Annual Summary of Vital Statistics?2001 
Marian F. MacDorman, Arialdi M. Minino, Donna M. Strobino and Bernard Guyer 
Pediatrics 2002;110;1037-1052 
DOI: 10.1542/peds.110.6.1037 
This information is current as of February 3, 2005 
The online version of this article, along with updated information and services, is
located on the World Wide Web at: 
http://www.pediatrics.org/cgi/content/full/110/6/1037 
PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly
publication, it has been published continuously since 1948. PEDIATRICS is owned, published, 
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
Grove Village, Illinois, 60007. Copyright ? 2004 by the American Academy of Pediatrics. All 
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275. 
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PEDIATRICS











Dec 2002 


VOL. 110 


NO. 6 


Annual Summary of Vital Statistics?2001
Marian F. MacDorman, PhD*; Arialdi M. Minino, MPH*; Donna M. Strobino, PhD?; and
Bernard Guyer, MD, MPH?
ABSTRACT. The number of births, the crude birth rate 5%, whereas the rate of vaginal birth after a previous
(14.5 in 2001), and the fertility rate (67.2 in 2001) all cesarean delivery tumbled 20%.
declined slightly (by 1% or less) from 2000 to 2001. Fer- In 2001, the provisional infant mortality rate was 6.9
tility rates were highest for Hispanic women (107.4), fol- per 1000 live births, the same as in 2000. Racial differ-
lowed by Native American (70.7), Asian or Pacific Is- ences in infant mortality remain a major public health
lander (69.4), black (69.3), and non-Hispanic white concern, with the rate for infants of black mothers 2.5
women (58.0). During the early to mid 1990s, fertility times those for infants of non-Hispanic white or His-
declined for non-Hispanic white, black, and American panic mothers. In 2000, 66% of all infant deaths occurred
Indian women. Rates for these population groups have among the 7.6% of infants born low birth weight. Among
changed relatively little since 1995; however, fertility has all states, Maine and Massachusetts had the lowest infant
increased for Asian or Pacific Islander and Hispanic mortality rates. The United States continues to rank
women.
The birth rate for teen mothers continued to fall, drop- poorly in international comparisons of infant mortality.
ping 5% from 2000 to 2001 to 45.9 births per 1000 females The provisional death rate in 2001 was 8.7 deaths per
aged 15 to 19 years, another record low. The teen birth 1000 population, the same as the 2000 final rate. In 2000,
rate has fallen 26% since 1991; declines were more rapid unintentional injuries and homicide remained the lead-
(35%) for younger teens aged 15 to 17 years than for older ing and second-leading causes of death for children 1 to
teens aged 18 to 19 years (20%). The proportion of all 19 years of age, although the death rate for homicide
births to unmarried women remained about the same at decreased by 10% from 1999 to 2000. Among uninten-
one-third. Smoking during pregnancy continued to de- tional injuries to children, two-thirds were motor vehi-
cline; smoking rates were highest among teen mothers. cle-related; among homicides, two-thirds were
The use of timely prenatal care increased slightly to firearm-related. Pediatrics 2002;110:1037?1052; birth, birth
83.4% in 2001. From 1990 to 2001, the use of timely pre- weight-specific mortality, death, infant mortality, low
natal care increased by 6% (to 88.5%) for non-Hispanic birth weight, mortality, multiple births, vital statistics,
white women, by 23% (to 74.5%) for black women, and International Classification of Diseases, 10th Revision,
by 26% (to 75.7%) for Hispanic women. The number and year 2001 population.
rate of twin births continued to rise, but the triplet/

birth rate declined for the second year in a row. For the
first year in almost a decade, the preterm birth rate de- ABBREVIATIONS. CDC, Centers for Disease Control and Preven-
clined (to 11.6%); however, the low birth weight rate was tion; NCHS, National Center for Health Statistics; IMR, infant
unchanged at 7.6%. The total cesarean delivery rate mortality rate; NMR, neonatal mortality rate; PNMR, postneonatal
jumped 7% from 2000 to 2001 to 24.4% of all births, the mortality rate; TFR, total fertility rate; LBW, low birth weight;
highest level reported since these data became available VBAC, vaginal births after previous cesarean; VLBW, very low
on birth certificates (1989). The primary cesarean rate rose birth weight.
his article is a long-standing feature in Pediat-
From the *Division of Vital Statistics, National Center for Health Statistics, rics. This year we have included a new section
Centers for Disease Control and Prevention, Hyattsville, Maryland; and the Ton preterm birth, thus providing additional
?Department of Population and Family Health Sciences, Johns Hopkins
Bloomberg School of Public Health, Baltimore, Maryland. detail about an important measure of infant health,
Received for publication Sep 24, 2002; accepted Sep 25, 2002. and a section on deaths on September 11, 2001. We
Reprint requests to (M.F.M.) National Center for Health Statistics, Centers have also included, for the first time since 1999,1
for Disease Control and Prevention, 6525 Belcrest Rd, Room 820, Hyatts- state-by-state comparisons of neonatal mortality
ville, MD 20782. E-mail: mmacdorman@cdc.gov
PEDIATRICS (ISSN 0031 4005). Copyright ? 2002 by the American Acad- rates for 500- to 1499-g infants, to provide an indica-
emy of Pediatrics. tor of the effectiveness of neonatal care. In addition,
PEDIATRICS Vol. 110 No. 6 December 2002 1037
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we have included a special section focusing on the infant deaths at 7 days of age. Fetal mortality rates are shown for
impact of the 2000 census on vital statistics data. fetal deaths at 20
 weeks of gestation. Fetal and perinatal mor-
For birth data, the most current information (2001) tality rates were computed by dividing the number of fetal orperinatal deaths by the number of live births plus fetal deaths.
was based on preliminary data, whereas more de- IMRs, NMRs, PNMRs, and fetal and perinatal mortality rates are
tailed analyses were based on final data (2000). For all shown per 1000 births (births plus fetal deaths for fetal and
mortality data, the 2001 preliminary data were not perinatal mortality rates).
available at the time of manuscript preparation, so The latest infant mortality statistics by birth weight were ob-
2001 provisional data were used. However, because tained from the 2000 period linked birth-infant death data set.
10 In
this data set, the death certificate was linked with the correspond-
the 2001 provisional data contain considerably less ing birth certificate for each infant who died in the United States
detail, most of the analysis of mortality data uses in 2000. The purpose of this linkage is to use additional variables
2000 final data. For childhood deaths, we have ex- available from the birth certificate, such as birth weight, to better
panded our previous analysis of 2000 mortality data2 interpret infant mortality patterns. Numbers of infant deaths wereweighted to compensate for the 1% to 2% of infant deaths for
to include information on childhood firearm and whom the matching birth certificate could not be identified.10 The
motor vehicle injuries. However, we have not re- weighting procedure results in the same overall IMR as that based
peated information on infant and general mortality on unlinked mortality data; however, small differences may exist
for 2000 for leading causes of death shown previous- because of geographic coverage differences, additional quality
ly,2 although we expect to include these data again in control, and weighting.
10
Population denominators for the calculation of birth, death, and
next year?s article. fertility rates are estimates of the US population as of July 1 of each
year, produced by the US Census Bureau.11,12 All population
denominators for this article for years since 1990 (including 2000
METHODS and 2001) are estimates based on the 1990 census. NCHS/CDC
The data presented in this report were obtained from vital will recalculate the population-based rates for the 1990s and 2000
statistics records?birth certificates, fetal death reports, and death when population estimates from the 2000 census and intercensal
certificates for residents of the United States. Data for 2000 and estimates become available. Because of differences between post-
earlier years are final and include all records. Birth data for 2001 censal estimated and census counts, it is expected that rates based
are preliminary and are based on over 96% of births reported to on the 2000 census will differ from those based on the 1990
the Centers for Disease Control and Prevention?s (CDC) National census-based estimates. Rates for Hispanics in particular are be-
Center for Health Statistics (NCHS). Mortality data for 2001 are lieved to be overstated by approximately 8% to 10%.3
provisional and are based on counts of death certificates reported International data on births, birth rates, and infant mortality
to NCHS by state health departments. More complete descriptions rates were obtained from United Nations sources including the
of vital statistics data systems are available elsewhere.3?6 Prelim- 1998 Demographic Yearbook,13 and the Population and Vital Statistics
inary birth and provisional mortality estimates for 2001 may differ Reports, Statistical Papers, with the most recent data as of January 1,
from the final data for 2001 that will include all records, but 2001,14 and January 1, 2002.15 If there was a discrepancy between
differences are usually small. figures for the 1998 Demographic Yearbook and the later reports, the
Current vital statistics patterns and recent trends through 2001 later report was used. Data on IMRs were not available for 1999 for
are presented in this report by state of residence, age, race, and 5 countries, although for 2 of these countries, provisional data
Hispanic origin, as well as other birth and death characteristics. were available for 2000.
More detailed data are available in the final birth files for 2000
than in the preliminary files for 2001, so some of the detailed NATURAL INCREASE
analyses of birth patterns focus on the 2000 data.
Hispanic origin and race are collected as separate items in vital As a result of natural increase (the excess of births
records. Persons of Hispanic origin may be of any race, although over deaths), 1.6 million persons were added to the
most births and infant deaths of Hispanic origin (97%) are to white population in 2000 (Table 1).5,6 The rate of natural
women. Because there are often important differences in child- increase was 5.8 persons per 1000 population in 2001
bearing patterns between non-Hispanic white and Hispanic
women, all tables which present data by race include data sepa- (based on preliminary and provisional data), com-
rately for non-Hispanic white and Hispanic women. pared with 6.0 in 2000.
The mother?s marital status for birth data, underlying cause of
death for deaths, and birth weight for infant deaths have the BIRTHS
following special considerations. Mother?s marital status was re-
ported directly on the birth certificates or through the electronic The number of births in the United States de-
birth registration process in all but 2 states (Michigan and New creased slightly in 2001 to 4 040 121 (preliminary
York) in 2000 and 2001. Details about the reporting of marital data), down 1% compared with the final total for
status in those 2 states and methods of edits and imputations 2000 (Table 1).5 The birth rate in 2001 was 14.5 births
applied to other items on the birth certificate are presented in
NCHS publications.3,5,7 per 1000 population, down 1% from the rate for 2000
Cause of death statistics in this report are based solely on the (14.7). The fertility rate, defined as the number of
underlying cause of death. The underlying cause of death is births per 1000 women aged 15 to 44 years, also
defined as ?(a) the disease or injury which initiated the train of decreased slightly to 67.2 in 2001, compared with
morbid events leading directly to death, or (b) the circumstances 67.5 in 2000. Following declines from 1991?1997, the
of the accident or violence which produced the fatal injury.? From 3
1999 to the present, cause of death data in the United States have fertility rate had increased from 1998 to 2000.
been classified according to the International Classification of Dis-
eases, 10th Revision.8 From 1979?1998, cause of death data in the Racial and Ethnic Composition
United States were classified according to the International Classi- Fertility rates vary among race and ethnicity
fication of Diseases, Ninth Revision.9
Infant mortality refers to the death of an infant under 1 year of groups, although the disparity has narrowed in re-
age. Infant mortality rates (IMRs) were computed by dividing the cent years for most groups. The rate for Hispanic
total number of infant deaths in each calendar year by the total women (107.4 births per 1000 aged 15?44 years in
number of live births in the same year.4,6,10 Neonatal mortality preliminary 2001 data) remains the highest.5 Rates in
rates (NMRs) are shown for infants dying between 0 and 27 days
of age, and postneonatal mortality rates (PNMRs) are shown for 2001 were considerably lower for black (69.3), Native
infants dying between 28 days and 1 year of age. Perinatal mor- American (70.7), and Asian or Pacific Islander
tality rates include fetal deaths at 28
 weeks of gestation and women (69.4), and substantially lower for non-His-
1038 ANNUAL SUMMARY OF VITAL STATISTICS?2001
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TABLE 1. Vital Statistics of the United States, 1915?2001 (Selected Years)
Item Number Rate*
2001 2000 1999 2001 2000 1999 1990 1980 1950 1915?
Live births 4 040 121 4 058 814 3 959 417 14.5 14.7 14.5 16.7 15.9 24.1 29.5
Fertility rate 67.2 67.5 65.9 70.9 68.4 106.2 125.0
Deaths 2 419 000 2 403 351 2 391 399 8.7 8.7 8.8 8.6 8.8 9.6 13.2
Age-adjusted rate ? 8.7 8.8 9.4 10.4 14.5 21.7
Natural increase 1 621 121 1 655 463 1 568 018 5.8 6.0 5.8 8.1 7.1 14.5 16.3
Infant mortality 27 600 28 035 27 937 6.9 6.9 7.1 9.2 12.6 29.2 99.9
Population base (in 277 740 275 265 272 691 248 710 226 546 150 697 100 546
thousands)
* Rates per 1000 population except for fertility, which is per 1000 women aged 15 to 44 years and infant mortality, which is per 1000 live
births.
? Birth rate adjusted to include states not in registration area (10 states and the District of Columbia when started in 1915). Death rate is
for death registration area. Infant mortality rate is for birth registration area.
?Data not available.
Notes: Birth data for 2001 are preliminary: mortality and infant mortality data for 2001 are provisional. All data for 2000 and earlier years
are final. Populations are as of July 1 for 1999, 2000, and 2001, and as of April 1 in 1950, 1980, and 1990. Population for 1915 is the midyear
estimate based on the April 15, 1910 census.
Source: CDC/NCHS, National Vital Statistics System and the US Census Bureau.
panic white women (58.0, tabular data not shown). nary data) was 5% lower than in 2000 (48.5), and is
Between 2000 and 2001, fertility rates declined for non- the lowest rate in 6 decades for which comparable
Hispanic white, black, Native American, and Asian or data have been available.5,16 The number of births to
Pacific Islander women, but rose for Hispanic women. teenagers declined in 2001, entirely as a result of the
In 2001, 21% of all births in the United States were to declining birth rate; in fact, the number of female
Hispanic women, compared with 14% in 1989 when teenagers has increased steadily since 1993.11,12
national data became available for this group. Teen birth rates declined for all age, race, and His-
Among populations of Hispanic origin for which panic origin groups from 2000 to 2001 (Table 3). The
fertility rates can be reliably computed, Mexican rate for the youngest teens, aged 10 to 14 years, was 0.8
American women continue to have the highest fer- per 1000; the number of births in this age group in 2001
tility, with a rate of 115.1 per 1000 in 2000 (Table 2), (7791) was the fewest since 1965. In 2001, teen birth
and the highest age-specific birth rates among rates ranged from 20.5 for Asian or Pacific Islander
women under age 30. In contrast, Asian or Pacific teens to 92.4 for Hispanic teens. Teen birth rates de-
Islander women have the highest rates among clined during the 1990s for all race and Hispanic origin
women age 30 and older.3 groups (Fig 1; Table 3),3,5,16 although the rate for His-
panic teens has declined only since the mid 1990s. On
Trends in Age-Specific Birth Rates the other hand, the rate for black teenagers in 2001 was
Teen Childbearing lower than in any year since 1960 when data for black
The birth rate for teenagers dropped 26% between women first became available.17 The reduction in the
1991, when it reached a 20-year high (62.1 per 1000 birth rate for black teens aged 15 to 17 is most striking,
aged 15?19), and 2001 (45.9). The 2001 rate (prelimi- as this rate declined 46% from 1991 to 2001.3,16
TABLE 2. Live Births, Age-Specific Birth Rates,* and TFRs by Race and Hispanic Origin of Mother: United States, Final, 2000
Live Births Age-Specific Birth Rate by Age of Mother* TFR?
15?44? 15?17 18?19 20?24 25?29 30?34 35?39 40?44
Total 4 058 814 67.5 27.4 79.2 112.3 121.4 94.1 40.4 7.9 2130.0
White 3 194 005 66.5 23.6 72.7 107.9 124.3 97.4 40.7 7.8 2113.5
Black 622 598 71.7 50.4 121.3 144.2 105.3 67.5 32.2 7.2 2193.0
Native American? 41 668 71.4 39.6 113.1 135.6 106.9 68.3 32.5 7.3 2100.5
Asian/Pacific Islander 200 543 70.7 11.5 37.0 72.0 125.8 120.8 60.4 12.7 2072.5
All Hispanic 815 868 105.9 60.0 143.6 184.6 170.8 109.0 48.7 11.6 3108.0
Mexican 581 915 115.1 65.0 154.5 197.9 175.4 112.4 50.7 12.2 3265.5
Puerto Rican 58 124 84.3 63.2 143.1 181.3 121.3 74.2 34.1 6.7 2584.0
Cuban 13 429 57.3 16.5 42.2 74.2 138.9 84.1 42.0 8.5 1871.0
Central and South 162 400 94.3 47.0 118.0 154.5 180.2 117.7 50.2 12.4 2969.5
American and other
Non-Hispanic white 2 362 968 58.5 15.8 56.8 89.6 112.8 94.0 39.0 7.2 1879.0
* Rates per 1000 women in age-specific group.
? Sum of age-specific birth rates times 5 divided by 1000 (includes rates for ages 10?14 and 45?49 years, not shown separately).
? Relates the number of births to women of all ages to women aged 15 to 44 years.
? Includes births to Aleuts and Eskimos.
Note: Race and Hispanic origin are reported separately on birth certificates. Persons of Hispanic origin may be of any race. In this table,
Hispanic women are classified only by place of origin; non-Hispanic women are classified by race. Populations are from the US Census
Bureau and are based on the 1990 Census. See section on Impact of the 2000 Census on vital statistics rates.
Source: CDC/NCHS, National Vital Statistics System, natality.
ARTICLES 1039
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TABLE 3. Birth Rates* for Teens, by Age, Race, and Hispanic Origin: United States, Final, Selected Years, 1990?2000 and Preliminary
2001
Age and Race and 2001 2000 1999 1991 1990? Percent
Hispanic Origin of Change
Mother 1991?2001
15?19 y
All races? 45.9 48.5 49.6 62.1 59.9 26
White, total 41.7 43.6 44.6 52.8 50.8 21
White, non-Hispanic 30.2 32.5 34.0 43.4 42.5 30
Black, total 73.1 79.4 81.0 115.5 112.8 37
Hispanic 92.4 94.4 93.4 106.7 100.3 13
15?17 y
All races? 25.3 27.4 28.7 38.7 37.5 35
White, total 21.9 23.6 24.8 30.7 29.5 29
White, non-Hispanic 14.2 15.8 17.1 23.6 23.2 40
Black, total 45.6 50.4 52.0 84.1 82.3 46
Hispanic 56.9 60.0 61.3 70.6 65.9 19
18?19 y
All races? 75.8 79.2 80.3 94.4 88.6 20
White, total 70.1 72.7 73.5 83.5 78.0 16
White, non-Hispanic 53.4 56.8 58.9 70.5 66.6 24
Black, total 113.0 121.3 122.8 158.6 152.9 29
Hispanic 143.1 143.6 139.4 158.5 147.7 10
* Rates per 1000 women in specified group.
? Includes races other than white and black.
? Excludes data for New Hampshire and Oklahoma, which did not report Hispanic origin.
Note: Race and Hispanic origin are reported separately on birth certificates. Persons of Hispanic origin may be of any race. In this table,
Hispanic women are classified only by place of origin; non-Hispanic women are classified by race. Populations are from the US Census
Bureau and are based on the 1990 Census. See section on Impact of the 2000 Census on vital statistics rates.
Source: CDC/NCHS, National Vital Statistics System, natality.
