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Am J Perinatol 2019; 36(12): 1271-1277
DOI: 10.1055/s-0038-1675835
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Understanding State-Level Variations in the US Infant Mortality: 2000 to 2015

Alireza Ebrahimvandi
1   Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia
,
Niyousha Hosseinichimeh
1   Department of Industrial and Systems Engineering, Virginia Tech, Blacksburg, Virginia
,
Jay Iams
2   Department of Obstetrics and Gynecology, The Ohio State University Wexner Medical, Columbus, Ohio
› Author Affiliations
Funding This research was funded by Burroughs Wellcome Fund, grant no. PV5UUM5O (N.H., PI).
Further Information

Publication History

28 June 2018

16 October 2018

Publication Date:
24 December 2018 (online)

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Abstract

Objective To exploit state variations in infant mortality, identify diagnoses that contributed to reduction of the infant mortality rate (IMR), and examine factors associated with preterm-related mortality rate (PMR).

Study Design Using linked birth-infant deaths files, we examined patterns in the leading causes of IMR. We compared these rates at both national and state levels to find reduction trends. Creating a cross-sectional time series of states' PMR and some explanatory variables, we implemented a fixed-effect regression model to examine factors associated with PMR at the state level.

Results We found substantial state-level variations in changes of the IMR (range =  − 2.87–2.08) and PMR (−1.77–0.67). Twenty-one states in which the IMR declined more than the national average of 0.99 (6.89–5.90) were labeled as successful. In the successful states, we found reduction in the PMR accounted for the largest decline in the IMR—0.90 fewer deaths. Changes in the other subgroups of leading causes did not differ significantly in successful and unsuccessful states.

Conclusion Trends in the causes of mortality are heterogeneous across states. Although its impact is not large, reducing the percentage of pregnant women with inadequate care is one of the mechanisms through which the PMR decrease.

Keywords

infant mortality - state-level variations - preterm birth

Supplementary Material

 

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