The decline in infant mortality in both the US and other countries is one of the triumphs of modern obstetric and neonatal care. The overall infant mortality rate in 2013 was 5.96 per 1,000, but infant mortality rates are much higher for non-Hispanic black infants (11.1) than for non-Hispanic white (5.06) or Hispanic infants (5.00). Infant mortality rates did decline for all three groups between 2005 and 2013.1
The news about spastic cerebral palsy (CP) is not as good. Research published this month in Pediatrics by Van Naarden Braun et al. (doi: 10.1542/peds.2015-2872) shows that the birth prevalence of spastic CP was stable from1985 to 2002, but racial disparity persisted between non-Hispanic black and non-Hispanic white infants.
Researchers from the Centers for Disease Control and Prevention used the data from the Metropolitan Atlanta Developmental Disabilities Surveillance Program. The system tracks CP, intellectual disability, hearing loss, vision impairment and autism spectrum disorders. The CDC scientists studied records of children at 8 years of age using administrative data from public school special education records and health care providers in the 5-county region of metropolitan Atlanta. Those records are linked to the birth certificate data in the Georgia vital statistics unit.
The birth prevalence of spastic CP per 1,000 infants changed little between 1985 (1.9 per 1,000 one-year survivors) and 2002 (1.8), and racial disparities between non-Hispanic black and non-Hispanic white children persisted (prevalence ratio of 1.8). The authors’ interpretation is that the stable prevalence of spastic CP during the 17-year study period suggests that infants with lower birthweights and gestational age are surviving without developing spastic CP. The authors say the stable trends in spastic CP are encouraging, but said further investigation is needed of the persistent disparities among racial groups.
The surveillance of developmental disabilities is important because it pinpoints differences in health status that can be identified early in life. Other researchers have studied disparities between black Americans and other groups in strokes, cardiovascular disease and access to care. This study suggests that sort of disparity spans the extremes of life. Clearly more work is needed.
1. Mathews TJ, MacDorman MF, Thorna ME. Infant Mortality Statistics From the 2013 Period: Linked Birth/Infant Death Data Set. National Vital Statistic Reports. Vol 64. No 9. August 6, 2015. http://www.cdc.gov/nchs/data/nvsr/nvsr64/nvsr64_09.pdf