After a century of declines, the U.S. infant mortality rate barely budged between 2000 and 2005, causing the United States to slip further behind other developed countries despite spending more on healthcare, according to a report released Wednesday.
The rate was 6.86 infant deaths per 1,000 live births in 2005, virtually unchanged from 6.89 in 2000. In 1900, the rate was 100 deaths per 1,000 live births.
The United States dropped to 29th in the world in infant mortality in 2004, the latest year for which data are available from all countries, tying with Poland and Slovakia. The year before, it was 27th. In 1960, it was 12th.
The report from the Centers for Disease Control and Prevention attributed the leveling off in mortality to a 9% increase in premature births over the same period and to stalled progress in saving the earliest preterm infants. Premature birth and low birth weight are by far the biggest causes of infant death.
Advances such as prenatal steroids that hasten lung development and other treatments that help premature infants breathe have allowed the vast majority of those infants to survive.
But the search for new breakthroughs is only one part of the solution, said Joann Petrini, director of the March of Dimes' perinatal data center.
"Several decades ago we saw really dramatic declines because we had these silver bullets," she said. "But the other piece is to see how can we prevent some of these babies from being born preterm in the first place."
Infant mortality rates vary by race and ethnicity, from a high of 13.63 per 1,000 births for African American women to a low of 4.42 for Cuban Americans, according to the CDC report. Differences in socioeconomic status and access to medical care did not entirely explain the gap, the report said.
A rise in twins and triplets, driven by the use of infertility treatments, contributed somewhat to the rise in premature and low-birth-weight births, Petrini said. But even accounting for those trends, premature births are increasing, possibly tied to rising rates of obesity, diabetes and hypertension.
What those conditions have in common is that they are preventable, and that, said Petrini and other health advocates, is where the United States falls behind other developed countries.
"We as a nation place less emphasis on primary care and prevention than a lot of these other industrialized democracies do that have lower rates than we do," said Dr. Ann O'Malley of the Center for Studying Health System Change, a Washington-based research group.
Twenty-two countries have infant mortality rates below 5 per 1,000 births, and Sweden, Norway, Finland, Japan, Hong Kong and Singapore are below 3.2.
Health advocates acknowledge that many of those countries have more homogeneous populations than the United States. But they also have fewer gaps in healthcare coverage and health systems that emphasize primary care.
"We're great in this country at taking care of really sick people with high-tech interventions," O'Malley said. "But we're not very good at plugging people into preventive care."