rates were driven by reductions in first birth rates,
which account for nearly 4 in 5 teen births. Rates for
repeat teen births have stabilized since 1996 after
falling in the early 1990s.16 Repeat births account for
only 21% of all teen births, but are of particular
concern; as a teenager with 2 or more children is at
greater risk for a host of difficulties.5,19
Childbearing for Women 20 Years of Age and Older
From 2000 to 2001, the birth rates for women 20 to
24 years of age decreased 2% to 110.2, while the rate
for 25- to 29-year-olds increased 1% to 121.8 (pre-
liminary data). Rates for women in these age groups
have been relatively stable over the last 2 decades.3
Birth rates for women in their thirties continued to
increase in 2001, to their highest levels in at least 30
years, to 95.6 per 1000 aged 30 to 34 and 41.4 per 1000
aged 35 to 39 years. Birth rates also rose for women
in their forties, reaching 8.1 per 1000 women aged 40
to 44 years in 2001, and more than doubling since
Fig 1. Birth rate for teens 15 to 19 years of age by race and 1981 (3.8). The steady upward trend in the rates for
Hispanic origin: United States, 1980?2001. women in their thirties and forties reflects in large
part the ongoing tendency for many women to make
up for previously postponed childbearing.3,20
Among teenagers, an estimated 55% of pregnan- The total fertility rate (TFR) is an estimate of the
cies ended in live birth, 29% in induced abortion, and number of births that a hypothetical group of 1000
15% in fetal loss in 1997, the most recent year for women would have if they experienced, throughout
which abortion statistics are available.18 During the their childbearing years, the age-specific birth rates
1990?1997 period, teenage birth rates fell 13%, while observed in a given year. Because it is computed
abortion rates fell much more, by nearly a third. from age-specific birth rates, the TFR is age-adjusted;
Patterns by age, race, and ethnicity are similar to it is not affected by changes over time in age com-
those for live births: pregnancy rates declined much position. In 2001, the TFR was 2121.5, slightly lower
more for younger than for older teenagers and much that the 30-year high of 2130.0 in 2000. The TFR
more for white and black teenagers than for Hispan- varies significantly among racial and ethnic origin
ics. groups (Table 2). From 2000 to 2001, TFRs declined
During the late 1990s, the declines in teenage birth by 1% for non-Hispanic white (1867.0) and Native
1040 ANNUAL SUMMARY OF VITAL STATISTICS?2001
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American (2072.0) mothers; by 2% for Asian or Pa- to 17 years (down 7%). The number also fell (by 3%)
cific Islander mothers (2038.0); and by 3% for black for 18- to 19-year-olds. Despite these reductions, the
mothers (2119.0). In contrast, the TFR for Hispanic proportions of nonmarital births among teenagers
women increased 2% to 3156.5 in 2001?the highest rose slightly in 2001 because total births to teenagers
TFR reported for this group since national data be- declined even more than births to unmarried teen-
came available in 1989. agers. Birth rates for unmarried teenagers, available
through 2000, describe the risk that an unmarried
Unmarried Mothers teenager will give birth. This rate declined by 15%
The number of births to unmarried women in- overall between 1994 and 2000.3
creased very slightly from 1 347 043 in 2000 to
1 350 154 in 2001 (preliminary data).3,5 This increase Smoking During Pregnancy
was entirely attributable to a 1% rise in the number Smoking during pregnancy has declined steadily
of unmarried women of childbearing age.5 The birth since 1989, the first year this information was re-
rate for unmarried women declined modestly to 44.9 ported on the birth certificate. In 2000 (latest year for
births per 1000 unmarried women aged 15 to 44 which data are available), 12.2% of women reported
years in 2001 compared with 45.2 in 2000. The birth smoking during pregnancy, which was 37% lower
rate has remained below the peak reached in 1994 than in 1989 (19.5%).3,22 Tobacco use during preg-
(46.9). In 2001, 33.4% of all births were to unmarried nancy is a risk factor for a variety of adverse out-
women, slightly higher than in 2000 (33.2%). This comes, including low birth weight (LBW), intrauter-
proportion has changed little since 1994.21 It in- ine growth retardation, and infant mortality, as well
creased for non-Hispanic white women (22.5%), and as negative consequences for child health.3,10,23?26
declined slightly for black (68.3%) and Hispanic The percentage of mothers who smoked during
(42.4%) women. pregnancy was highest for non-Hispanic white
The number of nonmarital births to teenagers de- women (15.6%), moderate for black women (9.1%),
clined from 2000 to 2001. Declines were substantial and lowest for Hispanic women (3.5%; Table 4). Teen
for teenagers under 15 years (down 9%) and aged 15 smoking during pregnancy decreased from 18.1% to
TABLE 4. Percentage of Births With Selected Characteristics, by Race and Hispanic Origin of Mother: United States, Final 1990, 2000,
Preliminary 2001
All Races* White, Total Non-Hispanic Black, Total Hispanic
White
2001 2000 1990 2001 2000 1990 2001 2000 1990? 2001 2000 1990 2001 2000 1990?
Mother
20 y of age 11.3 11.8 12.8 10.2 10.6 10.9 8.3 8.7 9.6 18.9 19.7 23.1 15.6 16.2 16.8
Unmarried 33.4 33.2 28.0 27.6 27.1 20.4 22.5 22.1 16.9 68.3 68.5 66.5 42.4 42.7 36.7
12 completed y of school? ? 16.4 17.6 ? 16.7 17.1 ? 8.1 15.2 ? 16.9 19.6 ? 44.4 53.9
16 or more completed y of ? 28.0 20.1 ? 29.4 21.7 ? 35.5 22.5 ? 14.6 9.4 ? 9.1 5.1
school?
Smoker? ? 12.2 18.4 ? 13.2 19.4 ? 15.6 20.9 ? 9.1 15.9 ? 3.5 6.7
Diabetes during pregnancy ? 2.9 2.1 ? 2.8 2.2 ? 2.8 2.3 ? 2.7 1.8 ? 2.8 2.4
Pregnancy-associated ? 3.9 2.7 ? 3.9 2.8 ? 4.3 3.1 ? 4.2 2.7 ? 2.8 2.3
hypertension
Health care utilization
First trimester prenatal care 83.4 83.2 75.8 85.2 85.0 79.2 88.5 88.5 83.3 74.5 74.3 60.6 75.7 74.4 60.2
Midwife-attended births ? 7.8 3.9 ? 7.8 3.9 ? 7.2 3.2 ? 7.3 4.5 ? 9.6 6.2
Cesarean delivery rate 24.4 22.9 22.7 24.2 22.8 23.0 24.5 23.1 23.4 25.8 24.3 22.1 23.5 22.1 21.2
Infant
Birth weight
VLBW 1.4 1.4 1.3 1.2 1.1 1.0 1.2 1.1 0.9 3.0 3.1 2.9 1.1 1.1 1.0
LBW 7.6 7.6 7.0 6.7 6.5 5.7 6.7 6.6 5.6 12.9 13.0 13.3 6.5 6.4 6.1
Preterm birth? ? 11.6 10.6 ? 10.6 8.9 ? 10.4 8.5 ? 17.3 18.8 ? 11.2 11.0
Multiple births per 1000 total
births
Live births in twin deliveries ? 29.3 22.6 ? 29.2 22.1 ? 32.2 22.9 ? 33.1 26.5 ? 20.2 18.0
(not percent)
Live births in higher-order ? 1.8 0.7 ? 2.1 0.8 ? 2.5 0.9 ? 0.8 0.5 ? 0.8 0.4
multiple deliveries (not
percent)
* Includes races other than white and black.
? Excludes data for New Hampshire and Oklahoma, which did not report Hispanic origin.
? Includes mothers 20 years of age and older. For 1990, excludes data for New York (exclusive of New York City) and Washington which
did not report educational attainment of mother.
? For 2000, excludes data for California, for 1999 excludes data for California and South Dakota, and for 1990 excludes data for California,
Indiana, New York, Oklahoma, and South Dakota which did not report tobacco use during pregnancy.
 VLBW is birth weight of 1500 g (3 lb, 4 oz), and LBW is birth weight of 2500 g (5 lb, 8 oz).
? Born before 37 completed weeks of gestation.
Note: Race and Hispanic origin are reported separately on birth certificates. Persons of Hispanic origin may be of any race. In this table,
Hispanic women are classified only by place of origin; non-Hispanic women are classified by race.
Source: CDC/NCHS, National Vital Statistics System, natality.
ARTICLES 1041
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17.8% from 1999 to 2000, a reversal of their generally
upward trend since 1994. Still, pregnant teens have
higher smoking rates than any other age group, and
teen smoking remains a major public health problem.
Variations by race and Hispanic origin were partic-
ularly marked for teen smokers. Fully 30.2% of non-
Hispanic white teens aged 15 to 19 years smoked
during pregnancy, compared with only 4.3% of His-
panic teens. Smoking during pregnancy by black
teenagers, historically relatively rare, has risen from
5.0% to 7.2% since 1994.3,22
Prenatal Care
The percentage of women who began prenatal care
in their first trimester of pregnancy increased slightly
from 83.2% in 2000 to 83.4% in 2001 (Table 4). This
percentage has increased by 10% since 1990 (75.8%).
Timely receipt of prenatal care is 1 area where efforts
to reduce racial disparities in health have been par-
tially successful, although disparities still exist. From
1990 to 2001, the percentage of women with first
trimester care increased by 6% (from 83.3% to 88.5%)
for non-Hispanic white women, but by 23% for black Fig 2. Total and primary cesarean rate and VBAC rate: United
women (from 60.6% to 74.5%), and by 26% for His- States, 1989?2001.
panic women (from 60.2% to 75.7%).
The benefits of prenatal care are difficult to mea-
sure, but timely and appropriate prenatal care may safety of VBAC compared with elective repeat cesar-31,32
promote better birth outcomes by providing early eans.
risk assessment to manage preexisting medical con- Multiple Births
ditions, and by offering health behavior advice such
as smoking cessation and nutrition counseling.27?29 The twin birth rate continued its upward climb in
The proportion of women beginning care late in 2000, increasing by 1% to 29.3 twin births per 1000
pregnancy (during the third trimester), or with no total births (Table 4). The twin birth rate has risen by
care at all, declined to 3.8% (preliminary data) in 55% since 1980 (18.9). In contrast, the higher order
2001, compared with 6.1% in 1990. multiple birth rate decreased 9% from 193.5 per100 000 live births in 1998 to 180.5 in 2000, reversing
a long-term trend. Before 1998, the higher order mul-
Cesarean Delivery tiple birth rate had more than doubled since 1991
The cesarean delivery rate increased sharply, by (81.4) and quadrupled since 1980 (37.0).3,33 Twins,
7%, from 22.9% of all births in 2000 to 24.4% of births triplets, and other higher order multiples accounted
in 2001 (Table 4).3,5,30 The cesarean delivery rate for 3.1% of all births in 2000.
declined steadily between 1989 and 1996, but has The increase in multiple births, especially higher
since climbed 17% in 5 years (Fig 2). The current level order multiples, has been associated with 2 related
is the highest reported since these data have been trends?older age at childbearing and increased use
available from birth certificates (1989). The rise is of ovulation-inducing drugs and assisted reproduc-
attributable to both an increase in the primary cesar- tive technologies, such as in vitro fertilization.3,33,34
ean rate (first cesareans per 100 live births to women The rise in multiple births has been especially steep
who had no previous cesarean; 16.9% in 2001) and a among births to women in the oldest childbearing
sharp decline in the rate of vaginal births after pre- ages; for example, nearly 1 in 5 (18.2%) births to
vious cesarean (VBAC) delivery. The VBAC rate fell women aged 45 to 54 years in 2000 was part of a
20% from 20.6% per 100 women with a previous multiple delivery compared with 1 in 50 in 1990
cesarean delivery in 2000 to 16.5% in 2001. It had (tabular data not shown).3
risen 50% from 1989?1996, but has fallen 72% since Multiple births, regardless of how conceived, tend
the 1996 high. to be high-risk births. About half of all twins and the
A recent study showed that cesarean rates rose for great majority of triplets are born preterm or LBW.
all racial, ethnic, and age groups between 1996 and This higher risk, coupled with the escalating multiple
1999.30 From 2000 to 2001, they increased 6% among birth rate, has had a large influence on overall na-
non-Hispanic white (24.5%), black (25.8%), and His- tional and state measures of infant health.3,33
panic (23.5%) women. In 2000 as in previous years,
cesarean rates increased steadily with advancing ma- Preterm Birth
ternal age and were more than twice as high for The preterm birth rate declined from 11.8% in 1999
mothers aged 40 to 54 years (36.1%) than for mothers to 11.6% for 2000 (the latest year for which data are
under age 20 (15.7%).3 The recent decline in the available), the first decline in this measure since 1992.
