US vital statistics show death rates down, birth rates up

provided by Johns Hopkins School of Public Health


s Americans say goodbye to a decade, a century and a millennium, the US death rate continues to decline, and the birth rate is up for the first time since 1990, according to the Annual Summary of Vital Statistics based on 1998 data.

December marked the 50th anniversary of the publication of the summary in Pediatrics, the journal of the American Academy of Pediatrics (AAP). The summary comes from the Department of Population and Family Health Sciences, Johns Hopkins School of Hygiene and Public Health in Baltimore, MD; and the Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention (CDC) in Hyattsville, MD.

Each year, the summary reports data for the US regarding the previous year's birth, death and fertility rates, as well as statistics on prenatal care, births to teenage mothers and unwed mothers, multiple birth rates, and low birth weight rates. It also reports the leading causes of death for adults and for children in various age groups. For 1998, most statistical indicators of Americans' health remained stable or improved slightly.

"As we reach the end of an era, we can use this data to appreciate how far we have come in improving public health," said lead author Bernard Guyer, MD, MPH, FAAP, of Johns Hopkins School of Public Health and Hygiene. "The outlook for children born in the new millennium promises to be bright. But we also need to pay attention to areas where we can be doing more, such as preventing injuries and homicide."


Infant mortality rates

  The US infant mortality rate was 7.2 per 1,000 live births, tying 1997's record low. However, that statistic represents 28,486 infant deaths and compares unfavorably with the rate in other developed nations. Sweden, for example had a rate of 3.6, Japan had a rate of 3.7, and Germany had a rate of 4.9. Even so, the US mortality rate has declined by more than 40 percent since 1980. New Hampshire had the lowest rate at 4.3 deaths per 1,000 live births. The District of Columbia had the highest at 13.2, and Mississippi was the next highest at 10.6.


Birth rates


The number of live births increased in 1998 to 3,944,046, a 2 percent increase over the previous year. The US population grew by 1,605,976, exclusive of immigration. The birth rate, defined as the number of live births per 1,000 population, increased slight-ly to 14.6. The US fertility rate, defined as the number of births per 1,000 women age 15 to 44 years, increased 1 percent to 65.6 per 1,000. While modest, this increase was the first since 1990, halting the steady decline in the number of births, birth rates and fertility rates in the 1990s.

Birth rates for teenagers in all age groups declined from 1997 to 1998. Rates for women in their 20s increased 1 to 2 percent, and for women in their 30s increased to the highest levels in at least 30 years, to 87.5 per 1,000 (aged 30 to 34) and 37.4 per 1,000 (aged 35 to 39). The rate for women aged 40 to 44 years, 7.3 per 1,000, was nearly double the low point of 3.8 in 1981.

The latest data on multiple births is from 1997, indicating a 3 percent rise in twin births since 1996, and a 52 percent jump since 1980. The number of triplet and other higher-order multiple births rose 16 percent from 1996 to 1997.


Childbirth issues

  The percent of women who received prenatal care in the first trimester improved for the ninth consecutive year, rising to 82.8 percent in 1998. This is a 10 percent increase over 1989 numbers. The number of births to unmarried women increased 3 percent in 1998. The authors attribute this increase mostly to the continued rise in the number of unmarried women of childbearing age.


Life and death matters

There were an estimated 2,338,070 deaths in the US in 1998. The preliminary death rate was 470.8 deaths per 100,000 population, a record low for the United States. The estimated expectation of life at birth reached a record high of 76.7 years, an increase of 0.2 year from 1997.

Between 1997 and 1998, death rates declined for HIV infection by 21 percent, for homicide by 14 percent, for suicide by 6 percent, for accidents and unintentional injuries by 5 percent, and for malignant tumors by 2 percent. Rates increased for pneumonia and influenza by 5 percent, for kidney disease by 2 percent, and for chronic obstructive pulmonary disease by 2 percent.

The death rate from infectious diseases overall has declined by 45 percent since 1995. But these account for a relatively small percentage of all deaths (2.2 percent in 1998).

For deaths among children, rates declined in all age groups from 1997 to 1998. Since 1979, death rates for children have declined 30 to 47 percent depending on age group. Unintentional injuries were the cause of most childhood deaths. For teens (15-19), the second-leading cause was homicide in 1998, accounting for 16 percent of all deaths and numbering 2,216.

This study was published in the peer-reviewed, scientific journal of the American Academy of Pediatrics, but does not necessarily reflect the policies or opinions of the Academy. The American Academy of Pediatrics is an organization of 55,000 primary care pediatricians, pediatric medical sub-specialists and pediatric specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. Contact: Johns Hopkins School of Public Health, Office of Public Affairs, (410) 955-6878.