U.S. Infant Mortality Still Lags Other Developed Countries
There’s more bad news for the U.S. on the infant mortality front: The U.S. ranks last of 26 countries in infant mortality: 6.1 per 1,000 live births, versus 2.5 in Sweden, according to a new study by the Centers for Disease Control and Prevention (CDC).
Infant mortality refers to the death of a baby before his first birthday. The proportion of pre-term births explains 39 percent of the difference between U.S. and Swedish outcomes, because the U.S. has a large proportion of pre-term births. This has led some to question the validity of the international comparison, because some countries measure very pre-term births (before 24 weeks differently). It has been argued that the U.S. will consider a baby born alive, who might be considered stillborn in another country, thereby making our infant mortality statistics look artificially worse.
This CDC study also looks only at babies born after 24 weeks, thus seeking to avoid that problem. The U.S. does quite well for babies born at 24 to 27 weeks of gestation. However, as gestation lengthened to normal term, the U.S. performance drops significantly.
Regrettably, other evidence points to large racial disparities in the U.S., with black babies doing especially poorly. Nevertheless, even if we exclude black babies, white, Hispanic, and Asian U.S. babies appear to do worse than in other countries.
Since Medicaid pays for about 40% of all births in the U.S., I suspect that our relatively poor infant mortality statistics are due mainly to poverty related causes as opposed to differences in the quality of healthcare among developed countries. Differences in the definition of a live birth among countries is probably also a small contributor to the adverse U.S. data.
Thank you for mentioning that. I should seek research that looks at Medicaid infant mortality versus others, controlling for other variables.
John when comparisons were done based upon the weight after birth some countries had none in the lowest weight category. Those are the ones that die most of the times. The US saves more of these infants than any other nation.
In some countries if the weight or height is less than a certain parameter they are left to die on the table and the death is referred to as a miscarriage. Data reporting is a major reason for the discrepancy seen.
But data reporting doesn’t answer the entire question. We have a social problem where mothers are addicted to drugs and that addiction causes high infant mortality.
Thus it is not our healthcare system that causes some to say we have high infant mortality. It is the combination of data collection and serious social problems along with a few other items.
We are best in the world at saving low birth weight infants and probably the best at saving infants born to drug addicted mothers. If we so well with the most difficult cases why does anyone think the healthcare system is the problem producing a higher than expected infant mortality rate?
The left likes to choose its variables when creating statistics to prove the US is a bad country. They have been quite successful in the mainstream media at convincing the public that this might be the case
Spend some time in the Neonatal ICUs around this country. I can’t imagine that these poor statistics are due to poor post-birth care. They may however be due to limited prenatal care, which is just as much a SES factor as a medical one.
There is other CDC research that is in accord with your statement.
John, I believe you’ll find Barry’s comment regarding the variety of differences in the definition of “live birth’s” highly enlightening. Where the U.S. counts as live births all babies who show “any evidence of life,” even the most premature and the smallest. Some countries don’t consider a “live birth” any infant who dies within the first 24 hours post delivery, sometimes longer.
This is well documented in a World Health publication in 2006: ISBN 92 4 156320 6 (NLM classification: WS 16)ISBN 978 92 4 156320 8.
As you know, the common way public health data is presented is incompletely understood beyond the bias of the reporter so don’t be hard on yourself. Mortality comparison between countries are generally useless.
Well, that’s why the CDC looked at births after 24 weeks of gestation – to get away from all that controversy. Would you agree that after 24 weeks of gestation you are highly likely to survive 24 hours?
Perhaps, still when it comes to exceptionally low birth weight babies, those <1,500 Grams, the US is the best place to be.
What about crack babies?
We have a problem in the US, but as someone else already said the problem has to do with social-economic problems not the quality of our healthcare system.
Then there is perennial question when these numbers get released: what is the infant mortality rate in Minnesota vs. Sweden?
Did they control for multiple births?
Hispanics in the USA have lower than average multiple births and lower than average infant mortality.
Fertility treatment is more common in the USA and increases infant mortality.
Also
African American babies are more likely to survive at any given birth weight but more likely to be low birth weight and so have a higher mortality.
Thank you. Where do we find the infertility treatment comparisons? Boivin (2007) (http://humrep.oxfordjournals.org/content/22/6/1506.full) doesn’t seem to show that.
I was sure that I had read that but I cannot find it now so sorry i must have been mistaken.
From this and Allen’s comment above, I wonder if birth weight wouldn’t be a fairer criterion than length of gestation.
A simple weight measurement is certainly less prone to errors and manipulation. And birth weight likely takes into account the other factors, such as gestation time, multiple births, drug use, and other prenatal issues such as diet, poverty and age of the mother.
…and all of these last are largely determined by social conditions and not by the health care system.
And the goal is to identify the contribution of each factor, not jumble them together!
I would have thought the first goal should be to determine whether the cause lies in the health delivery system or in other social factors.
Anyway how is length of gestation determined? A guess based on body size?
A very good question, that is addressed in the article. Actual conception is hard to measure, so real gestation is unknown. Waiting until 24 weeks of estimated gestation means you will be long enough away from actual conception such that you may not literally be at 24 weeks, but a small difference won’t have a practical effect on the measurement. (I’m hope I wrote that accurately.)
It is also true that there are virtually no heart attacks annually that occur in Kindergarten class rooms. Should we conclude then, that if one wants to avoid heart attacks all they need to do is go to a Kindergarten class room and stay there?
Over the past 30 years I’ve been surprised to see that my degrees in Economics inform my medical background more than the other way around. It’s absolutely astounding how poorly medicine understands statistics, especially nursing. Embarrassing really. //tom
New research just published indicates differences in reporting explain 40 percent of difference in U.S. outcomes: http://www.nber.org/papers/w20525.pdf.