VBAC rate may reflect renewed controversy over the The percentage of births born preterm (37 com-
1042 ANNUAL SUMMARY OF VITAL STATISTICS?2001
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pleted weeks of gestation) has risen fairly steadily though still substantially higher than for non-His-
over the last 2 decades, from 9.4% in 1981, and 10.6% panic white women, the preterm birth rate for black
in 1990. The very preterm birth rate (32 completed mothers has been trending slowly downward since
weeks of gestation) was 1.93% for 2000, virtually peaking at 18.9% in 1991. The percent preterm for
unchanged from that reported in 1990 (1.92%), but Hispanic women has been relatively stable since 1990
up from 1.81% in 1981. Preterm births have higher when it was 11.0%.
morbidity and mortality rates, when compared with
term births.35,36 The causes of preterm delivery, Birth Weight
which can result from spontaneous preterm labor, The rate of LBW (2500 g) was unchanged from
premature rupture of the membranes, or medical 1998 to 2001 at 7.6%, up from 7.5% in 1997.3,5 From
interventions such as induction of labor are not fully 1984 to 1998, the percentage of LBW births increased
understood, and until progress is made in this re- fairly steadily from the low of 6.7% reported in 1984.
gard, substantial reduction in the preterm birth rate The rate of very low birth weight (VLBW; births
seems unlikely.3,35?37 weighing 1500 g) was 1.43% in 2001, unchanged
From 1999 to 2000, the percentage of preterm from 2000. VLBW had risen moderately during the
births decreased from 10.5% to 10.4% for non-His- 1980s and 1990s (from 1.15% in 1980 to 1.45% in
panic white births, from 17.5% to 17.3% for black 1999).3 When compared with heavier infants (2500

births, and from 11.4% to 11.2% for Hispanic births. g), the risk of infant death in 2000 was 6 times higher
This is the first decline in the preterm rate for non- for infants weighing 1500 to 2499 g (15.8), and 98
Hispanic white births in more than a decade; rates times higher for infants born with weights of 1500 g
had been rising steadily, from 8.5% in 1990. Al- or less (244.3).10
TABLE 5. IMR, NMR, PNMR, Perinatal Mortality Rate and Fetal Mortality Rate by Race: Final
1980, 1999, and 2000
2000 1999 1980 Percent
Change,
1980?2000
IMR*? 6.9 7.1 12.6 45.2
White, total 5.7 5.8 10.9 47.7
White, non-Hispanic 5.7 5.8 ? ?
Black, total 14.1 14.6 22.2 36.5
Hispanic 5.6 5.8 ? ?
Black:white ratio 2.5 2.5 2.0
NMR*? 4.6 4.7 8.5 45.9
White, total 3.8 3.9 7.4 48.6
White, non-Hispanic 3.8 3.9 ? ?
Black, total 9.4 9.8 14.6 35.6
Hispanic 3.7 3.9 ? ?
Black:white ratio 2.5 2.5 2.0
PNMR*? 2.3 2.3 4.1 43.9
White, total 1.9 1.9 3.5 45.7
White, non-Hispanic 1.9 1.9 ? ?
Black, total 4.7 4.8 7.6 38.2
Hispanic 1.9 1.9 ? ?
Black:white ratio 2.5 2.5 2.2
Perinatal mortality rate* 7.0 7.1 13.2 47.0
White, total 5.9 6.1 11.8 50.0
White, non-Hispanic? 6.7 5.8 ? ?
Black, total 12.7 12.9 21.3 39.0
Hispanic? 6.0 6.2 ? ?
Black:white ratio 2.2 2.1 1.8
Fetal mortality rate*? 6.6 6.7 9.1 27.5
White, total 5.6 5.7 8.1 30.9
White, non-Hispanic? 5.0 5.3 ? ?
Black, total 12.4 12.6 14.7 15.6
Hispanic? 5.7 5.8 ? ?
Black:white ratio 2.2 2.2 1.8
* Includes races other than white and black.
? Rate per 1000 live births.
? In 1999, Oklahoma did not report Hispanic origin for fetal deaths.
? Number of fetal deaths at 
20 weeks of gestation per 1000 live births plus fetal deaths.
 Number of fetal deaths at 
28 weeks of gestation plus number of infant deaths at 7 days of age per
1000 live births plus fetal deaths at 
28 weeks of gestation.
?Data not available.
Note: Race and Hispanic origin are reported separately on vital records. Persons of Hispanic origin
may be of any race. In this table, Hispanic persons are classified only by place of origin; non-Hispanic
persons are classified by race. IMRs, NMRs, and PNMRs by race from unlinked data may differ
slightly from those based on the linked file (Table 6).
Source: CDC/NCHS, National Vital Statistics System, natality, mortality (unlinked file), and fetal
death files.
ARTICLES 1043
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Between 2000 and 2001, the LBW rate declined nic groups.10 Compared with non-Hispanic white
slightly for black births (from 13.0% to 12.9%) and mothers, IMRs were higher for American Indian (8.3)
increased slightly for non-Hispanic white (from 6.6% and Puerto Rican (8.2) mothers, but were lower for
to 6.7%) and Hispanic (from 6.4% to 6.5%) births. Asian and Pacific Islander (4.9) mothers.10 IMRs for
LBW among black births has declined from a high of Hispanic women were similar to those for non-His-
13.6% reported for 1991, but remains higher than panic white women. IMRs were higher for infants
levels reported during the early and mid-1980s whose mothers were teenagers or 40 years of age or
(12.6% to 12.8%). older, did not complete high school, were unmarried,
LBW rates tend to be highest for the youngest (15 began prenatal care after the first trimester of preg-
years) and the oldest mothers (ages 45
), but much nancy, or smoked during pregnancy. IMRs were also
of the LBW risk for the latter age group is attribut- higher for male infants, multiple births, and infants
able to their higher multiple birth rates. For 2000, born preterm or LBW.
55% of all LBW infants to women aged 45
 were
born in a multiple delivery, compared with 8% of
infants to mothers  15 years of age. When singleton Birth Weight-Specific Infant Mortality
births are examined, women 45 years and over were Birth weight is one of the most important predic-
substantially less likely than their youngest counter- tors of infant mortality. The IMR for a given popu-
parts to bear a LBW child.3 lation can be partitioned into 2 key components: the
birth weight distribution and birth weight-specific
INFANT MORTALITY mortality rates (the mortality rate for infants at a
In 2001, the provisional infant mortality rate was given weight). The IMR can decrease when either the
6.9, the same as the final 2000 rate (Table 1). The percentage of LBW births decreases or birth weight-
NMR was 4.6 per 1000 live births in 2000 (latest year specific mortality rates decrease. The percentage of
this rate is available), 2% less than the rate of 4.7 in LBW births increased from 1984 to 1998, but has
1999, while the PNMR was 2.3 per 1000 live births in stabilized since then (Fig 3). Thus, all of the decline in
both 1999 and 2000. Infant mortality in the United the IMR since 1980 has been attributable to declines
States has declined by 45% since 1980 (Table 5; Fig in birth weight-specific IMRs, which have been at-
3). tributed primarily to improvements in obstetric and
Racial differences in the IMR remain a major na- neonatal care.39 The United States has been unsuc-
tional concern.38?40 The mortality rate for infants of cessful in reducing the number of preterm and LBW
black mothers (14.1) was 2.5 times the rate for infants deliveries, although prevention efforts have the po-
of non-Hispanic white mothers (5.7; Table 5). Data tential to save many more infant lives and reduce
from the 2000 linked birth/infant death data pro- subsequent morbidity than do additional improve-
vides more accurate IMRs for detailed race and eth- ments in neonatal care.
In 2000, 66% of all infant deaths occurred to the
7.6% of infants born LBW, and 52% of all infant
deaths to the 1.4% of infants born VLBW.10 About
85% of all infants born weighing 500 g die within
the first year of life, with 98% of them dying within
the first few days of life (Table 6). An infant?s chances
of survival increase rapidly thereafter with increas-
ing birth weight. At birth weights of 1250 to 1499 g,
95 of 100 infants now survive the first year of life.
IMRs are lowest for infants weighing 3500 to 4499 g,
with small increases among the heaviest infants.
IMRs are higher for infants of black mothers than
for infants of non-Hispanic white or Hispanic moth-
ers, according to linked birth and infant death file
data. However, within detailed birth weight catego-
ries of 1250 g, IMRs are slightly lower for infants
born to black mothers compared with infants born to
non-Hispanic white mothers, although the differ-
ences were statistically significant only for the 750 to
999 g category. Among infants of black mothers, the
proportion of births at extremely LBWs is much
higher, thus accounting for much of the overall dis-
parity. At birth weights of 2500 g, IMRs are con-
sistently and significantly higher for infants of black
Fig 3. Infant, neonatal, and postneonatal mortality, LBW and than for infants of non-Hispanic white or Hispanic
VLBW, and preterm delivery, United States, 1980?2001. IMR in- mothers. In fact, the largest relative difference in
dicates infant deaths per 1000 live births; NMR indicates neonatal birth weight-specific IMRs among infants of His-
deaths per 1000 live births; PNMR indicates postneonatal deaths
per 1000 live births; LBW, percent low birth weight (2500 g); panic, non-Hispanic white, and black mothers is for
VLBW, percent very low birth weight (1500 g); PT, percent infants weighing 2500
 g (2.1, 2.3, and 3.9, respec-
preterm (37 weeks of gestation). tively). Thus, much of the excess mortality for black
1044 ANNUAL SUMMARY OF VITAL STATISTICS?2001
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TABLE 6. IMR and NMR by Birth Weight and Race of Mother, 2000 Linked File, and Percent Change in Birth Weight-Specific IMR,
1995?2000 Linked Files: United States
Birth Weight (g) IMR? NMR? % Change
in IMR
All Races* Non-Hispanic Black Hispanic All Races* Non-Hispanic Black Hispanic 1995?2000
White White
Total 6.9 5.7 13.5 5.6 4.6 3.8 9.1 3.8 9.2
2500 59.4 52.8 75.8 56.1 48.5 43.6 60.4 45.9 8.0
1500 244.3 229.5 266.9 235.6 214.5 204.8 228.6 206.9 9.0
500 846.1 859.8 836.9 822.1 828.3 842.3 817.5 805.7 6.4
500?749 476.3 492.2 458.4 477.9 415.7 439.2 382.9 424.9 9.8
750?999 155.8 159.0 141.6 163.4 118.3 126.8 96.1 127.6 14.4
1000?1249 77.3 80.8 71.7 75.5 54.1 60.7 42.1 53.5 9.6
1250?1499 45.6 43.2 44.8 49.2 33.0 34.0 29.1 32.6 16.5
1500?1999 28.3 26.9 27.9 32.8 18.5 18.3 15.1 24.1 14.8
2000?2499 11.7 12.0 11.7 11.6 6.3 6.9 5.0 6.2 13.3

2500 2.5 2.3 3.9 2.1 0.9 0.9 1.2 0.8 16.7
2500?2999 4.6 4.6 5.6 3.8 1.9 2.0 1.9 1.9 14.8
3000?3499 2.4 2.3 3.6 1.9 0.8 0.8 1.1 0.7 17.2
3500?3999 1.7 1.5 2.8 1.5 0.6 0.5 0.8 0.5 15.0
4000?4499 1.5 1.4 2.4 1.2 0.5 0.5 0.9 0.4 16.7

4500 2.5 2.1 4.7 2.0 1.3 1.1 ? ? 10.7
* Includes races other than white and black.
