NCHS Data Brief ■ No. 285 ■ September 2017

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

Infant Mortality Rates in Rural and Urban Areas in the 

United States, 2014 

Danielle M. Ely, Ph.D., Anne K. Driscoll, Ph.D., and T.J. Mathews, M.S.

Key findings 

Data from the National 

Vital Statistics System

● Infant mortality rates

decreased as urbanization level

increased, from 6.55 deaths per

1,000 births in rural counties

to 6.20 in small and medium

urban counties and 5.44 in large

urban counties.

● Neonatal mortality rates

were higher in rural counties

than in large urban counties,

and postneonatal mortality rates

decreased as urbanization level

increased.

● Mortality rates decreased as

urbanization level increased for

infants of mothers aged 20–29,

30–39, and 40 and over.

● For infants of non-Hispanic

white and non-Hispanic black

mothers, mortality rates were

lowest in large urban counties.

The infant mortality rate is often used as a measure of a country’s health 

because similar factors influence population health and infant mortality (1). 

Although infant mortality has declined in the United States, disparities still 

exist across geographic areas and demographic groups (2–4). Urbanization 

level, based on the number and concentration of people in a county, can impact 

health outcomes (3–9). Previous research indicates that infant mortality rates 

vary by urbanization level and also by maternal and infant characteristics 

(3–9). This report describes differences in infant mortality among rural, small 

and medium urban, and large urban counties in the United States by infant’s 

age at death, mother’s age, and race and Hispanic origin in 2014. 

Keywords: maternal age • race and Hispanic origin • National Vital Statistics 

System

Overall, infant mortality rates were highest in rural areas and 

lowest in large urban areas. 

NOTES: Significant decreasing linear trend from rural counties to large urban counties (p < 0.05). County designation is based

on mother’s county of residence. County classification is based on 2013 NCHS Urban–Rural Classification Scheme

for Counties. Access data table for Figure 1 at: https://www.cdc.gov/nchs/data/databriefs/db285_table.pdf#1. 

SOURCE: NCHS, National Vital Statistics System.

Figure 1. Infant mortality rates, by urbanization level: United States, 2014

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 285 ■ September 2017

■  2  ■

● In 2014, the infant mortality rate decreased as urbanization level increased. Infant mortality 

in rural counties was 6.55 deaths per 1,000 births, 6% higher than in small and medium 

urban counties (6.20) and 20% higher than in large urban counties (5.44) (Figure 1). 

● The infant mortality rate for small and medium urban counties was 14% higher than the rate 

in large urban counties.

Neonatal and postneonatal mortality rates were higher in rural counties 

than in large urban counties in 2014. 

● Neonatal mortality was 8% higher in both rural (4.11 per 1,000 births) and small and 

medium urban (4.12) counties compared with large urban counties (3.81) (Figure 2). 

● Postneonatal mortality decreased as urbanization level increased and was 17% higher in 

rural counties (2.43) than in small and medium urban counties (2.07) and 49% higher than in 

large urban counties (1.63).

1

Significantly different from large urban counties (p < 0.05). 2

Significant decreasing linear trend from rural counties to large urban counties (p < 0.05). 

NOTES: County designation is based on mother’s county of residence. County classification is based on 2013 NCHS Urban–Rural Classification Scheme for 

Counties. Access data table for Figure 2 at: https://www.cdc.gov/nchs/data/databriefs/db285_table.pdf#2. 

SOURCE: NCHS, National Vital Statistics System.

Figure 2. Infant mortality rates, by urbanization level and infant age at death: United States, 2014 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 285 ■ September 2017

■  3  ■

Mortality rates were highest in rural counties for infants of mothers in most 

age groups in 2014.

● For infants of mothers aged 20–29, 30–39, and 40 and over, mortality rates decreased as 

urbanization level increased (Figure 3).

● Compared with large urban counties, the infant mortality rate in rural areas was 8% higher 

for infants of mothers aged 20–29 (6.32 per 1,000 births compared with 5.86), 30% higher 

for infants of mothers aged 30–39 (6.01 and 4.61, respectively), and 54% higher for infants 

of mothers aged 40 and over (10.15 and 6.56, respectively).

● For infants of mothers under age 20, the pattern was consistent with older age groups, but 

the decreasing trend in rates across urbanization levels was not statistically significant.

 

Figure 3. Infant mortality rates, by urbanization level and age of mother: United States, 2014

1

Significant decreasing linear trend from rural counties to large urban counties (p < 0.05).

NOTES: County designation is based on mother’s county of residence. County classification is based on 2013 NCHS Urban–Rural Classification Scheme for 

Counties. Access data table for Figure 3 at: https://www.cdc.gov/nchs/data/databriefs/db285_table.pdf#3. 

