Child Mortality in the

United States, 1935-2007:

Large Racial and Socioeconomic Disparities Have Persisted Over Time

Gopal K. Singh, PhD

U.S. Department of Health and Human Services

Health Resources and Services Administration

Maternal and Child Health Bureau
Figure 1: Death Rates for Children Aged 1-4 Years

by Race, United States, 1935-2007

Child mortality in the United States has declined 

dramatically over the past century (1-5). The mortality rate 

for children aged 1-4 years declined from 1,418.8 deaths 

per 100,000 population in 1907 to 28.6 in 2007 (3, 4). The 

mortality rate for children aged 5-14 years declined from 

307.5 in 1907 to 15.3 in 2007 (3, 4). In 1900-1902, 90.2% 

of U.S. children aged 1 year survived to age 15, compared 

to 99.7% of children in 2007 (2, 4). Despite such impressive 

reductions in overall child mortality, large racial and ethnic 

disparities have continued to exist in the United States, and 

the recent evidence points to a widening of socioeconomic 

inequalities in child mortality (2, 3).

In this brief report, we analyze long-term trends in 

mortality among children aged 1-4 and 5-14 years according to race/ethnicity, sex, cause of death, family poverty 

level, and state of residence by using both historical and the 

latest national vital statistics data (3-5). As shown below, the 

impressive decline in the overall child mortality rates over 

the long term has been due to large reductions in mortality 

from unintentional injuries, pneumonia and influenza, 

cancer, and birth defects. 

Figure 2: Death Rates for Children Aged 5-14 Years

by Race, United States, 1935-2007

Trends in Mortality among Children Aged 1-4 and 5-14 

Years by Race and Sex

Although mortality trend data extend farther back in 

time for the entire United States and the birth and death 

registration areas, we chose 1935 as the start of the time 

trend analysis since it coincided with the inception of Title V 

of the Social Security Act, a national public health legislation 

aimed at promoting and improving the health and welfare 

services for all mothers and children. The death rate for children aged 1-4 years showed a consistently downward trend 

between 1935 and 2007, decreasing at a rapid rate of 3.3% 

per year (Figure 1). Although the rate of decline in mortality 

among both white and black children aged 1-4 was similar 

during 1935-2007, black children had 1.6 to 2.0 times higher 

mortality than white children throughout this period (Figure 

1). In 2007, the death rate for black children aged 1-4 was 

43.7 deaths per 100,000 population, 69% higher than the 

rate for white children (25.8). The detailed racial/ethnic data 

in 2007 indicate the lowest death rate among Asian/Pacific 

Islander children aged 1-4 years (20.9), followed by Hispanics (25.2), non-Hispanic whites (25.5), American Indians/

Alaska Natives (39.2), and blacks (43.7). As for the trend in 

sex differentials during the past 6 decades, the death rate 

for male children aged 1-4 has been approximately 15-30% 

higher than the rate for female children.
Figure 3: Leading Causes of Death among Children Aged 

1-4, United States, 2007

Figure 4: Leading Causes of Death among Children Aged 

1-4, United States, 1970

Figure 5: Leading Causes of Death among Children Aged 

5-14, United States, 2007

Figure 6: Leading Causes of Death among Children Aged 

5-14, United States, 1970
Figure 7: All-Cause Mortality Among Children Aged 1-14 

Years by County-Level Family Poverty Rate, United States, 

1969-2007

Figure 8: Relative Risk of All-Cause Child Mortality by 

County-Level Family Poverty Rate, 1969-2007

Mortality among children aged 5-14 years also showed 

a consistently downward trend during 1935-2007, with the 

rate decreasing from 150.0 deaths per 100,000 population 

in 1935 to 15.3 in 2007 (Figure 2). The average rate of 

decline in mortality among children aged 5-14 was 2.7% per 

year during this period, significantly lower than the pace of 

mortality decline for younger children aged 1-4. Although 

death rates for both white and black children aged 5-14 

years declined at a similar pace during 1935-2007, the 

relative risk of mortality was 33-75% higher among black 

children than white children during this period. According to 

the detailed racial/ethnic data in 2007, Asian/Pacific Islander 

children aged 5-14 years had the lowest death rate (10.9), 

followed by Hispanics (14.1), non-Hispanic whites (14.2), 

American Indians/Alaska Natives (17.0), and blacks (21.0). 

Regarding the trend in sex differentials during the past 6 

decades, the relative risk of mortality for male children aged 

5-14 years has been approximately 30-70% higher than that 

for female children.

