Trends in postneonatal mortality attributable to injury, United States, 1988-1998.

OBJECTIVE Half of all postneonatal mortality (PNM; deaths among infants aged 28-364 days) in the United States is caused by potentially preventable causes such as sudden infant death syndrome, infections, and injuries. A detailed analysis of PNM attributable to injury has not been conducted and may provide useful data in prioritizing prevention strategies and targeting high-risk populations. METHODS The authors used US infant death certificate data to analyze trends in PNM caused by injury during 1988-1998. Attending physicians, medical examiners, or coroners report cause of death on death certificates using a format specified by the World Health Organization and endorsed by the Centers for Disease Control and Prevention. The major causes of PNM by type of injury were evaluated, and trends were compared over time. Injury-related deaths per 100 000 live births were examined by race and region of residence. Rate ratios between black and white infants also were calculated. RESULTS Among major causes of PNM during the study period, injury mortality declined the least (13.0% decline; from 29.6 to 25.7 per 100 000 live births). All types of unintentional injury deaths declined except for mechanical suffocation rates, which increased from 4.8 to 7.1. Homicide rates increased slightly (8.5%) from an 11-year low in 1988 and accounted for a greater proportion of all PNM caused by injury by 1998 (27.5% in 1998, 22.1% in 1988). Overall, PNM rates attributable to injury declined less among blacks (8.7%) than whites (13.6%) during the study period, and rates were on average 2.6 times higher among black infants (range: 2.4-3.0). Unintentional injury declined less among blacks (15.4%) than among whites (24.9%), in part because of an increase in motor vehicle crash-related mortality rates among black infants. Although black infants were more than 3 times as likely to be a victim of homicide than white infants (range: 3.0-4.4), increases in homicide rates were similar among black infants (9.9%) and white infants (10.6%) from 1988 through 1998. Racial disparities in PNM attributable to injury varied by region. PNM rates attributable to injury increased only among black infants residing in the Midwest (10.2%) and West (27.7%) as a result of increases in unintentional injury (ie, motor vehicle crash-related deaths in the West and mechanical suffocation in the Midwest) and homicide rates in these regions. Homicide rates increased among all infants regardless of race, except for infants residing in the Northeast. CONCLUSIONS Overall PNM rates attributable to injury declined, yet rates of mechanical suffocation increased and large regional and racial disparities persisted. Death certificates have limited information to help explain the observed differences. Because injuries are frequently preventable, prevention strategies should encourage formation of infant and child death review teams to help identify community and system factors that may contribute to injury deaths. Health care providers can assist parents in providing a safe environment for infants by counseling on age-appropriate injury prevention as part of their anticipatory guidance and serving as child advocates. Additional studies should examine regional differences in death investigation practices, case ascertainment, and reporting of deaths attributed to intentional injuries.