SOURCE: NCHS, National Vital Statistics System. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 285 ■ September 2017

■  4  ■

Mortality rates were lowest in large urban counties for infants of

non-Hispanic white and non-Hispanic black mothers in 2014. 

● For infants of non-Hispanic white mothers, the mortality rate decreased as urbanization 

level increased; mortality for infants of non-Hispanic white mothers in rural counties 

(5.95 per 1,000) was 41% higher than in large urban counties (4.21) and 13% higher than in 

small and medium urban counties (5.28) (Figure 4). 

● For infants of non-Hispanic black mothers, mortality was 16% higher in rural counties 

(12.08) and 15% higher in small and medium urban counties (11.90) compared with large 

urban counties (10.39). 

● For infants of Hispanic mothers, the mortality rate was higher in small and medium urban 

counties (5.32) compared with large urban counties (4.84). While the rate for rural counties 

(5.32) was similar to the rate for small and medium urban counties, the difference compared 

with large urban counties was not statistically significant.

Figure 4. Infant mortality rates, by urbanization level and race and Hispanic origin of mother: United States, 2014

1

Significantly different from large urban counties (p < 0.05). 2

Significant decreasing linear trend from rural counties to large urban counties (p < 0.05).

NOTES: County designation is based on mother’s county of residence. County classification is based on the 2013 NCHS Urban–Rural Classification Scheme for 

Counties. Access data table for Figure 4 at: https://www.cdc.gov/nchs/data/databriefs/db285_table.pdf#4. 

SOURCE: NCHS, National Vital Statistics System. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 
NCHS Data Brief ■ No. 285 ■ September 2017

■  5  ■

Summary

Infant mortality rates varied by urbanization level overall and for key maternal and infant 

characteristics. For most maternal and infant characteristics, infant mortality rates were higher 

in rural counties than in large urban counties. These findings add to previous research on infant 

mortality by using expanded urban categorizations rather than a single urban classification in a 

rural-urban dichotomy, linked birth and infant death certificate data, and more recent data (3–9). 

The findings in this report are consistent with previous research and present new data indicating 

that small and medium urban county infant mortality rates generally fall between the rates of rural 

and large urban counties (3,4,6). These findings suggest a general disadvantage in infant survival 

for rural counties and among certain groups compared with more urbanized areas. 

Definitions

Infant mortality rate: Number of infant (aged under 1 year) deaths per 1,000 live births.

Neonatal and postneonatal infant deaths: Neonatal infant deaths occur within the first 28 days 

from birth. Postneonatal infant deaths occur after 28 days from birth to under 1 year of age.

Race and Hispanic origin: Race and Hispanic origin are reported separately on birth certificates. 

Persons of Hispanic origin may be of any race. Persons of non-Hispanic ancestry are further 

classified by race because of differences in fertility and maternal characteristics between Hispanic 

and non-Hispanic persons. Multiple-race data reported were bridged to single-race categories for 

comparability between states (10).

Urbanization level: County classification as urban or rural is based on the county of maternal 

residence (5). Counties were classified according to their metropolitan status using the National 

Center for Health Statistics (NCHS) Urban–Rural Classification Scheme (https://www.cdc.gov/

nchs/data_access/urban_rural.htm), by merging the county of maternal residence geographic 

federal information processing standard (FIPS) codes with county-level FIPS codes from the 

2013 NCHS Urban–Rural Classification Scheme data set. Metropolitan counties include large 

central counties, the fringes of large counties (suburbs), medium counties, and small counties. 

Nonmetropolitan counties include micropolitan statistical areas and noncore areas, including open 

countryside, rural towns (populations of less than 2,500), and areas with populations of 2,500–

49,999 that are not part of larger labor market areas (metropolitan areas). Due to the variation in 

urban county sizes, urban counties were put into two levels, large (large central and the fringes 

of large cities) and small and medium (which includes medium and small cities), for comparative 

purposes in this report. In this report, rural counties include micropolitan and noncore counties.
NCHS Data Brief ■ No. 285 ■ September 2017

■  6  ■

Data sources and methods

This report contains data from the period linked birth/infant death data set, which is part of 

the National Vital Statistics System (11). The period linked birth/infant death data set includes 

all infant deaths under 1 year of age reported on death certificates and all live births reported 

from birth certificates (11). The period linked birth/infant death data set is the primary data set 

for analyzing infant mortality trends and patterns in the United States and is the only source 

for examining race and Hispanic-origin infant mortality and other factors related to birth (11). 

Linked birth/infant death data sets are available from: https://www.cdc.gov/nchs/data_access/

vitalstatsonline.htm. 