? Figure does not meet standards of reliability or precision.
? IMR are infant deaths during a year per 1000 live births in specified group.
? NMR are deaths of infants 0 to 27 days of age per 1000 live births in specified group.
Note: IMRs and NMRs by race from the linked file differ slightly from those based on unlinked data because the linked file uses the
self-reported race of mother from the birth certificate, whereas the unlinked data uses the race of child as reported by the funeral director
on the death certificate. Race and Hispanic origin are reported separately on birth certificates. Persons of Hispanic origin may be of any
race. In this table, Hispanic women are classified only by place of origin; non-Hispanic women are classified by race.
Source: NCHS, 1995 and 2000 Period Linked Birth/Infant Death Data Sets.
infants can be explained by 2 factors: 1) A higher 1000, respectively), and the District of Columbia
incidence of LBW, VLBW, and preterm births among (12.0), Mississippi (10.7), and the Virgin Islands (13.4)
infants of black mothers; and 2) higher IMRs for had the highest. Although both LBW and IMR were
black infants weighing 2500
 g. highest for the District of Columbia, it is more ap-
IMRs for Hispanic mothers were significantly propriate to compare these data with those for other
higher than those for non-Hispanic white mothers large US cities because of the high concentrations of
for infants at birth weights of 1500 to 1999 g, but high-risk women in these areas. Variations by state
were significantly lower at birth weights of 2500 to in LBW and IMR reflect compositional differences by
2999 g and 3000 to 3499 g. Differences between the race, ethnicity, and socioeconomic status in the pop-
Hispanic and non-Hispanic white populations were ulation in addition to other factors (prenatal, quality
not statistically significant for the other specific birth of care, and postnatal influences on infants) that are
weight categories. associated with LBW or IMR.
IMRs declined significantly from 1995 to 2000 for NMRs for infants with birth weights of 500 to
all birth weight categories except for 4500
 g. IMRs 1499 g are presented in Table 8. Because of small
declined most rapidly (by 13%?17%) for infants with annual numbers of neonatal deaths at 500 to 1499 g
birth weights of 750 to 999 g and 1250 to 4499 g. In
contrast, mortality rates for infants born at 500 g in some states, data are presented for a 3-year time
declined by only 6% from 1995 to 2000, reflecting the period (1998?2000), and confidence intervals are pro-
limited success of intensive efforts made to save vided to aid in the interpretation of differences. Cal-
these very tiny infants. The few infants who do sur- ifornia, Massachusetts, and Utah had significantly
vive at these VLBWs are at great risk of suffering lower rates than the national average, while Hawaii,
lifetime disabilities such as blindness, mental retar- Illinois, Oklahoma, Puerto Rico and the Virgin Is-
dation, and neurologic disorders, necessitating in- lands had significantly higher rates.
creased levels of medical and parental care.41,42 It is possible to compare the statistics presented
here to get an idea of the reasons for the level of
Geographic Variation infant mortality in a particular state. For example, the
Table 7 presents information on state variations in percent LBW would tend to reflect prenatal factors
LBW and IMR for 2000 (the latest year for which such as maternal health conditions and the effective-
complete data are available for both LBW and IMR). ness of their management during prenatal care. In
Alaska, Oregon, Washington State (5.6% each), and contrast, the NMR for 500 to 1499 g infants may
American Samoa (2.7%) had the lowest percent of provide insight into the effectiveness of neonatal in-
LBW births, while Louisiana (10.3%), Mississippi tensive care. For example, the high IMR for the Dis-
(10.7%), the District of Columbia (11.9%), and Puerto trict of Columbia relates primarily to the high per-
Rico (10.8%) had the highest. Maine and Massachu- centage of LBW births, particularly for black mothers
setts had the lowest IMRs in 2000 (4.9 and 4.6 per who constitute the majority of mothers in the Dis-
ARTICLES 1045
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TABLE 7. Percent LBW and IMR by Race of Mother, United States and Each State, 2000
State of Residence Percent LBW? IMR?
All White, Non-Hispanic Black Hispanic All White, Non-Hispanic Black Hispanic
Races? Total White Races Total White
United States? 7.6 6.5 6.6 13.0 6.4 6.9 5.7 5.7 14.1 5.6
Alabama 9.7 7.7 7.8 14.0 6.5 9.4 6.6 6.6 15.4 *
Alaska 5.6 4.9 4.8 11.7 5.4 6.8 5.8 5.9 * *
Arizona 7.0 6.8 7.0 12.8 6.7 6.7 6.2 5.8 17.6 6.8
Arkansas 8.6 7.2 7.3 13.7 5.9 8.4 7.0 7.4 13.7 *
California 6.2 5.6 5.7 11.6 5.6 5.4 5.1 4.9 12.9 5.3
Colorado 8.4 8.0 8.0 14.8 8.1 6.2 5.6 5.6 19.5 5.5
Connecticut 7.4 6.8 6.4 12.0 8.6 6.6 5.6 4.9 14.4 8.8
Delaware 8.6 7.1 7.2 13.2 6.5 9.2 7.9 7.4 14.8 *
District of Columbia 11.9 7.4 6.8 14.0 8.3 12.0 * * 16.1 *
Florida 8.0 6.6 6.6 12.3 6.5 7.0 5.4 5.5 12.6 4.9
Georgia 8.6 6.6 6.7 12.7 5.6 8.5 5.9 6.1 13.9 5.0
Hawaii 7.5 5.3 5.0 10.4 7.3 8.1 6.5 * * 11.3
Idaho 6.7 6.7 6.5 * 7.5 7.5 7.5 7.1 * 10.0
Illinois 7.9 6.4 6.5 14.1 6.2 8.5 6.6 6.2 17.1 7.5
Indiana 7.4 6.7 6.9 12.6 5.3 7.8 6.9 7.0 15.8 5.3
Iowa 6.1 5.9 5.9 11.7 5.5 6.5 6.0 5.9 21.1 *
Kansas 6.9 6.5 6.6 12.2 5.9 6.8 6.4 6.3 12.2 6.9
Kentucky 8.2 7.7 7.7 13.7 7.3 7.2 6.7 6.5 12.7 *
Louisiana 10.3 7.4 7.4 14.3 7.3 9.0 5.9 6.0 13.3 *
Maine 6.0 6.0 6.0 * * 4.9 4.8 4.7 * *
Maryland 8.6 6.4 6.4 12.8 6.4 7.6 4.8 5.0 13.2 *
Massachusetts 7.1 6.7 6.4 10.7 8.4 4.6 4.0 3.7 9.9 5.1
Michigan 7.9 6.4 6.3 14.5 6.3 8.2 6.0 6.3 18.2 6.6
Minnesota 6.1 5.7 5.8 11.0 5.8 5.6 4.8 4.8 14.6 7.8
Mississippi 10.7 7.9 8.0 14.0 7.4 10.7 6.8 6.7 15.3 *
Missouri 7.6 6.6 6.6 13.2 6.4 7.2 5.9 5.8 14.7 10.1
Montana 6.2 6.1 6.1 * 7.9 6.1 5.5 5.5 * *
Nebraska 6.8 6.4 6.4 13.0 6.7 7.3 6.4 6.4 20.3 *
Nevada 7.2 6.7 7.1 12.9 6.1 6.5 6.0 5.6 12.7 6.9
New Hampshire 6.3 6.3 6.1 * * 5.7 5.5 5.9 * *
New Jersey 7.7 6.5 6.2 12.8 7.3 6.3 5.0 4.3 13.6 6.5
New Mexico 8.0 8.2 8.1 13.1 8.2 6.6 6.3 4.2 * 7.6
New York 7.7 6.7 6.5 11.4 7.3 6.4 5.4 5.8 10.9 4.1
North Carolina 8.8 7.1 7.3 13.6 6.1 8.6 6.3 6.6 15.7 4.6
North Dakota 6.4 6.5 6.3 * * 8.1 7.5 7.3 * *
Ohio 7.9 7.0 7.0 13.1 7.4 7.6 6.3 6.3 15.4 7.5
Oklahoma 7.5 6.9 7.1 13.1 6.3 8.5 7.9 8.0 16.9 8.0
Oregon 5.6 5.4 5.3 11.0 5.7 5.6 5.5 5.4 * 6.8
Pennsylvania 7.7 6.7 6.6 13.5 8.9 7.1 5.8 5.7 15.7 8.3
Rhode Island 7.2 6.5 6.4 13.1 6.5 6.3 5.9 4.0 * *
South Carolina 9.7 7.2 7.2 14.2 7.4 8.7 5.4 5.6 14.8 *
South Dakota 6.2 5.9 5.9 * * 5.5 4.3 4.3 * *
Tennessee 9.2 7.8 7.8 14.6 6.6 9.1 6.8 6.8 18.0 *
Texas 7.4 6.7 6.5 12.7 6.8 5.7 5.1 4.8 11.4 5.3
Utah 6.6 6.5 6.4 12.5 7.8 5.2 5.1 4.9 * 6.2
Vermont 6.1 6.0 5.9 * * 6.0 6.1 6.3 * *
Virginia 7.9 6.5 6.5 12.6 6.3 6.9 5.4 5.4 12.4 5.6
Washington 5.6 5.2 5.2 10.6 5.4 5.2 4.9 4.9 9.4 6.2
West Virginia 8.3 8.1 8.1 15.4 * 7.6 7.4 7.4 * *
Wisconsin 6.5 5.8 5.7 13.3 6.6 6.6 5.5 5.6 17.2 *
Wyoming 8.3 8.3 8.2 * 8.6 6.7 6.5 6.2 * *
Puerto Rico 10.8 10.7 ? 12.1 ? 9.7 10.2 ? * ?
Virgin Islands 9.1 8.8 * 9.2 9.8 13.4 * * * *
Guam 7.6 * * * * 5.8 * * * *
American Samoa 2.7 * ? * ? * * ? * ?
Northern Marianas 8.9 * ? * ? * * ? * ?
* Figure does not meet standards of reliability or precision (defined as 20 deaths in the numerator).
? Includes races other than white and black.
? Infant deaths under 1 year of age per 1000 live births.
? Percentage of births 2500 g (5 lb, 8 oz).
? Total excludes data for the territories.
?Data not available.
Note: Race and Hispanic origin are reported separately on birth certificates. Persons of Hispanic origin may be of any race. In this table,
Hispanic women are classified only by place of origin; non-Hispanic women are classified by race.
