Don't Fall Prey to Propaganda: Life Expectancy and Infant Mortality are Unreliable Measures for Comparing the U.S. Health Care System to Others
by David Hogberg, Ph.D.
...But infant mortality tells us a lot less about a health care system than one might think. The main problem is inconsistent measurement across nations. The United Nations Statistics Division, which collects data on infant mortality, stipulates that an infant, once it is removed from its mother and then "breathes or shows any other evidence of life such as beating of the heart, pulsation of the umbilical cord, or definite movement of voluntary muscles... is considered live-born regardless of gestational age."16 While the U.S. follows that definition, many other nations do not. Demographer Nicholas Eberstadt notes that in Switzerland "an infant must be at least 30 centimeters long at birth to be counted as living."17 This excludes many of the most vulnerable infants from Switzerland's infant mortality measure.
Switzerland is far from the only nation to have peculiarities in its measure. Italy has at least three different definitions for infant deaths in different regions of the nation.18 The United Nations Statistics Division notes many other differences.19 Japan counts only births to Japanese nationals living in Japan, not abroad. Finland, France and Norway, by contrast, do count births to nationals living outside of the country. Belgium includes births to its armed forces living outside Belgium but not births to foreign armed forces living in Belgium. Finally, Canada counts births to Canadians living in the U.S., but not Americans living in Canada. In short, many nations count births that are in no way an indication of the efficacy of their own health care systems.
The United Nations Statistics Division explains another factor hampering consistent measurement across nations:
...some infant deaths are tabulated by date of registration and not by date of occurrence... Whenever the lag between the date of occurrence and date of registration is prolonged and therefore, a large proportion of the infant-death registrations are delayed, infant-death statistics for any given year may be seriously affected.20
The nations of Australia, Ireland and New Zealand fall into this category.
Registration problems hamper accurate collection of data on infant mortality in another way. Looking at data from 1984-1985, Eberstadt argued that, "Underregistration of infant deaths may also be indicated by the proportion of infant deaths reported for the first twenty-four hours after birth."21 Eberstadt found that in the U.S. and Canada more than a third of all infant death occurred during the first day, but in Sweden and France they accounted for less than one-fifth. Table 3 shows that the pattern still holds today.
Chart 3-Infant Deaths
Inconsistent measurement explains only part of the difference between the U.S. and the rest of the world. Were measurements to be standardized, according to Eberstadt, "America might move from the bottom third toward the middle, but it would be unlikely to advance into the top half."22 Another factor affecting infant mortality Eberstadt identifies is parental behavior.23 Pregnant women in other countries are more likely to either be married or living with a partner. Pregnant women in such households are more likely to receive prenatal care than pregnant women living on their own. In the U.S., pregnant women are far more likely to be living alone. Although the nature of the relationship is still unclear (it is possible that mothers living on their own are less likely to want to be pregnant), it likely leads to a higher rate of infant mortality in the U.S.
In summary, infant mortality is measured far too inconsistently to make cross-national comparisons useful. Thus, just like life expectancy, infant mortality is not a reliable measure of the relative merits of health care systems....
nationalcenter.org
"...Critics of American health care often point out that other countries have higher life expectancies or lower infant mortality rates, but those two indicators are bad ways to measure the quality of a nation's health-care system. In the United States, very low-birth-weight infants have a much greater chance of being brought to term with the latest medical technologies. Some of those low-birth-weight babies die soon after birth, which boosts our infant mortality rate, but in many other Western countries, those high-risk, low-birth-weight infants are not included when infant mortality is calculated.
Life expectancies are also affected by other factors like violent crime, poverty, obesity, tobacco, and drug use, and other issues unrelated to health care. When you compare the outcome for specific diseases like cancer or heart disease, the United States outperforms the rest of the world..."
cato.org
Behind the Baby Count
By Bernadine Healy M.D.
health.usnews.com
"...The exclusion of any high-risk infants from the denominator or numerator in reported IMRs can be problematic for comparisons. The United States counts many infant births as live which other countries do not and therefore usually appears to have a much higher rate of infant mortality than similar countries. The US counts an infant exhibiting any sign of life as alive, no matter the month of gestation or the size, but other countries differ in these practices. For example, in Germany and Austria, fetal weight must reach one pound to be counted as a live birth, while in some other countries, including Switzerland, the baby must be at least 12 inches long. Both Belgium and France report babies as born lifeless if they are less than 26 weeks' gestation.[2]..."
