Microkhan by Brendan I. Koerner

Our Infant Mortality Conundrum

September 14th, 2009 · 7 Comments

InfantMortalityUnitedStates
No matter where you stand on the whole health-care debate, it’s tough to argue with the fact that our revamped system needs to address our appallingly high rate of infant mortality. Though the American economy is the largest in the OECD, our babies perish more frequently than the organization’s average. In fact, our national infant mortality rate is only slightly better than Lithuania’s, and it’s slightly worse than Slovakia’s. And as the chart above shows, no improvement has been made in nearly a decade—a fact in part ascribable to the paucity of pre-natal care available to the un- and under-insured.

What’s most tragic about this situation is that so little investment would be required to improve the rate. That’s because the key to reducing infant mortality at this point is merely to ratchet down the rate of exceedingly premature births—that is, births in which the infant gestated for less than 28 weeks. For a blueprint on how this might be achieved, check out this seventeen-year study of infant-mortality rates in Dane County, Wisconsin, where the longtime discrepancy between black and white infant-mortality rates vanished thanks to slightly better prenatal care:

The percentage of black women receiving adequate, adequate plus, and intermediate prenatal care (measured by expected number and timing of clinical visits using the Adequacy of Prenatal Care Utilization Index [the Kotelchuck Index]) increased from 81.6% to 85.3%. Improvement in quality of care received is suggested by an increase in maternal medical conditions recorded on the birth record from 48.9% to 59.4%, and a decrease in birth record reported obstetrical complications from 50.2% to 42.5%, coupled with substantial reductions in infant mortality for black women with reported medical conditions or obstetrical complications. The decrease in infant deaths per 1,000 live births for babies born to black mothers with previous child deaths (from 84.2 IMR [eight of 95] for 1990-2001 to zero IMR [none of 47] for 2002-2007) and to those with previous premature births (from 54.3 IMR for 1990-2001 to 8.1 IMR for 2002-2007) underscores major improvement in birth outcomes among highest-risk pregnancies.

Oh, and perhaps the most essential elements of that improved prenatal care? Getting moms to quit smoking.

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7 Comments so far ↓

  • Captured Shadow

    Interesting that both Canada and Sweden have socialized medicine but the Canadian rates are closer to the US rates than to Swedish ones. My hunch is that Swedes have higher levels of education for mothers and probably more stable income for them as well.
    It might be interesting to see a chart of Infant mortality vs Birth rates by country. My prediction is that countries with low population growth would also have low infant mortality.

  • Brendan I. Koerner

    Great comment. Gonna be posting about this exact issue either tomorrow or Wednesday, so pls. keep an eye peeled.

    It would be interesting to see which Canadian populations have the highest IM rates. I’m guessing there are problems in First People communities, as well as in economically depressed timber towns.

  • Brian Moore

    There’s also some data recording issues. There is not a unified system for determining what is a case of infant mortality. For example, with the extremely short gestation cases you mention, many countries simply do not list this as a case of infant mortality, and these numbers are self-reported. This isn’t without precedent, as many, many pregnancies self-terminate for no discernable reason at a young age. But due to the high priority placed on these cases in the US and Canada, and the fact that some are saved, the US/Canada considers these to be IM cases.

    Check out the comparing rates part:

    http://en.wikipedia.org/wiki/Infant_mortality#Comparing_infant_mortality_rates

    I don’t have a link right now, but my wife (who is a pathologist) and mother (who is a pediatrician) report that inconsistencies in reporting make up the majority of the measured difference in IM for the US and Canada.

  • Brendan I. Koerner

    @Brian Moore: Thanks for the link to the Wiki article on the reporting anomalies.

    It would obviously take a lot of deep diving to figure out who’s fudging, esp. when it comes to handling miscarriages. If/when I have time, I’ll read the latest WHO report and see if there are any asterisks.

    Would really like to see that U.S./Canada comparison if you can dig it up. That would definitely be contrarian, to say the least. On a related topic, do you have guess as to why IMRs in Canada continue to decline while they’ve remained static in the U.S.? Is this due to actual improvements in care, or statistical fudging (i.e. recording IMRs differently)?

    When all’s said and done, I still think it’s safe to say that the U.S. IMR is might higher than it should be, given our wealth. But then again, maybe the better correlation isn’t between overall wealth and IMRs, but rather income inequality and IMRs.

  • Brian Moore

    Sorry for the slow response.

    Here’s some more official stuff:

    http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1615029

    You were definitely right about native IM rates:

    http://www.thestar.com/News/Canada/article/610713

    I think as far as Canada vs US, I assume immigration rates affect it, but I wasn’t able to find anything that laid out the comparison.

    “When all’s said and done, I still think it’s safe to say that the U.S. IMR is might higher than it should be, given our wealth. But then again, maybe the better correlation isn’t between overall wealth and IMRs, but rather income inequality and IMRs.”

    Definitely. No one’s really going to be happy until it’s 0. And precisely the same things that affect adult health affect IM #’s — the things that are killing adults are obesity, smoking, etc… all of which negatively affect the baby. So if you find that these negative health factors are associated with something, it makes sense that IM would be as well — and having a low income certainly is one of those “somethings.”

  • Brendan I. Koerner

    @Brian Moore: Thanks for the links. Still got some more IM posts in the hopper, so stay tuned.

    I’m esp. interested in what role maternal smoking plays in IM. My hunch is that it’s a huge factor, and that by focusing on that alone we could see a statistically significant reduction in rates within a relatively short time period.

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