An all-time high in life expectancy, a new low in the national infant mortality rate, and a sixth straight yearly decline in teen pregnancy rates were among the positive U.S. health trends cited in the latest Annual Summary of Vital Statistics published in the December issue of Pediatrics.
"This report is about making slow but steady progress in many important areas of American health," said lead author Bernard Guyer, MD, MPH, professor and chair, Population and Family Health Sciences, Johns Hopkins School of Public Health. "We're seeing real improvement in the status of children and their mothers, and obviously there are trends in health care policy contributing to this. Of note are declines in infant mortality in several New England states, declines in teen pregnancy, and a nearly 50 percent decline in AIDS mortality rates."
Dr. Guyer stressed that the data should be used to focus resources on those areas--such as preventable fatal injuries to children (the leading cause of death for children of all ages) and low-birth-weight rates--where further improvement is needed. Some of the specific findings from the yearly summary:
Life expectancy and causes of death. Life expectancy at birth for all gender and race groups combined reached an all-time high of 76.5 years, while death rates for children and adults declined for heart disease, accidents, homicide, suicide, chronic liver disease, and diabetes. Mortality from HIV infection declined by 47 percent. Death rates for children from all major causes declined, although unintentional injuries remained the leading cause of death for children of all ages. Among teens ages 15 to 19, homicide accounted for 18 percent of all deaths, a significant decrease from 1996, and suicide accounted for 13 percent of all deaths, a two percent decrease from 1996. Children's deaths from motor vehicle traffic totaled nearly 7,500, while deaths from firearms totaled more than 4,000 among children ages one to nineteen.
Infant mortality rates. The U.S. infant mortality rate for 1997 was 7.1 deaths per 1,000 live births, representing 27,691 infant deaths. Although this was the lowest rate on record and three percent lower than the 1996 total of 28,237 deaths, the United States still compares poorly to other industrialized nations in this category. Maine's infant mortality rate was lowest in the United States in 1997 (4.4 deaths per 1,000 live births); the District of Columbia's was the highest (14.1 deaths per 1,000 live births). In Massachusetts, the rate among the black population fell to 8.8 deaths per 1,000 live births, considerably lower than that rate for any other state. For the first time, this year's report included information about fetal deaths, for which the latest available data were from 1996 and showed a decline of 24.2 percent since 1980.
Childbirth issues. The rate of teenage pregnancies dropped for the sixth consecutive year in 1997. A higher percentage of pregnant women sought prenatal care in the first trimester in 1997 (82.5 percent) than in the previous year (81.9 percent). Compared to 1996, the number of Hispanic mothers who received late or no prenatal care decreased from 6.7 percent to 6.2 percent. These rates were unchanged for white and black mothers.
Low-birth-weight birth rates were at the highest level reported since 1973, influenced largely by significant increases in higher-order multiple birth rates (triplets and greater), which climbed 20 percent for 1996, the largest single-year increase in at least 25 years.
Population increase. Based on preliminary data, 1,580,000 persons were added to the U.S. population in 1997 as a result of natural increase (the excess of births over deaths). The rate of natural increase was 5.9 per 1,000 population, unchanged from 1996, but down slightly from the 1995 rate of 6.0 per 1,000.
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PEDIATRICS