TABLE 4.-INFANT DEATHS, EXCESS OF ACTUAL NUMBER OVER EXPECTED 1

1 Assuming a rate of 18.3 or less per 1,000 prevailed among residents in all U.S. counties, 1956–60. * Includes counties, districts of Alaska, and independent cities of Virginia.

* The number of counties in this category is based on counties with an infant mortality rate no greater than 18.3 per 1,000.

The group of 56 counties having 400 or more excess deaths accounted for 35 percent of all excess infant mortality in counties of the United States during 1956-60, amounting in the aggregate to nearly 60,000. These counties and their cities of 50,000 or more population in 1960 are identified in table 5.

TABLE 5.-U.S. COUNTIES WITH 400 OR MORE INFANT DEATHS IN EXCESS OF EXPECTED NUMBER, 1956-60 1 (BY PLACE OF RESIDENCE)

TABLE 5.-U.S. COUNTIES WITH 400 OR MORE INFANT DEATHS IN EXCESS OF EXPECTED NUMBER, 1956-60 (BY PLACE OF RESIDENCE)-Continued

1 Assuming a rate of 18.3 or less per 1,000 prevailed among residents in all U.S. counties, 1956–60. * Includes counties and independent cities of Virginia.

INFANT MORTALITY IN LARGEST CITIES

Over a fifth of excess infant deaths in the United States in 1956-60 occurred in the 21 largest cities (500,000 population or more in 1960). In 1964 the infant death rate for these 21 cities as a group was 27.9 per 1,000, about 13 percent higher than the national average of 24.8 per 1,000. Furthermore, no gains were made in reducing this rate-it was the same in the 3-year period 1960-62. Accounting for this lack of progress was a significant increase in mortality of nonwhite infants, even though some decrease occurred in the rate for white infants. If the cities are considered individually, it can be noted that only Baltimore, Boston, and San Francisco recorded significant gains in 1964 in lowering their infant death rates from those prevailing in 1960-62.

In the perinatal period the death rate rose sharply in these cities, in contrast to the country as a whole. (Table 6.)

1 Perinatal deaths include neonatal (under 28 days) and fetal deaths in pregnancies of 20 or more (or not stated) weeks.

This increase in perinatal mortality in the cities reflected rising fetal death rates in the white group there was a 12-percent increase and in the nonwhite group an 18-percent increase over the respective fetal death rates in 1960-62. In poverty neighborhoods of these large cities, health problems are intensified. Several recent studies have provided estimates of the increase in prematurity rates (percent of live births 2,500 grams or less) and in infant death rates in deprived urban neighborhoods. (2) (3) (9) A report from the Chicago Department of Health compares infant mortality rates in poverty areas or neighborhoods of that city with rates in the rest of Chicago. (Table 7, figure 3.)

TABLE 7.-INFANT MORTALITY BY AGE, AND LOW BIRTH WEIGHT: CHICAGO, 1963-65, IN POVERTY AND NON