Leading Causes of Child Mortality

In 2007, unintentional injuries, birth defects, homicide, 

cancer, and heart disease were the top five leading causes 

of death of children aged 1-4, accounting for two-thirds of 

all deaths in 2007 (Figure 3). Deaths from motor vehicle 

accidents accounted for approximately 37% of all unintentional injury deaths among younger children in 2007 (3). 

Pneumonia and influenza were the fourth leading cause 

of death in 1970 (Figure 4). HIV/AIDS, which was not a 

prominent cause of death in 2007, contributed substantially 

to young children’s mortality from 1987 through 1996 during 

which the mortality rate from it doubled. While mortality 

rates from such leading causes of death as unintentional 

injuries, birth defects, pneumonia and influenza, cancer, and 

COPD declined by 66-71% between 1970 and 2007, the 

homicide rate for children aged 1-4 increased by 26%. 

Unintentional injuries, cancer, birth defects, homicide, 

heart disease, and suicide were the leading causes of 

death of older children aged 5-14, accounting for 70% of all 

deaths in 2007 (Figure 5). Although HIV/AIDS accounted 

for only 10 deaths among children aged 5-14 in 2007, it 

was a leading cause of death for older children in the late 

1980s through the mid-1990s. Although mortality from such 

leading causes of death as unintentional injuries, cancer, 

birth defects, pneumonia and influenza, and stroke fell 

by 59-73% between 1970 and 2007, the suicide rate for 

children aged 10-14 years increased by 44% (Figures 5 

and 6). No change in homicide and COPD mortality rates 

occurred between 1970 and 2007 for older children.
Figure 9: Unintentional Injury Mortality Among Children

Aged 1-14 Years by County-Level Family Poverty Rate,

United States, 1969-2007

Figure 10: Relative Risk of Unintentional Injury Mortality 

among Children Aged 1-14 Years by County-Level Family 

Poverty Rate, United States, 1969-2007

Trends in Socioeconomic Disparities in Child Mortality

Since household socioeconomic data are not available 

in national mortality statistics, county-level family poverty 

data from the 1990 and 2000 censuses were linked with 

county-level mortality data to compute mortality rates 

from 1969 to 2007 for children aged 1-14 years in three 

poverty rate categories: <5% (i.e., less than 5% of families 

below the poverty level in a county, referred to as the low 

poverty group), 5-14.99% (middle poverty group), and 

15% or higher (high poverty group) [2, 6, 7]. Details of the 

linkage methodology are provided elsewhere (2). During 

1969-2007, the all-cause mortality rate for children in the 

low poverty group declined by 65.8%, whereas the rate for 

children in the high poverty group decreased by 57.5% (Figure 7). The slower decline in mortality among higher poverty 

groups contributed to the widening socioeconomic gap in 

all-cause child mortality. All relative risks of mortality for 

the poverty groups were statistically significant. Compared 

to children in the low poverty group, children in the middle 

poverty and high poverty groups had 21% and 52% higher 

all-cause mortality risks in 1969-1971 and 31% and 88% 

higher all-cause mortality risks in 2003-2007, respectively 

(Figure 8).

Since unintentional injuries and violence account for 

nearly 50% of all child deaths, socioeconomic trends in child 

mortality from unintentional injuries and homicide were also 

analyzed. Socioeconomic disparities in child mortality from 

unintentional injuries were greater than those in all-cause 

mortality. During 1969-2007, unintentional injury mortality 

rates declined faster for children in the low poverty group 

compared to children in the higher poverty groups, leading 

to increased socioeconomic disparities in unintentional 

injury mortality over time (Figures 9 and 10). Compared 

to children in the low poverty group, children in the high 

poverty group had a 61% higher risk of unintentional injury 

mortality in 1969-1971 but a 154% higher mortality risk in 

2003-2007 (Figure 10).

Homicide rates increased from 1969 to 1995 and then 

decreased through 2007 for children in each socioeconomic 

group (data not shown). However, the socioeconomic 

disparities remained large during the entire 1969-2007 time 

period. Compared to children in the low poverty group, 

children in the high poverty group had 144%, 195%, and 

165% higher homicide rates in 1969-1971, 1990-1992, and 

2003-2007, respectively.

Geographic Disparities in Child Mortality 

During 2003-2007, the mortality rate for children aged 1-4 

varied considerably by state of residence, ranging from a low 

of 15.5 per 100,000 population for Massachusetts to a high of 

49.8 for Mississippi and 46.8 for Arkansas. Young childhood 

mortality was highest in the Southeastern and Southwestern 

regions and lowest in New England (Figure 11).
Figure 11: Death Rates per 100,000 Population for Children Aged 1-4 Years, 2003-2007

Figure 12: Death Rates per 100,000 Population for Children Aged 5-14 years, 2003-2007
During 2005-2007, mortality among children aged 5-14 

was substantially higher in the Southeastern and Southwestern regions and lower in New England, with the rate 

ranging from a low of 10.3 in Massachusetts to a high of 

31.1 in Alaska and 27.0 for the District of Columbia (Figure 

12). The geographic pattern in mortality for children aged 

5-14 was similar to that for children aged 1-4.

