Donna L Hoyert

Centers for Disease Control and Prevention, Druid Hills, GA, United States

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Publications (42)51.17 Total impact

  • Marian F Macdorman, Donna L Hoyert, T J Mathews
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    ABSTRACT: KEY FINDINGS Following a plateau from 2000 through 2005, the U.S. infant mortality rate declined 12% from 2005 through 2011. Declines for neonatal and postneonatal mortality were similar. From 2005 through 2011, infant mortality declined 16% for non-Hispanic black women and 12% for non-Hispanic white women. Infant mortality declined for four of the five leading causes of death during the 2005-2011 period. Infant mortality rates declined most rapidly among some, but not all, Southern states from 2005 through 2010. Despite these declines, states in the South still had among the highest rates in 2010. Rates were also high in 2010 in some states in the Midwest.
    NCHS data brief 04/2013;
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    ABSTRACT: The number of births in the United States declined by 1% between 2010 and 2011, to a total of 3 953 593. The general fertility rate also declined by 1% to 63.2 births per 1000 women, the lowest rate ever reported. The total fertility rate was down by 2% in 2011 (to 1894.5 births per 1000 women). The teenage birth rate fell to another historic low in 2011, 31.3 births per 1000 women. Birth rates also declined for women aged 20 to 29 years, but the rates increased for women aged 35 to 39 and 40 to 44 years. The percentage of all births to unmarried women declined slightly to 40.7% in 2011, from 40.8% in 2010. In 2011, the cesarean delivery rate was unchanged from 2010 at 32.8%. The preterm birth rate declined for the fifth straight year in 2011 to 11.72%; the low birth weight rate declined slightly to 8.10%. The infant mortality rate was 6.05 infant deaths per 1000 live births in 2011, which was not significantly lower than the rate of 6.15 deaths in 2010. Life expectancy at birth was 78.7 years in 2011, which was unchanged from 2010. Crude death rates for children aged 1 to 19 years did not change significantly between 2010 and 2011. Unintentional injuries and homicide were the first and second leading causes of death, respectively, in this age group. These 2 causes of death jointly accounted for 47.0% of all deaths of children and adolescents in 2011.
    PEDIATRICS 03/2013; 131(3):548-58. · 4.47 Impact Factor
  • Donna L Hoyert, Jiaquan Xu
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    ABSTRACT: This report presents preliminary U.S. data on deaths, death rates, life expectancy, leading causes of death, and infant mortality for 2011 by selected characteristics such as age, sex, race, and Hispanic origin.
    10/2012; 61(6):1-51.
  • Donna L Hoyert
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    ABSTRACT: While the overall risk of mortality decreased 60 percent over this 75-year period, there were fluctuations in the rate of decline most likely associated with changes in the broader environment. For example, the 29 percent decline in age-adjusted mortality in the earlier period from 1935 to 1954 was probably influenced by the introduction of various drugs such as antibiotics (2). In contrast, in the period 1955 to 1968, age-adjusted death rates decreased by only 2 percent, influenced in part by increases in diseases linked to tobacco use such as cancer and chronic lower respiratory diseases (3,4). In the most recent period from 1969 to 2010, significant progress in the prevention, diagnosis, and treatment of cardiovascular diseases (5) likely contributed to the 41 percent decline in age-adjusted mortality despite cancer continuing to increase from 1969 to 1990 and chronic lower respiratory diseases continuing to increase from 1969 to 1998. Because year-to-year changes in death rates are often small, one might not appreciate the full extent of progress in reducing mortality in the United States over the past ¾ of a century. For example, the 2010 age-adjusted death rate of 746.2 deaths per 100,000 population was just 0.5 percent lower than in 2009. However, the 2010 rate represented a 60 percent decrease from the 1935 age-adjusted death rate of 1,860.1 deaths per 100,000 population signaling significant progress in reducing the overall risk of death in the United States across all groups.
    NCHS data brief 03/2012;
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    Donna L Hoyert
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    ABSTRACT: An autopsy, the medical examination of a deceased person, may confirm clinical findings, provide more complete information to describe cause of death, or uncover conditions not recognized clinically prior to death. Two types are performed in the United States: a) hospital or clinical autopsies, which family or physicians request to clarify cause of death or assess care, and b) medicolegal autopsies, which legal officials order to further investigate the circumstances surrounding a death. The autopsy rate, or percentage of deaths that received this final assessment, was stable from the 1950s until the beginning of the 1970s, when the autopsy rate began to decrease. This report uses mortality data from the National Vital Statistics System (NVSS) over a 35-year period to examine changes in the autopsy rate and in the distribution of those autopsied by age and cause. Variation in autopsy patterns has implications for which deaths may have a more complete and conclusive cause-of-death determination.
