The number of births in the United States decreased between 2007 and 2008 (preliminary estimate: 4 251 095). Birth rates declined among all women aged 15 to 39 years; the decrease among teenagers reverses the increases seen in the previous 2 years. The total fertility rate decreased 2% in 2008 to 2085.5 births per 1000 women. The proportion of all births to unmarried women increased to 40.6% in 2008, up from 39.7% in 2007. The 2008 preterm birth rate was 12.3%, a decline of 3% from 2007. In 2008, 32.3% of all births occurred by cesarean delivery, up nearly 2% from 2007. Twin and triplet birth rates were unchanged. The infant mortality rate was 6.59 infant deaths per 1000 live births in 2008 (significantly lower than the rate of 6.75 in 2007). Life expectancy at birth was 77.8 years in 2008. Crude death rates for children aged 1 to 19 years decreased by 5.5% between 2007 and 2008. Unintentional injuries and homicide were, respectively, the first and second leading causes of death in this age group. These 2 causes of death jointly accounted for 51.2% of all deaths of children and adolescents in 2008. This annual article is a long-standing feature in Pediatrics and provides a summary of the most current vital statistics data for the United States. We also include a special feature this year on the differences in cesarean-delivery rates according to race and Hispanic origin.
- teenaged fertility
- infant mortality
- low birth weight
- multiple births
- cesarean rate
- vital statistics
- revised certificates
The data presented in this report were obtained from vital statistics records: birth certificates and death certificates for residents in all US states and the District of Columbia. Birth data for 2008 are preliminary and based on >99% of records. Mortality data for 2008 are preliminary and based on >99% of records. Birth and death data for 2007 and earlier years are final and include all records. More complete descriptions of vital statistics data systems are available elsewhere.1,–,6
Current vital statistics patterns and recent trends through 2007 and 2008 are presented according to age, race, and Hispanic origin as well as other birth and death characteristics. More detailed data are available for final 2007 births than for preliminary 2008 births; therefore, some of the detailed analyses of birth patterns are based on 2007 data. Hispanic origin and race are collected as separate items in vital records. Persons of Hispanic origin may be of any race. A number of reporting areas allow for multiple-race categories on birth and death certificates. However, until all areas revise their certificates to reflect updated reporting standards for race,7 multiple-race data are “bridged” back to single-race categories.3,4,8,9 For birth data, mothers' marital status was reported directly in all reporting areas but New York in 2007 and 2008. Details about the reporting of marital status in New York and editing methods and imputations as applied to other items on the birth certificate are presented in publications of the National Center for Health Statistics (NCHS).1,3,5
Cause-of-death statistics in this report are based solely on the underlying cause of death compiled in accordance with the International Classification of Diseases, 10th Revision (ICD- 10).10 The underlying cause of death is defined as “(a) the disease or injury which initiated the train of morbid events leading directly to death, or (b) the circumstances of the accident or violence which produced the fatal injury.”10 For certain causes of death such as unintentional injuries, homicide, suicide, drug-induced death, and sudden infant death syndrome, preliminary data may show lower numbers of death relative to final data for the same year. This is a function of the truncated nature of the preliminary file, primarily because cause-of-death information may not be available or may be incomplete when preliminary data are sent to NCHS but is available later for final data processing.
Ranking for leading causes of death is based on number of deaths.11 Infant mortality refers to the death of an infant younger than 1 year. Infant mortality rates (IMRs) were computed by dividing the total number of infant deaths in each calendar year by the total number of live births in the same year. Neonatal mortality rates (NMRs) are shown for infant deaths that occurred at less than 28 days, and postneonatal mortality rates (PNMRs) are shown for infant deaths that occurred between 28 days to less than 1 year of age. The denominator for both rates is the number of live births.
The latest infant mortality statistics according to race and Hispanic origin are from the 2006 period linked birth/infant death data set.12 In this data set, the death certificate was linked with the corresponding birth certificate for each infant who died in the United States in 2006. The purpose of this linkage was to use additional variables available from the birth certificate, such as birth weight, to better interpret infant mortality patterns.
