,739,000 134,860,000 133,402,000 131,820,000 131,028,000 129,969,000 128,961,000 128,181,000 127,362,000 126,485,000 125,690,000 124,949,000 124,149,000 123,188,000

Population residing in area

150,697,361 148,665,000 146,093,000 143,446,000 140,054,000 132,481,000 132,885,000 134,245,000 133,920,000 133,121,000 131,669,275 130,879,718 129,824,939 128,824,829 128,053,180 127,250,232 126,373,773 125,578,763 124,840,471 124,039,648 123,076,741 121,769,939 120,501,115 119,038,062 117,399,225 115,831,963 114,113,463 111,949,945 110,054,778 108,541,489

Number of States2/

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 47 46 46 46 44 40 35 33 33 30 30 27

Population residing in area

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 118,903,899 117,455,229 116,544,946 115,317,450 113,636,160 104,320,830 90,400,590 88,294,564 87,000,295 81,072,123 79,560,746 70,807,090

Number of States2/

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 47 47 47 46 44 42 41 40 39 38 37 34

Population residing in area

... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 118,903,899 118,148,987 117,238,278 115,317,450 113,636,160 107,084,532 103,822,683 102,031,555 99,318,098 96,788,197 92,702,901 87,814,447

1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951

211,909,000 209,896,000 207,661,000 204,270,000 202,677,000 200,706,000 198,712,000 196,560,000 194,303,000 191,889,000 189,242,000 186,538,000 183,691,000 179,933,000 177,264,000 174,141,000 171,274,000 168,221,000 165,275,000 162,391,000 159,565,000 156,954,000 154,287,000

211,357,000 209,284,000 206,827,000 203,211,926 201,385,000 199,399,000 197,457,000 195,576,000 193,526,000 191,141,000 188,483,000 185,771,000 182,992,000 179,323,175 176,513,000 173,320,000 170,371,000 167,306,000 164,308,000 161,164,000 158,242,000 155,687,000 153,310,000

1920 1919 1918 1917 1916 1915 1914 1913 1912 1911 1910 1909 1908 1907 1906 1905 1904 1903 1902 1901 1900

105,063,000 104,550,000 103,414,000

106,466,420 104,512,110 103,202,801 103,265,913 101,965,984 100,549,013 99,117,567 97,226,814 95,331,300 93,867,814 92,406,536 90,491,525 88,708,976 87,000,271 85,436,556 83,819,666 82,164,974 80,632,152 79,160,196 77,585,128 76,094,134

23 22 20 20 11 10

63,597,307 61,212,076 55,153,782 55,197,952 32,944,013 31,096,697

... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

... ... ... ... ... ... ... ... ... ... ... ... ... ... ...

- - - Data not available. ... Category not applicable. 1/ Alaska included beginning 1959 and Hawaii, 1960. 2/

The District of Columbia is not included in "Number of States," but it is represented in all data shown for each year.

SOURCE: Published and unpublished data from the U.S. Census Bureau; see text and table D.

34 33 30 27 26 24 24 23 22 22 20 18 17 15 15 10 10 10 10 10 10

86,079,263 83,157,982 79,008,412 70,234,775 66,971,177 61,894,847 60,963,309 58,156,740 54,847,700 53,929,644 47,470,437 44,223,513 38,634,759 34,552,837 33,782,288 21,767,980 21,332,076 20,943,222 20,582,907 20,237,453 19,965,446

Table 4-2. Estimated total population by race, and estimated female population by age and race: United States, 2004 [Populations estimated as of July 1] Asian or Age Total population

All races

White

Black

American

Pacific

Indian

Islander

293,655,404

238,268,102

38,600,765

3,148,484

13,638,053

15-44 years

62,033,402

48,758,090

9,115,649

745,279

3,414,384

10-14 years

10,314,017

7,970,814

1,749,557

149,173

444,473

15-19 years

10,094,408

7,882,326

1,623,541

146,719

441,822

15-17 years

6,074,126

4,730,761

991,660

88,794

262,911

18-19 years

4,020,282

3,151,565

631,881

57,925

178,911

20-24 years

10,168,314

7,948,811

1,569,086

137,971

512,446

25-29 years

9,566,092

7,424,518

1,427,396

115,539

598,639

30-34 years

10,129,814

7,877,175

1,458,754

111,792

682,093

35-39 years

10,481,803

8,290,818

1,472,528

111,698

606,759

40-44 years

11,592,971

9,334,442

1,564,344

121,560

572,625

45-49 years

11,204,882

9,126,191

1,442,853

111,542

524,296

Female population

NOTES: These population counts are estimated based on the 2000 census; see "Technical Notes." Race categories are consistent with the 1977 Office of Management and Budget (OMB) standards. The multiple-race population estimates were bridged to the single race categories of the 1977 OMB standards for comparability with the birth data; see "Technical Notes." SOURCE: U.S. Census Bureau. See reference 41.

Table 4-3. Estimated total population by specified Hispanic origin and estimated female population by age and specified Hispanic origin and by race for women of non-Hispanic origin: United States, 2004 [Populations estimated as of July 1] Hispanic Age Total population Female population 15-44 years 10-14 years 15-19 years 15-17 years 18-19 years 20-24 years 25-29 years 30-34 years 35-39 years 40-44 years 45-49 years

Total

Mexican

Puerto Rican

Non-Hispanic Cuban

Other Hispanic1

Total2

White

Black

41,322,073

27,239,634

3,796,668

1,615,256

8,670,410

252,333,331

199,775,516

36,921,613

9,675,716 1,849,239 1,610,907 978,802 632,105 1,692,204 1,746,376 1,707,611 1,531,559 1,387,059 1,124,013

6,342,530 1,287,209 1,063,976 643,799 420,177 1,152,713 1,187,946 1,143,451 958,065 836,379 632,549

895,458 192,908 169,131 101,899 67,232 140,572 149,086 149,322 144,142 143,205 121,460

280,672 47,645 36,712 25,850 10,862 32,568 42,753 46,282 61,685 60,672 53,200

2,157,027 321,475 341,085 207,252 133,833 366,353 366,575 368,555 367,660 346,799 316,809

52,357,686 8,464,778 8,483,501 5,095,324 3,388,177 8,476,110 7,819,716 8,422,203 8,950,244 10,205,912 10,080,869

39,792,952 6,270,957 6,398,834 3,830,286 2,568,548 6,383,764 5,804,787 6,289,881 6,868,928 8,046,758 8,082,874

8,690,960 1,661,367 1,550,705 946,674 604,031 1,495,431 1,350,322 1,384,303 1,405,377 1,504,822 1,394,156

1 Includes Central and South American and other and unknown Hispanic. 2 Includes races other than white and black.

NOTES: These population counts are estimated based on the 2000 census; see "Technical Notes." Race categories are consistent with the 1977 Office of Management and Budget (OMB) standards. The multiple-race population estimates were bridged to the single race categories of the 1977 OMB standards for comparability with the birth data; see "Technical Notes." SOURCE: U.S. Census Bureau. See reference 44.

4-4. Estimated total population and female population aged 15-44 years: United States, each state, and territory: July 1, 2004 Geographic area United States Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah

Total population

Females15-44 years

293,655,404

62,033,402

4,530,182 655,435 5,743,834 2,752,629 35,893,799 4,601,403 3,503,604 830,364 553,523 17,397,161 8,829,383 1,262,840 1,393,262 12,713,634 6,237,569 2,954,451 2,735,502 4,145,922 4,515,770 1,317,253 5,558,058 6,416,505 10,112,620 5,100,958 2,902,966 5,754,618 926,865 1,747,214 2,334,771 1,299,500 8,698,879 1,903,289 19,227,088 8,541,221 634,366 11,459,011 3,523,553 3,594,586 12,406,292 1,080,632 4,198,068 770,883 5,900,962 22,490,022 2,389,039

953,205 138,894 1,178,796 564,382 7,737,852 995,583 715,420 178,248 136,276 3,401,004 1,980,901 247,068 291,644 2,711,823 1,300,718 602,688 568,540 875,838 980,207 266,261 1,197,939 1,389,346 2,112,016 1,095,018 627,018 1,209,678 183,589 362,935 484,917 272,632 1,796,444 394,725 4,119,291 1,814,855 129,654 2,375,500 730,010 738,861 2,493,556 232,239 889,545 156,547 1,255,897 4,929,807 549,253

Page 1

Vermont Virginia Washington West Virginia Wisconsin Wyoming

621,394 7,459,827 6,203,788 1,815,354 5,509,026 506,529

126,655 1,599,066 1,324,693 357,916 1,156,113 102,339

Puerto Rico Virgin Islands Guam American Samoa Northern Marianas

3,894,855 108,775 166,090 57,902 78,252

853,843 22,581 37,124 12,946 31,112

Source: National Center for Health Statistics. Unpublished estimates of the July 1, 2004, United States population by age, sex, race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau, 2004.

Page 2

104

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

Technical notes Nature and sources of data Data in this report are based on information from all death certificates filed in the 50 states and the District of Columbia and are processed by the Centers for Disease Control and Prevention’s National Center for Health Statistics (NCHS). Data for 2004 are based on records of deaths that occurred during 2004 and were received as of March 31, 2006. The U.S. Standard Certificate of Death—which is used as a model by the states—was revised in 2003 (38). Prior to 2003, the Standard Certificate of Death had not been revised since 1989. This report includes data for 10 states (California, Idaho, Michigan, Montana, New Jersey, New York, Oklahoma, South Dakota, Washington, and Wyoming) that used the 2003 revision of the U.S. Standard Certificate of Death in 2004 for the entire year, two states (New Hampshire and Connecticut) that implemented the 2003 revision for part of 2004, and 38 states and the District of Columbia that collected and reported death data in 2004 based on the 1989 revision of the U.S. Standard Certificate of Death. Data for New Hampshire was collected and reported using the 1989 revision until mid-April, which is when the state began using the 2003 revision. Connecticut began using the 2003 revision in early 2004 but was unable to transmit the data to NCHS in the revised format; therefore, Connecticut converted data received on revised certificates into the old format and layout. The 1989 and 2003 revisions are described in detail elsewhere (38–41). Because most of the items presented in this report appear largely comparable despite changes to item wording and format in the 2003 revision, data from both groups of states are combined unless other­ wise stated. Data for Puerto Rico, the Virgin Islands, Guam, American Samoa, and the Northern Marianas are included in tables showing data by state but are not included in U.S. totals. Mortality statistics are based on information coded by the states and provided to NCHS through the Vital Statistics Cooperative Program (VSCP) and from copies of the original certificates received by NCHS from the state registration offices. In 2004, all the states and the District of Columbia participated in this program and submitted part or all of the mortality data for 2004 in electronic data files to NCHS. Except for Illinois and West Virginia, all areas provided precoded medical (cause­ of-death) data to NCHS. For 2004, all states submitted precoded demographic data for all deaths. Data for the entire United States refer to events occurring within the United States. Data shown for geographic areas are by place of residence. Beginning with 1970, mortality statistics for the United States exclude deaths of nonresidents of the United States. All data exclude fetal deaths. Mortality statistics for Puerto Rico, Virgin Islands, American Samoa, and Northern Marianas exclude deaths of nonresidents of Puerto Rico, Virgin Islands, American Samoa, and Northern Marianas. For Guam, however, mortality statistics exclude deaths that occurred to a resident of any place other than Guam or the United States.

