Objectives:

This report presents final 2022 infant mortality statistics by age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of death, and maternal state of residence. Trends in infant mortality are also examined.

Methods:

Descriptive tabulations of data are presented and interpreted for infant deaths and infant mortality rates using the 2022 period linked birth/infant death file. The linked birth/infant death file is based on birth and death certificates registered in all 50 states and the District of Columbia.

Results:

A total of 20,577 infant deaths were reported in the United States in 2022, up 3% from 2021. The U.S. infant mortality rate was 5.61 infant deaths per 1,000 live births, a 3% increase from the rate of 5.44 in 2021. The neonatal mortality rate increased 3% from 3.49 in 2021 to 3.59 in 2022, and the postneonatal mortality rate increased 4% from 1.95 to 2.02. The overall infant mortality rate increased for infants of American Indian and Alaska Native non-Hispanic, White non-Hispanic, and Dominican women in 2022 compared with 2021; changes in rates for the other race and Hispanic-origin groups were not significant. Infants of Black non-Hispanic women had the highest mortality rate (10.90) in 2022, followed by infants of American Indian and Alaska Native non-Hispanic and Native Hawaiian or Other Pacific Islander non-Hispanic (9.06 and 8.50, respectively), Hispanic (4.89), White non-Hispanic (4.52), and Asian non-Hispanic (3.51) women. Mortality rates increased from 2021 to 2022 among preterm (less than 37 weeks of gestation) infants (33.59 to 34.78) and for infants born term (37 to 41 weeks of gestation) (2.08 to 2.18). The five leading causes of infant death in 2022 were the same as in 2021. Infant mortality rates by state for 2022 ranged from a low of 3.32 in Massachusetts to a high of 9.11 in Mississippi.

Data by maternal and infant characteristics

This report presents descriptive tabulations of infant mortality data by a variety of maternal and infant characteristics. These tabulations are useful for understanding the basic relationships between risk factors and infant mortality, unadjusted for the possible effects of other variables. However, women with one risk factor often have other risk factors. For example, teen mothers are more likely to be unmarried and of a low-income status, while mothers who do not receive prenatal care are more likely to be of a low-income status and uninsured. The preferred method for disentangling the multiple interrelationships among risk factors is multivariate analysis; however, an understanding of the basic relationships between risk factors and infant mortality is the first step before more sophisticated types of analyses and may help identify high-risk subgroups for prevention efforts. This report presents several key risk factors for infant mortality: age at death, maternal race and Hispanic origin, maternal age, gestational age, leading causes of infant death, and maternal state of residence. For brevity, additional selected risk factors (sex, birthweight, plurality, and nativity [mother’s place of birth]) are presented in tables but not discussed in this report.

Race and Hispanic origin—Infant mortality rates are presented by race and Hispanic origin of the mother. The linked file is useful for computing accurate infant mortality rates by these characteristics because the race and Hispanic origin of the mother from the birth certificate are used in both the numerator and denominator of the infant mortality rate. In contrast, for rates based on the vital statistics mortality file, race information for the denominator is the race of the mother as reported on the birth certificate, while race information for the numerator is the race of the decedent as reported on the death certificate (2,3,8). More detail on the reliability of race and Hispanic-origin data from the linked file compared with the mortality file is available elsewhere (8).

Statistical significance—Statements in the text have been tested for statistical significance, and a statement that a given infant mortality rate is higher or lower than another rate indicates that the rates are significantly different using a two-tailed z test at the alpha level of 0.05. Comparisons between state rates and the U.S. rate take into account each state’s contribution to the U.S. rate. As a result, each state rate is compared with a unique U.S. rate independent of the state’s contribution to the total U.S. rate. Information on the methods used to test for statistical significance, as well as information on differences between period and cohort data, the weighting of the linked file, maternal age, period of gestation, birthweight, and cause-of-death classification is also available (1) (Technical Notes).

Trends in infant mortality and infant age at death

• In 2022, 20,577 infant deaths were reported in the United States, an increase of 3% from 2021 (19,928) (Figure 1, Table 1). The infant mortality rate was 5.61 deaths per 1,000 live births in 2022, an increase of 3% from the 2021 rate of 5.44.
• The U.S. infant mortality rate has generally trended downward since 1995 (the first year that the period linked birth/infant death file was available) and in 2022 was down 19% since the last increase in 2002 (6.95).
• The 2022 neonatal mortality rate (infant deaths at less than 28 days) of 3.59 was 3% higher than the rate in 2021 (3.49). The neonatal mortality rate has generally declined since 1995 and decreased 23% since the last increase in 2002 (4.67).
• The 2022 postneonatal mortality rate (infant deaths at 28 days or more) increased 4% to 2.02 from 1.95 in 2021. The postneonatal mortality rate has also generally declined since 1995 and decreased 11% since 2002 (2.28).

Figure 1

Infant, neonatal, and postneonatal mortality rates: United States, 1995–2022. SOURCE: National Center for Health Statistics, National Vital Statistics System, linked birth/infant death file.

Table 1

Live births; infant, neonatal, and postneonatal deaths; and mortality rate: United States, 1995–2022, and by maternal race and Hispanic origin, 2017–2022

Race and Hispanic origin

• The mortality rate for infants of American Indian and Alaska Native women increased from 7.46 infant deaths per 1,000 births to 9.06 from 2021 to 2022, and the rate for infants of White women increased from 4.36 to 4.52 (Tables 1 and 2, Figure 2). Increases in rates for infants born to Black (10.55 to 10.90), Hispanic (4.79 to 4.89), and Native Hawaiian or Other Pacific Islander (7.76 to 8.50) women were not significant. The decline in the rate for infants born to Asian women (3.69 to 3.51) was not significant.
• Among Hispanic-origin subgroups, the mortality rate for infants of Dominican women increased from 3.27 to 4.74 from 2021 to 2022; increases in mortality rates for infants of Central and South American (4.20 to 4.36), Cuban (3.56 to 3.94), and Puerto Rican (6.05 to 6.32) women were not significant. The decline in the mortality rate for infants of Mexican women (4.91 to 4.79) from 2021 to 2022 was not significant.
• In 2022, infant mortality continued to vary by race: infants of Black women had the highest mortality rate (10.90), followed by infants of American Indian and Alaska Native and Native Hawaiian or Other Pacific Islander (9.06 and 8.50, respectively), Hispanic (4.89), White (4.52), and Asian (3.51) women.
• Infants of Black women also had the highest neonatal mortality rate in 2022 (6.44) compared with infants of the other race and Hispanic-origin groups; the lowest mortality rate was for infants of Asian women (2.47) (Table 2).
• In 2022, postneonatal mortality rates were higher for infants of Black (4.45), American Indian and Alaska Native (3.81), and Native Hawaiian or Other Pacific Islander (3.75) women than for infants of White (1.63), Hispanic (1.54), and Asian (1.03) women.
• Among Hispanic-origin subgroups in 2022, the mortality rate for infants of Puerto Rican women (6.32) was higher than that of infants of Mexican (4.79), Dominican (4.74), Central and South American (4.36), and Cuban (3.94) women.

Table 2

Infant mortality rate, live births, and infant deaths, by selected characteristics and maternal race and Hispanic origin: United States, 2022

Figure 2

Infant mortality rate, by maternal race and Hispanic origin: United States, 2021 and 2022. ¹Significantly different from 2021 (p < 0.05). ²People of Hispanic origin may be of any race.

Maternal age

• The mortality rate for infants of women ages 25–29 increased from 2021 to 2022 (5.15 infant deaths per 1,000 births to 5.37) (Figure 3, Table 2). Increases in rates for infants of females ages 15–19 (9.15 to 9.86), 20–24 (6.87 to 7.13), 30–34 (4.48 to 4.59), and 35–39 (4.92 to 4.99) were not significant.
• Nonsignificant declines were seen for infants of females younger than 15 (14.92 to 14.25) and for infants of women age 40 and older (6.74 to 6.73).
• In 2022, mortality rates were highest for infants of females younger than age 15 and ages 15–19 (14.25 and 9.86, respectively), decreased to a low of 4.59 for infants of women ages 30–34, and then increased to 6.73 for infants of women age 40 and older.

Figure 3

Infant mortality rate, by maternal age: United States, 2021 and 2022. ¹Significantly different from 2021 (p < 0.05). SOURCE: National Center for Health Statistics, National Vital Statistics System, linked birth/infant death file.

Gestational age

• Mortality rates increased among preterm infants overall (less than 37 weeks of gestation) from 2021 to 2022, from 33.59 deaths per 1,000 live births to 34.78 (Table, Table 2). Increases were seen among early preterm infants (less than 34 weeks of gestation), from 103.08 to 107.94; the increase for infants born at 34–36 weeks (8.11 to 8.29) was not significant.
• Mortality rates also rose for infants born at term, or at 37–41 weeks (2.08 to 2.18). The increase in the rate at 42 weeks or more (3.79 to 4.23) was nonsignificant.
• In 2022, 65% of infant deaths occurred among infants born preterm (less than 37 weeks of gestation), unchanged from 2021.

Table

Infant mortality rate, by gestational age: United States, 2015–2022

Leading causes of infant death

• In 2022, the five leading causes of all infant deaths were the same as those in 2021: congenital malformations (19.5% of infant deaths), disorders related to short gestation and low birth weight (14.0%), sudden infant death syndrome (SIDS) (7.4%), unintentional injuries (6.6%), and maternal complications (5.9%) (Table 3).
• From 2021 to 2022, the infant mortality rate increased for maternal complications (from 30.4 infant deaths per 100,000 live births to 33.1).
• The increases in rates for congenital malformations (108.9 to 109.2), SIDS (39.8 to 41.7), and unintentional injuries (35.5 to 36.8), and the decline for disorders related to short gestation and low birth weight (80.7 to 78.6) were not significant (Table 3).
• Congenital malformations was the leading cause of death for infants born to American Indian and Alaska Native (178.8), Asian (70.3), White (99.6), and Hispanic (119.5) women in 2022 (Table 4).
• In 2022, disorders related to short gestation and low birth weight was the leading cause of death for infants of Black women (188.1).

Table 3

Infant deaths, percentage of deaths, and infant mortality rate, by five leading causes of infant death: United States, 2010–2022

Table 4

Infant deaths and mortality rate for the five leading causes of infant death, by maternal race and Hispanic origin: United States, 2022 [Rates are per 100,000 live births in specified group]

Infant mortality by state

• By state, infant mortality ranged from a low of 3.32 infant deaths per 1,000 births in Massachusetts to a high of 9.11 in Mississippi (Figure 4, Table 5).
• Twelve states had infant mortality rates significantly lower than the national infant mortality rate: California, Colorado, Connecticut, Massachusetts, Minnesota, Nevada, New Hampshire, New Jersey, New York, Oregon, Rhode Island, and Washington.
• Nineteen states had infant mortality rates significantly higher than the U.S. infant mortality rate: Alabama, Arizona, Arkansas, Delaware, Florida, Georgia, Indiana, Louisiana, Michigan, Mississippi, Missouri, North Carolina, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Virginia, and West Virginia.

Figure 4

Infant mortality rate, by state: United States, 2022. SOURCE: National Center for Health Statistics, National Vital Statistics System, linked birth/infant death file.

Table 5

Infant mortality rate: United States and each state, 2022 [By place of residence]

Data source and 2003 revision

Information on the data source for the linked birth/infant death file is available elsewhere (1). Additionally, further information on the 2003 revision of the birth certificate is available (3); see also the U.S. Standard Certificate of Live Birth (9).

Weighting

In 2022, a record weight was added to the U.S. linked file to compensate for the 1.4% of infant death records that could not be linked to their corresponding birth certificates. The percentage of records linked varied by registration area, ranging from 94.5% through 100.0% (Table). The number of infant deaths in the linked file for the 50 states and the District of Columbia was weighted to equal the sum of the linked plus unlinked infant deaths by state of occurrence of birth and age at death (younger than 7 days, 7–27 days, and 28 days to younger than 1 year). The addition of the weight reduced the potential for bias in comparing infant mortality rates by maternal and infant characteristics.