Birth data for 2008 are for selected items that were collected by using both the 1989 (unrevised) and the 2003 (revised) US standard certificates of live birth. The 2003 revision is described in detail elsewhere.3,5,13,14 Twenty-seven states (California, Colorado, Delaware, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Michigan, Montana, Nebraska, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oregon, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Vermont, Washington, and Wyoming) had implemented the revised birth certificates as of January 1, 2008 (accounting for 65% of 2008 births).1 Information on prenatal care and smoking during pregnancy are not comparable between the 2 versions of the birth certificate,3,13,14 and data on these topics are not combined. Prenatal care data in this report are based on 22 reporting areas (accounting for 53% of 2007 births) that implemented the revised birth certificate as of January 1, 2007.3 Information on smoking during pregnancy is based on the same reporting area with the exclusion of Florida (accounting for 48% of 2007 births).3 Trend analysis of prenatal care and smoking during pregnancy was compromised by the yearly change in the composition of revised and unrevised reporting areas. Information on prenatal care and smoking during pregnancy, based on limited geographic coverage, is not generalizable to the entire United States.
Mortality data for 2008 were collected by using both the 1989 (unrevised) and 2003 (current or “revised”) versions of the US standard certificate of death. The 2003 revision is described in detail elsewhere.2,4 A list of the 31 reporting areas with revised death certificates as of January 1, 2008, is available elsewhere.2 The remaining 20 areas reported data in 2008 on the basis of the 1989 “unrevised” version of the death certificate. All mortality data items presented in this report are considered comparable between revisions; accordingly, revised and unrevised data are combined.
Population denominators for the calculation of birth, death, and fertility rates are estimates based on the population enumerated by the US Census Bureau as of April 1, 2000. Estimates for 2000–2008 and revised estimates for the intercensal period 1991–1999 were produced under a collaborative arrangement between the US Census Bureau and the NCHS. To calculate birth and death rates for these time periods, reported population data for multiple-race persons were bridged back to single-race categories.8,9 In addition, the 2000 census counts were modified to be consistent with the 1977 Office of Management and Budget (OMB) race categories.15
Data for the international comparisons of births and IMRs were obtained from the 2008 United Nations Demographic Yearbook.16
Nearly 1.8 million persons were added to the US population in 2008 as a result of natural increase (the excess of births over deaths) (Table 1).1,2 The rate of natural increase was 5.8 persons per 1000 population in 2008.
In 2008, there were 4 251 095 births, ∼2% fewer than in 2007 (4 316 233), which was the highest number ever registered for the United States (Table 1).1 The crude birth rate decreased by 2% in 2008 to 14.0 births per 1000 total population from 14.3 in 2007. The general fertility rate (the number of births per 1000 women aged 15–44 years) declined 1% in 2008 to 68.7. Birth rates declined among everyone in the 15- to 39-year age group; rates increased for women aged 40 years and older (Fig 1).1 The total fertility rate in 2008 was 2085.5 births per 1000 women, a 2% decrease compared with the rate in 2007 (2122.5). The total fertility rate estimates the number of births that a hypothetical group of 1000 women would have if they experienced, throughout their childbearing years, the age-specific birth rates observed in a given year.
Racial and Ethnic Composition
The general fertility rate declined for the 3 largest race and Hispanic-origin groups between 2007 and 2008.1 Decreases ranged from <1% for non-Hispanic white and non-Hispanic black women to 3% for Hispanic women. Rates for Asian or Pacific Islander and Native American women were essentially unchanged. Fertility rates for these groups in 2008 ranged from a low of 59.6 births per 1000 women aged 15 to 44 for non-Hispanic white women to a high of 98.6 for Hispanic women (Table 2).
