Time series analysis of impact of COVID-19 on infant and neonatal mortality in the United States.

BACKGROUND

This study aims to conduct a time series analysis to assess the effect of COVID-19 on infant and neonatal mortality in its first three years.

METHODS

Linked infant birth and death certificate data from the United States between 2016 and 2022 were used. Long Short-Term Memory (LSTM) and Autoregressive Integrated Moving Average (ARIMA)/ARIMA with Exogenous Variables (ARIMAX) were employed to predict monthly infant and neonatal mortality trends in 2022 with and without incorporating COVID-19 as a feature. Interrupted Time Series Analysis was conducted to measure monthly rate changes before (pre-March 2020) and during the COVID-19 period (March 2020-December 2022).

RESULTS

Infant and neonatal deaths declined from 2016 to 2020/2021, with increases observed starting in May 2022. Incorporating COVID-19 as a variable into prediction models reduced the predictive performance of both LSTM and ARIMA/ARIMAX models. Compared to the pre-COVID-19 period, ITS showed no significant changes in monthly infant and neonatal death rates. However, significant increases were noted in low birth weight, low Apgar scores, and infrequent prenatal visits during 2021-2022.

CONCLUSION

COVID-19 altered the previously continuous decline in infant and neonatal deaths in 2022. Despite this late increase, the overall impact of COVID-19 on infant and neonatal mortality remains minimal.

IMPACT

Infant and neonatal deaths showed a steady decline from 2016 through 2020/2021. However, an increase in infant and neonatal deaths emerged in the later stages of the COVID-19 pandemic (2022). Rates of risk factors associated with infant and neonatal deaths, such as low birth weight and inadequate prenatal care, increased during the COVID-19 period. Understanding the shifts in infant and neonatal mortality and related risk factors during the COVID-19 pandemic provides valuable insights into its impact and enhances preparedness for future pandemics.