Source: CDC/NCHS, 2000 National Vital Statistics System, mortality (unlinked file) and natality.
trict. In contrast, the NMR for 500- to 1499-g births is to be a product of both a lower NMR for 500- to
not significantly different from the national average. 1499-g infants, and a slightly lower percentage of
The comparatively low IMR for Massachusetts seems LBW births. The higher NMRs for 500- to 1499-g
1046 ANNUAL SUMMARY OF VITAL STATISTICS?2001
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TABLE 8. NMR for Infants Born Weighing 500 to 1499 g by Race and Hispanic Origin of Mother: United States and Each State,
1998?2000 Linked Files
All Races* Non-Hispanic White Black Hispanic
Rate? 95% CI? Rate? 95% CI? Rate? 95% CI? Rate? 95% CI?
United States? 141.6 (139.6?143.6) 140.2 (137.3?143.0) 138.6 (135.1?142.0) 148.7 (143.5?153.9)
Alabama 136.8 (123.4?150.2) 138.2 (118.1?158.4) 135.6 (117.2?153.9) 
Alaska 133.6 (92.5?186.7)   
Arizona 158.3 (141.4?175.2) 163.5 (137.8?189.1) 131.9 (81.7?201.7) 164.7 (136.5?192.8)
Arkansas 137.8 (118.6?156.9) 152.5 (126.0?178.9) 115.8 (89.0?148.2) 
California 133.1 (127.1?139.1) 128.7 (117.9?139.5) 114.6 (100.8?128.3) 145.5 (135.9?155.0)
Colorado 142.8 (125.8?159.7) 127.8 (107.3?148.3) 169.0 (115.6?238.5) 172.6 (137.7?213.7)
Connecticut 123.4 (106.3?140.4) 117.2 (93.5?140.9) 115.9 (86.6?152.0) 137.5 (98.7?186.6)
Delaware 170.7 (134.3?214.0) 158.4 (109.0?222.4) 179.9 (124.6?251.4) 
District of Columbia 142.1 (112.0?177.9)  136.9 (105.7?174.5) 
Florida 137.8 (129.4?146.2) 138.4 (125.3?151.6) 133.3 (120.4?146.2) 144.1 (122.9?165.3)
Georgia 152.7 (142.1?163.3) 148.5 (131.4?165.6) 153.7 (139.5?167.9) 147.7 (102.8?205.4)
Hawaii 184.7 (146.7?222.7)   
Idaho 165.9 (131.1?207.0) 151.9 (115.6?195.9)  
Illinois 156.5 (147.0?165.9) 155.7 (141.3?170.1) 145.9 (131.3?160.6) 179.6 (153.6?205.5)
Indiana 152.1 (137.7?166.5) 151.6 (134.8?168.5) 148.4 (117.9?179.0) 158.6 (94.0?250.7)
Iowa 133.0 (111.2?154.7) 135.0 (111.0?159.1)  
Kansas 144.3 (123.1?165.5) 149.1 (123.7?174.5) 118.6 (75.2?178.0) 149.5 (87.1?239.4)
Kentucky 132.4 (116.6?148.1) 136.8 (118.9?154.7) 124.7 (91.0?166.9) 
Louisiana 130.5 (118.1?142.9) 151.8 (127.9?175.8) 122.0 (107.2?136.7) 
Maine 140.6 (103.3?187.0) 138.7 (100.8?186.2)  
Maryland 131.8 (119.3?144.4) 131.3 (109.8?152.8) 133.0 (116.6?149.4) 161.5 (97.2?252.1)
Massachusetts 125.0 (111.4?138.6) 123.3 (106.4?140.2) 129.6 (100.1?165.2) 134.9 (99.8?178.3)
Michigan 152.8 (141.8?163.7) 144.8 (129.9?159.7) 158.7 (140.4?176.9) 165.8 (110.2?239.7)
Minnesota 137.8 (120.1?155.4) 134.5 (114.2?154.7) 125.5 (84.6?179.1) 
Mississippi 141.2 (125.4?157.0) 109.6 (87.0?136.2) 156.9 (136.1?177.6) 
Missouri 141.4 (126.8?156.0) 137.9 (119.9?156.0) 145.1 (119.1?171.0) 
Montana 128.5 (90.5?177.1) 102.0 (64.7?153.1)  
Nebraska 152.2 (123.3?181.1) 142.8 (112.5?178.7)  
Nevada 143.5 (118.4?168.5) 120.7 (89.9?158.7)  174.1 (124.4?237.1)
New Hampshire 126.8 (95.0?165.8) 118.1 (84.8?160.2)  
New Jersey 138.8 (127.9?149.6) 122.0 (106.3?137.7) 147.6 (129.2?166.0) 152.3 (124.6?180.0)
New Mexico 172.1 (143.2?201.0) 177.1 (131.8?232.8)  171.4 (132.8?217.7)
New York 140.8 (133.2?148.4) 132.9 (120.5?145.2) 143.3 (131.1?155.5) 142.0 (124.8?159.2)
North Carolina 151.6 (140.8?162.4) 147.2 (131.6?162.7) 151.6 (135.6?167.6) 175.9 (129.7?233.2)
North Dakota 161.9 (111.4?227.4) 152.9 (98.9?225.7)  
Ohio 151.0 (140.5?161.5) 154.7 (141.8?167.7) 137.4 (118.9?155.8) 218.2 (142.5?319.7)
Oklahoma 174.2 (152.8?195.6) 192.9 (165.1?220.7) 131.7 (92.7?181.5) 
Oregon 142.4 (119.2?165.7) 146.5 (118.8?174.2)  130.2 (82.5?195.3)
Pennsylvania 142.8 (132.5?153.1) 139.3 (126.5?152.0) 147.0 (127.7?166.3) 154.8 (112.9?207.1)
Rhode Island 116.2 (87.3?151.6) 101.6 (65.8?150.0)  
South Carolina 151.5 (136.3?166.7) 145.7 (122.1?169.3) 155.3 (135.0?175.7) 
South Dakota 153.9 (108.9?211.3) 140.9 (91.2?208.0)  
Tennessee 141.7 (128.3?155.1) 143.4 (125.4?161.4) 132.9 (112.6?153.3) 
Texas 133.1 (126.4?139.8) 139.0 (127.3?150.7) 117.7 (105.1?130.4) 138.2 (127.1?149.3)
Utah 110.2 (91.4?128.9) 111.9 (90.9?133.0)  
Vermont 163.1 (110.1?232.9) 170.3 (114.1?244.6)  
Virginia 136.8 (124.9?148.8) 133.6 (116.7?150.4) 140.7 (121.9?159.4) 135.0 (89.0?196.4)
Washington 127.1 (111.2?143.0) 126.8 (106.8?146.7) 96.6 (58.2?150.9) 116.0 (77.7?166.6)
West Virginia 140.6 (113.1?168.2) 143.5 (114.3?172.7)  
Wisconsin 141.5 (124.8?158.3) 139.1 (119.1?159.1) 127.4 (95.7?166.3) 194.2 (121.7?294.0)
Wyoming 178.8 (116.8?262.0) 178.4 (113.1?267.6)  
Puerto Rico 298.0 (272.6?323.4) 295.0? (268.7?321.3) 333.3 (242.2?447.5) ?
Virgin Islands 289.7 (185.6?431.1)  291.7 (182.8?441.6) 295.5 (180.5?456.3)
Guam    
* Includes races other than white and black.
? Rates are per 1000 live births weighing 500 to 1499 g.
? 95% confidence interval.
? Excludes data for the territories.
 Figure does not meet standards of reliability or precision (based on 20 deaths in the numerator).
? Puerto Rico does not report data on Hispanic origin, so this rate is for white (not non-Hispanic white) mothers.
?Data not available.
Note: Race and Hispanic origin are reported separately on birth certificates. Persons of Hispanic origin may be of any race. In this table,
Hispanic women are classified only by place of origin; non-Hispanic women are classified by race. Data for American Samoa and
Northern Marianas are not available from the 1998?2000 Linked Birth/Infant Death Data Sets.
Source: NCHS, 1998?2000 Linked Birth/Infant Death Data Sets.
infants in Puerto Rico and the Virgin Islands have eas in neonatal and perinatal care, as well as a variety
persisted for a number of years, and may reflect of social factors such as poverty and access to
differences between the United States and these ar- care.43,44
ARTICLES 1047
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INTERNATIONAL COMPARISONS DEATHS
Table 9 compares IMRs for the United States with Provisional Mortality Data for 2001 and Final Data for
IMRs for other developed countries for 1997, 1998, 2000
and 1999, along with the number of births and birth In 2001, as in 2000, there were 2.4 million deaths
rates for 1999. Countries with a population of at least in the United States. The crude death rate remained
2.5 million, and with an IMR less than the US rate in unchanged from 2000 to 2001 at 8.7 deaths per 1000
1 of the 3 years are included in the table. (Spain and population (Table 1).6 Data for 2001 are provisional,
Italy are not included because IMR data were avail- whereas data for 2000 are final. The age-adjusted
able for only 1 of the 3 years). Cuba was added this death rate for 2000 was 872.0 deaths per 100 000 US
year because its 1999 IMR was less than the US rate. standard population, a record low for the nation.4
As in previous years, the IMR for the US is higher Age-adjusted death rates are better indicators of the
in 1999 than for the other 23 countries in the table. A risk of mortality over time than crude (unadjusted)
major reason for the higher rate is the higher per- death rates because they control for variations in the
centage of LBW infants born in the United States age composition of the population.
relative to other developed countries. The lack of
progress in reducing this percentage indicates that September 11, 2001 Deaths
improvements in IMR relative to other developed With a deep sense of sadness, we report on the
countries are unlikely in the near future. Reporting progress of the filing of death certificates associated
variations among countries, particularly in the re- with the events of September 11, 2001. As of Septem-
porting of VLBW infants dying soon after birth, may ber 3, 2002, a total number of 2948 death certificates
also explain some of the differences in rates, al- (provisional data) had been issued that were associ-
though the magnitude of resulting differences is un- ated with the acts of terrorism involving hijacked
known.45?47 These smallest infants account for a sig- planes in New York City, Virginia, and Pennsylva-
nificant proportion of infant deaths in the US and nia. This number represents over 96% of the esti-
other countries, so variations in reporting of these mated deaths that resulted from the attacks (Table
events as live births or stillbirths have the potential 10). About two thirds of the death certificates in New
to significantly impact overall infant mortality rates. York City were issued as a result of a court order in
the absence of a body. Additional information on
deaths associated with the attack on the World Trade
TABLE 9. Number of Live Births and Birth Rates for 1999 and Center can be found in a special issue of the Mortality
IMR for 1997, 1998, and 1999 for Countries of 250 000 Population and Morbidity Weekly Report that commemorates the
and With IMR Equal to or Less than the United States Rate for events of September 11, 2001.48
1997, 1998, or 1999
Number of Births Birth IMR Expectation of Life
In 1999 Rate 1999 The estimated expectation of life at birth for a
1999 1998 1997 given year represents the average number of years
Hong Kong 51 453 7.5 3.1 3.2 3.9 that a hypothetical group of infants would be ex-
Japan 1 175 000* 9.3* 3.2*? 3.6 3.7 pected to live if, through their lifetime, they were to
Sweden 88 173* 10.0* 3.4* ? 3.7
Singapore 43 193* 11.1* 3.5* 4.2* 3.8 experience the age-specific death rates prevailing
Norway 59 191* 13.3* 3.9 4.0 4.1 during the year of their birth. In 2000, the expectation
Finland 57 648 11.2 ? 4.2 3.9 of life at birth reached a record high of 76.9 years, an
Denmark 66 232 12.4 4.2 4.7 5.3 increase of 0.2 years from the previous year.4 In 2000,
Austria 77 381* 9.5* 4.4* 4.9 4.7
France 744 100* 12.6* 4.4* 4.8* 4.8 life expectancy at birth was 80.0 years for white
Germany 770 744 9.4 4.5 4.6 4.9 females, 74.9 years for black females, 74.8 years for
Switzerland 78 408 11.0 4.6 ? 4.5 white males, and 68.2 years for black males.