Table

Percentage of infant deaths linked to their corresponding birth records, by state of occurrence of death: United States and each state, 2022

The 2022 linked file initially included 20,613 infant death records. Of these records, 20,334 were linked; 279 were unlinked because corresponding birth certificates could not be identified. The 20,613 linked and unlinked records contained 31 records of infants whose mothers’ usual place of residence was outside of the United States; these records were excluded from linked file analyses for a weighted total of 20,577 infant deaths by place of residence for 2022.

Comparison of infant mortality data between linked file and vital statistics mortality file

The overall infant mortality rate of 5.61 from the 2022 period linked file is statistically the same as that from the 2022 vital statistics mortality file (5.60) (10). The number of infant deaths in the linked file (20,334) differs slightly from the number in the mortality file (20,553) (10). Differences in numbers of infant deaths between the two data sources are primarily due to geographic coverage differences. For the vital statistics mortality file, all deaths occurring in the 50 states and the District of Columbia are included regardless of the place of birth of the infant. In contrast, to be included in the U.S. linked file, both the birth and death must occur in the 50 states or the District of Columbia (the territory linked file is a separate file). Weighting of the linked file also may contribute to small differences in numbers and rates by specific variables between these two data sets.

Period of gestation

Beginning with the 2014 data year, the National Center for Health Statistics (NCHS) transitioned to a new standard for estimating the gestational age of the newborn. The new measure—the obstetric estimate of gestation at delivery—replaces the measure based on the date of the last normal menses (11). Accordingly, gestational age data shown in this report are based on the obstetric estimate of gestation at delivery. National data based on obstetric estimate of gestation at delivery data are available only from data year 2007 forward. Information on and discussion of the reasons for the change, as well as a detailed comparison of the two measures, are presented elsewhere (11).

Sex, birthweight, plurality, and nativity

Detailed definitions and more information on sex, birthweight, plurality, and nativity are available elsewhere (1,3).

Cause-of-death classification

The mortality statistics presented in this report were compiled in accordance with World Health Organization regulations, which specify that member nations classify and code causes of death according to the current revision of the International Statistical Classification of Diseases (ICD). ICD provides the basic guidance to code and classify causes of death, details disease classification, and supplies definitions, tabulation lists, the format of the death certificate, and the rules for coding cause of death. Cause-of-death data presented in this report were coded by procedures outlined in annual issues of the NCHS Instruction Manual (12,13).

In this report, tabulations of cause-of-death statistics are based solely on the underlying cause of death. Generally, more medical information is reported on death certificates than is directly reflected in the underlying cause of death. This is captured in NCHS multiple cause-of-death statistics (14,15).

Tabulation lists and cause-of-death ranking

The cause-of-death rankings for ICD–10 are based on the “List of 130 Selected Causes of Infant Death.” The tabulation lists and rules for ranking leading causes of death are published in the NCHS Instruction Manual, Part 9: "ICD–10 Cause-of-death Lists for Tabulating Mortality Statistics" (16).

Computation of rates

Information on and discussion of computation of rates (1) is also available from the “User Guide to the 2010 Natality Public Use File” at: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/natality/UserGuide2010.pdf.

Random variation in infant mortality rates

For information and discussion on random variation and significance testing for linked data (1), see also the “User Guide to the 2010 Natality Public Use File” at: https://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/natality/UserGuide2010.pdf.

Availability of linked file

Linked file data are available for download from the Vital Statistics Online Data Portal: https://www.cdc.gov/nchs/data_access/vitalstatsonline.htm. Linked period file data may also be accessed via the Centers for Disease Control and Prevention’s WONDER database, available from: https://wonder.cdc.gov/lbd.html. Beginning with 2005, the public-use file no longer includes geographic detail; such files are available upon special request (see the NCHS Division of Vital Statistics data release policy at: https://www.cdc.gov/nchs/nvss/nvss-restricted-data.htm). Data are also available in issues of Vital and Health Statistics, Series 20; National Vital Statistics Reports; and NCHS Data Briefs from the NCHS website: https://www.cdc.gov/nchs/products/index.htm.