Discussion

Monitoring changes in the health and well-being of 

children is one of the most important goals of the U.S. 

Department of Health and Human Services (8). Dramatic 

reductions in mortality rates over the long term for children 

in all racial and socioeconomic groups should, undoubtedly, 

be seen as a major public health success (2). These reductions in the overall child mortality rate were due to large 

declines in mortality from unintentional injuries, pneumonia 

and influenza, cancer, and birth defects (1, 2). However, 

trends in child mortality from violent deaths have been less 

encouraging as homicide rates for children aged 1-14 and 

suicide rates for children aged 10-14, even though they 

are currently lower than the peak rates of the mid-1990s, 

increased significantly between 1969 and 2007.

Improvements in living conditions, better nutrition, 

advances in medical care, and the introduction of Medicaid 

in 1965 have been cited as factors responsible for the 

long-term decline in child mortality, particularly from such 

medical or “biologic” causes as pneumonia and influenza, 

cancer, and birth defects (1, 2). Unintentional injury mortality among children includes deaths due to motor vehicle 

crashes, accidental drowning, and residential fires, and 

disparities in mortality from such injuries arise mainly due to 

social and environmental factors, including socioeconomic 

disadvantage and poor housing or living conditions (1, 2). 

Motor vehicle safety improvements, mandatory seat belt 

use, efforts to reduce drinking and driving, lower speed 

limits and increased enforcement, and increased availability 

of statewide trauma systems have been suggested as 

factors responsible for the long-term decline in mortality due 

to motor vehicle crashes (2, 9).

Despite the impressive reductions in overall child mortality over the long term, racial/ethnic, socioeconomic, and 

geographic disparities in child mortality remain substantial, 

with black children continuing to experience at least 50% 

higher mortality risk than their white counterparts. Moreover, 

socioeconomic disparities in mortality have increased 

over time, with children in the high poverty group currently 

experiencing two- to three-fold higher risks of all-cause and 

unintentional mortality than their more affluent counterparts, 

respectively. These marked disparities among social groups 

indicate the potential for further improvements in U.S. child 

mortality.

Currently, the mortality rates for children in several states 

as well as in some racial/ethnic groups fall short of the 

Healthy People 2010 goals – which are set at 20 deaths per 

100,000 population for younger children aged 1-4 and 15 

deaths per 100,000 population for older children aged 5-14 

(8). While none of the major racial/ethnic groups have met 

the 2010 target set for younger children, the 2007 mortality 

rates for American Indian/Alaska Native and black children 

aged 5-14 were 13% and 40% higher than the 2010 target, 

respectively. In 2007, children in several states such as 

Alabama, Alaska, Arkansas, Mississippi, Montana, New 

Mexico, North Dakota, Oklahoma, South Carolina, West 

Virginia, and Wyoming had at least one-third higher mortality rates than the Healthy People 2010 target. Connecticut, 

Massachusetts, New Hampshire, and Vermont were the 

only states in 2007 with lower mortality rates for children 

aged 1-4 than the national target for the year 2010. 

References

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U.S. Department of Health, Education, and Welfare; 1968. 

5. National Center for Health Statistics. Health, United States, 2009 with Special Feature on Medical Technology. Hyattsville, MD: US 

Department of Health and Human Services; 2010. 

6. U.S. Census Bureau. Census of Population and Housing,2000, Summary File 3. Washington, DC: U.S. Census Bureau; 2005. 

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8. U.S. Department of Health and Human Services. Healthy People 2010: Midcourse Review. Washington, DC: U.S. Government Printing Office; 2006.

9. Adekoya N. Motor vehicle-related death rates – United States, 1999-2005. MMWR Morb Mortal Wkly Rep. 2009;58(7):161-165.
Copyright Information:

All materials appearing in this report are in the public domain and may be reproduced or copied without permission; citation as

to source, however, is appreciated.

Suggested Citation:

Singh GK. Child Mortality in the United States, 1935-2007: Large Racial and Socioeconomic Disparities Have Persisted Over 

Time. A 75th Anniversary Publication. Health Resources and Services Administration, Maternal and Child Health Bureau.

Rockville, Maryland: U.S. Department of Health and Human Services; 2010. 

This publication is available online at http://www.mchb.hrsa.gov/

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