Czech Republic 89 471 8.7 4.6 5.2* 5.9
Netherlands 200 445 12.7 5.2 5.2 5.2
Canada 331 050*? 10.8 ? 5.3 5.5
Belgium 115 864? 11.3 ? 5.5 6.1 TABLE 10. Estimated Deaths From Acts of Terrorism: New
Greece 116 038* 10.9* 5.5* 6.1* 6.4 York City, Pennsylvania, and Virginia?September 11, 2001
Ireland 53 354 14.2 5.5 6.2* 6.2 Area Estimated Death Estimated
Australia 246 573* 13.0* 5.6* 5.0 5.3 Total Certificates Certificates
Portugal 116 038 11.6 5.6 8.4* 6.4 Deaths Issued Not Yet Filed
Israel 131 936 21.5 5.8 5.7 6.0
United Kingdom 700 100* 11.9* 5.8* ? 5.9 All areas 3062 2948 114
New Zealand 56 605? 14.8 6.1? 5.5 6.5 New York City 2829 2726* 103*
Cuba 150 871 13.5 6.4 ? 7.2 Pennsylvania 44 44 0
United States 3 959 417 14.5 7.1 7.2 7.2 Virginia 189 178 11
* Provisional data. * Three victims injured in the attacks died after September 11,
? 2000 data, no 1999 data. 2001, in states other than New York. Death certificates for these
? 1998 data, no 1997 data. decedents were issued, 1 each, by the states of Massachusetts,
Sources: United Nations. 1998 Demographic Yearbook, Population Missouri, and New Jersey.48
and Vital Statistics Report, Statistical Papers, Series A Vol. L11, Notes: Figures for deaths are by area of occurrence, in contrast
No. 1, Jan. 2000. Population and Vital Statistics Report, Statistical with other data from the National Vital Statistics System that are
Papers, Series A, Vol. L111, No. 1, Jan. 2001. Population and Vital usually reported by area of residence. Counts based on reports as
Statistics Report, Statistical Papers, series A, Vol. LIV, No. 1, of September 11, 2002. Data shown are subject to change as death
January, 2002 certificates are filed, corrected, and amended.
1048 ANNUAL SUMMARY OF VITAL STATISTICS?2001
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Deaths Among Children (With Special Focus on Motor this report was prepared. However, sufficient data
Vehicle Accidents and Injuries From Firearm from the 2000 census have been released to indicate
Discharge) that there will be significant changes in population
In 2000, 25 955 children and adolescents who were counts for the total population as well as specific
between the ages of 1 and 19 died in the United subgroups and that these changes will produce sig-
States (667 less deaths than were reported in 1999; nificant shifts in vital rates. In this section we will
Table 11).4 The death rate for children and adoles- discuss the 2 most important sources of change.
cents between the ages 1 and 19 decreased 3% in 2000 The first source of change comes from the fact that
(from 35.8?34.7 per 100 000 population). the April 1, 2000, census counted 6.2 million (2.2%)
Analysis of final mortality data for 2000 for chil- more people than had been estimated for July 1,
dren and teenagers mostly confirm what had been 2000, based on extrapolations from the 1990 census
previously reported using preliminary data.1,49 Un- (compare 281 421 906 with 275 264 999).50?52 The
intentional injuries and homicide remained the lead- April 1, 2000, census count of the Hispanic popula-
ing and second leading causes of death for the age tion (35 305 818) was 8.8% higher than the 1990-
group (same as 1999). A significant decrease (10%) in based estimate for July 1, 2000 (32 463 770), thus ac-
the death rate for homicide was observed between counting for a sizable portion of the total increment.
1999 and 2000, the seventh consecutive yearly de- As a result, when revised, the vital rates for the total
crease. The modest declines in death rates for unin- population, and especially those for the Hispanic
tentional injuries and for congenital malformations, population, will be generally lower than those cur-
deformations, and chromosomal abnormalities (of rently being published (and included in this article).
1% and 6%, respectively) were not significant. Moreover, the differences between the census count
Within the category of unintentional injuries, the and the 1990-based estimate vary by age. For exam-
death rate for motor vehicle accidents did not change ple, for Hispanic women aged 15 to 44 years, the
significantly from 1999 to 2000. Within the category census count is 9.5% higher than the 1990-based
of homicide, the rate for homicides involving dis- estimate.
charge of a firearm decreased between 1999 and 2000 The second source of change primarily affects vital
for children and adolescents aged 1 to 19 years. The rates calculated by race and derives from the fact that
death rate for cancer remained constant since 1999, the April 1, 2000, census implemented the ?Revisions
and the small increase in the rate for suicide was not to the Standards for the Classification of Federal Data
significant. on Race and Ethnicity,? promulgated by the US Of-
The ranking of leading causes of death varied be- fice of Management and Budget in October 1997.53
tween the age groups under 19 years (with the ex- The 2000 census allowed respondents to ?Mark one
ception of unintentional injuries, which is consis- or more races to indicate what this person considers
tently the leading cause across all age groups). himself/herself to be,? while vital records for the
Homicide was the fourth leading cause of death for most part still collect only a single race designation
all age groups below 15 years, yet it was the second for each respondent, following the old standard pro-
leading cause of death among 15- to 19-year-olds. An mulgated in 1977. This is generally only the first race
inverse trend was seen for congenital malformations, mentioned if 1 race is reported?a method adopted
which was the second leading cause of death for decades ago and now built in to all electronic vital
children aged 1 to 4 years but dropped in importance record systems, with the exception of California,
with age as cancer, homicide, and suicide became which revised its systems for 2000 vital records. This
more prominent. The proportion of deaths from un- has produced a degree of incompatibility between
intentional injuries that involve motor vehicle acci- census data and vital statistics data, because (except
dents increased with age: from 36% of all accidental for California) the Office of Management and Bud-
deaths for children aged 1 to 4 years, to 78% of get?s Revised Standards have not yet been imple-
accidental deaths to adolescents aged 15 to 19 years. mented in the States? vital records.
The proportion of deaths from unintentional firearm To see the importance of the difference between
injuries increased for each age group to 10 to 14 years these 2 methods of collecting race information, con-
(3% of accident deaths); then dropped again for ad- sider the following results from the 2000 census,
olescents aged 15 to 19 years. The proportion of based on findings derived from the Public Law 94?
homicides caused by discharge of a firearm increased 171 (Redistricting) file shown in Table 12. In this
dramatically for each age group: from 8% of homi- table, people who reported only 1 race (ie, ?Alone?),
cides for children aged 1 to 4 years, to 81% of homi- together with those who reported that same specified
cides for the age group 15 to 19 years. race plus 1 or more other races (ie, ?In combina-
tion?), are combined to create the category ?Alone or
in combination.? The last column shows the increase
IMPACT OF THE 2000 CENSUS ON VITAL that the ?In combination? number represents as a
STATISTICS RATES percent of the ?Alone? number. For example, the ?In
As noted in the ?Methods? section, the vital statis- combination? number for Native Hawaiian and
tics rates presented in this report have been calcu- Other Pacific Islander is more than double the num-
lated using populations estimated on the basis of the ber reporting Native Hawaiian and Other Pacific
1990 census. This was done because comparable pop- Islander alone. Under the old standard, the number
ulation figures by age, sex, race, and ethnicity based of people who would have reported a single race
on the 2000 census were not yet available at the time would presumably lie between the ?Alone? number
ARTICLES 1049
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TABLE 11. Deaths and Death Rates for the 5 Leading Causes of Childhood Death in Specified Age Groups: United States, 1999?2000
Age, Causes of Death, and ICD-10 Codes Rank* 2000 1999 Percent
Change
Number Percent Rate? Number Percent Rate? 1999?2000
Total: 1?19 y
All causes ? 25 955 100.0 34.7 26 622 100.0 35.8 3.1
Accidents (unintentional injuries) (V01-X59, Y85-Y86) 1 11 560 44.5 15.5 11 677 43.9 15.7 1.3
Motor vehicle accidents (V02-V04, V09.0, V09.2, V12-V14, V19.0- ? 7674 29.6 10.3 7619 28.6 10.2 1.0
V19.2, V19.4-V19.6, V20-V79, V80.3-V80.5, V81.0-V81.1, V82.0-
V82.1, V83-V86, V87.0-V87.8, V88.0-V88.8, V89.0, V89.2)
Accidental discharge of firearms (W32?W34) ? 192 0.7 0.3 214 0.8 0.3 0.0
Assault (homicide) (X85-Y09, Y87.1) 2 2641 10.2 3.5 2901 10.9 3.9 10.3
Assault (homicide) by discharge of firearms (X93-95) ? 1764 6.8 2.4 1982 7.4 2.7 11.1
Malignant neoplasms (C00?C97) 3 2179 8.4 2.9 2175 8.2 2.9 0.0
Intentional self-harm (suicide) (X60?X84, 87.0) 4 1928 7.4 2.6 1859 7.0 2.5 4.0
Intentional self-harm (suicide) by discharge of firearms (X72?X74) ? 1007 3.9 1.3 1078 4.0 1.4 7.1
Congenital malformations, deformations and chromosomal 5 1119 4.3 1.5 1199 4.5 1.6 6.3
abnormalities (Q00?Q99)
1?4 y
All causes ? 4979 100.0 32.9 5249 100.0 34.7 5.2
Accidents (unintentional injuries) (V01?X59, Y85?Y86) 1 1826 36.7 12.1 1898 36.2 12.6 4.0
Motor vehicle accidents (V02?V04, V09.0, V09.2, V12?V14, V19.0? ? 651 13.1 4.3 650 12.4 4.3 0.0
V19.2, V19.4?V19.6, V20?V79, V80.3?V80.5, V81.0?V81.1,
V82.0?V82.1, V83?V86, V87.0?V87.8, V88.0?V88.8, V89.0, V89.2)