    NCHS data brief 08/2011;
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    ABSTRACT: To estimate mortality ratios for all reported pregnancy deaths in the United States, 1999-2005, and to estimate the effect of the 1999 implementation of International Classification of Diseases, Tenth Revision (ICD-10) and adoption of the U.S. Standard Certificate of Death, 2003 Revision, on the ascertainment of deaths resulting from pregnancy. We combined information on pregnancy deaths from the National Vital Statistics System and the Pregnancy Mortality Surveillance System to estimate maternal (during or within 42 days of pregnancy) and pregnancy-related (during or within 1 year of pregnancy) mortality ratios (deaths per 100,000 live births). Data for 1995-1997, 1999-2002, and 2003-2005 were compared in order to estimate the effects of the change to ICD-10 and the inclusion of a pregnancy checkbox on the death certificate. The maternal mortality ratio increased significantly from 11.6 in 1995-1997 to 13.1 for 1999-2002 and 15.3 in 2003-2005; the pregnancy-related mortality ratio increased significantly from 12.6 to 14.7 and 18.1 during the same periods. Vital statistics identified significantly more indirect maternal deaths in 2002-2005 than in 1999-2002. Between 2002 and 2005, mortality ratios increased significantly among 19 states using the revised death certificate with a pregnancy checkbox; ratios did not increase in states without a checkbox. Changes in ICD-10 and the 2003 revision of the death certificate increased ascertainment of pregnancy deaths. The changes may also have contributed to misclassification of some deaths as maternal in the vital statistics system. Combining data from both systems estimates higher pregnancy mortality ratios than from either system individually.
    Obstetrics and Gynecology 07/2011; 118(1):104-10. · 4.80 Impact Factor
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    ABSTRACT: This report presents final 2006 data on U.S. deaths, death rates, life expectancy, infant and maternal mortality, and trends by selected characteristics such as age, sex, Hispanic origin, race, marital status, educational attainment, injury at work, state of residence, and cause of death. It also presents more detailed information than previously presented about the mortality experience of the American Indian or Alaska Native and the Asian or Pacific Islander populations. Information reported on death certificates, which are completed by funeral directors, attending physicians, medical examiners, and coroners, is presented in descriptive tabulations. The original records are filed in state registration offices. Statistical information is compiled in a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Prevention's National Center for Health Statistics. Causes of death are processed in accordance with the International Classification of Diseases, Tenth Revision (ICD-10). In 2006, a total of 2,426,264 deaths were reported in the United States. The age-adjusted death rate was 776.5 deaths per 100,000 standard population, a decrease of 2.8 percent from the 2005 rate and a record low historical figure. Life expectancy at birth rose 0.3 years, from a revised 2005 value of 77.4 years to a record 77.7 years in 2006. Age-specific death rates increased for those aged 25-34 years but decreased for most other age groups: 5-14 years, 35-44 years, 45-54 years, 55-64 years, 65-74 years, 75-84 years, and 85 years and over. The 15 leading causes of death in 2006 remained the same as in 2005. Heart disease and cancer continued to be the leading and second-leading causes of death, together accounting for almost half of all deaths. The infant mortality rate in 2006 was 6.69 deaths per 1,000 live births. Mortality patterns in 2006, such as the decline in the age-adjusted death rate to a record historical low, were generally consistent with long-term trends. Life expectancy increased in 2006 from 2005.
    National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 04/2009; 57(14):1-134.
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    ABSTRACT: This report presents final 2005 data on U.S. deaths, death rates, life expectancy, infant and maternal mortality, and trends by selected characteristics such as age, sex, Hispanic origin, race, marital status, educational attainment, injury at work, state of residence, and cause of death. This report presents descriptive tabulations of information reported on death certificates, which are completed by funeral directors, attending physicians, medical examiners, and coroners. The original records are filed in the state registration offices. Statistical information is compiled into a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Prevention's National Center for Health Statistics (NCHS). Causes of death are processed in accordance with the International Classification of Diseases, Tenth Revision (ICD-10). In 2005, a total of 2,448,017 deaths were reported in the United States. The age-adjusted death rate was 798.8 deaths per 100,000 standard population, representing a decrease of 0.2 percent from the 2004 rate and a record low historical figure. Life expectancy at birth remained the same as that in 2004-77.8 years. Age-specific death rates decreased for the age group 65-74 years but increased for the age groups 15-24 years, 25-34 years, and 45-54 years. The 15 leading causes of death in 2005 remained the same as in 2004. Heart disease and cancer continued to be the leading and second leading causes of death, together accounting for almost one-half of all deaths. The infant mortality rate in 2005 was 6.87 deaths per 1,000 live births. Generally, mortality patterns in 2005, such as the age-adjusted death rate declining to a record historical low, were consistent with long-term trends. Life expectancy in 2005 remained the same as that in 2004.