Cause-of-death classification The mortality statistics presented in this report were compiled in accordance with World Health Organization (WHO) regulations, which

specify that member nations classify and code causes of death in accordance with the current revision of the International Classification of Diseases (ICD). The ICD provides the basic guidance used in virtually all countries to code and classify causes of death. Effective with deaths occurring in 1999, the United States began using the Tenth Revision of this classification (ICD–10) (8). For earlier years, causes of death were classified according to the revisions then in use: 1979–1998, Ninth Revision; 1968–1978, Eighth Revision, adapted for use in the United States; 1958–1967, Seventh Revision; and 1949–1957, Sixth Revision. Changes in classification of causes of death that are due to these revisions may result in discontinuities in cause-of-death trends. Con­ sequently, cause-of-death comparisons among revisions require con­ sideration of comparability ratios and, where available, estimates of their standard errors. Comparability ratios between the Ninth and Tenth Revisions, between the Eighth and Ninth Revisions, between the Seventh and Eighth Revisions, and between the Sixth and Seventh Revisions may be found in other NCHS reports and independent tabulations (22–24,42–44). Rules for coding cause(s) of death may sometimes require modi­ fication when evidence suggests that such modifications will improve the quality of cause-of-death data. Prior to 1999, such modifications were made only when a new revision of the ICD was implemented. A process for updating the ICD was introduced with ICD–10 that allows for mid-revision changes. These changes, however, may affect com­ parability of data between years for select causes of death. Minor changes may be implemented every year, whereas major changes may be implemented every 3 years (e.g., 2003 data year). The ICD not only details disease classification but also provides definitions, tabulation lists, the format of the death certificate, and the rules for coding cause of death. Cause-of-death data presented in this publication were coded by procedures outlined in annual issues of the NCHS Instruction Manual (45,46), which includes rules for selecting the underlying cause of death for tabulation purposes, definitions, tabu­ lation lists, and regulations on the use of the ICD. Before 1968, mortality medical data were based on manual coding of an underlying cause of death for each certificate in accordance with WHO rules. Effective with data year 1968, NCHS converted to com­ puterized coding of the underlying cause and manual coding of all causes (multiple causes) on the death certificate. In this system, called ‘‘Automated Classification of Medical Entities’’ (ACME) (47), multiple cause codes serve as inputs to the computer software that employs WHO rules to select the underlying cause. All cause-of-death data in this report are coded using ACME. The ACME system is used to select the underlying cause of death for all death certificates in the United States. In addition, NCHS has developed two computer systems as inputs to ACME. Beginning with 1990 data, the Mortality Medical Indexing, Classification, and Retrieval system (MICAR) (48,49) was introduced in order to automate coding multiple causes of death. In addition, MICAR provides more detailed information on the conditions reported on death certificates than is available through the ICD code structure. Then, beginning with data year 1993, SuperMICAR, an enhancement of the MICAR system, was introduced. SuperMICAR allows for literal entry of the multiple causeof-death text as reported by the certifier. This information is then automatically processed by the MICAR and ACME computer systems. Records that cannot be automatically processed by MICAR or SuperMICAR are manually multiple-cause coded and then further

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

processed through ACME. For 2004, all of the Nation’s death records were multiple-cause coded using SuperMICAR. In this report, tabulations of cause-of-death statistics are based solely on the underlying cause of death. The underlying cause is defined by WHO as ‘‘the disease or injury which initiated the train of events leading directly to death, or the circumstances of the accident or violence which produced the fatal injury’’ (8). It is selected from the conditions entered by the physician in the cause-of-death section of the death certificate. When more than one cause or condition is entered by the physician, the underlying cause is determined by the sequence of conditions on the certificate, provisions of the ICD, and associated selection rules and modifications. Generally, more medical information is reported on death certificates than is directly reflected in the under­ lying cause of death. This is shown in NCHS multiple cause-of-death statistics (50–52).

Tabulation lists and cause-of-death ranking Tabulation lists for ICD–10 are published in the NCHS Instruc­ tion Manual, Part 9, ICD–10 Cause-of-Death Lists for Tabulating Mortality Statistics (updated October 2002) (53). For this report, two tabulation lists are used, namely, the List of 113 Selected Causes of Death used for deaths of all ages and the List of 130 Selected Causes of Infant Death used for infants. These lists are also used to rank leading causes of death for the two population groups. For the List of 113 Selected Causes of Death, the group titles Major cardiovascular diseases (ICD–10 codes I00–I78) and Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (ICD–10 codes R00–R99), are not ranked. In addition, category titles that begin with the words ‘‘Other’’ and ‘‘All other’’ are not ranked to determine the leading causes of death. When one of the titles that represents a subtotal is ranked (for example, Tubercu­ losis [ICD–10 codes A16–A19]), its component parts are not ranked (in this case, Respiratory tuberculosis [ICD–10 code A16] and Other tuberculosis [ICD–10 codes A17–A19]). For the List of 130 Selected Causes of Infant Death, the same ranking procedures are used, except that the category Major cardiovascular diseases is not in the list. More detail regarding ranking procedures can be found in ‘‘Deaths: Leading Causes for 2004’’ (30). Leading cause-of-death trends, discussed in this report, are based on cause-of-death data according to ICD–10 for 1999–2004, and on data for the most comparable ICD–9 cause-of-death titles for 1979–1998. Tables showing ICD–9 categories that are comparable to the ICD–10 titles in the List of 113 Selected Causes of Death may be found in ‘‘Comparability of Cause of Death Between ICD–9 and ICD–10: Preliminary Estimates’’ (24) and ‘‘Deaths: Final Data for 1999’’ (25). Although, in some cases, categories from the list of 113 selected causes are identical to those in the old list of 72 selected causes of death used with ICD–9, it is important to note that many of these categories are not comparable with categories in the list of 72 selected causes, even though the cause-of-death titles may be the same. Trend data for 1979–1998 that is classified by ICD–9 but is sorted into the List of 113 Selected Causes of Death developed for ICD–10 can be found on the mortality website at http://www.cdc.gov/nchs/ data/statab/hist001r.pdf. Revision of the ICD and resulting changes in classification and rules for selecting the underlying cause of death have important implications for the analysis of mortality trends by cause of death. For

105

some causes of death, the discontinuity in trend can be substantial (23,24). Therefore, considerable caution should be used in analyzing cause-of-death trends for periods of time that extend across more than one revision of the ICD.

Codes for terrorism Beginning with data for 2001, NCHS introduced categories *U01–*U03 for classifying and coding deaths caused by acts of terrorism. The asterisks before the category codes indicate that they are not part of the International Classification of Diseases, Tenth Revision (ICD–10). Deaths classified to the terrorism categories are included in the categories for Assault (homicide) and Intentional self-harm (suicide) in the 113 cause-of-death list and in the category for Assault (homicide) in the 130 cause-of-death list for infants. Additional information on these new categories can be found at http://www.cdc.gov/nchs/about/otheract/icd9/terrorism_code.htm.

Race and Hispanic origin The 2003 revision of the U.S. Standard Certificate of Death allows the reporting of more than one race (multiple races) (38). This change was implemented to reflect the increasing diversity of the population of the United States and to be consistent with the decennial census. The race and ethnicity items on the revised certificate are compliant with the 1997 revision of the Race and Ethnic Standards for Federal Statistics and Administrative Reporting. These were issued by the Office of Management and Budget (OMB), and have replaced the previous standards that were issued in 1977. The new standards mandate the collection of more than one race where applicable for Federal data (9). In addition, the new certificate is compliant with the OMB-mandated minimum set of five races to be reported for Federal data. Multiple race includes any combination of white, black or African American, American Indian or Alaska Native (AIAN), Asian, and Native Hawaiian or Other Pacific Islander (NHOPI). If two or more specific subgroups such as Korean and Chinese are reported, these count as a single race of Asian rather than as multiple races. In 2004, multiple race was reported on the revised death certifi­ cates of California, Idaho, Michigan, Montana, New Hampshire, New Jersey, New York, Oklahoma, South Dakota, Washington, and Wyo­ ming as well as on the unrevised certificates of Hawaii, Maine, Min­ nesota, and Wisconsin (Table I). Because New Hampshire did not report multiple race for the entire data year, the following computations exclude data for New Hampshire. More than one race was reported for 0.5 percent of the records in the 14 reporting states. Although still uncommon, multiple races were reported more often for younger decedents than for older decedents (2.4 percent of decedents under 25 years of age versus 0.7 percent of decedents between 25 and 64 years of age and 0.3 percent of decedents 65 years of age and older). No decedent was reported as having more than four races. Of those records where more than one race was reported, the NHOPI category was mentioned in combination with another race (49.2 percent) more often than the other categories (white, 0.4; black or African American, 0.9; Asian, 5.1; AIAN, 16.2 percent). Although Connecticut began using the 2003 revision of the death certificate in early 2004, they were unable to transmit the data to NCHS

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Table I. Deaths by race: California, Hawaii, Idaho, Maine, Michigan, Minnesota, Montana, New Jersey, New York, Oklahoma, South Dakota, Washington, Wisconsin, and Wyoming, 2004 [By state of occurrence] Race

Deaths

Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 748,855 One race. . . . . . . . . . . . . . . . . . . . . . . . White . . . . . . . . . . . . . . . . . . . . . . . Black . . . . . . . . . . . . . . . . . . . . . . . Asian . . . . . . . . . . . . . . . . . . . . . . . American Indian . . . . . . . . . . . . . . . . . Other1. . . . . . . . . . . . . . . . . . . . . . . NHOPI2 . . . . . . . . . . . . . . . . . . . . . . Two or more races . . . . . . . . . . . . . . . . . . Two races. . . . . . . . . . . . . . . . . . . . . . American Indian and white . . . . . . . . . . Asian and white . . . . . . . . . . . . . . . . . Asian and NHOPI. . . . . . . . . . . . . . . . NHOPI and white . . . . . . . . . . . . . . . . Black and white . . . . . . . . . . . . . . . . . Black and American Indian . . . . . . . . . . Black and Asian . . . . . . . . . . . . . . . . . American Indian and Asian . . . . . . . . . . Black and NHOPI . . . . . . . . . . . . . . . . American Indian and NHOPI . . . . . . . . . Three races . . . . . . . . . . . . . . . . . . . . . . Asian, NHOPI, and white . . . . . . . . . . . Black, American Indian, and white . . . . . . Black, Asian, and white . . . . . . . . . . . . American Indian, Asian, and white . . . . . . American Indian, NHOPI, and white . . . . . Black, American Indian, and Asian . . . . . . Black, Asian, and NHOPI . . . . . . . . . . . Black, American Indian, and NHOPI . . . . . American Indian, Asian, and NHOPI . . . . . Four races . . . . . . . . . . . . . . . . . . . . . . . American Indian, Asian, NHOPI, and white . Black, Asian, NHOPI, and white . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. 745,433 . 638,228 . 66,691 . 27,159 . 6,031 . 5,958 . 1,366 . 3,422 . 3,029 . 944 . 533 . 507 . 479 . 363 . 123 . 47 . 20 . 8 . 5 . 382 . 302 . 44 . 14 . 9 . 6 . 2 . 2 . 2 . 1 . 11 . 8 . 3

Percent of deaths 100.0

99.5

85.2

8.9

3.6

0.8

0.8

0.2

0.5

0.4

0.1 0.1 0.1 0.1 0.0 0.0 0.0 0.0 *

* 0.1 0.0 0.0 * *

*

*

* *

*

* *

*























* Figure does not meet standards of reliability or precision; see ‘‘Random variation’’ section.

1 Includes records for which race was reported as ‘‘other.’’ Further processing assigns ‘‘other’’

race to one of the recognized categories. Other race comprises a wide variety of responses;

however, the most common is to check ‘‘other’’ and not provide future specification or to report

a Hispanic group as a race.

2 NHOPI is Native Hawaiian or Other Pacific Islander.

in the revised format. Connecticut converted data received on revised certificates into the old format and layout for transmission to NCHS. Data from the vital records of the remaining 34 states and the District of Columbia are based on the 1989 revision of the U.S. Standard Certificate of Death, which follows the 1977 OMB standard, allowing only a single race to be reported (10,41). In addition, these states report a minimum set of four races as stipulated in the 1977 standard. These are White, Black or African American, American Indian or Alaska Native (AIAN), and Asian or Pacific Islander (API). In order to provide uniformity and comparability of the data during the transition period, before all or most of the data are available in the new multiple-race format, it was necessary to ‘‘bridge’’ the responses of those for whom more than one race was reported (multiple race) to one, single race. The bridging procedure is similar to the procedure used to bridge multiracial population estimates (12,13). Multiracial decedents are imputed to a single race (either white, black, AIAN, or API) according to their combination of races, Hispanic origin, sex, and

age indicated on the death certificate. The imputation procedure is described in detail at http://www.cdc.gov/nchs/data/dvs/Multiple_race_ documentation_5-10-04.pdf. Race and Hispanic origin are reported separately on the death certificate. Therefore, data shown by race include persons of Hispanic and non-Hispanic origin, and data for Hispanic origin include persons of any race. In this report, unless otherwise specified, deaths of Hispanic origin are included in the totals for each race group—white, black, AIAN, and API—according to the decedent’s race as reported on the death certificate. Data shown for Hispanic persons include all persons of Hispanic origin of any race. Mortality data for the Hispanic-origin population are based on deaths to residents of all 50 states and the District of Columbia. Data year 1997 was the first year that mortality data for the Hispanic population were available for the entire United States. Quality of race and Hispanic origin data—Death rates for Hispanic, AIAN, and API persons should be interpreted with caution because of inconsistencies in reporting Hispanic origin or race on the death cer­ tificate as compared with race on censuses, surveys, and birth cer­ tificates. Studies have shown underreporting on death certificates of AIAN, API, and Hispanic decedents as well as undercounts of these groups in the censuses (16–18,54). A number of studies have been conducted on the reliability of race reported on the death certificate by comparing race on the death certificate with that reported on another data collection instrument, such as the census or a survey (16–18,54). Differences may arise because of differences in who provides race information on the compared records. Race information on the death certificate is reported by the funeral director as provided by an informant or, in the absence of an informant, on the basis of observation. In contrast, race on the census or on the Current Population Survey (CPS) is obtained while the individual is alive and is self-reported or reported by another member of the household familiar with the individual and, therefore, may be considered more valid. A high level of agreement between the death certificate and the census or survey report is essential to assure unbiased death rates by race. Studies (16–18,54) show that a person self-reported as AIAN or Asian on census or survey records was sometimes reported as white on the death certificate. The net effect of misclassification is an under­ estimation of deaths and death rates for races other than white and black. In addition, undercoverage of minority groups in the census and resultant population estimates introduces biases into death rates by race (16–18,54–56). Unlike the 1990 census, coverage error in the 2000 census was found to be statistically significant only for the non-Hispanic white and non-Hispanic black populations, with the former having been over-counted by approximately 1.13 percent and the latter under-counted by approximately 1.84 percent (55). The National Longitudinal Mortality Study (NLMS) (17), examined the reliability of race and Hispanic origin reported on approximately 250,000 death certificates with what was reported on a total of 26 CPS conducted by the U.S. Bureau of the Census for the years 1979–1985 (18). Agreement between the two sources was found to be excellent for the white and black populations, both exhibiting CPS to death certificate ratios of 1.00. On the other hand, substantial differences were found for other race groups. The ratio of CPS to death certificates was found to be 1.30 for the AIAN population and 1.07 for the API

