OBJECTIVE: We examined a trend in infant mortality caused by congenital mal
formations in the United States, particularly for the racial disparity betw
een whites and nonwhites.
METHODS: We used US annual summary data on cause-specific infant mortality
for 1970-97 and detailed birth and infant death linked data for 1985-87, 19
89-91, and 1995-97.
RESULTS. Congenital malformations became a more prominent cause of infant m
ortality in 1997 and accounted for 22.1% of all infant deaths compared with
15.1% in 1970. Congenital malformations of nervous, cardiovascular, and re
spiratory systems accounted for more than 60% of all malformation deaths. M
alformations incompatible with life (anencephaly, encephalocele, hypoplasti
c lungs, renal agenesis, and trisomies 13 and 18) were the cause of one-thi
rd of all malformation deaths. In 1970-71, infant mortality caused by conge
nital malformations in nonwhites was lower, 2.6 (confidence interval [CI] 2
.5, 2.7) per 1000, compared with whites, 3.1 (CI 3.0,3.1) per 1000. However
, in 1996-97, the rate of congenital malformation-specific infant mortality
was higher in nonwhites, 1.7 (CI 1.7, 1.8) per 1000, compared with whites,
1.6 (CI 1.5,1.6) per 1000. This trend was most pronounced with central ner
vous system malformations. Although whites had an almost two-fold higher in
fant mortality rate from central nervous system malformations compared with
nonwhites in 1970-71, this disparity was no longer present by 1996-97.
CONCLUSION: Congenital malformations have become a leading cause of infant
mortality in the 1990s. Over the last several decades, this mortality decli
ned more slowly in nonwhites than in whites. (C) 2001 by the American Colle
ge of Obstetricians and Gynecologists.