    National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 05/2008; 56(10):1-120.
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    ABSTRACT: US births increased 3% between 2005 and 2006 to 4,265,996, the largest number since 1961. The crude birth rate rose 1%, to 14.2 per 1000 population, and the general fertility rate increased 3%, to 68.5 per 1000 women 15 to 44 years. Births and birth rates increased among all race and Hispanic-origin groups. Teen childbearing rose 3% in 2006, to 41.9 per 1000 females aged 15 to 19 years, the first increase after 14 years of steady decline. Birth rates rose 2% to 4% for women aged 20 to 44; rates for the youngest (10-14 years) and oldest (45-49) women were unchanged. Childbearing by unmarried women increased steeply in 2006 and set new historic highs. The cesarean-delivery rate rose by 3% in 2006 to 31.1% of all births; this figure has been up 50% over the last decade. Preterm and low birth weight rates also increased for 2006 to 12.8% and 8.3%, respectively. The 2005 infant mortality rate was 6.89 infant deaths per 1000 live births, not statistically higher than the 2004 level. Non-Hispanic black newborns continued to be more than twice as likely as non-Hispanic white and Hispanic infants to die in the first year of life in 2004. For all gender and race groups combined, expectation of life at birth reached a record high of 77.9 years in 2005. Age-adjusted death rates in the United States continue to decline. The crude death rate for children aged 1 to 19 years decreased significantly between 2000 and 2005. Of the 10 leading causes of death for children in 2005, only the death rate for cerebrovascular disease was up slightly from 2000, whereas accident and chronic lower respiratory disease death rates decreased. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.
    PEDIATRICS 05/2008; 121(4):788-801. · 4.47 Impact Factor
  • Donna L Hoyert
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    ABSTRACT: This report presents data on U.S. deaths to pregnant or recently pregnant women, summarizes long-term processing issues, and examines recent changes affecting the data and the impact of the changes on the statistics for these women. This report presents descriptive tabulations of information reported on death certificates that are completed by funeral directors, attending physicians, medical examiners, and coroners. The original records are filed in the state registration offices. Statistical information is compiled into a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS). Causes of death are processed in accordance with the International Classification of Diseases (ICD). Maternal mortality fluctuates from year to year but was 12.1 deaths per 100,000 live births in 2003. The implementation of the International Classification of Diseases, Tenth Revision (ICD-10) in 1999 resulted in about a 13 percent increase in the number of deaths identified as maternal deaths between 1998 and 1999. The rate increased again between 2002 and 2003 after a separate pregnancy question became a standard item on the U.S. Standard Certificate of Death. The adoption of a standard separate question on pregnancy facilitates the identification of late maternal deaths. Maternal deaths increased with the introduction of the ICD-10 and with changes associated with the addition of a separate pregnancy status question on the U.S. Standard Certificate of Death. These changes may result in better identification of maternal deaths.
    Vital & health statistics. Series 3, Analytical and epidemiological studies / [U.S. Dept. of Health and Human Services, Public Health Service, National Center for Health Statistics] 03/2007;
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    ABSTRACT: This report presents 2003 fetal and perinatal mortality data by a variety of characteristics, including maternal age, marital status, race, Hispanic origin, and state of residence; and by infant birthweight, gestational age, plurality, and sex. Trends in fetal and perinatal mortality are also examined. Descriptive tabulations of data are presented and interpreted. The U.S. fetal mortality rate in 2003 was 6.23 fetal deaths of 20 weeks of gestation or more per 1,000 live births and fetal deaths. Fetal and perinatal mortality rates have declined slowly but steadily from 1990 to 2003. Fetal mortality rates for 28 weeks of gestation or more have declined substantially, whereas those for 20-27 weeks of gestation have not declined. Fetal mortality rates are higher for a number of groups, including non-Hispanic black women, teenagers, women aged 35 years and over, unmarried women, and multiple deliveries. Over one-half (51 percent) of fetal deaths of 20 weeks of gestation or more occurred between 20 and 27 weeks of gestation.