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

population, indicating net underreporting on death certificates of 30 per­ cent for the AIAN population and 7 percent for the API population. The ratio of deaths for CPS to death certificates for Hispanics was found to be 1.05 percent, indicating a net underreport on death certificates for the population of 5 percent. In 2004, data on Central and South American and Other Hispanic origin reflects some processing problems for two areas. New York City and California have fewer records identifying decedents as being of Central and South American origin and more as Other Hispanic origin because literal text reported on the death certificates was not submitted to NCHS. For New York State, records that do not indicate a check in one or more of the Hispanic Origin checkboxes are reported as Non-Hispanic. Other races and race not stated—Beginning in 1992, all records coded as ‘‘Other races’’ (0.16 percent of the total deaths in 2004) were assigned to the specified race of the previous record. Records for which race was unknown, not stated, or not classifiable (0.16 percent) were assigned the racial designation of the previous record. Infant and maternal mortality rates—For 1989–2004, as in pre­ vious years, infant and maternal deaths continue to be tabulated by the race of the decedent. However, beginning with the 1989 data year, the method of tabulating live births by race was changed from race of parents to race of mother as stated on the birth certificate. This change affects infant and maternal mortality rates because live births are the denominators of these rates (40,57). To improve continuity and ease of interpretation, trend data by race in this report have been retabulated by race of mother for all years beginning with the 1980 data year. Quantitatively, the change in the basis for tabulating live births by race results in more white births and fewer black births and births of other races. Consequently, infant and maternal mortality rates under the new tabulating procedure tend to be about 2 percent lower for white infants and about 5 percent higher for black infants than when they are computed by the previous method of tabulating live births by race of parents. Rates for most other minority races also are higher when computed by race of mother (58,59). Infant mortality rates for the Hispanic-origin population are based on numbers of resident infant deaths reported to be of Hispanic origin and numbers of resident live births by Hispanic origin of mother for the United States. In computing infant mortality rates, deaths and live births of unknown origin are not distributed among the specified Hispanic and non-Hispanic groups. In 2004, the percentage of infant deaths of unknown origin was 0.9 and the percentage of live births to mothers of unknown origin was 0.8 for the United States. Small numbers of infant deaths for specific Hispanic-origin groups result in infant mortality rates subject to relatively large random variation (see ‘‘Random variation’’). Infant mortality rates by Hispanic origin are less subject to reporting error when based on linked files of infant deaths and live births (36,60). Infant mortality rates calculated from the general mortality file for specified race and Hispanic origin contain errors because of reporting problems that affect the classification of race and Hispanic origin on the birth and death certificates for the same infant. Infant mortality rates by specified race and Hispanic origin are more accurate when based on the linked file of infant deaths and live births (36,60). The linked file computes infant mortality rates using the race and Hispanic origin of the mother from the birth certificate in both the numerator and denomi­ nator of the rate. In addition, mother’s race and Hispanic origin from the birth certificate are considered to be more accurately reported than

107

infant’s race and Hispanic origin from the death certificate because, on the birth certificate, race is generally reported by the mother at the time of delivery whereas, on the death certificate, infant’s race and Hispanic origin are reported by an informant, usually the mother but sometimes by the funeral director. Estimates of reporting errors have been made by comparing rates based on the linked files with those in which the race of infant death is based on information from the death certificate (18,60).

Life tables The life table provides a comprehensive measure of the effect of mortality on life expectancy. It is composed of sets of values showing the mortality experience of a hypothetical group of infants born at the same time and subject throughout their lifetime to the age-specific death rates of a particular time period, usually a given year. Beginning with final data reported for 1997, the life table methodology was changed from previous annual reports. Previously, U.S. life tables were abridged and constructed by reference to a standard table (61). In addition, the age range for these life tables was limited to 5-year age groups ending with the age group 85 years and over. For data years 1997–1999, a revised life table methodology was used to construct complete life tables by single years of age that extend to age 100 (62) using a methodology similar to that of the decennial life tables (63). The advantages of the revised methodology are its comparability with decennial life table methodology, greater accuracy, and greater age detail. A comparison of the two methods shows small differences in resulting values for life expectancy (62). Although the revised method produces complete life tables—that is, life tables by single years of age—life table data shown in this report are summarized in 5-year age groupings. To calculate the probability of dying at each age, the revised methodology uses vital statistics death rates for ages under 85 years and mortality data from the Medicare program for ages 85 years and over. Medicare data were used to model the probability of dying at ages 85 and over because the data are shown to be significantly more reliable than vital statistics data at the oldest ages (64). Life tables for 2000–2003 used a slight modification of the life table method introduced in 1997. (As a result of an error recently discovered in the originally published 2003 life tables, and because population estimates in single-years for ages 85 and over have become available from the U.S. Census Bureau, the 2003 tables have been re-estimated based on the original 1997 methodology. Likewise, the 2004 life tables are based on the original 1997 methodology. See text below.) Beginning with the 2004 data year, the methodology developed in 1997 was used without the modification used from 2000–2003, as population estimates in single-years for ages 85 and over became available from the U.S Census Bureau. For data year 2004, pooled 1999–2001 Medicare data were used to model the probability of dying at ages 85 and over.

Causes of death contributing to changes in life expectancy Causes of death contributing to changes in life expectancy were estimated using a life table partitioning technique. The method partitions changes into component additive parts and identifies the

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causes of death having the greatest influence, positive or negative, on changes in life expectancy (19,65,66).

Injury mortality by mechanism and intent In Table 18, injury mortality data are presented using the External cause of injury mortality matrix for ICD–10. In this frame­ work, causes of injury deaths are organized principally by mechanism (e.g., firearm or poisoning), and secondarily by manner or intent of death (e.g., unintentional, suicide, homicide, etc.). The number of deaths for selected causes in this framework may differ from those shown in tables that use the standard mortality tabulation lists. Following WHO conventions, standard mortality tabu­ lations (Table 10) present external causes of death (ICD–10 codes *U01–*U03,V01–Y89). In contrast, the matrix (Table 18) excludes deaths classified to Complications of medical and surgical care (ICD–10 codes Y40–Y84,Y88). For additional information on injury data presented in this framework, see http://www.cdc.gov/nchs/about/ otheract/ice/matrix10.htm and ‘‘Deaths: Injuries, 2002’’ (6).

Codes for firearm deaths Causes of death attributable to firearm mortality include ICD–10 codes *U01.4, Terrorism involving firearms (homicide); W32–W34, Accidental discharge of firearms; X72–X74, Intentional self-harm (suicide) by discharge of firearms; X93–X95, Assault (homicide) by discharge of firearms; Y22–Y24, Discharge of firearms, undetermined intent; and Y35.0, Legal intervention involving firearm discharge. Deaths from injury by firearms exclude deaths due to explosives and other causes indirectly related to firearms.

Codes for drug-induced deaths The list of codes included in drug-induced causes was expanded in the 2003 data year to be more comprehensive. Causes of death attributable to drug-induced mortality include ICD–10 codes D52.1, Drug-induced folate deficiency anemia; D59.0, Drug-induced hemolytic anemia; D59.2, Drug-induced nonautoimmune hemolytic anemia; D61.1, Drug-induced aplastic anemia; D64.2, Secondary sideroblastic anemia due to drugs and toxins; E06.4, Drug-induced thyroiditis; E16.0, Drug-induced hypoglycemia without coma; E23.1, Drug-induced hypopituitarism; E24.2, Drug-induced Cushing’s syn­ drome; E27.3, Drug-induced adrenocortical insufficiency; E66.1, Drug-induced obesity; selected codes from the ICD–10 title Mental and behavioral disorders due to psychoactive substance use, specifi­ cally, F11.0–F11.5, F11.7–F11.9, F12.0–F12.5, F12.7–F12.9, F13.0– F13.5, F13.7–F13.9, F14.0–F14.5, F14.7–F14.9, F15.0–F15.5, F15.7–F15.9, F16.0–F16.5, F16.7–F16.9, F17.0, F17.3–F17.5, F17.7–F17.9, F18.0–F18.5, F18.7–F18.9, F19.0–F19.5, F19.7–F19.9; G21.1, Other drug-induced secondary parkinsonism; G24.0, Druginduced dystonia; G25.1, Drug-induced tremor; G25.4, Drug-induced chorea; G25.6, Drug-induced tics and other tics of organic origin; G44.4, Drug-induced headache, not elsewhere classified; G62.0, Drug-induced polyneuropathy; G72.0, Drug-induced myopathy; I95.2, Hypotension due to drugs; J70.2, Acute drug-induced interstitial lung disorders; J70.3, Chronic drug-induced interstitial lung disorders; J70.4, Drug-induced interstitial lung disorder, unspecified; L10.5, Drug-induced pemphigus; L27.0, Generalized skin eruption due to

drugs and medicaments; L27.1, Localized skin eruption due to drugs and medicaments; M10.2, Drug-induced gout; M32.0, Drug-induced systemic lupus erythematosus; M80.4, Drug-induced osteoporosis with pathological fracture; M81.4, Drug-induced osteoporosis; M83.5, Other drug-induced osteomalacia in adults; M87.1, Osteonecrosis due to drugs; R78.1, Finding of opiate drug in blood; R78.2, Finding of cocaine in blood; R78.3, Finding of hallucinogen in blood; R78.4, Finding of other drugs of addictive potential in blood; R78.5, Finding of psychotropic drug in blood; X40–X44, Accidental poisoning by and exposure to drugs, medicaments and biological substances; X60–X64, Intentional self-poisoning (suicide) by and exposure to drugs, medicaments and biological substances; X85, Assault (homi­ cide) by drugs, medicaments and biological substances; and Y10–Y14, Poisoning by and exposure to drugs, medicaments and biological substances, undetermined intent. Drug-induced causes exclude accidents, homicides, and other causes indirectly related to drug use. Also excluded are newborn deaths associated with mother’s drug use.

Codes for alcohol-induced deaths The list of codes included in alcohol-induced causes was expanded in the 2003 data year to be more comprehensive. Causes of death attributable to alcohol-induced mortality include ICD–10 codes E24.4, Alcohol-induced pseudo-Cushing’s syndrome; F10, Mental and behavioral disorders due to alcohol use; G31.2, Degen­ eration of nervous system due to alcohol; G62.1, Alcoholic polyneur­ opathy; G72.1, Alcoholic myopathy; I42.6, Alcoholic cardiomyopathy; K29.2, Alcoholic gastritis; K70, Alcoholic liver disease; K86.0, Alcoholinduced chronic pancreatitis; R78.0, Finding of alcohol in blood; X45, Accidental poisoning by and exposure to alcohol; X65, Intentional self-poisoning by and exposure to alcohol; and Y15, Poisoning by and exposure to alcohol, undetermined intent. Alcohol-induced causes exclude accidents, homicides, and other causes indirectly related to alcohol use. This category also excludes newborn deaths associated with maternal alcohol use.

Marital status Age-specific and age-adjusted death rates by marital status are shown in Table 25 by sex. Mortality data by marital status is generally of high quality. A study of death certificate data using the 1986 National Mortality Followback Survey showed a high level of consis­ tency in reporting marital status (56). Age-adjusted death rates by marital status were computed based on the age-specific rates and the standard population for ages 25 years and over. Although age-specific death rates by marital status are shown for the age group 15–24 years, they are not included in the computation of the age-adjusted rate because of their high variability, particularly for the widowed population. Also, the age groups 75–84 and 85 years and over are combined due to high variability in death rates in the 85 year and over age group, particularly for the never-married population.

