Thursday, May 06, 2010

Fun with statistics

Dr. Linda Halderman looks at the charge that US health care is inferior because of the high infant mortality rate.  I'd love to see footnotes or links to solid references, but she states:

U.S. infant mortality rates (deaths of infants <1 year of age per 1,000 live births) are sometimes cited as evidence of the failings of the U.S. system of health care delivery. Universal health care, it's argued, is why babies do better in countries with socialized medicine.

But in fact, 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 <500g 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.

When Canada briefly registered an increased number of low weight babies previously omitted from statistical reporting, the infant mortality rose from 6.1 per 1,000 to 6.4 per thousand in just one year.

According to research done by Canada's Bureau of Reproductive and Child Health, "Comparisons of infant mortality rates by place and time should be adjusted for the proportion of such live births, especially if the comparisons involve recent years."

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.

I mentioned in a comment, and will repeat here:

Apparently, the World Health organization has defined "live birth" as:

A live birth occurs when a fetus, whatever its gestational age, exits the maternal body and subsequently shows any sign of life, such as voluntary movement, heartbeat, or pulsation of the umbilical cord, for however brief a time and regardless of whether the umbilical cord or placenta are intact. (Wikipedia)

If low birth weight babies aren't being counted in a nation's statistics, it is at odds with this definition. I'd love to see a link to a definitive source.

Now, I suspect this definition doesn't have much legal force, but I'm sure lots of people would be happy if everyone simply infers that this definition is universally used.

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