The NCHS Urban–Rural Classification Scheme data provide geographic FIPS codes and NCHS 

Urban–Rural Classification Scheme information for all counties in the United States. The NCHS 

county classification scheme data are available from: https://www.cdc.gov/nchs/data_access/

urban_rural.htm.

References to rates indicate that differences are statistically significant at the 0.05 level (10). 

References to decreasing linear trends are statistically significant at the 0.05 level and were 

assessed using the Cochran-Armitage test for trends, a modified chi-squared test. 

About the authors

Danielle M. Ely, Anne K. Driscoll, and T.J. Mathews are with the National Center for Health 

Statistics, Division of Vital Statistics, Reproductive Statistics Branch.
NCHS Data Brief ■ No. 285 ■ September 2017

■  7  ■

References

1. CDC. Reproductive health: Infant mortality. 2016. Available from: https://www.cdc.gov/

reproductivehealth/MaternalInfantHealth/InfantMortality.htm.

2. Guyer B, Freedman MA, Strobino DM, Sondik EJ. Annual summary of vital statistics: Trends 

in the health of Americans during the 20th century. Pediatrics 106(6):1307–17. 2000.

3. Lishner DM, Larson EH, Rosenblatt RA, Clark SJ. Chapter 12: Rural maternal and perinatal 

health. In: Ricketts TC, III, editor. Rural health in the United States. New York, NY: Oxford 

University Press, Inc. 134–149. 1999.

4. Singh GK, Siahpush M. Widening rural-urban disparities in all-cause mortality and mortality 

from major causes of death in the USA, 1969–2009. J Urban Health 91(2):272–92. 2014.

5. Ingram DD, Franco SJ. NCHS urban–rural classification scheme for counties. National 

Center for Health Statistics. Vital Health Stat 2(154). 2012.

6. Rowland Hogue CJ, Vasquez C. Toward a strategic approach for reducing disparities in infant 

mortality. Am J Public Health 92(4):552–6. 2002.

7. Meit M, Knudson A, Gilbert T, Yu ATC, Tanenbaum E, Ormson E, et al. The 2014 update of 

the rural-urban chartbook. Rural Health Reform Policy Research Center. 2014.

8. Eberhardt MS, Pamuk ER. The importance of place of residence: Examining health in rural 

and nonrural areas. Am J Public Health 94(10) 1682–6. 2004.

9. Peck J, Alexander K. Maternal, infant, and child health in rural areas: A literature review. In: 

Gamm L, Hutchinson L, Dabney B, Dorsey A, editors. Rural healthy people 2010: A companion 

document to healthy people 2010. 2003.

10. Martin JA, Hamilton BE, Osterman MJK, et al. Births: Final data for 2015. National vital 

statistics reports; vol 66 no 1. Hyattsville, MD: National Center for Health Statistics. 2017.

11. Mathews TJ, MacDorman MF, Thoma ME. Infant mortality statistics from the 2013 period 

linked birth/infant death data set. National vital statistics reports; vol 64 no 9. Hyattsville, MD: 

National Center for Health Statistics. 2015.
NCHS Data Brief ■ No. 285 ■ September 2017

For e-mail updates on NCHS publication 

releases, subscribe online at: 

https://www.cdc.gov/nchs/govdelivery.htm.

For questions or general information

about NCHS:

Tel: 1–800–CDC–INFO (1–800–232–4636)

TTY: 1–888–232–6348

Internet: https://www.cdc.gov/nchs

Online request form: https://www.cdc.gov/info

ISSN 1941–4927 Print ed.

ISSN 1941–4935 Online ed.

DHHS Publication No. 2017–1209

CS281473

U.S. DEPARTMENT OF

HEALTH & HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Health Statistics

3311 Toledo Road, Room 4551, MS P08

Hyattsville, MD 20782–2064

OFFICIAL BUSINESS 

PENALTY FOR PRIVATE USE, $300

For more NCHS Data Briefs, visit:

https://www.cdc.gov/nchs/products/databriefs.htm.

FIRST CLASS MAIL 

POSTAGE & FEES PAID 

CDC/NCHS

PERMIT NO. G-284

Suggested citation

Ely DM, Driscoll AK, Mathews TJ. Infant 

mortality rates in rural and urban areas in the 

United States, 2014. NCHS data brief, no 

285. Hyattsville, MD: National Center for 

Health Statistics. 2017.

Copyright information

All material appearing in this report is in 

the public domain and may be reproduced 

or copied without permission; citation as to 

source, however, is appreciated.

National Center for Health 

Statistics

Charles J. Rothwell, M.S., M.B.A., Director

Jennifer H. Madans, Ph.D., Associate 

Director for Science

Division of Vital Statistics 

Delton Atkinson, M.P.H., M.P.H., P.M.P., 

Director

Hanyu Ni, Ph.D., M.P.H., Associate

Director for Science