Message 23860593
Another reason why we may have a higher infant mortality deathrate. Financial reason to not have them qualify as "stillborn."
8.1 Earned Income Tax Credit: Qualifying Child Rules
My child was born and only lived 40 minutes. Can she be used as a qualifying child when figuring the earned income credit and the child tax credit?
If your child was born alive and died during the same year, and the exemption tests are met, you can take the full exemption. This is true even if the child lived only for a moment. Whether your child was born alive depends on state or local law. There must be proof of a live birth shown by an official document such as a birth certificate. Under these circumstances, if you do not have a social security number for the child, you may attach a copy of the child's birth certificate instead and enter "DIED" in column 2 of line 6c of the Form 1040 (PDF) or Form 1040A (PDF).
irs.gov
Message 23251559
Infant mortality
Posted by:
Economist.com | NEW YORK
Categories:
Healthcare
Lies, damned lies, and statistics
ONE OF the health statistics most frequently used to compare national health care systems is infant mortality. It is also one that America does particularly poorly on, which is one of the reasons that the World Health Organisation ranked it below places like Morocco and Costa Rica in its 2000 annual report. (That is not the only reason; America also fared poorly on things like income measures).
The problem with this is that even seemingly straightforward comparisons like this aren't necessarily apples to apples. In Slate today, a pediatric cardiologist explains why:
Comparing infant mortality rates between countries is fraught with uncertainty—after all, it's hard to argue that every country's figures are reliable. But it's still worth asking what more we can do to stop babies from dying. Defined as death before one year of age, infant mortality frequently gets framed in the United States as a problem of insufficient health-care funding. In December, for example, a New York Times column blamed it on the lack of a single-payer health insurer. However, a closer look reveals the counterintuitive possibility that high infant mortality in the United States might be the unintended side effect of increased spending on medical care.
Infant deaths in poor nations are roughly six times more common than in developed areas and result mainly from easily treated infections like diarrhea in the first few months. By contrast, the majority of deaths in developed countries result from extreme prematurity or birth defects that kill a newborn in the first few days or weeks of life. According to a 2002 analysis by the Centers for Disease Control and Prevention, at least a third of all infant mortality in the United States arises from complications of prematurity; other studies assert the figure is closer to half. Thus—at the risk of oversimplifying—infant mortality in the United States principally is a problem of premature birth, which today complicates just over one in 10 pregnancies.
To reduce infant mortality, then, we need to prevent premature births, and if that fails, improve care of premature babies once born. (Prematurity is also linked to other problems; for example, it's the leading cause of mental retardation and cerebral palsy in children.) But modern medicine isn't good at preventing prematurity—just the opposite. Better and more affordable medical care actually has worsened the rate of prematurity, and likely the rate of infant mortality, by making fertility treatment widespread. According to a 2006 Institute of Medicine report, the numbers of women using assistive reproductive technology doubled from 1996 to 2002. At least half of their pregnancies culminated in multiple births (twins or more), which are at high risk of premature delivery.
Meanwhile, no amount of money or resources seems to reduce the rate of preterm births. Take prevention: Of numerous strategies, an inexhaustive list includes enhanced prenatal care, improved maternal nutrition, treatment of vaginal infections, better maternal dental care, monitors to detect early labor, bed rest, better hydration, and programs for smoking cessation. But, as well described in an erudite 1998 review in the New England Journal of Medicine by researchers at the University of Alabama, none of these strategies has had a substantial impact on the risk of preterm birth in clinical trials. (Of course, some of them, like better prenatal care, may be good for other reasons.) Despite a doubling of health-care spending as a portion of the gross domestic product since 1981, the rate of preterm birth has jumped 30 percent.
economist.com |
