Wegman M E
School of Public Health, University of Michigan, Ann Arbor 48109-2029.
Pediatrics. 1993 Dec;92(6):743-54.
A new low in the infant mortality rate was reached in 1992, at 848.7 deaths per 100,000 live births, a decline of 5% from 894.4 in 1991. Birth, death, and marriage rates were also lower, but the divorce rate inched up to 4.8 per 1000 population, the same level as in 1988. The age-adjusted death rate was 504.9 per 100,000 population, the lowest in US history. Natural increase in the population, excess of births over deaths, decreased from 1,941,389 to 1,907,000, from 7.7 to 7.5 per 1000 population. Births outside hospital were fewer, both in numbers and in proportion to all births. Birth rates increased at both ends of the age range but declined in the principal childbearing years. Births to unmarried mothers increased again, comprising more than one fifth of white births and two thirds of black births. A higher proportion of newborns weighed less than 2500 g than in 1989. Life expectancy at birth increased again, to 75.7 years overall, paralleled in both sexes and white and black races. The age-adjusted death rate for cardiovascular diseases declined, but malignancies of the respiratory system increased again, to almost six times what it was in 1940. Chronic obstructive pulmonary diseases, despite slight improvement since 1991, caused death more than eight times as often as in 1940. Black and white infant mortality rates both showed a decline, greater in the white neonatal component; the black/white discrepancy widened slightly. Infant mortality in those of Hispanic origin was slightly higher than non-Hispanic whites, but the National Center for Health Statistics warns that Hispanic rates may be understated. There was little change in causes of infant mortality, or in black to white ratios for the several causes. On the world scene, most industrialized countries showed declines in infant mortality matching the US. In 1991, 21 countries, 15 in Europe, 3 in Asia, 2 in Oceania, and 1 in North America, had infant mortality rates less than the US. The decline in most other countries has been more rapid than in the US.
1992年婴儿死亡率降至新低,为每10万例活产848.7例死亡,比1991年的894.4例下降了5%。出生、死亡和结婚率也有所下降,但离婚率微升至每1000人口4.8例,与1988年的水平相同。年龄调整后的死亡率为每10万人口504.9例,为美国历史最低。人口自然增长,即出生数超过死亡数的部分,从1941389人降至1907000人,从每1000人口7.7降至7.5。医院外出生的数量及其占所有出生数的比例均有所减少。年龄范围两端的出生率上升,但主要生育年龄段的出生率下降。未婚母亲生育的孩子数量再次增加,占白人出生数的五分之一以上,黑人出生数的三分之二。体重不足2500克的新生儿比例高于1989年。出生时的预期寿命再次提高,总体达到75.7岁,男女以及白人和黑人种族均如此。心血管疾病的年龄调整死亡率下降,但呼吸系统恶性肿瘤再次增加,几乎是1940年的六倍。慢性阻塞性肺疾病尽管自1991年以来略有改善,但导致死亡的频率仍是1940年的八倍多。黑人和白人婴儿死亡率均呈下降趋势,白人新生儿部分下降幅度更大;黑人与白人的差距略有扩大。西班牙裔婴儿死亡率略高于非西班牙裔白人,但美国国家卫生统计中心警告称,西班牙裔的死亡率可能被低估。婴儿死亡原因或几种原因的黑人与白人比例变化不大。在世界范围内,大多数工业化国家的婴儿死亡率下降幅度与美国相当。1991年,有21个国家,其中欧洲15个、亚洲3个、大洋洲2个、北美洲1个,其婴儿死亡率低于美国。大多数其他国家的下降速度比美国更快。