Educational attainment Beginning in 2003, some registration areas adopted the new standard death certificate, which includes a revised educational attainment item. This replaces the previous item which focused on

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

highest grade of school completed. The subject of the new item continues to focus on collegiate track education and does not capture vocational training. The item was changed to be consistent with the U.S Census Bureau data, to improve the ability to identify specific degrees, to improve the ability to identify persons who had completed 12 years of education but did not hold either a GED or high school diploma, and to replace the old item which was inappropriately and inaccurately used to infer degree status. According to testing by the U.S Census Bureau, the new item identifies about 2 percent more individuals with less than a high school diploma or equivalent, 13 percent fewer individuals with a high school diploma, and 8 per­ cent more individuals with at least some college (67). In 2004, 12 states used the preferred question for all or part of the year. These states included California, Connecticut, Idaho, Michigan, Montana, New Hampshire, New Jersey, New York, Oklahoma, South Dakota, Washington, and Wyoming. Because most states have not yet adopted the preferred question, Table 26 is still shown using the old education item. However, Table II shows a comparison of the percent distribution of deaths by measures of educational attainment in use in 2002 and 2004 for nine states. Three of the 12 states using the revised certificate are not included in Table II. Those states are New Hampshire because they did not begin using the new item until mid-April, Connecticut because they were unable to transmit data to NCHS in the revised format, and South Dakota because they first began reporting education in 2004 and, therefore, have no com­ parison data for 2002. Table 26 is based on data from 36 states and the District of Columbia that continue to use the unrevised educational attainment item and whose data were approximately 80 percent or more complete on a place-of-occurrence basis. Data for Georgia and Rhode Island were excluded because the educational attainment item was not on their certificates. Data for California, Idaho, Michigan, Montana, New Jersey, New York, Oklahoma, South Dakota, Washington, Wyoming, and New York City were excluded because these states used the revised educational attainment item, and their data would therefore not be comparable to data based on the unrevised item. Age-specific and age-adjusted death rates by educational attain­ ment are shown in Table 26. Age-adjusted death rates by educational attainment were computed based on the age-specific rates and the standard population for ages 25–64 years. Data for age groups 65 years and over are not shown because reporting quality is poorer at older than younger ages (68). Rates by educational attainment are affected by differences in measurement of education for the numerator and the denominator. The

numerator is based on number of years of education completed as reported on the death certificate, whereas the denominator is based on highest degree completed as reported on census surveys (67).

Injury at work Information on deaths attributed to injuries at work is derived from a separate item on the death certificate that asks the medical certifier whether the death resulted from an injury sustained at work. The item is on the death certificate of all states. Number of deaths, age-specific death rates, and age-adjusted death rates for injury at work are shown in Tables 27 and 28. Deaths, crude death rates, and age-adjusted death rates for injury at work are shown for ages 15 years and over. Age-adjusted death rates for injury at work were computed using age-specific death rates and the U.S. standard population based on year 2000 standard for ages 15 years and over. See section on ‘‘Computing rates.’’

Infant mortality Infant mortality rates are the most commonly used index for measuring the risk of dying during the first year of life. The rates presented in this report are calculated by dividing the number of infant deaths in a calendar year by the number of live births registered for the same period and are presented as rates per 1,000 or per 100,000 live births. For final birth figures used in the denominator for infant mortality rates, see ‘‘Births: Final Data for 2004’’ (69). In contrast to infant mortality rates based on live births, infant death rates are based on the estimated population under 1 year of age. Infant death rates that appear in tabulations of age-specific death rates in this report are calculated by dividing the number of infant deaths by the July 1, 2004, population estimate of persons under 1 year of age, based on 2000 census populations. These rates are presented as rates per 100,000 population in this age group. Because of differences in the denominators, infant death rates may differ from infant mortality rates. Another data source is available for infant mortality. The linked file of live births and infant deaths differs from the infant mortality data presented in this report in the following ways: the linked file includes only events in which both the birth and the death occur in the United States and includes late filed births. During the processing of the linked file, there is an additional opportunity to exclude infant records that are duplicate records or records that have additional information that raise questions about their age. Therefore, although the differences are

Table II. Percent distribution of deaths by education items: California, Idaho, Michigan, Montana, New Jersey, New York, Oklahoma, Washington, and Wyoming, 2002 and 2004 [By state of occurrence. Excludes nonresidents of the United States. Due to rounding, the sum of the subgroups may not add to the total] 2002

2004 Percent distribution

Years of school completed Total . . . . . . . . . Under 12 years . 12 years . . . . . 13 years or more Not stated . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

NOTE: GED is General Education Development high school equivalency diploma.

100 26.3 42.8 27.4 3.5

109

Percent distribution

Educational attainment Total . . . . . . . . . . . . . . . . . . . . . . . Less than high school diploma or GED . High school diploma or GED . . . . . . . Some college or collegiate degree. . . . Not stated . . . . . . . . . . . . . . . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

100 28.9 39.4 29.8 1.9

110

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

normally miniscule, infant mortality rates based on the linked file tend to be somewhat smaller than those based on data from the general mortality file as presented in this report. The linked file uses the mother’s self-reported race from the child’s birth certificate (36,60). Because the mother’s self-report is of better quality than infant’s race from the death certificate and because the numerator and denominator are referring to the same individual’s race, the linked file is the preferred source for infant mortality by race.

The number of maternal deaths has been tending to increase as a result of direct and indirect effects of inclusion of a pregnancy status item on the U.S. Standard Certificate of Death (71). For states that already had a separate question, additional guidance being provided on use in identifying maternal deaths is resulting in more deaths being identified. For states that are adopting the standard item, additional information is available to use in identifying maternal deaths.

Maternal mortality

Quality of reporting and processing cause of death

Maternal mortality rates are computed on the basis of the number of live births. The maternal mortality rate indicates the likelihood of a pregnant woman dying of maternal causes. Rates are calculated by dividing the number of maternal deaths in a calendar year by the number of live births registered for the same period and are presented as rates per 100,000 live births. The number of live births used in the denominator is an approximation of the population of pregnant women who are at risk of a maternal death. ‘‘Maternal deaths’’ are defined by the WHO as ’’the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes‘‘ (8). Included in these deaths are ICD–10 codes A34, O00–O95, and O98–O99. Some state death certificates include a separate question regarding pregnancy status. A positive response to the question is interpreted if ’’pregnant‘‘ was reported in Part II of the cause-of-death section of the death certificate. If a specified length of time is not provided by the medical certifier, the pregnancy is assumed to have been terminated 42 days or less prior to death. Moreover, if only indirect maternal causes of death (i.e., a previously existing disease or a disease that developed during pregnancy that was not due to direct obstetric causes but was aggravated by physiologic effects of preg­ nancy) are reported in Part I and pregnancy is reported in either Part I or Part II, the death is classified as a maternal death. An evaluation study for the 1995–1997 period found that 35 per­ cent more maternal deaths were identified through surveillance efforts than solely by using the death certificate. A number of explanations accounted for the underascertainment, including lack of information reported in the cause-of-death section, use of fewer sources, and some differences in identification (70). This differential conceivably is decreasing because of changes in the coding of indirect maternal causes under ICD–10 that accounted for a nearly a 13 percent increase in maternal deaths in ICD–10 compared with ICD–9 and the increasing use of a pregnancy status checkbox on death certificates. The 2003 revision of the U.S. Standard Certificate of Death introduced a standard question format with categories to take advan­ tage of additional codes available in ICD–10 for deaths with a con­ nection to pregnancy, childbirth, and the puerperium. As states revise their certificates, most are expected to introduce the standard item or replace pre-existing questions with the standard item, so that there will be wider adoption of a pregnancy status item across the country and greater standardization of the particular item used. As of 2004, 28 states (one state added the question midyear) have a separate question related to pregnancy status of female decedents around the time of their death, and two states have a prompt that encourages certifiers to report recent pregnancies on the death certificate; however, at least six different questions are used.

One index of the quality of reporting causes of death is the proportion of death certificates coded to Chapter XVIII; Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (ICD–10 codes R00–R99). Although deaths occur for which the underlying causes are impossible to determine, this proportion indicates the care and consideration given to the cause-of-death statement by the medical certifier. This proportion also may be used as a rough measure of the specificity of the medical diagnoses made by the certifier in various areas. The percentage of all reported deaths in the United States assigned to Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified, was 1.26 in 2004, differing little from 2002 and 2003 (1.23 and 1.28, respectively) but lower than in 2000 and 2001 (1.33 and 1.34 percent, respectively). From 1990 to 1999, the percentage of deaths from this cause for all ages combined was fairly stable, fluctuating between 1.08 and 1.18 percent. Rules for coding cause(s) of death may sometimes require modi­ fication when evidence suggests that such modifications will improve the quality of cause-of-death data. These changes, however, may affect comparability of data between years for select causes of death.

Rare causes of death Selected causes of death considered to be of public health concern are routinely confirmed by the states according to agreed upon procedures between the state vital statistics programs and the National Center for Health Statistics. These causes, termed ‘‘Infre­ quent and rare causes of death,’’ are listed in the NCHS instruction manuals Parts 2a, 11, and 20 (46,72,73). For data year 2004, complete confirmation of deaths from infre­ quent and rare causes was not provided by the following states: California, Illinois, Indiana, Kentucky, Maryland, Massachusetts, Michigan, Minnesota, Nebraska, Nevada, New Hampshire, New Jersey, New York, North Carolina, Ohio, and Oklahoma.

Population bases for computing rates Populations used for computing death rates and life tables shown in this report represent the population residing in the United States, enumerated as of April 1 for census years and estimated as of July 1 for all other years. Population estimates used to compute death rates for the United States for 2004 are shown by race for 10-year age groups in Table III and are available by single years of age on the mortality website at: http://www.cdc.gov/nchs/about/major/ dvs/popbridge/popbridge.htm (74).

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

Population estimates in Table IV for Mexicans, Puerto Ricans, Cubans, and other Hispanics, and population estimates by marital status in Tables V, are based on the CPS adjusted to resident popu­ lation control totals for the United States (75) and, as such, are subject to sampling variation (see ‘‘Random variation’’). The control totals used are 2000-based population estimates for the United States for July 1, 2004 (74). Population estimates by educational attainment, shown in Table VI, are also based on the CPS adjusted to resident population control totals (74), and are also subject to sampling variation (see ‘‘Random variation’’). The control totals used are 2000-based popu­ lation estimates for 38 states and the District of Columbia for July 1, 2004 (75). Population estimates for each state, shown in Table VII, were estimated from state-level postcensal population estimates based on the 2000 census, estimated as of July 1, 2004 (74). Population esti­ mates for Puerto Rico, Virgin Islands, Guam, American Samoa, and Northern Marianas, also shown in Table VII, are based on the 2000 census, estimated as of July 1, 2004 (76). Population estimates for each state and territory are based on demographic analysis and are therefore not subject to sampling variation. Death rates for 1991–2004 shown in this report are based on populations that are consistent with the 2000 census levels (74,75,77–81). These estimates were produced under a collaborative arrangement with the U.S. Census Bureau and are based on the 2000 census counts by age, race, and sex, which were modified to be consistent with U.S. Office of Management and Budget racial catego­ ries as of 1977 and historical categories for death data (10). The modification procedures are described in detail elsewhere (12,13).

Computing rates Except for infant and maternal mortality rates, rates are on an annual basis per 100,000 estimated population residing in the specified area. Infant and maternal mortality rates are per 1,000 or per 100,000 live births. Comparisons made in the text among rates, unless otherwise specified, are statistically significant at the 0.05 level of significance. Lack of comment in the text about any two rates does not mean that the difference was tested and found not to be significant at this level. Age-adjusted rates (R ′) are used to compare relative mortality risks among groups and over time. However, they should be viewed as relative indexes rather than as actual measures of mortality risk. They were computed by the direct method, that is, by applying agespecific death rates (Ri) to the U.S. standard population age distribution (Table VIII) R′ =

O

Psi Ps

Ri

i

where Psi is the standard population for age group i, and Ps is the total U.S. standard population (all ages combined). Beginning with the 1999 data year, a new population standard was adopted by NCHS for use in age-adjusting death rates. Based on the projected year 2000 population of the United States, the new standard replaces the 1940 standard population that had been used for over 50 years. The new population standard affects levels of mortality and, to some extent, trends and group comparisons. Of particular note are the

111

effects on race comparison of mortality. For detailed discussion, see Age Standardization of Death Rates: Implementation of the Year 2000 Standard (82). Beginning with 2003 data, the traditional standard million population along with corresponding standard weights to six decimal places were replaced by the projected year 2000 population age distribution (see Table VIII). The effect of the change is negligible and does not significantly affect comparability with age-adjusted rates cal­ culated using the previous method. All age-adjusted rates shown in this report are based on the year 2000 standard population. The year 2000 standard population used for computing age-adjusted rates and standard errors, excluding those by marital status, education, injury at work, and the U.S. territories, is shown in Table VIII. Age-adjusted rates by marital status were computed by applying the age-specific death rates to the U.S. standard population for ages 25 years and over. Although age-specific death rates by marital status are shown for the age group 15–24 years, they are not included in the calculation of age-adjusted rates because of their high variability, particularly for the widowed population. Also, the age groups 75–84 and 85 years and over are combined because of high variability in death rates in the 85 years and over age group, particularly for the nevermarried population. The year 2000 standard population used for com­ puting age-adjusted rates and standard errors by marital status is shown in Table IX. Age-adjusted rates by educational attainment were computed by applying the age-specific death rates to the U.S. standard population for ages 25–64 years. Data for age groups 65 years and over are not shown because reporting quality is poorer for older ages than for younger ages (67). The year 2000 standard population used for com­ puting age-adjusted rates and standard errors by education is shown in Table X. Age-adjusted rates for injury at work were computed by applying the age-specific death rates to the U.S. standard population for ages 15 years and over. The year 2000 standard population used for computing age-adjusted rates and standard errors for injury at work is shown in Table XI. Age-adjusted rates for Puerto Rico, Virgin Islands, Guam, American Samoa, and Northern Marianas were computed by applying the age-specific death rates to the U.S. standard population. Age groups for 75 years and over were combined because population counts were unavailable by age group for ages over 75 years. The year 2000 standard population used for computing age-adjusted rates and standard errors for the territories is shown in Table XII. Using the same standard population, death rates for the total population and for each race-sex group were adjusted separately. The age-adjusted rates were based on 10-year age groups. Age-adjusted death rates should not be compared with crude rates. Death rates for the Hispanic population are based only on events to persons reported as Hispanic. Rates for non-Hispanic white persons are based on the sum of all events to white decedents reported as non-Hispanic and white decedents with origin not stated. Hispanic origin is not imputed if it is not reported.

