Why is U.S. child mortality rate highest among wealthy nations?
It’s no surprise that the United States ranks last in child mortality among the world’s wealthiest countries — that’s been true for years. A new study examines how this sad situation came to be.
According to data from the World Health Organization and the global Human Mortality Database, the problems go back to the 1960s. During that decade, the U.S. infant mortality rate — for babies less than a year old — and the U.S. childhood mortality rate — for those between the ages of 1 and 19 — began to exceed the combined rates for the other 19 richest nations.
If the U.S. had performed as well as its peer countries between 1961 and 2010, more than 600,000 childhood deaths could have been avoided over those 50 years, the study authors said.
The results were published Monday in the journal Health Affairs.
“The care of children is a basic moral responsibility of our society,” wrote the study authors, led by Ashish Thakrar at Johns Hopkins Hospital in Baltimore. “The U.S. outspends every other nation on health care per capita for children, yet outcomes remain poor.”
The situation could get worse, the authors added: The Trump administration’s budget includes “substantial cuts to the Children’s Health Insurance Program, which covers 7 million children, and to the Supplemental Nutrition Assistance Program, which directs three-quarters of its benefits to households with children.”
But there’s plenty of evidence that things were bad already. Babies born in the U.S. have a lower life expectancy than their counterparts in other countries. In part, that’s because they face higher rates of obesity, injury, HIV infection and teen pregnancy, according to a 2013 report from the U.S. Institute of Medicine.
Dr. Thakrar and his colleagues compared the U.S. to the other countries in the Organization for Economic Cooperation and Development. These countries — Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland and the United Kingdom — are similar to the U.S. in terms of “economic development and political structure,” they wrote. They dubbed this collection the OECD19.
Then they compared the U.S. to the OECD19 using two separate data sources.
The first was the Human Mortality Database, which takes census data, population estimates and vital statistics from 38 countries and uses them to compute mortality rates for different age groups. The HMD is maintained by UC Berkeley and the Max Planck Institute for Demographic Research in Germany.
The second was the WHO Mortality Database, which tracks both mortality and causes of death according to age and sex for the 114 countries that belong to the World Health Organization. The researchers grouped all possible causes of death into nine categories: infectious diseases; cardiovascular disease; cancer; neuropsychiatric conditions; other noncommunicable diseases (such as respiratory conditions or diabetes); congenital problems; perinatal conditions that occur during pregnancy or the early days of life; and intentional and accidental injuries.
Neither source contained information that allowed the researchers to account for differences in childhood mortality due to racial, income or other socioeconomic disparities.
In 1961, the number of children and teens in the OECD19 (144 million) was twice as high as in the U.S. (71 million). By 2010, that gap had closed substantially, to 112 million and 83 million, respectively.
At the start of the study, the U.S. had lower rates of infant mortality and childhood mortality. And the U.S. and the OECD19 saw steep declines in their mortality rates over the 50-year period. But the gains in the OECD19 overtook those in the U.S., the researchers found.
In the 1960s, the infant mortality rate in the U.S. was 240.7 deaths per 10,000 infants, compared with 250.3 deaths per 10,000 in the OECD19. By the 1970s, that discrepancy had flipped, with 147.1 deaths per 10,000 in the OECD19 and 157.4 per 10,000 in the U.S. In the last decade of the study, 2001 to 2010, the infant mortality rate in the U.S. was down to 68.8 deaths per 10,000, but that was 76 percent higher than the OECD19 rate of 39 deaths per 10,000.
The situation was similar for childhood mortality. During the 1960s overall, both the U.S. and the OECD19 experienced 6.7 deaths per 10,000 among ages 1 to 19. In the 1970s, the OECD19 had the edge, with 5.3 deaths per 10,000 compared with 6.2 deaths per 10,000 in the U.S. And in the 2000s, the U.S. childhood mortality rate of 3.1 deaths per 10,000 was 55 percent higher than the OECD rate of 2 deaths per 10,000.
“The care of children is a basic moral responsibility of our society. The U.S. outspends every other nation on health care per capita for children, yet outcomes remain poor.” — Dr. Ashish Thakrar, a first-year resident in internal medicine at Johns Hopkins Hospital in Baltimore.