Trends in Age-Specific Birth Rates
Teenage birth rates in the United States started a 14-year decrease in 1991 and then had a 2-year increase in 2006 and 2007 (Table 3). The birth rate for teenagers decreased 2% in 2008 from 2007. The 2008 rate was 41.5 births per 1000 teenagers aged 15 to 19 years, down from 42.5 in 2007 (Table 3; Fig 1).1 The birth rate for teenagers aged 15 to 17 years decreased 2% to 21.7 per 1000 in 2008, and the birth rate for older teenagers aged 18 to 19 years decreased 4% to 70.7 per 1000 (Table 3).
Childbearing for Women in their 20s and 30s
The 2008 birth rate for women aged 20 to 24 years was 103.1 births per 1000 women (Table 2), a decrease of 3% compared with the rate in 2007 (106.4) (Fig 1).1 The rate for women aged 25 to 29 years also decreased in 2008 to 115.1 (a decrease of 2%). The birth rate in 2008 for women aged 30 to 34 years declined <1% to 99.3 from 99.9 in 2007. For women aged 35 to 39 years the rate declined 1% in 2008 to 46.9 per 1000 women from 47.5 in 2007. This is the first decline for women aged 35 to 39 years since 1978.1,3
Childbearing for Women Aged 40 Years and Older
The birth rate for women aged 40 to 44 years increased 4% between 2007 and 2008 to 9.9 births per 1000 women (Table 2; Fig 1), the highest rate in 4 decades. The birth rate for women aged 45 to 49 years also increased in 2008, from 0.6 to 0.7 (data not shown). This rate has more than tripled since 1990.
The total number of births to unmarried women increased nearly 1%, to 1 727 950 in 2008. The 2008 total is up 27% from 2002, when recent increases began.17 The birth rate for unmarried women in 2008 was 52.0 births per 1000 unmarried women aged 15 to 44 years. The rate had increased 21% from 2002 (43.7) to 2007 (52.9), after several years of relative stability. The proportion of all births to unmarried women increased to 40.6% in 2008, up from 39.7% in 2007. This proportion increased for the 3 largest race and Hispanic-origin population groups (Table 4). Births to unmarried women increased from 2007 to 2008 for ages ≥25 years. In 2008, 87% of births to teenagers, 61% to women aged 20 to 24, and 33% to women aged 25 to 29 years were to unmarried women.1
Smoking During Pregnancy
For the 21 states with revised information on tobacco use in 2007, the overall smoking rate during pregnancy was 10.4%.3 The rate for non-Hispanic white women (16.3%) was 60% more than that for non-Hispanic black women (10.1%) and more than 7 times as high as that for Hispanic women (2.1%).3 These racial-ethnic variations are consistent with patterns observed for many years before the tobacco-use item was revised.18
For the 22 states with revised prenatal care data in 2007, 70.8% of mothers were reported to have begun care within the first 3 months of pregnancy. For the 18 states with revised prenatal care data for both 2006 and 2007, the percentage of women with timely prenatal care declined 2% to 67.5% and those with late or no care increased 6% to 8.4%. The year 2007 was the fourth consecutive year for which levels of timely receipt of prenatal care did not improve.19,20
Large disparities according to race and Hispanic origin persisted in prenatal care receipt for the 22 states with revised prenatal care data. In 2007, as in earlier years, non-Hispanic black and Hispanic women were less likely than non-Hispanic white women to begin care in the first trimester of pregnancy (59.2%, 64.7%, and 76.2%, respectively).3
The total cesarean-delivery rate rose to 32.3% in 2008, which marks the 12th consecutive year of increase and another record high for the nation (Table 4).1 This rate has climbed by 56% since 1996 (20.7%); however, in the past few years the pace of increase has slowed. From 2007 to 2008, increases in the percentage of births via cesarean delivery were reported for all age, race, and Hispanic-origin groups: non-Hispanic white (by 1%), non-Hispanic black and Hispanic (by 2% each), and Asian or Pacific Islander (by nearly 4%). More detailed discussion of differences in cesarean deliveries according to race and ethnicity is presented later.
