Annual Summary of Vital Statistics—1997 Bernard Guyer, MD, MPH*; Marian F. MacDorman, PhD‡; Joyce A. Martin, MPH‡; Kimberley D. Peters‡; and Donna M. Strobino, PhD* Note: Readers will notice that this annual article is changing over time by incorporating new datasets and providing new analyses while, at the same time, maintain- ing continuity with the historic presentation of the data. We want to point out several features of this year’s paper and to emphasize to practicing pediatricians and obstetri- cians the importance of the accurate completion of the birth and death certificates from which the data reported here are drawn. This year we present expanded information from the birth certificates on the characteristics of mothers and their preg- nancies. Improvement in the accuracy of this information reported on birth certificates will have an enormous pay-off in monitoring the health of women. For the first time, this year’s article presents data on fetal deaths. Again, by directing the reader to these important data, we hope to increase the mo- tivation of physicians to complete fetal death certificates ac- curately so that long-term trends can be monitored better. Again, this years’s article uses data from the linked birth/ infant death dataset to present information on birth weight- specific survival of infants. These results are important be- cause they measure the performance of the health care system in managing neonates. For the second year, we present data on the major causes of child death and, in addition, provide a new framework for analyzing childhood injury mortality data that classifies deaths according to intent and mechanism of injury. Again, our goal is to examine the important causes of death, to encourage accurate reporting by physicians, and to make these data more accessible to clinicians and policy- makers. ABSTRACT. Many positive trends in the health of Americans continued into 1997. In 1997, the preliminary birth rate declined slightly to 14.6 births per 1000 popu- lation, and the fertility rate, births per 1000 women 15 to 44 years of age, was unchanged from the previous year (65.3). These indicators suggest that the downward trend in births observed since the early 1990s may have abated. Fertility rates for white, black, and Native American women were essentially unchanged between 1996 and 1997. Fertility among Hispanic women declined 2% in 1997 to 103.1, the lowest level reported since national data for this group have been available. For the sixth consec- utive year, birth rates dropped for teens. Birth rates for women 30 years or older continued to increase. The pro- portion of births to unmarried women (32.4%) was un- changed in 1997. The trend toward earlier utilization of prenatal care continued for 1997; 82.5% of women began prenatal care in the first trimester. There was no change in the percent- age with late (third trimester) or no care in 1997. The cesarean delivery rate rose slightly to 20.8% in 1997, a reversal of the downward trend observed since 1989. The percentage of low birth weight (LBW) infants rose again in 1997 to 7.5%. The percentage of very low birth weight was up only slightly to 1.41%. Among births to white mothers, LBW increased for the fifth consecutive year, to 6.5%, whereas the rate for black mothers remained un- changed at 13%. Much, but not all, of the rise in LBW for white mothers during the 1990s can be attributed to an increase in multiple births. In 1996, the multiple birth rate rose again by 5%, and the higher-order multiple birth rate climbed by 20%. Infant mortality reached an all time low level of 7.1 deaths per 1000 births, based on preliminary 1997 data. Both neonatal and postneonatal mortality rates declined. In 1996, 64% of all infant deaths occurred to the 7.4% of infants born at LBW. Infant mortality rates continue to be more than two times greater for black than for white infants. Among all the states in 1996, Maine, Massachu- setts, and New Hampshire had the lowest infant mortal- ity rates. Despite declines in infant mortality, the United States continues to rank poorly in international compar- isons of infant mortality. Expectation of life at birth reached a new high in 1997 of 76.5 years for all gender and race groups combined. Age-adjusted death rates declined in 1997 for diseases of the heart, accidents and adverse affects (unintentional injuries), homicide, suicide, malignant neoplasms, cere- brovascular disease, chronic liver disease and cirrhosis, and diabetes. In 1997, mortality due to HIV infection declined by 47%. Death rates for children from all major causes declined again in 1997. Motor vehicle traffic inju- ries and firearm injuries were the two major causes of traumatic death. A large proportion of childhood deaths continue to occur as a result of preventable injuries. Pediatrics 1998;102:1333–1349; birth, death, infant mortal- ity, low birth weight, mortality, multiple births, injury, vital statistics. ABBREVIATIONS. IMR, infant mortality rate; HIV, human immu- nodeficiency virus; LBW, low birth weight; NCHS, National Cen- ter for Health Statistics; ICD–9, International Classification of Dis- eases, 9th Revision; SIDS, sudden infant death syndrome; RDS, respiratory distress syndrome. M any positive trends in the health of Ameri- cans continued into 1997, although there were still some problems. The infant mor- tality rate (IMR) for the United States declined in From the *Department of Population and Family Health Sciences, Johns Hopkins School of Hygiene and Public Health, Baltimore, Maryland; and the ‡Division of Vital Statistics, National Center for Health Statistics, Cen- ters for Disease Control and Prevention, Hyattsville, Maryland. Received for publication Oct 2, 1998; accepted Oct 2, 1998. Reprint requests to (B.G.) Johns Hopkins School of Hygiene and Public Health, 624 N Broadway, Baltimore, MD 21205. PEDIATRICS (ISSN 0031 4005). Copyright © 1998 by the American Acad- emy of Pediatrics. PEDIATRICS Vol. 102 No. 6 December 1998 1333