CDC Finds U.S. 30th in Infant Mortality

TUESDAY Nov. 3, 2009 -- When comparing rates of infant mortality, the United States lags dismally behind most other developed countries, largely because of a disproportionately high number of babies delivered prematurely, according to a new government report.

"The U.S. in 2005 ranked 30th in the world in infant mortality," said Marian F. MacDorman, a statistician at the U.S. National Center for Health Statistics and lead author of a data brief the agency released Tuesday. "The main cause of the high infant mortality rate is the very high percentage of preterm births in the U.S."

Dr. Alan Fleischman, medical director at the March of Dimes, said the finding "is an indictment of the way we deliver health care in the United States, and it's a reiteration of prematurity as the No. 1 public health problem in America."

"This gives us direct evidence that the extraordinary prematurity rate in the U.S. directly impacts on infant death," Fleischman said.

Dr. James M. Greenberg, director of neonatology at Cincinnati Children's Hospital Research Foundation, agreed with that conclusion, but added that infant mortality "also includes things like deaths from child abuse and from infectious diseases during the first 12 months of life."

In the United States in 2004, one in eight babies was born prematurely, compared with one in 18 in Ireland and Finland.

"Once a baby is born preterm, we do a good job of saving it," MacDorman said. "What we're not successful at is preventing preterm birth in the first place."

Fleischman seemed to agree. "The quality of neonatal intensive care is superb," he said. "We know how to rescue babies who are born very tiny, but what we don't do well is prevent prematurity."

Reasons for this, he said, include a lack of universal access to health care for women of childbearing age or pregnant women of any age. "That's a tremendous difference with our European friends," Fleischman said.

There's also not enough attention on social and behavioral factors that affect prematurity, such as smoking and alcohol and drug use, he said.

After declining for several years, U.S. infant mortality rates have stagnated since 2000. Early births, however, have risen 36 percent since 1984.

According to the new report, the United States had an infant mortality rate in 2005 of 6.86 deaths per 1,000 live births. However, 22 countries had mortality rates of 5 per 1,000 births or lower, and the rate was 3.0 or lower in Sweden, Finland, Japan, Hong Kong and Singapore.

Differences in the way births are reported, however, could affect some of the data, according to the authors of the report.

If statistics exclude births that occur at less than 22 weeks gestation, the infant mortality rate for the United States in 2004 would be 5.8 deaths per 1,000 live births, the authors said.

That rate would still be nearly double the infant mortality rate for Sweden and Norway.

If the number of early births was the same, however, the U.S. infant mortality rate would plummet to 3.9 deaths per 1,000 live births, according to the report.

"The suggestion that we would decrease the number of deaths by 33 percent if our gestational age distribution was similar to Sweden is a dramatic way of pointing out this is really serious," Fleischman said.

Though many experts see infant mortality -- along with life expectancy -- as a critical indicator of how a society's health care is doing in general, Dr. Harold Perl, a neonatologist at Hackensack University Medical Center in New Jersey said he thinks it's a "terrible tool."

Figures such as those in the government report don't take into account whether a country, for instance, allows termination of pregnancy if a fetus has a lethal congenital defect, he said, which could skew the infant mortality figures down.

"The numbers need to be drilled down to make sure we're not comparing apples and oranges," Perl said.

More information

The March of Dimes has more on premature birth.

Posted: November 2009


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