The rise over the last several decades in multiple-birth rates seems to have halted. The 2007 twin birth rate was essentially unchanged for the third straight year at 32.2 per 1000 births (Table 4).3 This rate (twin deliveries per 1000 births) had risen 70% from 1980 to 2004. The extended rise of triplet and higher-order multiple births (triplet/+) may have ended. The triplet/+ rate for 2007 was 148.9 per 100 000 total births, not significantly different from 2006 (153.3). The triplet/+ rate (the number of triplets, quadruplets, quintuplets, and other higher-order multiples per 100 000 live births) increased rapidly during the 1980s and 1990s but has generally trended downward since the all-time high in 1998 (193.5).
Infants born in twin and triplet/+ deliveries are much more likely to be born too soon and too small and, accordingly, to not survive the first year of life. Fifty-seven percent of twins and nearly all (96%) triplets were LBW in 2007 compared with 6% of singletons.3
The preterm birth rate was 12.3% for 2008, a decline of 3% from 2007, which follows a slight decline between 2006 and 2007 (12.8%–12.7%) (Table 4).1 The preterm rate (infants delivered at <37 completed weeks of gestation per 100 births) had previously been on the rise for more than 2 decades.3 The decline for 2008 occurred predominantly among infants born at 34 to 36 weeks, or late preterm. The late-preterm rate, which had climbed over 25% since 1990, was down 2% between 2007 and 2008 from 9.0% to 8.8% (Fig 2). The total preterm rate declined among births to non-Hispanic white (from 11.5% to 11.1%), non-Hispanic black (from 18.3% to 17.5%), and Hispanic (from 12.3% to 12.1%) mothers.21
Low Birth Weight
The low birth weight (LBW) (<2500 g) rate was unchanged in 2008 at 8.2% (Table 4).1 The percentage of infants born at a LBW had been rising fairly steadily since the mid-1980s (6.7% in 1984) but declined slightly between 2006 and 2007.3 A small decline in the total LBW rate was reported for non-Hispanic black women, but levels were essentially unchanged for other groups (Table 4). The very LBW (<1500 g) rate declined slightly from 2007 to 2008 (from 1.49% to 1.46%).
Over the past several decades, national LBW levels have been strongly influenced by the rise in the rate of multiple births, more than one-half of which are delivered at <2500 g (see “Multiple Births”). A rise in LBW was also observed between 1990 and 2006 for singleton deliveries.3
The full birth weight distribution has changed markedly in recent years for all births as well as for singletons only.3 During 1990–2007, the percentage of births weighing 4000 g or more decreased by nearly 30% (from 10.9% to 7.7%). The average birth weight seems to have declined even among low-risk term births.24 The reasons for this shift toward lower birth weights are not fully understood but may include obstetric intervention earlier in pregnancy, older maternal age, and increased use of infertility therapies.24,–,26
In 2008 a total of 28 033 infant deaths were reported in the United States according to preliminary data.2 The IMR was 6.59 infant deaths per 1000 live births, a figure that is significantly lower (by 2%) than the 2007 rate of 6.75. The NMR for 2008 was 4.27, also significantly lower than the 2007 NMR of 4.41 neonatal deaths per 1000 live births.
The 2006 linked birth/infant death data show wide and persistent variation in IMRs according to race and Hispanic origin. As in past years, the highest rate was for infants born to non-Hispanic black mothers: 13.35 deaths per 1000 live births, which is more than double the rate of infants born to non-Hispanic white mothers (5.58) (Fig 3).12 Among Hispanic subgroups, rates ranged from 4.52 for Central and South American mothers to 8.01 for Puerto Rican mothers. The IMRs for Hispanic subgroups have fluctuated slightly since 2000.
Geographic Variation in Infant Outcomes
Table 5 lists information for states on the percentages of preterm birth, percentages of LBW births, IMRs, and NMRs for 2008, which are based on preliminary data. For 2008, Mississippi had the highest percentages of LBW (11.8%) and preterm (18.0%) births. Alaska had the lowest percentage of LBW births (6.0%), and Vermont had the lowest preterm rate (9.5%) in 2008. States in the southeastern United States had the highest IMR and NMR. In 2008, IMRs for the states ranged from 3.95 in New Hampshire to 9.97 in Mississippi. The IMR for the District of Columbia was 10.89. These geographic patterns have been observed for many years.
