In calendar year 2022, annual infant mortality alarmingly rose in four states while receding to a reassuring degree in just one.

The four sources of special concern are Georgia, Iowa, Missouri and Texas.

The lone ray of light is Nevada.

Meanwhile the provisional infant mortality rate for the whole of the U.S. rose 3%, from 19,928 deaths in 2021 to 20,538 in 2022.

This spike may not seem steep, but it marks the first time in two decades that this important metric of population health at the national level has seen a year-over-year increase.

In fact, U.S. infant mortality had dropped 22% over the 20 years ending in 2021.

The figures are from a report released Nov. 1 by the CDC’s National Center for Health Statistics.

Noting that the report uses provisional rather than finalized counts, the NCHS says it concentrated on the 98.6% of cases in which death certificates had links to birth certificates. Analyzing the two documents side by side can shed quantitative light on the role played in the early death by maternal age, gestational age, and various other mother and child factors recorded at time of birth.

For example, the analysis showed mortality rates increased in cases involving two of the 10 leading causes of death: maternal complications and bacterial sepsis.

Other key findings from the Nov. 1 report:

• The provisional infant mortality rate for the United States in 2022 was 5.60 infant deaths per 1,000 live births (that rate was 5.44 in 2021).
• The neonatal mortality rate increased 3% from 3.49 to 3.58 and the postneonatal mortality rate by 4%, from 1.95 to 2.02.
• Mortality rates increased significantly among infants of American Indian and Alaska Native, non-Hispanic (7.46 to 9.06) and White, non-Hispanic women (4.36 to 4.52).
• Infant mortality rates increased significantly for infants of women ages 25-29 from 5.15 to 5.37.
• Mortality rates increased significantly for total preterm (less than 37 weeks of gestation) and early preterm (less than 34 weeks of gestation) infants.
• The mortality rate increased significantly for male infants from 5.83 infant deaths per 1,000 live births to 6.06.

Commenting on the national 3% rise, Elizabeth Cherot, MD, president and CEO of the March of Dimes, tells The New York Times she’s “surprised and disappointed” by the data.

“We were making strides, but these trends are clearly going in the wrong direction,” Cherot says. “We were just coming out of Covid. We were doing a lot of telemedicine. Did that shift something? Were protocols changing? Was access a bigger issue? We know mental health can also have an impact. A lot of things changed in the last three years.”

The report’s authors are NCHS statistician Danielle Ely, PhD, and NCHS research analyst Anne Driscoll, PhD. 

Read the whole thing (PDF).