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2. Patterns of Childhood Death in America
Pages 41-71

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From page 41...
... This chapter summarizes information about the death rates and leading causes of death for children of different ages. It also reviews information about where children die.
From page 42...
... . The relatively high infant mortality rate in the United States has been attributed in part to this country's large number of low birth weight infants, which in turn, reflects underlying social and economic problems and disparities (see, e.g., Guyer et al., 2000; Hoyert et al., 2001)
From page 43...
... For infants, the leading causes of death include congenital anomalies (a highly diverse group of malformations and other conditions) , disorders related to short gestation and low birth weight, and sudden infant death syndrome.
From page 44...
... Infant ( < 1) 1 -4 5-14 15-24 1 Congenital Accidentsb Accidents Accidents anomaliesa 1,898 3,091 13,656 5,473 2 Short gestation Congenital Malignant Homicid' and LBWC anomalies neoplasms 4,998 4,392 549 1,012 3 SIDS Malignant Homicide Suicide 2,648 neoplasms 432 3,901 418 4 Complications of Homicide Congenital Malignar pregnancy 376 anomalies neoplasm 1,399 428 1 724 5 Respiratory distress Diseases of Diseases of Diseases syndrome the heart the heart the heart 1,110 1834 277 1,069 6 Placental cord Pneumonia Suicide Congenit membranes and influenza 242 anomalie 1,025 130 434 7 Accidents Perinatal periode Chronic lower Chronic ]
From page 45...
... PATTERNS OF CHILDHOOD DEATH IN AMERICA ause and 45 15-24 25-44 45-64 >65 Accidents Accidents Malignant Diseases of 13,656 27,121 neoplasms the heart 135,748 607,265 Homicide Malignant Diseases of Malignant 4,998 neoplasms the heart neoplasms 20,737 99,161 390,122 Suicide Diseases of Accidents Stroke 3,901 the heart 18,924 148,599 16,666 Malignant Suicide Stroke Chronic lower neoplasms 11,572 15,215 respiratory disease 1,724 108,112 Diseases of HIV infection Chronic lower Pneumonia the heart 8,961 respiratory diseases and influenza 1,069 14,407 57,282 Congenital Homicide Diabetes mellitus Diabetes mellitus anomalies 7,437 13,832 51,843 434 Cower Chronic lower Diseases of the liver Diseases of the liver Alzheimer's y diseases respiratory diseases 3,709 12,005 Disease 209 44,020 oplasms HIV Stroke Suicide Accidents 198 3,154 7,977 32,219 a Stroke Diabetes mellitus HIV Nephritis nza 182 2,524 5,056 29,938 Pneumonia Pneumonia Septicemia Septicemia and influenza and influenza 4,399 24,626 179 1,402 continued next page
From page 46...
... 705.6g 34.7 19.2 81.2 NOTE: The rank order of leading causes of death changed somewhat between 1998 and 1999, reflecting in part changes in the coding rules for selecting underlying cause of death between the ninth and tenth editions of the International Classification of Diseases. aCongenital malformations, deformations, and chromosomal abnormalities.
From page 47...
... rather than per 1,000 live births, which is the infant mortality rate (see Table 2.4)
From page 48...
... This estimate did not link the potential for benefit to an assumed life expectancy of six months or less, a criterion for Medicare or Medicaid hospice benefits. Some children who die from critical acute problems might need intensive palliative or hospice services for a few days or even hours, whereas children with complex chronic problems might need mostly intermittent services over a period of months or years.
From page 49...
... Most of the decline in fetal death rates in recent decades has occurred in the late fetal period. Leading Causes of Infant Death Understanding the common causes of infant death is important in understanding the potential role of supportive care for these children and their families.
From page 50...
... that is not an induced termination of pregnancy.b Some states use the term "stillbirth" for such fetal deaths Fetal deaths of 28 weeks' or more gestationb Late fetal deaths plus infant deaths within 7 days of birth. (definitions of perinatal mortality vary and sometimes include fetal and infant deaths from the twentieth or the twenty-eighth week of gestation through the seventh or twenty-seventh day of life)
From page 51...
... 51 · s~ 1 of Go He ad of Ad · c~ of en Ad · s~ Ad ad ¢ o 1 u, o o u, v u, oo v ¢ If ~ so ~ ~ .
From page 52...
... reported that about one-quarter of all infant deaths in Washington state during 1980 to 1998 were linked to complex chronic conditions such as cardiac, brain, and spinal malformations, with the rest relatively evenly divided between injuries and other acute events (e.g., extreme prematurity, SIDS, respiratory distress syndrome)
From page 53...
... Congenital anomalies may be inherited or sporadic (for example, arising de nova during embryonic development)
From page 54...
... Congenital heart disease is the major cause of death in children with congenital anomalies, but it still occurs in only 0.5 to 0.8 percent of live births. The incidence of cardiac anomalies is higher in fetal deaths (10 to 25 percent)
From page 55...
... . For this reason and, more generally, to learn more about sudden unexplained infant deaths, death scene
From page 56...
... Of the age groups reviewed in this chapter, children aged 5 to 9 have the lowest death rate, with lower rates of death from most leading causes including unintentional and intentional injuries. TABLE 2.6 Top Five Causes of Death in Children Aged 1-4 and 5-9 Years, Death Rates, and Total Deaths (1999)
From page 57...
... Among children aged 1 to 4, motor vehicle occupant injury is the leading cause of unintentional injury-related death, followed by drowning, fire and burns, airway obstruction injuries (choking and suffocation) , and motor vehicle pedestrian injuries.
From page 58...
... According to the National Cancer Institute, the death rate between 1994 and 1998 from all cancers was 2.7 per 100,000 for children aged 0 to 4 and 5 to 9 years (Ries, 20011. Leukemias and brain and other nervous system cancers were the most common types of cancer in these two age groups (as well as in the 10- to 14-year group)
From page 59...
... Gunshot wounds account for 5 percent of pediatric injuries seen in emergency departments and produce the highest death rate due to injury (NPTR, 2001 ) .5 In 1999, homicide was the fourth leading cause of death for children aged 1 to 4 years and was also the fourth leading cause for 5- to 9-yearolds, who had the lowest rate among children.
From page 60...
... SOURCE: NCHS, 2001b. Leading Causes of Death for Children 10 to 14 and 15 to 19 Table 2.7 reports the leading causes of death for children aged 10 to 14 and 15 to 19.
From page 61...
... Overall, malignant neoplasms are the second leading cause of death in 10- to 14-year-olds and the fourth leading cause of death in 15- to 19-yearolds. The cancer death rate is, however, slightly higher in the older teens than in the younger group (3.8 per 100,000 versus 2.6 per 100,000 in 1999)
From page 62...
... 1994) , reported higher death rates from motor vehicle crashes and unintentional injuries for children in rural areas.
From page 63...
... Northeast 13.6 19.0 5.9 8.0 South 32.8 33.3 8.5 11.8 Midwest 30.8 26.3 8.7 10.7 West 23.5 30.0 8.8 11.0 NOTE: Infant mortality rate is per 1,000 live births. Other death rates are per 100,000 children aged 15 to 19.
From page 64...
... suggests that the American habit of separating statistics based on race, especially infant mortality statistics, has led to a policy in children's health that focuses on welfare and reducing poverty rather than on improving all children's health. He argues that such policy allows for bias against certain races, or moral character judgments against socioeconomically disadvantaged groups, and may contribute to resistance to policies that would benefit all children, such as universal health care coverage for children.
From page 65...
... Low birth weight is the primary cause of infant mortality in black infants and occurs at a rate of 280.9 per 100,000 live births compared to 72 per 100,000 for white infants.10 Infants born to black American women are more likely to have low birth weights than those born to either white American women or African-born black women in the United States, which suggests the role that social and cultural factors may play in this difference (Stoll and Kliegman, 2000a,b)
From page 66...
... Black adolescents between the ages of 15 and 19 years are killed at six times the rate for white adolescents (37.5 per 100,000 versus 5.7 per 100,000~. In contrast, suicide and motor vehicle death rates are almost half again as high among white adolescents, ages 15 to 19, compared to black adolescents in this age group (8.6 per 100,000 versus 5.9 per 100,000 for suicide and 28.4 versus 18.2 per 100,000 for motor vehicle deaths)
From page 67...
... For example, not Only may careful efforts to prevent or relieve the Pam and other distress that accompany certain treatments improve a child's comfort and quality of life, it may improve the child's ability to tolerate or cooperate wad treatment. Just as hospice providers work with patients and families to reevaluate Be goals of cure as Be end stage of an illness approaches, '`upstream palliative care" involves the periodic discussion of prognosis and care options and, as appropnate, the reconsideration of the goals of care during the early stages of complex chronic illnesses, for example, during '`rouhne" visits and check ups.
From page 68...
... . Of those who died in the hospital, nearly half died in the pediatric intensive care unit (PICU)
From page 69...
... Although data are limited, children who die of complex chronic conditions such as AIDS, cystic fibrosis, and muscular dystrophy usually die in the hospital, typically following several earlier hospitalizations for crises that they survived. One multicenter study of children with AIDS who died reported that nearly 65 percent died in the hospital and almost one-quarter died at home (Langston et al., 2001~.
From page 70...
... In a study of a diverse set of 16 pediatric intensive care units, Levetown and colleagues (1994) found that of 5,415 consecutive admissions to the PICUs, 265 (5 percent)
From page 71...
... In addition to encouraging preventive health services and other policies and programs to counter or reduce socioeconomic inequalities, advocates of pediatric palliative care need to consider how their programs can best serve disadvantaged and troubled families and how they can best identify the kinds of support desired by these families for themselves and their children. Fifth, hospitals, especially their neonatal and pediatric intensive care units, play a particularly important role in care for children who die of complex chronic problems.


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