Random variation The mortality data presented in this report, with the exception of data for 1972, are not subject to sampling error. In 1972, mortality data were based on a 50 percent sample of deaths because of

112

Table III. Estimated population by 10-year age groups, specified race and sex: United States, 2004 [Populations are postcensal estimates based on the 2000 census, estimated as of July 1, 2004, see ‘‘Technical Notes’’]

Age Total . . . . . . . Under 1 year . . . 1–4 years. . . . . 5–14 years . . . . 15–24 years . . . 25–34 years . . . 35–44 years . . . 45–54 years . . . 55–64 years . . . 65–74 years . . . 75–84 years . . . 85 years and over

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

White

Black

American Indian or Alaska Native

Asian and Pacific Islander

Total

Male

Female

Total

Male

Female

Total

Male

Female

Total

Male

Female

Total

Male

Female

293,655,404 4,077,187 15,994,081 40,750,728 41,701,105 40,031,937 44,108,652 41,618,805 29,078,923 18,463,473 12,970,882 4,859,631

144,537,402 2,085,436 8,177,557 20,860,278 21,438,383 20,336,031 22,033,878 20,452,674 13,999,435 8,427,628 5,218,229 1,507,873

149,118,002 1,991,751 7,816,524 19,890,450 20,262,722 19,695,906 22,074,774 21,166,131 15,079,488 10,035,845 7,752,653 3,351,758

238,268,102 3,176,265 12,461,493 31,633,848 32,727,487 31,506,447 35,619,055 34,444,360 24,803,473 15,952,643 11,562,349 4,380,682

117,915,508 1,625,299 6,380,698 16,229,235 16,896,350 16,204,754 17,993,795 17,115,739 12,062,385 7,357,705 4,688,373 1,361,175

120,352,594 1,550,966 6,080,795 15,404,613 15,831,137 15,301,693 17,625,260 17,328,621 12,741,088 8,594,938 6,873,976 3,019,507

38,600,765 661,160 2,599,363 6,719,897 6,440,904 5,535,770 5,732,303 4,929,108 2,900,104 1,732,803 994,740 354,613

18,416,886 337,225 1,319,973 3,413,646 3,248,277 2,649,620 2,695,431 2,278,248 1,292,946 721,663 359,196 100,661

20,183,879 323,935 1,279,390 3,306,251 3,192,627 2,886,150 3,036,872 2,650,860 1,607,158 1,011,140 635,544 253,952

3,148,484 43,272 178,321 572,170 584,333 471,466 465,813 396,380 235,866 120,668 59,781 20,414

1,572,049 22,026 90,367 290,104 299,643 244,135 232,555 192,286 113,559 55,762 24,999 6,613

1,576,435 21,246 87,954 282,066 284,690 227,331 233,258 204,094 122,307 64,906 34,782 13,801

13,638,053 196,490 754,904 1,824,813 1,948,381 2,518,254 2,291,481 1,848,957 1,139,480 657,359 354,012 103,922

6,632,959 100,886 386,519 927,293 994,113 1,237,522 1,112,097 866,401 530,545 292,498 145,661 39,424

7,005,094 95,604 368,385 897,520 954,268 1,280,732 1,179,384 982,556 608,935 364,861 208,351 64,498

SOURCE: National Center for Health Statistics. Estimates of the July 1, 2004, United States resident population by age, sex, race, and Hispanic origin, prepared under a collaborative arrangement with the U.S. Census Bureau. 2005.

Table IV. Estimated population by 10-year age groups, according to specified Hispanic origin, race for non-Hispanic population, and sex: United States, 2004 [Populations for all origins, Hispanic, non-Hispanic, non-Hispanic white, and non-Hispanic black are postcensal estimates based on the 2000 census, estimated as of July1, 2004; populations for Mexican, Puerto Rican, Cuban, Central and South American and other and unknown Hispanic are based on the Current Population Survey adjusted to resident population control totals. Due to rounding, population estimates for Hispanic subgroups may not add to Hispanic control totals. The control totals are 2000-based population estimates for the United States for July 1, 2004; see ‘‘Technical Notes’’]

Hispanic origin, race for non-Hispanic population, and sex All origins . . . . . . . . . . . Male . . . . . . . . . . Female . . . . . . . . . Hispanic. . . . . . . . . Male . . . . . . . . . . Female . . . . . . . . . Mexican American . . . . . Male . . . . . . . . . . Female . . . . . . . . . Puerto Rican . . . . . . . . Male . . . . . . . . . . Female . . . . . . . . . Cuban . . . . . . . . . . . Male . . . . . . . . . . Female . . . . . . . . . Central and South American Male . . . . . . . . . . Female . . . . . . . . . Other Hispanic . . . . . . . Male . . . . . . . . . . Female . . . . . . . . . Non-Hispanic1 . . . . . . Male . . . . . . . . . . Female . . . . . . . . . White . . . . . . . . . . . Male . . . . . . . . . . Female . . . . . . . . . Black . . . . . . . . . . . Male . . . . . . . . . . Female . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Total

Under 1 year

1–4 years

5–14 years

15–24 years

25–34 years

35–44 years

45–54 years

55–64 years

65–74 years

75–84 years

85 years and over

293,655,404 144,537,402 149,118,002 41,322,073 21,347,067 19,975,006 27,239,634 14,308,129 12,931,505 3,796,668 1,873,185 1,923,483 1,615,256 836,311 778,945 6,698,717 3,359,080 3,339,637 1,971,693 970,321 1,001,372 252,333,331 123,190,335 129,142,996 199,775,516 97,986,186 101,789,330 36,921,613 17,591,122 19,330,491

4,077,187 2,085,436 1,991,751 906,645 463,176 443,469 675,088 344,906 330,182 65,903 36,378 29,525 20,861 9,444 11,417 106,177 54,443 51,734 38,618 18,003 20,615 3,170,542 1,622,260 1,548,282 2,311,447 1,183,535 1,127,912 633,727 323,126 310,601

15,994,081 8,177,557 7,816,524 3,463,280 1,769,126 1,694,154 2,508,864 1,276,274 1,232,590 263,826 131,676 132,150 93,093 49,475 43,618 452,134 232,615 219,519 145,354 79,083 66,271 12,530,801 6,408,431 6,122,370 9,182,432 4,705,654 4,476,778 2,481,257 1,259,543 1,221,714

40,750,728 20,860,278 19,890,450 7,662,196 3,918,696 3,743,500 5,330,669 2,725,485 2,605,184 758,766 390,781 367,985 199,041 106,824 92,217 1,020,963 506,090 514,873 352,735 189,501 163,234 33,088,532 16,941,582 16,146,950 24,587,374 12,623,328 11,964,046 6,356,421 3,228,916 3,127,505

41,701,105 21,438,383 20,262,722 7,097,580 3,794,469 3,303,111 4,834,388 2,617,699 2,216,689 645,468 335,765 309,703 151,258 81,978 69,280 1,153,232 600,550 552,682 313,229 158,473 154,756 34,603,525 17,643,914 16,959,611 26,158,589 13,375,991 12,782,598 6,139,230 3,093,094 3,046,136

40,031,937 20,336,031 19,695,906 7,616,544 4,162,557 3,453,987 5,241,024 2,909,627 2,331,397 574,229 275,821 298,408 197,466 108,431 89,035 1,311,731 722,486 589,245 292,074 146,189 145,885 32,415,393 16,173,474 16,241,919 24,395,789 12,301,121 12,094,668 5,238,855 2,504,230 2,734,625

44,108,652 22,033,878 22,074,774 6,160,458 3,241,840 2,918,618 3,871,513 2,077,069 1,794,444 550,226 262,879 287,347 271,567 149,210 122,357 1,200,929 615,372 585,557 266,212 137,310 128,902 37,948,194 18,792,038 19,156,156 29,873,175 14,957,489 14,915,686 5,488,073 2,577,874 2,910,199

41,618,805 20,452,674 21,166,131 4,028,291 2,022,757 2,005,534 2,390,845 1,238,207 1,152,638 427,471 207,446 220,025 182,397 100,538 81,859 800,080 377,550 422,530 227,486 99,006 128,480 37,590,514 18,429,917 19,160,597 30,694,282 15,228,450 15,465,832 4,764,636 2,200,194 2,564,442

29,078,923 13,999,435 15,079,488 2,222,088 1,057,912 1,164,176 1,263,640 632,221 631,419 259,879 120,818 139,061 166,501 81,161 85,340 368,394 154,577 213,817 163,652 69,130 94,522 26,856,835 12,941,523 13,915,312 22,722,334 11,070,814 11,651,520 2,814,236 1,253,399 1,560,837

18,463,473 8,427,628 10,035,845 1,270,259 565,561 704,698 642,429 294,517 347,912 171,389 81,723 89,666 161,055 82,869 78,186 189,590 61,058 128,532 105,798 45,393 60,405 17,193,214 7,862,067 9,331,147 14,755,436 6,823,868 7,931,568 1,686,037 701,718 984,319

12,970,882 5,218,229 7,752,653 684,511 279,593 404,918 375,223 154,712 220,511 59,519 20,581 38,938 123,290 55,317 67,973 81,306 29,280 52,026 45,174 19,708 25,466 12,286,371 4,938,636 7,347,735 10,913,284 4,422,410 6,490,874 971,702 350,614 621,088

4,859,631 1,507,873 3,351,758 210,221 71,380 138,841 105,951 37,412 68,539 19,992 9,317 10,675 48,727 11,064 37,663 14,181 5,059 9,122 21,361 8,525 12,836 4,649,410 1,436,493 3,212,917 4,181,374 1,293,526 2,887,848 347,439 98,414 249,025

1 Includes races other than white and black. SOURCE: Population estimates for specified Hispanic subgroups based on unpublished tabulations prepared by the Housing and Household Economic Statistics Division, U.S. Bureau of the Census. Population estimates for all origins, Hispanic, non-Hispanic, non-Hispanic white, and non-Hispanic black were prepared under a collaborative arrangement with the U.S. Census Bureau. See references 74 and 75.

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

All races

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

113

Table V. Estimated population for ages 15 years and over by marital status, 10-year age groups and sex: United States, 2004 [Population estimates are based on the Current Population Survey adjusted to resident population controls for the United States. The control totals used are 2000-based population estimates for the United States for July 1, 2004] Marital status and sex All races . . . . . Never married . Ever married . Married . . . Widowed . . Divorced. . . All races, male. . Never married . Ever married . Married . . . Widowed . . Divorced. . . All races, female. Never married . Ever married . Married . . . Widowed . . Divorced. . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . .

15 years and over

15–24 years

25–34 years

35–44 years

45–54 years

55–64 years

65–74 years

75 years and over

232,833,387 67,707,285 165,126,102 128,079,499 14,796,434 22,250,169 113,414,137 37,279,391 76,134,746 64,094,964 2,781,335 9,258,447 119,419,250 30,427,894 88,991,356 63,984,535 12,015,099 12,991,722

41,701,101 37,281,921 4,419,180 4,073,771 29,292 316,117 21,438,385 19,825,499 1,612,886 1,481,729 8,882 122,275 20,262,716 17,456,422 2,806,294 2,592,042 20,410 193,842

40,031,946 15,266,925 24,765,021 22,157,023 132,816 2,475,182 20,336,032 8,938,254 11,397,778 10,319,345 31,403 1,047,030 19,695,914 6,328,671 13,367,243 11,837,678 101,413 1,428,152

44,108,670 7,457,641 36,651,029 30,647,477 382,338 5,621,214 22,033,892 4,473,280 17,560,612 15,007,751 92,316 2,460,545 22,074,778 2,984,361 19,090,417 15,639,726 290,022 3,160,669

41,618,799 4,557,089 37,061,710 29,674,076 841,322 6,546,312 20,452,681 2,554,312 17,898,369 14,912,194 197,987 2,788,188 21,166,118 2,002,777 19,163,341 14,761,882 643,335 3,758,124

29,078,902 1,705,224 27,373,678 21,153,119 1,783,737 4,436,822 13,999,422 854,581 13,144,841 11,039,621 317,144 1,788,076 15,079,480 850,643 14,228,837 10,113,498 1,466,593 2,648,746

18,463,480 770,301 17,693,179 12,352,563 3,466,315 1,874,301 8,427,633 385,178 8,042,455 6,663,921 652,152 726,382 10,035,847 385,123 9,650,724 5,688,642 2,814,163 1,147,919

17,830,489

668,184

17,162,305

8,021,470

8,160,614

980,221

6,726,092

248,287

6,477,805

4,670,403

1,481,451

325,951

11,104,397

419,897

10,684,500

3,351,067

6,679,163

654,270

SOURCE: Population estimates based on unpublished tabulations prepared by the Housing and Household Economic Statistics Division of the U.S. Census Bureau. 2006.

resource constraints. Mortality data, even based on complete counts, may be affected by random variation. That is, the number of deaths that actually occurred may be considered as one of a large series of possible results that could have arisen under the same circumstances (83,84). When the number of deaths is small (perhaps fewer than 100), random variation tends to be relatively large. Therefore, considerable caution must be observed in interpreting statistics based on small numbers of deaths. Measuring random variability—To quantify the random variation associated with mortality statistics, one must make an assumption regarding the appropriate underlying distribution. Deaths, as infrequent events, can be viewed as deriving from a Poisson probability distribution. The Poisson distribution is simple conceptually and computa­ tionally, and it provides reasonable, conservative variance estimates for

mortality statistics when the probability of dying is relatively low (83). Using the properties of the Poisson distribution, the standard error (SE) associated with the number of deaths (D) is 1.

SE(D) = √var(D) = √D

where var(D) denotes the variance of D. The standard error associated with crude and age-specific death rates (R) assumes that the population denominator (P) is a constant and is 2.

SE(R) =

Œ

( PD) = ŒP1 var(D) = ŒPD =

var

2

2

R

√D

Table VI. Estimated population for ages 25–64, by educational attainment and sex: Total of 36 reporting states and the District of Columbia, 2004 [Population estimates based onthe Current Population Survey adjusted to resident population controls. The control totals used are 2000-based population estimates for 36 states and the District of Columbia for July 1, 2004; see ‘‘Technical Notes’’] Years of school completed and sex

25–64 years

25–34 years

35–44 years

45–54 years

55–64 years

All races Both sexes . . . . . . . . . . Under 12 years . . . . . . 12 years . . . . . . . . . . 13 or more years . . . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

100,884,157 11,834,841 32,946,304 56,103,012

26,103,560 3,308,587 7,812,097 14,982,876

28,434,907 3,160,916 9,459,818 15,814,173

27,034,884 2,736,017 8,940,892 15,357,975

19,310,806 2,629,321 6,733,497 9,947,988

Male . . . . . . . . . . Under 12 years . . 12 years . . . . . . 13 or more years .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

50,076,765 6,328,547 16,578,349 27,169,869

13,252,843 1,875,007 4,299,945 7,077,891

14,196,270 1,773,291 4,931,903 7,491,076

13,310,247 1,420,222 4,369,789 7,520,236

9,317,405 1,260,027 2,976,712 5,080,666

Female . . . . . . . . Under 12 years . . 12 years . . . . . . 13 or more years .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

. . . .

50,807,392 5,506,294 16,367,955 28,933,143

12,850,717 1,433,580 3,512,152 7,904,985

14,238,637 1,387,625 4,527,915 8,323,097

13,724,637 1,315,795 4,571,103 7,837,739

9,993,401 1,369,294 3,756,785 4,867,322

SOURCE: Population estimates based on unpublished tabulations prepared by the Housing and Household Economic Statistics Division, U.S. Census Bureau. 2006.

114

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

Table VII. Estimated population for the United States, each state, Puerto Rico, Virgin Islands, Guam, American Samoa, and Northern Marianas, 2004 [Populations for the United States are postcensal estimates produced in 2004 based on the 2000 census estimated as of July 1, 2004. Populations for each state, Puerto Rico, Virgin Islands, Guam, American Samoa, and Northern Marianas are postcensal estimates produced in 2005 based on the 2000 census estimated as of July 1, 2004] Area

Total

United States . . . . . . . . . . . . . . . . . . . . . .

293,655,404

Alabama . . . . . . . Alaska . . . . . . . . Arizona . . . . . . . . Arkansas . . . . . . . California. . . . . . . Colorado . . . . . . . Connecticut . . . . . Delaware. . . . . . . District of Columbia Florida . . . . . . . . Georgia . . . . . . . Hawaii . . . . . . . . Idaho . . . . . . . . . Illinois . . . . . . . . Indiana . . . . . . . . Iowa . . . . . . . . . Kansas . . . . . . . . Kentucky . . . . . . . Louisiana. . . . . . . Maine. . . . . . . . . Maryland . . . . . . . Massachusetts . . . Michigan . . . . . . . Minnesota . . . . . . Mississippi . . . . . . Missouri . . . . . . . Montana . . . . . . . Nebraska. . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . .

4,530,182

655,435

5,743,834

2,752,629

35,893,799

4,601,403

3,503,604

830,364

553,523

17,397,161

8,829,383

1,262,840

1,393,262

12,713,634

6,237,569

2,954,451

2,735,502

4,145,922

4,515,770

1,317,253

5,558,058

6,416,505

10,112,620

5,100,958

2,902,966

5,754,618

926,865

1,747,214

Area Nevada. . . . . . New Hampshire. New Jersey . . . New Mexico . . . New York . . . . North Carolina. . North Dakota . . Ohio . . . . . . . Oklahoma . . . . Oregon . . . . . . Pennsylvania . . Rhode Island . . South Carolina . South Dakota . . Tennessee . . . . Texas . . . . . . . Utah . . . . . . . Vermont . . . . . Virginia . . . . . . Washington . . . West Virginia . . Wisconsin . . . . Wyoming . . . . .

Total

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . .

2,334,771 1,299,500 8,698,879 1,903,289 19,227,088 8,541,221 634,366 11,459,011 3,523,553 3,594,586 12,406,292 1,080,632 4,198,068 770,883 5,900,962 22,490,022 2,389,039 621,394 7,459,827 6,203,788 1,815,354 5,509,026 506,529

Puerto Rico . . . . Virgin Islands . . . Guam. . . . . . . . American Samoa . Northern Marianas

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

3,894,855 108,775 166,090 57,902 78,252

SOURCE: U.S. Census Bureau. See references 74 and 76.

Table VIII. United States standard population Age All ages . . . . . . Under 1 year . . . 1–4 years . . . . . 5–14 years . . . . 15–24 years . . . . 25–34 years . . . . 35–44 years . . . . 45–54 years . . . . 55–64 years . . . . 65–74 years . . . . 75–84 years . . . . 85 years and over

. . . . . . . . . . . .

. . . . . . . . . . . .

Population . . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

. . . . . . . . . . . .

274,633,642

3,794,901 15,191,619 39,976,619 38,076,743 37,233,437 44,659,185

37,030,152

23,961,506

18,135,514

12,314,793

4,259,173

Table X. United States standard population for ages

25–64 years

Population

Age 25–64 25–34 35–44 45–54 55–64

years . years . years . years . years .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

. . . . .

Table XI. United States standard population for ages 15 years and over Age

Table IX. United States standard population for ages 25 years and over Age 25 years and over 25–34 years . . . . 35–44 years . . . . 45–54 years . . . . 55–64 years . . . . 65–74 years . . . . 75 years and over

. . . . . . .

. . . . . . .

Population . . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

177,593,760 37,233,437

44,659,185

37,030,152

23,961,506

18,135,514

16,573,966

142,884,280

37,233,437

44,659,185

37,030,152

23,961,506

15 years and over 15–24 years . . . . 25–34 years . . . . 35–44 years . . . . 45–54 years . . . . 55–64 years . . . . 65 years and over

. . . . . . .

. . . . . . .

Population . . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

. . . . . . .

215,670,503

38,076,743

37,233,437

44,659,185

37,030,152

23,961,506

34,709,480

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

Table XII. United States standard population for the territories Age All ages . . . . . . Under 1 year . . . 1–4 years . . . . . 5–14 years . . . . 15–24 years . . . . 25–34 years . . . . 35–44 years . . . . 45–54 years . . . . 55–64 years . . . . 65–74 years . . . . 75 years and over

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

. . . . . . . . . . .

274,633,642

3,794,901

15,191,619

39,976,619

38,076,743

37,233,437

44,659,185

37,030,152

23,961,506

18,135,514

16,573,966

The coefficient of variation or relative standard error (RSE) is a useful measure of relative variation. The RSE is calculated by dividing the statistic (e.g., number of deaths, death rate) into its standard error and multiplying by 100. For the number of deaths RSE(D) = 100

Œ

SE(D) √D = 100 D = 100 D

1 D

For crude and age-specific death rates RSE(R) = 100

Œ

R / √D SE(R) = 100 R = 100 R

The RSE for the IMR is 6.

Population

RSE(IMR) = 100

Œ

SE(R) = R

RSE(D) = RSE(R) = 100

Œ

8.

1 D

SE(R ′) =

Œ ( ) Œ {( ) ( )} Psi 2 ∑ Ps var (Ri) = i

∑ i

Psi Ps

2

Ri2 Di

where Ri = age-specific rate for the ith age group Psi = age-specific standard population for the ith age group from the U.S. standard population age distribution (see Table VIII and age-adjusted death rate under ‘‘Definition of terms’’) Ps = total U.S. standard population (all ages combined) Di = number of deaths for the ith age group The RSE for the age-adjusted rate, RSE(R′), can easily be calculated by dividing SE(R′) from formula 4 by the age-adjusted death rate, (R ′), and multiplying by 100. RSE(R ′) = 100

SE(R ′) R′

For tables showing infant and maternal mortality rates based on live births (B) in the denominator, calculation of the standard error assumes random variability in both the numerator and denominator. The standard error for the infant mortality rate (IMR) is 5.

SE(IMR) =

Œ

var(D) + IMR c var(B) E(B)2

( )

1 b + 0.67 a + D P

SE(R ′) =

η{(PP ) R [D1 + 0.67 (a + Pb )]} si

i

The standard error of the age-adjusted death rate (R ′) is 4.

=

Œ

D

D2

B

B3

2+

1 1 + D B

For age-adjusted death rates (R ′)

Thus, 3.

Œ

SE(IMR) = 100 IMR

For maternal mortality rates, formulas 5 and 6 may be used substituting the maternal mortality rate for the IMR. Formulas 1–6 may be used for all tables presented in this report except for death rates and age-adjusted death rates shown in Tables 5, 25, and 26 which are calculated using population figures that are subject to sampling error (see the following subsection). Tables 5, 25, and 26—Death rates for Mexicans, Puerto Ricans, Cubans, Central and South Americans, and other and unknown His­ panics in Table 5, rates by marital status in Table 25 and rates by educational attainment in Table 26 are based on population estimates derived from the U.S. Census Bureau CPS for 2004 and adjusted to resident population control totals. As a result, the rates are subject to sampling variability in the denominator as well as random variability in the numerator. For crude and age-specific death rates (R), the standard error is calculated as 7.

1 D

115

where the number of births, B, is also assumed to be distributed according to a Poisson distribution, and E(B) is the expectation of B.

s

2

2 i

i

i

where a and b in formulas 7 and 8 represent parameters presented in Table XIII, which are derived from the CPS data for 2004 and 2005 and vary depending on the subgroup of interest (85,86). Suppression of unreliable rates—Beginning with 1989 data, an asterisk is shown in place of a crude or age-specific death rate based on fewer than 20 deaths, the equivalent of an RSE of 23 percent or more. The limit of 20 deaths is a convenient, if somewhat arbitrary, benchmark, below which rates are considered to be too statistically unreliable for presentation. For infant and maternal mortality rates, the same criterion (fewer than 20 deaths) is used to determine whether an asterisk (*) is presented in place of the rate. For age-adjusted death rates, the suppression criterion is based on the sum of the age-specific deaths (i.e., if the sum of the age-specific deaths is fewer than 20, an asterisk (*) is presented in place of the rate). These procedures are used throughout this report except for death rates shown in Tables 5, 25, and 26. For death rates shown in Tables 5, 25, and 26, sampling variability in the population denominator has a substantial impact on the overall variability in the rate. Therefore, the number of deaths in the numerator is not used as the sole suppression factor. RSEs for rates shown in Tables 5, 25, and 26 are derived from formulas 7 and 8 by dividing the results of formulas 7 and 8 by the crude or age-specific rate and age-adjusted rate, respectively, and multiplying by 100. Rates are replaced by asterisks (*) if the calculated RSE is 23 percent or more. In some cases, for smaller population subgroups, the estimated sample population from the CPS may be zero, even though deaths are pre­ sented for these same subgroups. In these cases, the death rate is incalculable and is automatically replaced with an asterisk (*).