    National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 03/2007; 55(6):1-17.
  • Donna L Hoyert, Hsiang-Ching Kung, Jiaquan Xu
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    ABSTRACT: Objectives-This report presents information on autopsy data in 2003 and compares data for 1993 and 2003. Methods-Death certificates are completed by funeral directors, attending physicians, medical examiners, and coroners. The original records are filed in the state registration offices. Statistical information is compiled into a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Prevention's National Center for Health Statistics. This report focuses on the autopsy item on the death certificate and presents descriptive tabulations. Results-In 2003, autopsies were performed for 7.7 percent of deaths occurring in 47 states and the District of Columbia. This was less than in 1994, when the data was last available in this database. Decedents with particular characteristics were more likely to be autopsied than others. For example, almost one-third of infant deaths, more than one-half of decedents aged 15-24 years, and almost none of the decedents aged 85 years and over were autopsied.
    Vital and health statistics. Series 20, Data from the National Vital Statistics System. 03/2007;
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    ABSTRACT: Trends in preterm-related causes of death were examined by maternal race and ethnicity. A grouping of preterm-related causes of infant death was created by identifying causes that were a direct cause or consequence of preterm birth. Cause-of-death categories were considered to be preterm-related when 75 percent or more of total infant deaths attributed to that cause were deaths of infants born preterm, and the cause was considered to be a direct consequence of preterm birth based on a clinical evaluation and review of the literature. In 2004, 36.5 percent of all infant deaths in the United States were preterm-related, up from 35.4 percent in 1999. 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. The preterm-related infant mortality rate for non-Hispanic black mothers was higher than the total infant mortality rate for non-Hispanic white, Mexican, and Asian or Pacific Islander mothers. The leveling off of the U.S. infant mortality decline since 2000 has been attributed in part to an increase in preterm and low-birthweight births. Continued tracking of preterm-related causes of infant death will improve our understanding of trends in infant mortality in the United States.
    International Journal of Health Services 02/2007; 37(4):635-41. · 1.24 Impact Factor
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    ABSTRACT: This report presents final 2003 data on U.S. deaths; death rates; life expectancy; infant and maternal mortality; and trends by selected characteristics such as age, sex, Hispanic origin, race, marital status, educational attainment, injury at work, State of residence, and cause of death. A previous report presented preliminary mortality data for 2003 and summarized key findings in the final data for 2003. This report presents descriptive tabulations of information reported on death certificates, which are completed by funeral directors, attending physicians, medical examiners, and coroners. The original records are filed in the State registration offices. Statistical information is compiled into a national database through the Vital Statistics Cooperative Program of the Centers for Disease Control and Prevention's, National Center for Health Statistics (NCHS). Causes of death are processed in accordance with the International Classification of Diseases, Tenth Revision (ICD-10). In 2003, a total of 2,448,288 deaths were reported in the United States. The age-adjusted death rate was 832.7 deaths per 100,000 standard population, representing a decrease of 1.5 percent from the 2002 rate and a record low historical figure. Life expectancy at birth rose by 0.2 years to a record high of 77.5 years. Considering all deaths, age-specific death rates rose only for those 45-54 years and declined for the age groups 55-64 years, 65-74 years, 75-84 years, and 85 years and over. For the most part, the 15 leading causes of death in 2003 remained the same as in 2002. Heart disease and cancer continued to be the leading and second leading causes of death, together accounting for over half of all deaths. Homicide became the 15th leading cause in 2003, dropping from the 14th leading cause in 2002. Pneumonitis dropped out of the top 15 altogether, and Parkinson's disease entered the list as the 14th leading cause of death. The infant mortality rate in 2003 was 6.85 per 1,000 births. Generally, mortality patterns in 2003 were consistent with long-term trends. Life expectancy in 2003 increased again to a new record level. The age-adjusted death rate declined to a record low historical figure. The infant mortality rate decreased significantly in 2003; except for 2002, it either decreased or remained level each successive year from 1958 to 2003.
    National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 05/2006; 54(13):1-120.
