Annual Summary of Vital Statistics—2002

Abstract

The crude birth rate in 2002 was 13.9 births per 1000 population, the lowest ever reported for the United States. The number of births, the crude birth rate, and the fertility rate (64.8) all declined slightly (by 1% or less) from 2001 to 2002. Fertility rates were highest for Hispanic women (94.0), followed by black (65.4), Asian or Pacific Islander (63.9), Native American (58.0), and non-Hispanic white women (57.5). Fertility rates declined slightly for all race/ethnic groups from 2001 to 2002. The birth rate for teen mothers continued to fall, dropping 5% from 2001 to 2002 to 42.9 births per 1000 women aged 15 to 19 years, another record low. The teen birth rate has fallen 31% since 1991; declines were more rapid for younger teens aged 15 to 17 (40%) than for older teens aged 18 to 19 (23%). The proportion of all births to unmarried women remained approximately the same at one third. Smoking during pregnancy continued to decline; smoking rates were highest among teen mothers. In 2002, 26.1% of births were delivered by cesarean section, up 7% since 2001 and 26% since 1996. The primary cesarean rate has risen 23% since 1996, whereas the rate of vaginal birth after a previous cesarean delivery has fallen 55%. The use of timely prenatal care increased slightly to 83.8% in 2002. From 1990 to 2002, the use of timely prenatal care increased by 6% (to 88.7%) for non-Hispanic white women, by 24% (to 75.2%) for black women, and by 28% (to 76.8%) for Hispanic women, thus narrowing racial disparities. The percentage of preterm births rose to 12.0% in 2002, from 10.6% in 1990 and 9.4% in 1981. Increases were largest for non-Hispanic white women. The percentage of low birth weight (LBW) births also increased to 7.8% in 2002, up from 6.7% in 1984. Twin and triplet/+ birth rates both increased by 3% from 2000 to 2001. Multiple births accounted for 3.2% of all births in 2001. The infant mortality rate (IMR) was 6.9 per 1000 live births (provisional data) in 2002 compared with 6.8 in 2001 (final data). The ratio of the IMR among black infants to that for white infants was 2.5 in 2001, the same as in 2000. Racial differences in infant mortality remain a major public health concern. The role of LBW in infant mortality remains a major issue. New Hampshire, Utah, and Massachusetts had the lowest IMRs. State-by-state differences in IMR reflect racial composition, the percentage of LBW, and birth weight-specific neonatal mortality rates for each state. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth reached a record high of 77.2 years for all sex and race groups combined in 2001. Death rates in the United States continue to decline. Between 2000 and 2001, death rates declined for the 3 leading causes of death: diseases of the heart, malignant neoplasms, and cerebrovascular diseases. Death rates for children ages 1 to 19 years decreased for unintentional injuries by 3.3% in 2001; the death rate for chronic lower respiratory diseases decreased by 25% in 2001. Can...

Differences associated with age, transfer status, and insurance coverage in end‐of‐life hospital care for children

“…These age-specific findings are consistent with vital statistics published separately for each of the study years regarding overall childhood mortality. [18][19][20] This study highlights what many health care providers may not recognize: to meet the needs of the greatest numbers of families with gravely ill children, EOL care efforts must focus on the very youngest. Many of these children may not have chronic conditions, which have been a central focus of many pediatric EOL efforts to date.…”

The cardiopulmonary system: research and training opportunities

“…Congenital heart disease is the major category of cardiovascular problems leading to neonatal morbidity and mortality. 1 Presently, most clinical and research efforts are directed toward diagnosis and surgical treatment of congenital heart disease. This biophysical model of congenital heart disease focuses on anatomic diagnostic techniques, evaluations for other anomalies, and surgical repair, which provides no information about cause.…”

“…Two facts about infant mortality are striking: although the overall infant mortality decreased to 6.8 per 1000 in the US in 2001, this rate exceeds that of 25 other countries, and there is a large racial disparity with an infant mortality of 14 per 1000 in black infants. 1 The delivery trends do not favor improving outcomes. In the US, the rates of preterm births, multiple births and higher order multiple births are increasing.…”

“…Lung-related problems contribute to about 20% of deaths and the combination of circulatory diseases and congenital malformations, which often include heart abnormalities, account for about 24% of infant mortality. 1 The number of very low birth weight infants with the highest morbidities and mortalities are increasing and, although their gestation-adjusted mortalities are decreasing, their morbidities are not. 2 The poor neurodevelopmental outcomes in very preterm infants must be a major research focus, and these outcomes correlate with cardiopulmonary abnormalities.…”

Secular Trends in Cesarean Delivery Rates among Macrosomic Deliveries in the United States, 1989 to 2002

“…The macrosomic categories were selected in accordance with previously published data indicating increasing risks of complications and adverse outcomes across the birth weight thresholds. 1 Since current data indicate that the rate of cesarean delivery is highest among non-Hispanic black women, 8,17 we will further assess trends among white, black and Hispanic subgroups. Notwithstanding the host of information concerning secular trends in cesarean rates, temporal changes in the delivery method of high birth weight infants has not been fully explored and may provide important insight regarding the outcomes experienced by this population.…”