Leading Causes of Infant Death
In 2008, 56.1% of all infant deaths (Table 6) were attributable to 5 leading causes: congenital malformations, deformations, and chromosomal abnormalities (20.1%); disorders related to short gestation and LBW, not elsewhere classified (16.9%); sudden infant death syndrome (SIDS) (8.2%); newborn affected by maternal complications of pregnancy (6.3%); and accidents (unintentional injuries) (4.6%).2 These 5 leading causes of infant death are the same as they were in 2007.4
Table 7 lists births for 2008 and IMRs for 2006, 2007, and 2008 for the United States and 28 other countries.16 Final 2008 data are not available for a few countries. The countries are ranked from the lowest to highest IMR in the latest available year. Seven countries had an IMR that was less than half the US rate (6.6) in 2008; their rates were <3.0 infant deaths per 1000 live births. Discussed elsewhere27,–,30 are potential reasons that the United States has a higher IMR than other industrialized countries.
There were 2 473 018 deaths in the United States in 2008 (Table 1), 49 306 more than in 2007. Age-adjusted death rates are better indicators of the risk of mortality over time than crude death rates, because they control for changes in the age composition of the population. The age-adjusted death rate decreased by 0.2% from 760.2 deaths per 100 000 US standard population in 2007 to 758.7 in 2008,2 which was a record low for the United States.2
In 2008, life expectancy at birth was 77.8 for the US population and was 80.6 years for white women, 76.8 years for black women, 75.7 years for white men, and 70.2 years for black men. The estimated life expectancy at birth for a given year represents the average number of years that a group of infants would be expected to live if, throughout their lifetime, they were to experience the age-specific death rates that prevailed during the year of their birth.
Deaths Among Children
A total of 22 844 children and adolescents aged 1 to 19 years died in the United States in 2008 (Table 8).2 The death rate for children aged 1 to 19 years decreased by a statistically significant 5.5% from 30.9 per 100 000 population in 2007 to 29.2 in 2008.
For all children aged 1 to 19 years, the leading cause of death was accident (unintentional injuries), which accounted for 38.8% of all deaths in 2008 and 42.5% of all deaths in 2007. The second leading cause of death was homicide, which accounted for 12.4% of all deaths in 2008 and 12.3% of all deaths in 2007. Between 2007 and 2008, the death rate decreased significantly for unintentional injuries and homicide, whereas the rate increased significantly for suicide and for influenza and pneumonia. Rates did not change significantly for the other leading causes of death among children.
Why Are Cesarean-Delivery Rates Higher for Non-Hispanic Black Women?
Cesarean-delivery rates have increased for all maternal age, race, and Hispanic origin groups since the mid-1990s.1 During this period, they were highest for non-Hispanic black women.31 According to 2008 preliminary data, 34.5% of non-Hispanic black women had a cesarean delivery compared with 32.4% and 31.0% of non-Hispanic white and Hispanic women, respectively.1 Although cesarean-delivery rates increase with maternal age for all race and ethnic groups, they are highest for non-Hispanic black women at all ages (Table 9).
A 2005 report of low-risk births revealed that, even among low-risk first births, non-Hispanic black women had a higher likelihood of cesarean delivery overall and in all maternal age groups.32 We explored possible reasons for the higher cesarean-delivery rate among non-Hispanic black women in 2007, the most recent year for which final birth data are available. Analysis was limited to low-risk women (singleton pregnancy, term birth, cephalic presentation, as defined by Healthy People 2010 goals,33 and having their first birth). Data were from the 22-state revised reporting area (described above), because many items such as cephalic presentation, prepregnancy diabetes, and prepregnancy weight were only available on the 2003 revised birth certificate. Patterns of cesarean delivery according to race, Hispanic origin, and maternal age for the 22 revised states are similar to those shown in Table 9 for all states.