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    ABSTRACT: The crude birth rate in 2004 was 14.0 births per 1000 population, the second lowest ever reported for the United States. The number of births and the fertility rate (66.3) increased slightly (by <1%) from 2003 to 2004. Fertility rates were highest for Hispanic women (97.7), followed by Asian or Pacific Islander (67.2), non-Hispanic black (66.7), Native American (58.9), and non-Hispanic white (58.5) women. The birth rate for teen mothers continued to fall, dropping 1% from 2003 to 2004 to 41.2 births per 1000 women aged 15 to 19 years, which is another record low. The teen birth rate has fallen 33% since 1991; declines were more rapid for younger teens aged 15 to 17 (43%) than for older teens aged 18 to 19 (26%). The proportion of all births to unmarried women is now slightly higher than one third. Smoking during pregnancy declined slightly from 2003 to 2004. In 2004, 29.1% of births were delivered by cesarean delivery, up 6% since 2003 and 41% since 1996 (20.7%). The primary cesarean delivery rate has risen 41% since 1996, whereas the rate of vaginal birth after a previous cesarean delivery has fallen 67%. The use of timely prenatal care was 84.0% in both 2003 and 2004. The percentage of preterm births rose to 12.5% in 2004 from 10.6% in 1990 and 9.4% in 1981. The percentage of low birth weight births also increased to 8.1% in 2004, up from 6.7% in 1984. Twin birth rate and triplet/+ birth rates increased by 1% and <1%, respectively, from 2002 to 2003. Multiple births accounted for 3.3% of all births in 2003. The infant mortality rate was 7.0 per 1000 live births in 2002 compared with 6.8 in 2001. The ratio of the infant mortality rate among non-Hispanic black infants to that for non-Hispanic white infants was 2.4 in 2002, the same as in 2001. The United States continues to rank poorly in international comparisons of infant mortality. Expectation of life at birth reached a record high of 77.6 years for all gender and race groups combined. Death rates in the United States continue to decline, with death rates decreasing for 8 of the 15 leading causes. Death rates for children < or =19 years of age declined for 7 of the 10 leading causes in 2003. The death rates did not increase for any cause, and rates for heart disease, influenza, and pneumonia and septicemia did not change significantly for children as a group. A large proportion of childhood deaths, however, continue to occur as a result of preventable injuries.
    PEDIATRICS 01/2006; 117(1):168-83. · 4.47 Impact Factor
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    Donna L Hoyert, Hsiang-Ching Kung, Betty L Smith
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    ABSTRACT: This report presents preliminary U.S. data on deaths, death rates, life expectancy, leading causes of death, and infant mortality for the year 2003 by selected characteristics such as age, sex, race, and Hispanic origin. Data in this report are based on a large number of deaths comprising approximately 93 percent of the demographic file and 91 percent of the medical file for all deaths in the United States in 2003. The records are weighted to independent control counts for 2003. For certain causes of death such as unintentional injuries, homicides, suicides, and respiratory diseases, preliminary, and final data differ because of the truncated nature of the preliminary file. Comparisons are made with 2002 final data. The age-adjusted death rate for the United States decreased from 845.3 deaths per 100,000 population in 2002 to 831.2 deaths per 100,000 population in 2003. Age-adjusted death rates decreased between 2002 and 2003 for the following causes: Diseases of heart, Malignant neoplasms, Cerebrovascular diseases, Accidents (unintentional injuries), Influenza and pneumonia, Intentional self-harm (suicide), Chronic liver disease and cirrhosis, and Pneumonitis due to solids and liquids. They increased between 2002 and 2003 for the following: Alzheimer's disease, Nephritis, nephrotic syndrome and nephrosis, Essential (primary) hypertension and hypertensive renal disease, and Parkinson's disease. Life expectancy at birth rose by 0.3 years to a record high of 77.6 years.
    National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 03/2005; 53(15):1-48.
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    ABSTRACT: The U.S. infant mortality rate (IMR) increased from 6.8 infant deaths per 1,000 live births in 2001 to 7.0 in 2002, the first increase in more than 40 years. From 2001 to 2002, IMR increased for very low birthweight infants as well as for preterm and very preterm infants. Although IMR for very low birthweight infants increased, most of the increase in IMR from 2001 to 2002 was due to a change in the distribution of births by birthweight and, more specifically, to an increase in infants born weighing less than 750 grams. The majority of infants born at less than 750 grams die within the first year of life; thus, these births contribute disproportionately to overall IMR. Increases in births at less than 750 grams occurred fornon-Hispanic white, non-Hispanic black, and Hispanic women. Most of the increase occurred among mothers 20 to 34 years of age. Although multiple births contributed disproportionately, most of the increase in births at less than 750 grams occurred among singletons. Three hypotheses were evaluated to assess their possible impact on the increase in less than 750-gram births: possible changes in (1) the reporting of births or fetal deaths, (2) the risk profile of births, and (3) medical management of pregnancy. Although each of these factors may have contributed to the increase, the relative effects of these and other factors remain unclear. More detailed studies are needed to further explain the 2001-2002 infant mortality increase.