Accidental discharge of firearms (W32?W34) ? 18 0.4 ? 12 0.2 ? 0.0
Congenital malformations, deformations and chromosomal 2 495 9.9 3.3 549 10.5 3.6 8.3
abnormalities (Q00?Q99)
Malignant neoplasms (C00?C97) 3 420 8.4 2.8 418 8.0 2.8 0.0
Assault (homicide) (X85?Y09, Y87.1) 4 356 7.2 2.3 376 7.2 2.5 8.0
Assault (homicide) by discharge of firearms (X93?X95) ? 28 0.6 0.2 50 1.0 0.3 33.3
Diseases of heart (I00?I09, I11, I13, I20?I51) 5 181 3.6 1.2 183 3.5 1.2 0.0
5?9 y
All causes ? 3253 100.0 16.4 3474 100.0 17.4 5.7
Accidents (unintentional injuries) (V01?X59, Y85?Y86) 1 1391 42.8 7.0 1459 42.0 7.3 4.1
Motor vehicle accidents (V02?V04, V09.0, V09.2, V12?V14, V19.0? ? 780 24.0 3.9 802 23.1 4.0 2.5
V19.2, V19.4?V19.6, V20?V79, V80.3?V80.5, V81.0?V81.1,
V82.0?V82.1, V83?V86, V87.0?V87.8, V88.0?V88.8, V89.0, V89.2)
Accidental discharge of firearms (W32?W34) ? 18 0.6 ? 19 0.5 ? 0.0
Malignant neoplasms (C00?C97) 2 489 15.0 2.5 509 14.7 2.6 3.8
Congenital malformations, deformations and chromosomal 3 198 6.1 1.0 207 6.0 1.0 0.0
abnormalities (Q00?Q99)
Assault (homicide) (X85?Y09, Y87.1) 4 140 4.3 0.7 186 5.4 0.9 22.2
Assault (homicide) by discharge of firearms (X93?X95) ? 50 1.5 0.3 61 1.8 0.3 0.0
Diseases of heart (I00?I09, I11, I13, I20?I51) 5 106 3.3 0.5 116 3.3 0.6 16.7
10?14 y
All causes ? 4160 100.0 20.9 4121 100.0 21.1 0.9
Accidents (unintentional injuries) (V01?X59, Y85?Y86) 1 1588 38.2 8.0 1632 39.6 8.3 3.6
Motor vehicle accidents (V02?V04, V09.0, V09.2, V12?V14, V19.0? ? 992 23.8 5.0 969 23.5 5.0 0.0
V19.2, V19.4?V19.6, V20?V79, V80.3?V80.5, V81.0?V81.1,
V82.0?V82.1, V83?V86, V87.0?V87.8, V88.0?V88.8, V89.0, V89.2)
Accidental discharge of firearms (W32?W34) ? 49 1.2 0.2 57 1.4 0.3 33.3
Malignant neoplasms (C00?C97) 2 525 12.6 2.6 503 12.2 2.6 0.0
Intentional self-harm (suicide) (X60?X84, Y87.0) 3 300 7.2 1.5 242 5.9 1.2 25.0
Intentional self-harm (suicide) by discharge of firearms (X72?X74) ? 110 2.6 0.6 103 2.5 0.5 20.0
Assault (homicide) (X85?Y09, Y87.1) 4 231 5.6 1.2 246 6.0 1.3 7.7
Assault (homicide) by discharge of firearms (X93?X95) ? 137 3.3 0.7 163 4.0 0.8 12.5
Congenital malformations, deformations and chromosomal 5 201 4.8 1.0 221 5.4 1.1 9.1
abnormalities (Q00?Q99)
15?19 y
All causes ? 13 563 100.0 68.2 13 778 100.0 69.8 2.3
Accidents (unintentional injuries) (V01?X59, Y85?Y86) 1 6755 49.8 34.0 6688 48.5 33.9 0.3
Motor vehicle accidents (V02?V04, V09.0, V09.2, V12?V14, V19.0? ? 5251 38.7 26.4 5198 37.7 26.3 0.4
V19.2, V19.4?V19.6, V20?V79, V80.3?V80.5, V81.0?V81.1,
V82.0?V82.1, V83?V86, V87.0?V87.8, V88.0?V88.8, V89.0, V89.2)
Accidental discharge of firearms (W32?W34) ? 107 0.8 0.5 126 0.9 0.6 16.7
Assault (homicide) (X85?Y09, Y87.1) 2 1914 14.1 9.6 2093 15.2 10.6 9.4
Assault (homicide) by discharge of firearms (X93?X95) ? 1549 11.4 7.8 1708 12.4 8.6 9.3
Intentional self-harm (suicide) (X60?X84, Y87.0) 3 1621 12.0 8.2 1615 11.7 8.2 0.0
Intentional self-harm (suicide) by discharge of firearms (X72?X74) ? 897 6.6 4.5 975 7.1 4.9 8.2
Malignant neoplasms (C00?C97) 4 745 5.5 3.7 745 5.4 3.8 2.6
Diseases of heart (I00?I09, I11, I13, I20?I51) 5 403 3.0 2.0 463 3.4 2.3 13.0
* Rank based on 2000 data. Ranking is shown for 5 leading causes for specified age groups. For an explanation of ranking procedures, see
Technical Appendix in Vital Statistics of the United States, Vol II, Mortality Part A (published annually).
? Rate per 100 000 population in specified group.
? Figure does not meet standards of reliability or precision (defined as 20 deaths in the numerator).
Source: CDC/NCHS, National Vital Statistics System, mortality, 1999?2000.
1050 ANNUAL SUMMARY OF VITAL STATISTICS?2001
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TABLE 12. Persons Reporting a Specified Race Alone or in Combination With 1 or More Other Race Categories: United States 2000
Census
Specified Race Alone or in Alone In Percent Increase,
Combination Combination ?In Combination?
Over ?Alone?
White 216 930 975 211 460 626 5 470 349 2.6
Black or African American 36 419 434 34 658 190 1 761 244 5.1
American Indian and Alaska Native 4 119 301 2 475 956 1 643 345 66.4
Asian 11 898 828 10 242 998 1 655 830 16.2
Native Hawaiian and Other Pacific Islander 874 414 398 835 475 579 119.2
Source: US Census Bureau. The Two or More Races Population: 2000. Census 2000 Brief, Nov. 2001
and the ?Alone or in combination? number. Clearly, 2000. National Vital Statistics Reports. Vol. 50, No. 8. Hyattsville, MD:
a birth or death rate for one of these race groups National Center for Health Statistics; 2002
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This will take considerable resources and at least 2000, Volume I, Natality, Technical Appendix. Hyattsville, MD: National
several years to accomplish, and not all registration Center for Health Statistics; 2002. Available at : http://www.cdc.gov/nchs/data/techap00.pdf
systems will be able to implement the Revised Stan- 8. World Health Organization. Manual of the International Statistical Classi-
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the start. Until there is a complete conversion of vital Switzerland: World Health Organization; 1992
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sus Bureau population estimates and vital statistics 10. Mathews TJ, Menacker F, MacDorman MF. Infant Mortality Statistics
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11. US Census Bureau. Unpublished census file. Nchsres2001base1990.xls.
race definition, NCHS is working with the Census Estimates of the United States by age, sex, race, and Hispanic origin:
Bureau to produce population estimates (referred to 2001. Washington, DC: US Census Bureau
as a ?bridge?) based on a race concept that is reason- 12. US Census Bureau. Unpublished census file Nchsres2001s
ably compatible with that used in vital records for 1990base.xls. Estimates of the population for the States by age, and sex:
2000, to facilitate trend analysis of vital rates. Specif- 2001. Washington, DC: US Census Bureau13. United Nations. Demographic Yearbook 1998. New York, NY: United
ically, NCHS has developed an algorithm for the Nations; 2001
Bureau to use in converting multiple-race totals to 14. United Nations. Population and Vital Statistics Report, Series A, Vol-
single-race totals for the 4 basic race categories spec- ume LII, No. 1. Data available as of January 1, 2001, Department of
ified in the 1977 race standard. This work is ongoing Economic and Social Affairs, Statistics Division; 2001
15. United Nations, Population and Vital Statistics Report, Series A, Vol-
at this time and will be thoroughly evaluated for ume LIII, No. 1. Data available as of January 1, 2002, Department of
validity as it becomes available. The goal of bridging Economic and Social Affairs, Statistics Division; 2002
is to aid in the transition to the new standard. 16. Ventura SJ, Mathews TJ, Hamilton BE. Births to Teenagers in the United
Bridged denominators will only be used until suffi- States, 1940?2000. National Vital Statistics Reports. Vol. 49, No. 10.
cient numbers of states begin collecting multiple race Hyattsville, MD: National Center for Health Statistics; 200117. National Center for Health Statistics. Vital Statistics of the United States,
data to enable the production of rates based on mul- 1998, Volume I, Natality. Hyattsville, MD: National Center for Health
tiple-race data. Statistics; 2002. Available at: http://www.cdc.gov/nchs
18. Ventura SJ, Mosher WD, Curtin SC, Abma JC, Henshaw S. Trends in
ACKNOWLEDGMENTS Pregnancy Rates for the United States, 1976?97: An Update. National Vital
We wish to thank James Weed, Stephanie Ventura, Joyce Mar- Statistics Reports. Vol. 49, No. 4. Hyattsville, MD: National Center for
tin, Paul Sutton, and Brady Hamilton for major contributions to Health Statistics; 2001
the manuscript; Paul Sutton, Martha Munson, Melissa Park, 19. Maynard RA, ed. Kids Having Kids: Economic Costs and Social Conse-
Thomas Dunn, and Yashu Patel for content review; and Sheila quences of Teen Pregnancy. Washington, DC: The Urban Institute Press;
Thomas for her assistance with obtaining and verifying the accu- 1996
racy of the international data. 20. Ventura SJ. Trends and Variations in First Births to Older Women, 1970?86.
Vital and Health Statistics 21(47). Hyattsville, MD: National Center for
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red/htm 1997;62:58782?58790
ADMINISTRATION BREAKS THE BANK
?Although uncontrolled costs constitute a multifaceted problem, administrative
waste deserves special emphasis. . . administrators represent the fastest-growing
sector of the health care labor force, expanding at 3 times the rate of physicians and
other clinical personnel. The United States spends more than any other economi-
cally developed country on administration, which consumes approximately 25% of
health care costs. This figure compares unfavorably to all countries with national
health programs, which spend between 6% and 18% of health care costs on
administration. . . If the United States could reduce administrative spending to a
proportion comparable to that of countries with national health programs, the
savings (currently about 10% of total expenditures of $1 trillion, or about $100
billion) would be adequate to provide universal access to health services without
additional spending.?
Waitzkin H. The Front Lines of Medicine. Lanham, MD: Rowman & Littlefield Publishers, Inc; 2002
Submitted by Student
1052 ANNUAL SUMMARY OF VITAL STATISTICS?2001
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Annual Summary of Vital Statistics?2001 
Marian F. MacDorman, Arialdi M. Minino, Donna M. Strobino and Bernard Guyer 
Pediatrics 2002;110;1037-1052 
DOI: 10.1542/peds.110.6.1037 
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