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Risk Factors for Diarrhea-associated Infant Mortality in the United States, 2005–2007

Mehal, Jason M. MPH*; Esposito, Douglas H. MD, MPH†‡; Holman, Robert C. MS*; Tate, Jacqueline E. PhD; Callinan, Laura S. MPH*; Parashar, Umesh D. MB BS, MPH

The Pediatric Infectious Disease Journal: July 2012 - Volume 31 - Issue 7 - p 717–721
doi: 10.1097/INF.0b013e318253a78b
Original Studies

Background: Diarrhea-associated deaths among US children increased from the mid-1980s through 2006, particularly among infants. Understanding risk factors for diarrhea-associated death could improve prevention strategies.

Methods: Records of singleton infants with diarrhea listed anywhere on the death certificate were selected from the US Linked Birth/Infant Death data for the period, 2005 to 2007; characteristics of these infants were compared with those of infants who survived their first year.

Results: During 2005 to 2007, 1087 diarrhea-associated infant deaths were reported; 86% occurred among low birth weight (LBW, <2500 g) infants. Compared with normal birth weight (NBW, ≥2500 g) infants, LBW infants had a greater mortality rate (risk ratio: 91.9, 95% confidence interval: 77.4–109.0) and younger median age at death (7 versus 15 weeks, P < 0.0001). The most common codiagnoses for diarrhea-associated death among LBW and NBW infants were sepsis (26%) and volume depletion (20%), respectively. Among LBW infants, 97% of diarrhea-associated deaths occurred in inpatient settings, whereas 27% of NBW infant deaths occurred in outpatient settings and 5.3% in the decedent’s home. Male sex, black race, unmarried status and low 5-minute Apgar score (<7) increased mortality odds among LBW infants whereas, among NBW infants, low 5-minute Apgar score, black race, young maternal age (<25 years) and high birth order (third or more) increased mortality odds.

Conclusions: Efforts to reduce diarrhea-associated morality should focus on understanding and improving management of diarrhea in vulnerable LBW infants. For prevention of diarrhea-associated deaths in NBW infants, educating mothers who fit the high-risk profile regarding home hydration therapy and timely access to medical treatment is important.

Supplemental Digital Content is available in the text.

From the *Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Dis-ease Control and Prevention; Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention; and the Epidemic Intelligence Service, Office of Work-force and Career Development, Centers for Disease Control and Prevention, Atlanta, GA.

Accepted for publication March 1, 2012.

Funded through the Centers for Disease Control and Prevention. The authors have no other funding or conflicts of interest to disclose.

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Address for correspondence: Jason M. Mehal, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd, MS A-30 Atlanta, GA 30333. E-mail:

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (

© 2012 Lippincott Williams & Wilkins, Inc.