116

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

Table XIII. Current Population Survey standard error parameters for death rates in Tables 5, 25, and 26 White, black, nonHispanic white, or non-Hispanic black

Total Characteristic Table 5 All origins . . . . . . . . . . . . . . . . . . . . . . . . . . Hispanic subgroups (Mexican, Puerto Rican, Cuban, and Other Hispanic) . . . . . . Table 25 All marital status groups combined. . . . . . . . . . . . Marital status subgroups (Never married, Ever married, Married, Widowed, Divorced) . . . . . . Table 26 All education groups . . . . . . . . . . . . . . . . . . . . Education subgroups (Under 12 years, 12 years, 13 years or over) . . . . . . . . . . . . . . . . . . . . .

a

b

a

Hispanic b

a

b

0.000000

0

0.000000

0

0.000000

0

...

...

...

...

–0.000096

3,809

0.000000

0

...

...

...

...

–0.000009

2,652

...

...

...

...

0.000000

0

...

...

...

...

–0.000005

1,206

...

...

...

...

. . . Category not applicable.

SOURCE: The a and b parameters are the average of the 2003 and 2004 Current Population Survey standard error parameters. See references 85 and 86.

Confidence intervals and statistical tests based on 100 deaths or more—When the number of deaths is large, a normal approximation may be used in the calculation of confidence intervals and statistical tests. The number of deaths that constitutes ‘‘large’’ is to some extent a subjective judgment. In general, for crude and age-specific death rates and for infant and maternal mortality rates, the normal approxi­ mation performs quite well when the number of deaths is 100 or greater. For age-adjusted rates, the criterion for use of the normal approximation is somewhat more complicated (58,82,87). Formula 9 is used to calculate 95 percent confidence limits for the death rate when the normal approximation is appropriate. 9.

L(R) = R – 1.96(SE(R)) and U(R) = R + 1.96(SE(R))

where L(R) and U(R) are the lower and upper limits of the confidence interval, respectively. The resulting 95 percent confidence interval can be interpreted to mean that the chances are 95 out of 100 that the ‘‘true’’ death rate falls between L(R) and U(R). For example, suppose that the crude death rate for Malignant neoplasms is 188.6 per 100,000 population based on 553,888 deaths. Lower and upper 95 percent confidence limits using formula 9 are calculated as L(188.6) = 188.6 – 1.96(.25) = 188.1 and U(188.6) = 188.6 + 1.96(.25) = 189.1 Thus, the chances are 95 out of 100 that the true death rate for malignant neoplasms is between 188.1 and 189.1. Formula 9 can also be used to calculate 95 percent confidence intervals for the number of deaths, age-adjusted death rates, infant mortality rates, and other mortality statistics when the normal approximation is appropriate by replacing R with D, R ′, IMR, etc. When testing the difference between two rates, R1 and R2 (each based on 100 or more deaths), the normal approximation may be used to calculate a test statistic, z, such that 10.

z=

R1 – R 2

√SE(R1)2 + SE(R2 )2

If ?z? ≥ 1.96 then the difference between the rates is statistically significant at the 0.05-level. If ?z ? < 1.96 then the difference is not

statistically significant. Formula 10 can also be used to perform tests for other mortality statistics when the normal approximation is appropriate (when both statistics being compared meet the normal criteria) by replacing R1 and R2 with D1 and D2, R ′ and R′ , etc. Suppose that the age-adjusted death rate for Malignant neoplasms of trachea, bronchus, and lung (lung cancer) for females is 41.3 per 100,000 U.S. standard population in 2003 (R1) and 40.9 per 100,000 U.S. standard population in 2004 (R2). The standard error for each of these figures, SE(R1) and SE(R2), is calculated using formula 4. Using formula 10, one can test if the decrease in the age-adjusted rate is statistically significant. z=

41.3 – 40.9

√(0.159)2 + (0.157)2

= 1.79

Because z = 1.79 < 1.96, the decrease from 2003 to 2004 in the female age-adjusted death rate for lung cancer is not statistically significant. Confidence intervals and statistical tests based on fewer than 100 deaths—When the number of deaths is not large (fewer than 100), the Poisson distribution cannot be approximated by the normal distribution. The normal distribution is a symmetric distribution with a range from – ∞ to + ∞. As a result, confidence intervals based on the normal distribution also have this range. The number of deaths or the death rate, however, cannot be less than zero. When the number of deaths is very small, approximating confidence intervals for deaths and death rates using the normal distribution will sometimes produce lower con­ fidence limits that are negative. The Poisson distribution, in contrast, is an asymmetric distribution with zero as a lower bound. Thus, confidence limits based on this distribution will never be less than zero. A simple method based on the more general family of gamma distri­ butions, of which the Poisson is a member, can be used to approximate confidence intervals for deaths and death rates when the number of deaths is small (82,87). For more information regarding how the gamma method is derived, see Derivation of the gamma method at the end of this section.

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

Calculations using the gamma method can be made using commonly available spreadsheet programs or statistical software (e.g., Excel, SAS) that include an inverse gamma function. In Excel, the function ‘‘gammainv(probability, alpha, beta)’’ returns values associated with the inverse gamma function for a given probability between 0 and 1. For 95 percent confidence limits, the probability associated with the lower limit is .05/2=.025 and the probability associated with the upper limit is 1-(.05/2)=.975. Alpha and beta are parameters associated with the gamma distribution. For the number of deaths and crude and age-specific death rates, alpha=D (the number of deaths) and beta=1. In Excel, the following formulas can be used to calculate lower and upper 95 percent confidence limits for the number of deaths and crude and age-specific death rates L(D) = GAMMAINV(.025, D, 1) and U(D) = GAMMAINV(.975, D+1, 1) Confidence limits for the death rate are then calculated by dividing L(D) and U(D) by the population (P) at risk of dying (see formula 17). Alternatively, 95 percent confidence limits can be estimated using the lower and upper confidence limit factors shown in Table XIV. For the number of deaths, D, and the death rate, R, 11. L(D) = L x D and U(D) = U x D 12. L(R) = L x R and U(R) = U x R where L and U in formulas 11 and 12 are the lower and upper confidence limit factors which correspond to the appropriate number of deaths, D, in Table XIV. For example, suppose that the death rate for AIAN females aged 10–14 is 21.5 per 100,000 and based on 32 deaths. Applying formula 12, values for L and U from Table XIV for 32 deaths are multiplied by the death rate, 21.5, such that L(R) = L(21.5) = 0.683999 x 21.5 = 14.7 and U(R) = U(21.5) = 1.411702 x 21.5 = 30.4 These confidence limits indicate that the chances are 95 out of 100 that the actual death rate for AIAN females aged 10–14 is between 14.7 and 30.4 per 100,000. Although the calculations are similar, confidence intervals based on small numbers for age-adjusted death rates, infant and maternal mortality rates, and rates that are subject to sampling variability in the denominator are somewhat more complicated (58,82). Refer to the most recent version of the Mortality Technical Appendix for more details, available from: (http://www.cdc.gov/nchs/datawh/statab/pubd/ta.htm). When comparing the difference between two rates, R1 and R2, where one or both of the rates are based on fewer than 100 deaths, a comparison of 95 percent confidence intervals may be used as a statistical test. If the 95 percent confidence intervals do not overlap, then the difference can be said to be statistically significant at the 0.05-level. A simple rule of thumb is: if R1 > R2, then test if L(R1) > U(R2) or if R2 > R1, and then test if L(R2) > U(R1). Positive tests denote statistical significance at the 0.05-level. For example, suppose that AIAN females aged 10–14 years have a death rate (R1) of 21.5 based on 32 deaths and that API males aged 10–14 years have a death rate (R2) of 10.6 per 100,000 based on 47 deaths. The 95 percent confidence limits for R1 and R2 calculated using formula 12 would be L(R1) = L(21.5) = 0.683999 x 21.5 = 14.7 and U(R1) = U(21.5) = 1.411702 x 21.5 = 30.4

117

L(R2) = L(10.6) = 0.734762 x 10.6 = 7.8 and U(R2) = U(10.6) = 1.329788 x 10.6 = 14.1 Because R1 > R2 and L(R1) > U(R2), it can be concluded that the difference between the death rates for AIAN females aged 10–14 years and API females of the same age is statistically significant at the .05-level. That is, taking into account random variability, API females aged 10–14 years have a death rate that is significantly lower than that for AIAN females of the same age. This test may also be used to perform tests for other statistics when the normal approximation is not appropriate for one or both of the statistics being compared by replacing R1 and R2 with D1 and D2, R ′1, and R ′2, etc. Users of the method of comparing confidence intervals should be aware that this method is a conservative test for statistical significance. That is, the difference between two rates may, in fact, be statistically significant even though confidence intervals for the two rates overlap (88). Thus, caution should be observed when interpreting a nonsignificant difference between two rates, especially when the lower and upper limits being compared overlap only slightly. Derivation of the gamma method—For a random variable X that follows a gamma distribution Γ(y,z), where y and z are the parameters that determine the shape of the distribution (89): E(X) = yz and Var (X) = yz2. For the number of deaths, D, E(D) = D and Var (D) = D. It follows that y = D and z = 1. Thus, 13.

D ~ Γ(D,1)

From equation 13, the shape of the distribution of deaths clearly depends only on the number of deaths. For the death rate, R, E(R ) = R and Var (R) = D/P 2. It follows, in this case, that y = D and z = P –1. Thus, 14.

R ~ Γ(D,P –1)

A useful property of the gamma distribution is that for X ~ Γ (y,z), one can divide X by z such that X/z ~ Γ(y,1). This converts the gamma distribution into a simplified, standard form dependent only on parameter y. Expressing equation 14 in its simplified form gives R

= D ~ Γ(D,1) P –1 From equation 15, the shape of the distribution of the death rate is clearly also dependent solely on the number of deaths. Using the results of equations 13 and 15, one can use the inverse gamma distribution to calculate upper and lower confidence limits. Lower and upper 100(1–α) percent confidence limits for the number of deaths, L(D) and U(D), are estimated as 15.

16.

L(D) = Γ –1(D,1)(α / 2) and U(D) = Γ –1(D+1,1)(1–α / 2)

where Γ –1 represents the inverse of the gamma distribution and D+1 in the formula for U(D) reflects a continuity correction made necessary by the fact that D is a discrete random variable and the gamma distribution is a continuous distribution. For a 95 percent confidence interval, α = .05. For the death rate, it can be shown that 17.

L(R) =

U(D) L(D) and U(R) = P P

118

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

Table XIV. Lower and upper 95 percent confidence limit factors for the number of deaths and death rate when the number of deaths is less than 100 Number of deaths (D) 1 . 2 . 3 . 4 . 5 . 6 . 7 . 8 . 9 . 10 . 11 . 12 . 13 . 14 . 15 . 16 . 17 . 18 . 19 . 20 . 21 . 22 . 23 . 24 . 25 . 26 . 27 . 28 . 29 . 30 . 31 . 32 . 33 . 34 . 35 . 36 . 37 . 38 . 39 . 40 . 41 . 42 . 43 . 44 . 45 . 46 . 47 . 48 . 49 . 50 .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lower confidence limit (L)

Upper confidence limit (U)

0.025318 0.121105 0.206224 0.272466 0.324697 0.366982 0.402052 0.431729 0.457264 0.479539 0.499196 0.516715 0.532458 0.546709 0.559692 0.571586 0.582537 0.592663 0.602065 0.610826 0.619016 0.626695 0.633914 0.640719 0.647147 0.653233 0.659006 0.664493 0.669716 0.674696 0.679451 0.683999 0.688354 0.692529 0.696537 0.700388 0.704092 0.707660 0.711098 0.714415 0.717617 0.720712 0.723705 0.726602 0.729407 0.732126 0.734762 0.737321 0.739806 0.742219

5.571643 3.612344 2.922424 2.560397 2.333666 2.176579 2.060382 1.970399 1.898311 1.839036 1.789276 1.746799 1.710030 1.677830 1.649348 1.623937 1.601097 1.580431 1.561624 1.544419 1.528606 1.514012 1.500491 1.487921 1.476197 1.465232 1.454947 1.445278 1.436167 1.427562 1.419420 1.411702 1.404372 1.397400 1.390758 1.384422 1.378368 1.372578 1.367033 1.361716 1.356613 1.351709 1.346993 1.342453 1.338079 1.333860 1.329788 1.325855 1.322053 1.318375