The results show that a number of known risk factors for cesarean delivery, such as diabetes, hypertension, macrosomia, and labor induction, do not explain the higher rates for non-Hispanic black women. For example, macrosomia was less common among non-Hispanic black women than non-Hispanic white and Hispanic women (data not shown), but non-Hispanic black women were more likely to suffer from prepregnancy diabetes and chronic hypertension. Even when women with these conditions or risk factors were excluded from the analysis, cesarean-delivery rates for non-Hispanic black women remained higher (data not shown).
Studies have shown that obesity is also a risk factor for cesarean delivery.34,–,36 Women who are obese (BMI ≥ 30) are at least twice as likely to have a cesarean delivery as women with normal weight (BMI < 25).36 Data from the National Health and Nutrition Survey indicate that non-Hispanic black women have higher rates of obesity than non-Hispanic white and Hispanic women,37 which may influence their higher cesarean-delivery rates.
Although data on BMI are not yet available in the national birth data, we examined prepregnancy weight of women who gave birth in 2007 in the 22-state revised reporting area. Among low-risk women, non-Hispanic black women had a significantly higher mean prepregnancy weight (155 lb) than non-Hispanic white (150 lb) and Hispanic (140 lb) women, and the differences in mean prepregnancy weight according to race and Hispanic origin increased with maternal age.
Prepregnancy weight of more than 200 lb among low-risk pregnancies was also examined as a surrogate measure for obesity, because these women would generally be considered obese even among tall women. Non-Hispanic black women in every age group were more likely to weigh more than 200 lb. For the ≥25-year age group, at least 17% of non-Hispanic black women weighed more than 200 lb compared with ∼10% and 7% of non-Hispanic white and Hispanic women, respectively (see Fig 4). These data also indicate that low-risk non-Hispanic black women who weighed more than 200 lb were nearly twice as likely to give birth via cesarean delivery as low-risk non-Hispanic black women who weighed between 100 and 150 lb (45% vs 24%).
A limitation of this analysis is that prepregnancy weight has been shown to be a weaker predictor of cesarean-delivery risk than BMI.34 A woman's height also may be an independent contributory factor, because short stature has been shown to have an additive effect on cesarean-delivery risk.35
Although it seems that obesity has an influence on the differences in cesarean-delivery rates according to race and Hispanic origin, it is unclear how strong that influence may be. Indeed, there is evidence that even when controlling for BMI, higher rates for non-Hispanic black women have persisted.38,39 Other possible contributing factors that may influence the differences according to race and Hispanic origin in cesarean deliveries are maternal choice, patient education, and physician practice patterns. Further study is necessary to fully understand differences in cesarean-delivery rates according to race and Hispanic origin.
Vital statistics remain a valuable tool for monitoring the health of the US population. Efforts to speed up data receipt and processing are ongoing.40
We thank Joyce A. Martin, Brady E. Hamilton, Marian F. MacDorman, Sharon Kirmeyer, Stephanie J. Ventura, Jiaquan Xu, Sherry L. Murphy, Kenneth D. Kochanek, and Betzaida Tejada-Vera for contributions to the manuscript and Yashodhara Patel and Elizabeth Wilson for content review.
- Accepted October 25, 2010.
