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February 05, 2013 11:55 AM The Zombie Infant Mortality Explanation

By Aaron Carroll

There is it, in the lead of an editorial in the WSJ:

Those Misleading World Health Rankings

The numbers are distorted because, for instance, U.S. doctors try so hard to save premature babies.

And from later in the piece:

Another major gauge of health is infant mortality. As the report’s authors point out, the U.S. has the highest infant-mortality rate among high-income countries. Again, this isn’t a good indicator of the quality of the American health-care system. The elevated U.S. rate is a function of both the technological advancement of American hospitals and discrepancies in how different countries define a live birth.

Doctors in the U.S. are much more aggressive than foreign counterparts about trying to save premature babies. Thousands of babies that would have been declared stillborn in other countries and never given a chance at life are saved in the U.S.

If only someone had addressed this issue in a public venue. Perhaps at CNN.com?

When compared to peer countries, the United States was the absolute worst with respect to still births, infant mortality, and low birth weight. Some have tried to blame this on “coding” differences. In other words, they will claim that other countries will refuse to define a premature birth as we do, resulting in artificially high numbers in the US. But when this report recalculated the rates to exclude such births equally in all countries, we still ranked last.

See, this is something people trot out all the time to try and explain our bad infant mortality. They cherry pick a country or a year and say we do things differently. But let’s use a little common sense here. We’re giving our data to these studies. They aren’t stealing it in the middle of the night. So if we really think we’re being cheated, we should change how we measure things. Moreover, it’s not us versus the rest of the world. Each country does things differently. The United States is not the only developed country that tries to save premature babies.

Let me quote directly from the study (page 66-7):

The high rate of adverse birth outcomes in the United States does not appear to be a statistical artifact, such as a difference in coding practices for very small infants who die soon after birth (MacDorman and Mathews, 2009). Indeed, country rankings remained identical even when Palloni and Yonker (2012) recalculated the rates to exclude preterm births (less than 22 weeks of gestation).

There are lots of reasons why our infant mortality is terrible. This isn’t one of them. It’s a zombie idea.

[Cross-posted at The Incidental Economist]

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Aaron Carroll ,MD, is an associate professor of Pediatrics and the associate director of Children’s Health Services Research at Indiana University School of Medicine.

Comments

  • emily on February 06, 2013 7:16 AM:

    Come on, it's the WSJ. Their editorial page is chock full of zombie ideas. This one should be right at home alongside the zombie bond vigilantes and the zombie Zimbabwe-level inflation.