Number of deaths (D) 51 . 52 . 53 . 54 . 55 . 56 . 57 . 58 . 59 . 60 . 61 . 62 . 63 . 64 . 65 . 66 . 67 . 68 . 69 . 70 . 71 . 72 . 73 . 74 . 75 . 76 . 77 . 78 . 79 . 80 . 81 . 82 . 83 . 84 . 85 . 86 . 87 . 88 . 89 . 90 . 91 . 92 . 93 . 94 . 95 . 96 . 97 . 98 . 99 .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Lower confidence limit (L)

Upper confidence limit (U)

0.744566 0.746848 0.749069 0.751231 0.753337 0.755389 0.757390 0.759342 0.761246 0.763105 0.764921 0.766694 0.768427 0.770122 0.771779 0.773400 0.774986 0.776539 0.778060 0.779549 0.781008 0.782438 0.783840 0.785215 0.786563 0.787886 0.789184 0.790459 0.791709 0.792938 0.794144 0.795330 0.796494 0.797639 0.798764 0.799871 0.800959 0.802029 0.803082 0.804118 0.805138 0.806141 0.807129 0.808102 0.809060 0.810003 0.810933 0.811848 0.812751

1.314815 1.311367 1.308025 1.304783 1.301637 1.298583 1.295616 1.292732 1.289927 1.287198 1.284542 1.281955 1.279434 1.276978 1.274582 1.272245 1.269965 1.267738 1.265564 1.263440 1.261364 1.259335 1.257350 1.255408 1.253509 1.251649 1.249828 1.248045 1.246298 1.244587 1.242909 1.241264 1.239650 1.238068 1.236515 1.234992 1.233496 1.232028 1.230586 1.229170 1.227778 1.226411 1.225068 1.223747 1.222448 1.221171 1.219915 1.218680 1.217464

For more detail regarding the derivation of the gamma method and its application to age-adjusted death rates and other mortality statistics, see references (7,82,87).

available in the Vital Statistics of the United States, Mortality, theVital and Health Statistics, Series 20 reports, and the National Vital Statistics Reports through NCHS.

Availability of mortality data

Definitions of terms

Mortality data are available in publications, unpublished tables, and electronic products as described on the mortality website at the following address: http://www.cdc.gov/nchs/deaths.htm. More detailed analysis than that provided in this report is possible by using the mortality public-use data set issued each data year. Since 1991, the data set is available through NCHS in CD-ROM format. Data are also

Infant deaths—Deaths of infants aged under 1 year. Neonatal deaths—Deaths of infants aged 0–27 days. Postneonatal deaths—Deaths of infants aged 28 days–1 year. Crude death rate—Total deaths per 100,000 population for a specified period. The crude death rate represents the average chance of dying during a specified period for persons in the entire population.

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

Age-specific death rate—Deaths per 100,000 population in a specified age group, such as 1–4 years or 5–9 years for a specified period. Age-adjusted death rate—The death rate used to make compari­ sons of relative mortality risks across groups and over time. This rate should be viewed as a construct or an index rather than as direct or actual measure of mortality risk. Statistically, it is a weighted average of the age-specific death rates, where the weights represent the fixed population proportions by age (89).

119

National Vital Statistics Reports, Vol. 55, No. 19, August 21, 2007

13

Table E. Number of infant deaths, percentage of total infant deaths, and infant mortality rates for 2004, and percentage change in infant mortality rates from 2003 to 2004 for the 10 leading causes of infant death in 2004: United States [Rates are infant deaths per 100,000 live births]

Rank1

Cause of death (Based on the International Classification of Diseases, Tenth Revision, 1992)

Number

Percent of total deaths

... 1 2 3 4 5 6 7 8 9 10 ...

All causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Congenital malformations, deformations and chromosomal abnormalities . . . . . (Q00–Q99) Disorders related to short gestation and low birth weight, not elsewhere classified. . . (P07) Sudden infant death syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (R95) Newborn affected by maternal complications of pregnancy . . . . . . . . . . . . . . . . . (P01) Accidents (unintentional injuries) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (V01–X59) Newborn affected by complications of placenta, cord and membranes . . . . . . . . . . (P02) Respiratory distress of newborn. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P22) Bacterial sepsis of newborn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P36) Neonatal hemorrhage. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (P50–P52,P54) Diseases of the circulatory system . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (I00–I99) All other causes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (residual)

27,936 5,622 4,642 2,246 1,715 1,052 1,042 875 827 616 593 8,706

100.0 20.1 16.6 8.0 6.1 3.8 3.7 3.1 3.0 2.2 2.1 31.2

Rate

Percent change2 from 2003 to 2004

679.4 136.7 112.9 54.6 41.7 25.6 25.3 21.3 20.1 15.0 14.4 211.7

–0.8 –0.5 –4.8 3.2 –0.2 10.8 –5.9 4.9 6.3 –5.7 –0.7 ...

. . . Category not applicable.

1 Rank based on number of deaths; see ‘‘Technical Notes.’’

2 Percentage change based on a comparison of the 2004 infant mortality rate with the 2003 infant mortality rate.

Hispanic maternal mortality—The maternal mortality rate for His­ panic women was 8.5 deaths per 100,000 live births. The ratio of the Hispanic-to-non-Hispanic-white maternal mortality rates was 0.9 in 2004 compared with 1.2 in 2003. As with other statistics involving Hispanic origin, these should be interpreted with caution because of inconsistencies between reporting Hispanic origin on death certificates and on censuses and surveys; see ‘‘Technical Notes.’’

10.

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41. Tolson G, Barnes J, Gay G, Kowaleski J. The 1989 revision of the U.S. standard certificates and reports. National Center for Health Statistics. Vital Health Stat 4(28). 1991. 42. National Center for Health Statistics. Comparability of mortality statis­ tics for the Sixth and Seventh Revisions, United States, 1958. Vital Statistics—Special reports 51(4). 1965. 43. Klebba A, Dolman A. Comparability of mortality statistics for the Seventh and Eighth Revisions of the International Classification of Diseases, United States. National Center for Health Statistics. Vital Health Stat 2(66). 1975. 44. Klebba A, Scott J. Estimates of selected comparability ratios based on dual coding of 1976 death certificates by the Eighth and Ninth Revisions of the International Classification of Diseases. Monthly vital statistics report; vol 28 no 11. Hyattsville, MD: National center for Health Statistics. 1980. 45. National Center for Health Statistics. Vital statistics, instructions for classifying multiple causes of death. NCHS instruction manual; part 2b. Hyattsville, MD: Public Health Service. Published annually. 46. National Center for Health Statistics. Vital statistics, instructions for classifying the underlying cause of death. NCHS instruction manual; part 2a. Hyattsville, MD: Public Health Service. Published annually. 47. National Center for Health Statistics. Vital statistics, ICD–10 ACME decision tables for classifying underlying causes of death. NCHS instruction manual; part 2c. Hyattsville, MD: Public Health Service. Published annually. 48. National Center for Health Statistics. Vital statistics, data entry instruc­ tions for the mortality medical indexing, classification, and retrieval system (MICAR). NCHS instruction manual; part 2g. Hyattsville, MD: Public Health Service. Published annually. 49. National Center for Health Statistics. Vital statistics, dictionary of valid terms for the mortality medical indexing, classification, and retrieval system (MICAR). NCHS instruction manual; part 2h. Hyattsville, MD: Public Health Service. Published annually. 50. National Center for Health Statistics. Public-use data set documenta­ tion: Mortality data set for ICD–10, 2004. Hyattsville, MD: Public Health Service. Forthcoming. 51. Chamblee RF, Evans MC. TRANSAX, the NCHS system for producing multiple cause-of-death statistics, 1968–78. National Center for Health Statistics. Vital Health Stat 1(20). 1986. 52. Israel RA, Roseberg HM, Curtin LR. Analytical potential for multiple cause-of-death data. Am J Epidemiol 124(2): 161–79. 1986. 53. National Center for Health Statistics. ICD–10 cause-of-death lists for tabulating mortality statistics (updated October 2002). NCHS instruction manual; part 9. Hyattsville, MD: Public Health Service. Available from: http://www.cdc.gov/nchs/about/major/dvs/im.htm. 2002. 54. Sorlie PD, Rogot E, Johnson NJ. Validity of demographic characteris­ tics on the death certificate. Epidemiology 3(2):181–4. 1992. 55. Mulry M. Summary of accuracy and coverage evaluation for census 2000. Research report series statistics #2006–3. Washington, DC: Statistical Research Division, U.S. Census Bureau. Available from: http://www.census.gov/srd/papers/pdf/rrs2006-03.pdf. 2006. 56. Poe GS, Powell-Griner E, McLaughlin JK. Comparability of the death certificate and the 1986 national mortality followback survey. National Center for Health Statistics. Vital Health Stat 2(118). Available from: http://www.cdc.gov/nchs/data/series/sr_02/sr02_118.pdf. 1993. 57. National Center for Health Statistics. Technical appendix. Vital statistics of the United States, 1989, vol I, natality. Hyattsville, MD. 1993. 58. National Center for Health Statistics. Technical Appendix. Vital statistics of the United States, 1999, mortality. Hyattsville, MD. Available from: http://www.cdc.gov/nchs/datawh/statab/pubd/ta.htm. 1999.

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15

77. National Center for Health Statistics. Bridged-race intercensal popula­ tion estimates for July 1, 1990–July 1, 1999, by year, county, 5-year age groups, bridged-race, Hispanic origin, and sex (one ASCII file each per separate year), prepared under a collaborative arrangement with the U.S. Census Bureau. Available from: http://www.cdc.gov/ nchs/about/major/dvs/popbridge/popbridge.htm. 2003. 78. National Center for Health Statistics. Bridged-race population estimates for April 1, 2000, by county, single-year of age, bridged-race, Hispanic origin, and sex (br040100.txt), prepared under a collaborative arrange­ ment with the U.S. Census Bureau. Available from: http://www.cdc. gov/nchs/about/major/dvs/popbridge/popbridge.htm. 2003. 79. National Center for Health Statistics. Bridged-race vintage 2001 postcensal estimates of the resident population of the United States as of July 1, 2001, by age, sex, race, and Hispanic origin (pcen_v2001.txt), prepared under a collaborative arrangement with the U.S. Census Bureau. Available from: http://www.cdc.gov/nchs/about/ major/dvs/popbridge/popbridge.htm. 2003. 80. National Center for Health Statistics. Bridged-race vintage 2002 postcensal estimates of the resident population of the United States as of July 1, 2002, by age, sex, race, and Hispanic origin (pcen_v2002.txt), prepared under a collaborative arrangement with the U.S. Census Bureau. Available from: http://www.cdc.gov/nchs/about/ major/dvs/popbridge/popbridge.htm. 2003. 81. National Center for Health Statistics. Bridged-race vintage 2003 postcensal estimates of the resident population of the United States as of July 1, 2003, by age, sex, race, and Hispanic origin (pcen_v2003.txt), prepared under a collaborative arrangement with the U.S. Census Bureau. Available from: http://www.cdc.gov/nchs/about/ major/dvs/popbridge/popbridge.htm. 2004. 82. Anderson RN, Rosenberg H. Age standardization of death rates: Implementation of the year 2000 standard. National vital statistics reports; vol 47 no 3. Hyattsville, MD: National Center for Health Statistics. Available from: http://www.cdc.gov/nchs/data/nvsr/nvsr47/ nvs47_03.pdf. 1998. 83. Brillinger D. The natural variability of vital rates and associated statistics. Biometrics 42:693–734. 1986. 84. Chiang C. Introduction to Stochastic Processes in Biostatistics. New York:Wiley; 1968. 85. DeNavas-Walt C, Proctor B, Lee C. Income, poverty, and health insurance coverage in the United States: 2004. Current population reports; P60–229. Washington, DC: U.S. Census Bureau. Available from: http://www2.census.gov/prod2/popscan/p60-229.pdf. 2005. 86. DeNavas-Walt C, Proctor B, Mills R. Income, poverty, and health insurance coverage in the United States:2003. Current population reports; P60–226. Washington, DC: U.S. Census Bureau. Available from: http://www2.census.gov/prod2/popscan/p60-226.pdf. 2004. 87. Fay M, Feuer E. Confidence intervals for directly standardized rates: a method based on the gamma distribution. Stat Med 16:791–801. 1997. 88. Schenker N, Gentleman J. On judging the significance of differences by examining the overlap between confidence intervals. The American Statistician 55:182–6. 2001. 89. Arnold S. Mathematical Statistics. Englewood Cliffs, NJ: Prentice Hall; 1990.

List of Detailed Tables 1. Number of deaths, death rates, and age-adjusted death rates, by race and sex: United States, 1940, 1950, 1960, 1970, and 1980–2004 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Number of deaths, death rates, and age-adjusted death rates, by Hispanic origin, race for non-Hispanic population, and sex: United States, 1997–2004 . . . . . . . . . . . . . . . . . . . . . . . . .

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