title: Risk factors for diarrhea-associated infant mortality in the United States, 2005-2007.
abstract: 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.
authors.affiliation: Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. JMehal@cdc.gov
authors.forename: Jason M
authors.initials: JM
authors.lastname: Mehal
authors.forename: Douglas H
authors.initials: DH
authors.lastname: Esposito
authors.forename: Robert C
authors.initials: RC
authors.lastname: Holman
authors.forename: Jacqueline E
authors.initials: JE
authors.lastname: Tate
authors.forename: Laura S
authors.initials: LS
authors.lastname: Callinan
authors.forename: Umesh D
authors.initials: UD
authors.lastname: Parashar
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D003967:Diarrhea / Q000453:epidemiology* / Q000401:mortality* / Q000517:prevention & control; D004501:Education, Medical; D005260:Female; D005440:Fluid Therapy / Q000379:methods; D006266:Health Education; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult