Monday, August 18, 2008

Infant Mortality: Measurements Not Consistent

In international comparisons of infant mortality, the U.S. usually ranks behind most other countries, many of whom have socialized medicine (see chart above, click to enlarge). But do countries around the world measure infant mortality consisently and uniformly? Apparently not, see explanation below from a doctor:

The main factors affecting early infant survival are birth weight and prematurity. The way that these factors are reported — and how such babies are treated statistically — tells a different story than what the numbers reveal.

Low birth weight infants are not counted against the “live birth” statistics for many countries reporting low infant mortality rates.

According to the way statistics are calculated in Canada, Germany, and Austria, a premature baby weighing less than 500 kg is not considered a living child.

But in the U.S., such very low birth weight babies are considered live births. The mortality rate of such babies — considered “unsalvageable” outside of the U.S. and therefore never alive — is extraordinarily high; up to 869 per 1,000 in the first month of life alone. This skews U.S. infant mortality statistics.

Norway boasts one of the lowest infant mortality rates in the world. But when the main determinant of mortality — weight at birth — is factored in, Norway has no better survival rates than the United States.

Read more here.

Thanks to Craig Newmark for the pointer.

15 Comments:

At 8/18/2008 9:05 AM, Anonymous QT said...

There are many statistics that are measured differently around the world ie. poverty & inflation

We hear statistics every day and few of us actually check what we are hearing. Infant mortality offers an excellent example of the importance of looking at methodology and determining whether the statistics are being used to present a particular view.

When you hear on the news that a study shows that proposed tax cuts will not help the average family in Canada whose income is 45k, how many of us actually visit Statistics Canada to find out that the average family income is over 62k AFTER TAXES and the figure cited is average personal income not average family income? This is clearly stated in the footnotes from the report generated by a so-called non-partisan think tank. None of news agencies looked beyond the press release.

So the next time you hear that a hummingbird burns 70,000 calories a day, don't buy it until you check it. (no..it doesn't).

 
At 8/18/2008 9:23 AM, Anonymous Mich said...

Minor mistake:
"a premature baby weighing less than 500 kg is not considered a living child"
500kg is too much, 500g is more reasonable ;)

 
At 8/18/2008 10:11 AM, Anonymous c3p0 said...

You might ask another question: why is the US #5 in low-birth-weight births? Does it have anything to do with our #1 rank in teenage pregnancy or our #1 rank in teen birth rate?

 
At 8/18/2008 10:49 AM, Blogger spencer said...

The truth is that there is not a big difference in the health outcomes of the various wealthy countries systems. Yes, one can cherry pick items or data in one or anther, but that does not alter the first statement.

But without a doubt the US system is by far the most expensive.

The important question is why does the US spend so much more to get about the same results.

Blaming the government is an easy ideological response, but the truth is that it is the weird combined system we have let evolve that no logical person would propose if they were stating from scratch.

 
At 8/18/2008 11:32 AM, Anonymous Fred said...

"But without a doubt the US system is by far the most expensive."

You can blame that on all those expensive MRI machines that exist in abundance in the U.S. but, are scarce in Canada or you can blame it on those expensive cancer meds used in the U.S. but, not prescribed in the UK.

 
At 8/18/2008 11:45 AM, Anonymous GW South said...

@ Mich -

I don't know Mich - I've seen a few three year olds who might have come out of their mom a few kilos north of 500kg.

 
At 8/18/2008 11:46 AM, Blogger Dane said...

There has been a lot made of the apparent increase in U.S. infant mortality lately. News stories invariably quote a health expert on structural racism. Your post definitely highlights issues with comparative methodology. But if we're seeking an explanation for U.S. increase, see the "Barker hypothesis" concerning the deep connections across generations between mothers and babies and disease later in life.

 
At 8/18/2008 12:04 PM, Blogger juandos said...

"Blaming the government is an easy ideological response, but the truth is that it is the weird combined system we have let evolve that no logical person would propose if they were stating from scratch"...

ROFLMAO!

Good point but we do have a semi-socialist medical system in this country now and what part if any it might play in these high numbers is an open question...

Maybe a polling of inner city obstetrics hospital personnel would give people a much more rounded and realistic picture of why domestic infant mortality rates are what they are...

I wonder what part HMOs play in all this?

Maybe nothing at all...

If one considers what Nick Eberstadt has to say in his book: Tryanny of Numbers (page 31, Table 1-2) it seems that this country has had a fairly high infant mortality rate for quite awhile...

 
At 8/18/2008 7:13 PM, Blogger Dr. T said...

To C3PO: The U.S. reports a high number of low birth weight deliveries. Most countries would consider such low birth weight deliveries to be miscarriages rather than births. Miscarriages don't count as infant deaths.

I am a pathologist, and for years I have told my medical students and residents to disregard the infant mortality statistics from other countries. We use the most stringent reporting standards, so our neonatal deaths are higher than most developed countries. Also, we penalize ourselves by attempting to save premature infants as young as 22 weeks gestational age. Many of those premies die, and the deaths are included in the infant mortality statistics.

 
At 8/18/2008 8:47 PM, Blogger OBloodyHell said...

> You might ask another question: why is the US #5 in low-birth-weight births? Does it have anything to do with our #1 rank in teenage pregnancy or our #1 rank in teen birth rate?

Or you could ask if others even report such as "births", or just classify them as stillbirths or some other similar "dead @ delivery" classification.

With our Gyno, Obstetric, and Materity Ward tech, we attempt to save anything with a beating heart, and damn the expense. Is this true in other nations? Not a lot of them, where, as the entry notes, survivability is already abysmally low...

You also ignore the fact that, in the USA (possibly in other Euro nations, too, but few other places), you also have a lot of women past typical child-bearing age attempting to have their first child. This, too, contributes to lots of issues @ birth (not to suggest such women should not, by any means, attempt to have children -- only to call attention that it certainly affects both real infant mortality stats as well as contributing to increased numbers of problem cases

> But without a doubt the US system is by far the most expensive.

The important question is why does the US spend so much more to get about the same results.


Well, since we do much of the world's R&D in this area, is this really surprising? R&D is expensive.

And unless you cite a reliable source that says otherwise, I'm going to suspect that we shoulder a hell of a lot of the world's expense of new developments in not just pharmaceuticals but also advanced medical techniques. And that this probably contributes a large segment of that expense, more even than the hybrid system you complain about.

One of the reason we attempt to save so many low birth-weight babies is because we CAN save so many low birthweight babies, and we are also rich enough that we can shoulder the expense.

If you segmented off all the expensive but marginal-outcome procedures off, how bad would our healthcare costs be/rank without those?

Hmmmm?

 
At 8/18/2008 9:08 PM, Blogger juandos said...

"With our Gyno, Obstetric, and Materity Ward tech, we attempt to save anything with a beating heart, and damn the expense. Is this true in other nations?"...

Good point obh!

 
At 8/19/2008 2:53 AM, Anonymous rg said...

obloodyhell,

"And unless you cite a reliable source that says otherwise, I'm going to suspect that we shoulder a hell of a lot of the world's expense of new developments in not just pharmaceuticals but also advanced medical techniques."

Now I don't know who exactly you mean with "we", but I do agree that a lot of the pharmaceutical R&D is done in the US. But why should that mean that "we" shoulder a lot of the world's expense? How?

And so I fail to understand the logic in when you say

"Well, since we do much of the world's R&D in this area, is this really surprising? R&D is expensive."

Why should it not be a surprise? After all "we" don't give this stuff away to the rest of the world, "we" sell it to them. Or did "we" misunderstand something here?

rg

 
At 8/19/2008 9:40 AM, Anonymous Anonymous said...

In addition to definitions, there is another reason so many socialist countries report better infant mortality stats than the US.

They lie.

 
At 8/19/2008 8:01 PM, Blogger OBloodyHell said...

> After all "we" don't give this stuff away to the rest of the world, "we" sell it to them.

RG, are you under the impression that they pay the same amount for access to this pharma/tech that an American does?

The subject was:
> But without a doubt the US system is by far the most expensive.
after all.

I'm not saying that they don't pay anything, but Americans pay top prices for the tech/pharma R&D. Most of the rest of the world gets a substantially discounted rate.

Does it not seem absurdly likely that this feeds into the expense of the US Healthcare system? Probably more even than its hybridized nature (or perhaps it's the hybridized nature which does the paying that the others dodge by completely socializing their systems... Hmmmm.... Hmmmm.... If that conjecture is right, then "de-hybridizing" it would probably shatter the R&D work by completely defunding it, unless you're arguing for full privatization, which runs the risk of denying basic care to many of those earning less than $10k per family-member).

 
At 8/20/2008 12:44 AM, Anonymous rg said...

obloodyhell,

What is the "Hmmmm.... Hmmmm...." for? Does that make you more right or just less sure?

I would assume the Total Health Expenditures Per Capita includes ALL costs, including the cost paid by the taxpayer via subsidies. This however would mean, it doesn't matter if they are "hybridized or completely socialized" or what ever other word you would like to mix in here.

So unless the USA gives money away to countries such as Switzerland, Japan, France etc to cover their healthcare cost, you are simply wrong.

However, if the USA does give money to these countries to cover their healthcare cost you may be right. But this would of course beg the question, WHY? What benefits would the USA get from that, and shouldn't we subtract that from the cost?

rg

 

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