- Address correspondence to T. J. Mathews, MS, Centers for Disease Control and Prevention, National Center for Health Statistics, 3311 Toledo Rd, Room 7318, Hyattsville, MD 20782. E-mail:
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
- NCHS =
- National Center for Health Statistics •
- IMR =
- infant mortality rate •
- NMR =
- neonatal mortality rate •
- PNMR =
- postneonatal mortality rate •
- OMB =
- Office of Management and Budget •
- LBW =
- low birth weight
- Miniño AM,
- Xu J,
- Kochanek KD
- 5.↵National Center for Health Statistics. Detailed technical notes to the United States 2007 data: natality. In: User Guide to the 2007 Natality Public Use File. Available at: ftp://ftp.cdc.gov/pub/Health_Statistics/NCHS/Dataset_Documentation/DVS/natality/UserGuide2007.pdf. Accessed September 13, 2010
- 6.↵National Center for Health Statistics. Detailed technical notes to the United States 2007 data: mortality. 2010; In press
- 7.↵Office of Management and Budget. Revisions to the standards for the classification of federal data on race and ethnicity. Available at: clinton4.nara.gov/OMB/fedreg/ombdir15.html. Accessed September 13, 2010
- Ingram DD,
- Parker JD,
- Schenker N,
- et al
- 10.↵World Health Organization. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. 2nd ed. Geneva, Switzerland: World Health Organization; 2004
- 13.↵National Center for Health Statistics. U.S. standard certificate of live birth, 2003 revision. Available at: www.cdc.gov/nchs/data/dvs/birth11-03final-ACC.pdf. Accessed September 13, 2010
- 14.↵National Center for Health Statistics. Report of the panel to evaluate the U.S. standard certificates and reports: appendix B. Available at: www.cdc.gov/nchs/data/dvs/panelreport_acc.pdf. Accessed September 14, 2010
- 15.↵Office of Management and Budget. Directive No. 15: race and ethnic standards for federal statistics and administrative reporting. Available at: http://wonder.cdc.gov/wonder/help/populations/bridged-race/directive15.html. Accessed September 16, 2010
- 16.↵United Nations. Tables 9 and 15. In: United Nations Demographic Yearbook, 2008. New York, NY: United Nations; 2010. Available at: http://unstats.un.org/unsd/demographic/products/dyb/dyb2008.htm. Accessed September 30, 2010
- Ventura SJ
- Mathews TJ
- Martin JA,
- Osterman MJK,
- Sutton PD
- MacDorman MF,
- Mathews TJ
- Sepkowitz S
- Menacker F,
- Hamilton BE
- 33.↵US Department of Health and Human Services. Healthy People 2010. 2nd ed. Washington, DC: US Government Printing Office. 2000. Available at: www.health.gov/healthypeople. Accessed on October 6, 2010
- 40.↵National Center for Health Statistics. About the National Vital Statistics System. Available at: www.cdc.gov/nchs/nvss/about_nvss.htm. Accessed September 16, 2010
NUTMEG: Enjoying a large glass of eggnog liberally sprinkled with nutmeg, I wondered about the provenance of the spice. After all, I had been enjoying nutmeg for decades. According to an article in Saveur (2010;134:79), nutmeg has been a prized spice for centuries. Nutmeg, Myristica fragrans or musky scent, is indigenous to Indonesia. For hundreds of years, the two spices made from nutmeg, nutmeg made from the seed's kernel, and mace made from the waxy red covering of the seed, were only produced in the Banda Islands. The spice became a prized commodity in medieval Europe and was used liberally by the wealthy to create richly flavored dishes. As nutmeg moved west along the spice trail, its cost rose dramatically. When nutmeg became the treatment of choice for the plague, a small sack was worth the cost of a house in London with servant included. The Dutch and English East India companies waged merciless campaigns for control of the nutmeg producing islands. In the 18th century, however, seedlings were smuggled out of Indonesia and soon nutmeg was growing in far-flung tropical regions of the world including the Caribbean. As the highly-spiced dishes of the medieval ages waned in popularity, others turned to nutmeg for its narcotic properties. In high concentrations, myristicin, the compound that gives nutmeg much of it pungency, can induce euphoria and even hallucinations. Nutmeg was grated over the infamous punch drinks of 18th and 19th century England and may have been responsible for some of the more outrageous behaviors associated with the drink. Historic figures as disparate as Lord Byron and Malcolm X used the spice recreationally. Currently, while nutmeg is often associated with eggnog and the winter holiday season, it is used to flavor innumerable dishes and drinks, including Coca-Cola. The enduring popularity of nutmeg may be due to its ability to enhance other flavors. As for me, a little nutmeg goes a long way to enhance the taste of cakes, pies, eggs, and savory dishes. Yum.
Noted by WVR, MD
- Copyright © 2011 by the American Academy of Pediatrics