Respiratory distress syndrome mortality in the United States, 1987 to 1995

OBJECTIVE: To review respiratory distress syndrome (RDS) mortality since the introduction of surfactant. DESIGN: Population-based historical cohort study. METHODS: United States vital statistic data were used for the years 1987 to 1995. Linked birth and infant death file data were available for the years 1987 to 1991 and for 1995. US natality and mortality files were used for the years 1992 to 1994. RESULTS: Whereas overall infant mortality decreased 25% over the-9 year period from a rate of 979 deaths/100,000 live births (LB) to a rate of 736, mortality attributed to RDS decreased 56% from a rate of 84 to 37. The crude black-white relative risk for RDS-related mortality increased from 2.02 in 1987 to 2.76 in 1995. The largest and most consistent drop in RDS-related mortality occurred in the 2000 to 2499 gm birth weight and 33- to 36-week gestation groups; average annual decline=20%. There was a change in the distribution of the underlying causes of death over the 9-year period with an increase in the proportion of mortality attributed to prematurity. CONCLUSION: Since the advent of surfactant there has been a marked reduction in mortality attributed to RDS. Of concern is the increasing disparity between black and white RDS-related mortality.