    International Journal of Health Services 02/2005; 35(3):415-42. · 1.24 Impact Factor
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    ABSTRACT: The U.S. infant mortality rate increased from 6.8 infant deaths per 1,000 live births in 2001 to 7.0 in 2002, the first increase in more than 40 years. From 2001 to 2002 infant mortality rates increased for very low birthweight infants as well as for preterm and very preterm infants. Although infant mortality rates for very low birthweight infants increased, most of the increase in the infant mortality rate from 2001 to 2002 was due to a change in the distribution of births by birthweight and, more specifically, to an increase in infants born weighing less than 750 grams (1 lb 10 1/2 oz). The majority of infants born weighing less than 750 grams die within the first year of life; thus, these births contribute disproportionately to the overall infant mortality rate. Increases in births at less than 750 grams occurred for non-Hispanic white, non-Hispanic black, and Hispanic women. Most of the increase occurred among mothers 20-34 years of age. Although multiple births contributed disproportionately, most of the increase in births at less than 750 grams occurred among singletons. Three hypotheses were evaluated to assess their possible impact on the increase in less than 750-gram births: first, possible changes in the reporting of births or fetal deaths; second, possible changes in the risk profile of births; and third, possible changes in medical management of pregnancy. Although each of these factors may have contributed to the increase, the relative effects of these and other factors remain unclear. More-detailed studies are needed to further explain the 2001-02 infant mortality increase.
    National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 02/2005; 53(12):1-22.
  • Donna L Hoyert
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    ABSTRACT: The National Vital Statistics System is the fundamental source of mortality statistics in the United States. The cause-of-death classification which is used to assign medical terms to a standard taxonomy is revised periodically, and it is necessary to account for these changes when investigating trends. This paper presents birth defects mortality statistics and preliminary information on the most recent transition between revisions of the classification. Descriptive statistics are presented using multiple cause and underlying cause counts, rankings of leading causes of death, infant mortality rates, and age-adjusted death rates. Comparability results are based upon records that have been coded using two separate classifications. Birth defects remain the leading cause of death for infants and among the leading causes for younger age groups. The trend for birth defect mortality shows that the risk of dying from birth defects decreased between 1950 and 2000. The effect of implementing successive revisions of the cause-of-death classification was relatively minor until the implementation of the most recent revision. Fewer records are assigned to birth defects in the latest revision than in the previous revision. Researchers investigating mortality trends related to birth defects need to be aware that the cause-of-death classification changes periodically. The effect of the changes between two successive classifications can be measured and explained.
    Birth Defects Research Part A Clinical and Molecular Teratology 10/2003; 67(9):651-5. · 2.27 Impact Factor
  • Joyce A Martin, Donna L Hoyert
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    ABSTRACT: The most comprehensive source of US data on fetal deaths of 20 gestational weeks or greater is available through the National Vital Statistics System (NVSS). The NVSS is a collaborative effort between the independent reporting areas (the individual States and the territories), and the federal government or its agent, the Centers for Disease Control, and Prevention's National Center for Health Statistics (NCHS). The federal government has no authority to register vital events. The registration of births, deaths, fetal deaths, marriages, and divorces is solely a state responsibility. However, NCHS is mandated by law to produce national data based on vital events. To promote the uniformity necessary to create a national file from this decentralized system, NCHS attempts to influence state systems via the development of certain standards, primarily, The Model State Vital Statistics Act and Regulations (The Model Law), and the Standard Certificates and Reports. The Model Law definitions for live birth, fetal death and induced termination of pregnancy are based on international standards set by The World Health Organization. All states have definitions of fetal death consistent with the Model Law. The Model Law also recommends reporting requirements for fetal death, but state requirements vary. This variation results in differences in reporting of fetal deaths among areas. Other limitations to the national fetal death file include: the under-reporting of fetal deaths incidence, higher than acceptable levels of missing data for some items, and the accuracy of the data reported. Also of concern is the potential misclassification of fetal deaths and short-lived live births. These limitations are amenable to improvement. The upcoming revision of the US Standard Report of Fetal Death addresses these issues and offers an opportunity to strengthen the quality of fetal death data. The development of worksheets, detailed specifications and instruction manuals, and a reformatted cause of death section should importantly enhance the quality of national fetal death file and ultimately reduce the incidence of these tragic events.
    Seminars in Perinatology 03/2002; 26(1):3-11. · 2.81 Impact Factor