NC infant mortality rate hits all-time low, overdose deaths plunge. Here’s why.

North Carolina’s infant mortality rate hit an all-time low and overdose-related deaths plummeted in 2024, the N.C. Department of Health and Human Services announced Monday.

A new report shows the infant mortality rate dropped 8.7% from 6.9 to 6.3 deaths per 1,000 births, with the number of deaths decreasing from 828 in 2023 to 770 in 2024. Infant mortality is traditionally defined as the death of an infant before their first birthday.

Drug overdose deaths fell 34%, from 4,442 deaths in 2023 to 2,934 deaths in 2024, the first decline in fatal overdoses since 2019.

State leaders say expanding Medicaid across North Carolina, coupled with more distribution of overdose-reversal medications, drove the nosedive in deaths.

But racial disparities persist, and officials say their work isn’t finished.

“We are encouraged by the declines in overdose-related deaths and infant mortality rates in North Carolina, which coincide with recent investments in our health system,” Dr. Kelly Kimple, the director of DHHS’ Division of Public Health, wrote in the report. “However, other trends show that there is still work to be done, and our department remains committed to improving health outcomes for everyone who calls North Carolina home.”

Here’s what the report found.

Infant mortalities drop, but racial disparities persist

State officials say progress on infant mortality was driven by a nearly 15% decrease in neonatal deaths, meaning more babies are surviving “the earliest and most vulnerable” weeks of life.

And two years after North Carolina became the 41st state to expand Medicaid, state leaders say more than 700,000 patients gained access to the critical care they needed, including maternal and infant care.

“This historic decline highlights how Medicaid expansion continues to improve health outcomes for children and families in North Carolina,” the report states.

But as infant mortality rates dropped across the state, rates among non-Hispanic Black infants remained nearly three times higher than among non-Hispanic white infants, according to the report.

Of the 770 infant deaths in 2024, more than 40% were Black children, the report stated. But the mortality rate among Black infants also saw a slight decrease, dropping from 340 deaths in 2023 to 315 in 2024.

“It’s absolutely egregious that we have babies dying as a result of their race or ethnicity in a state like North Carolina where we have excellent care and community-based services,” said Dr. Dorothy Cilenti, a clinical professor at the UNC-Chapel Hill’s Department of Maternal and Child Health and the associate dean of public health practice. “There’s absolutely no reason.”

The report said state officials will continue to target these “unacceptable” disparities through initiatives like the “I Gave Birth” campaign — a collaboration among 48 hospitals and providers to improve postpartum care in the first six to eight weeks after childbirth — and programs for maternal mental health.

Cilenti said it’s “exciting” to see the improving data, which she said is likely due to factors like better practices in childbirth and more investment in women’s health, like a drop in smoking rates during pregnancy.

But keeping infant mortality rates low can only be done by considering the “upstream” inequities of motherhood, Cilenti said, like making a livable wage, having access to healthy food and affordable housing and helping mothers balance breastfeeding with their job — all factors that improve a family’s health.

She said there must be state-wide willingness and attention to bring the mortality rates down in order for the trend to continue.

“It has to be political will,” Cilenti said. “This has to remain a priority. There has to be a complete intolerance for preventable deaths.”

Overdose deaths decrease in 2023

The state in 2024 saw its biggest decline in overdose deaths since 2019, the report states, including a sizable decrease in opioid-related overdose deaths, which fell 38.3%, from 3,656 in 2023 to 2,254 in 2024.

These rates decreased most significantly among Hispanic and Black residents, according to the new data.

State officials attributed the drop to Medicaid expansion and prevention efforts like increased access to naloxone or NARCAN, a fast-acting medication used to reverse overdoses. In 2024, DHHS distributed more than 150,000 doses of reversal medications to organizations across the state.

“As Attorney General, I held big opioid drug companies accountable for their roles in sparking an addiction epidemic that harmed communities across the state, and we secured $1.5 billion to reinvest in those communities to help folks get the care they need while keeping drugs off the streets,” Gov. Josh Stein wrote in the report. “Medicaid expansion is also enabling more people to get the health care they need. This sharp decline in overdose-related deaths is a clear demonstration of the investments North Carolina has made to keep people safe and healthy.”

Total deaths decrease across NC

Deaths in North Carolina declined for the third year in a row after hitting a peak during the pandemic. The state reported 106,603 deaths in 2024, a roughly 1% decrease from 2023 and a steep drop from 118,040 deaths in 2021.

Deaths in the Triangle saw only slight changes in 2024, according to DHHS data. Wake County deaths decreased only nominally, but deaths increased in Orange County by about 8%, from 1,626 in 2023 to 1,769 in 2024.

In Durham County, deaths decreased by about 4%, from 3,954 in 2023 to 3,793 in 2024.

Faith Wardwell

The News & Observer