Comparing Apples to Oranges

Imagine my surprise when reading this article about French health care, I read this quote:

Infant mortality rates are often cited as a reason socialized medicine and single-payer systems are better than what we have here. But according to Dr. Linda Halderman, a policy adviser in the California State Senate, these comparisons are bogus.

Official World Health Organization statistics show the U.S. lagging behind France in infant mortality rates — 6.7 per 1,000 live births vs. 3.8 for France. Halderman notes that in the U.S., any infant born that shows any sign of life for any length of time is considered a live birth. In France — in fact, in most of the European Union — any baby born before 26 weeks’ gestation is not considered alive and therefore doesn’t “count” in reported infant mortality rates.

This definitely makes a difference in infant mortality and neonatal mortality, n’est-ce pas? Most states have definitions of live and stillbirth which are similar to definitions used by the United Nations, namely, that if there is any sign of life (the umbilical cord still pulsing, the child taking even one breath, etc.), then the baby is considered to have been born alive. But if these extremely premature babies are just swept under the rug in most European statistics, then that is, at the least, disturbing. Sort of like counting up adult deaths but saying, “heart attacks don’t count, though.”

Since I recently learned how to do screen-shots, I’ll post the results of the CDC infant mortality rates (this is infant deaths from a live birth, as most broadly defined, up until one year of age), by gestational age for all mothers and babies  — as broad as I can make it — from 2003-2005:

GA 17-47

As you can see, it includes births from before 20 weeks of pregnancy (which no baby yet has survived, as far as I know), and combines all deaths from all gestational ages [from 17-47 weeks] into a single figure of 6.83/1000 deaths. Below is the same query, but limited to births from 28 weeks and above, including pregnancies of unknown gestation (which may also be below 28 weeks):

GA 28-42+This drops it to 3.76, a tad lower than the above-stated French infant mortality rate — although it’s not a perfect comparison, because it starts at 28 weeks, rather than at 26 weeks. [And if you exclude “unknown” gestational age, the rate drops a bit lower, to 3.64.] I wonder what the French (and other European nations’) infant mortality rate would be, if it were to include births as premature as what we count. So, it’s similar, if not identical.

This does change things in my mind. While as an absolute, we need to prevent premature births as much as possible (and I will note that the above figures do not include stillbirths; and many babies born so fragile and premature do not survive the birth process), so we can still do more and make our figures better; as a comparative measure, it’s simply inaccurate to say that the U.S. has worse infant mortality than European countries, if we include these high-mortality gestations in our figures, and they don’t. It’s apples and oranges.

Frankly, I’m a little irritated that I’ve not heard this before. I can understand impoverished countries not counting babies prior to 27 weeks, because they don’t have the technology of saving babies born so prematurely, while we do. But for France — which ought to have as much access to technology as we do — not to count babies that they could save in infant mortality rates is a little upsetting. Especially when it falsely makes us look worse by comparison.


4 Responses

  1. Yes, wouldn’t it be nice it we were measuring the same thing? But we are not. And to confound things more, we have a very diverse population. AHHH. So when anyone states an infant mortality statistic to me as law, I have to shake my head. I used to bash my head into the keyboard but got sick of the letter h appearing for days on my forehead.

    And we really cannot use infant mortality. 1 year is just too long. It has to at least be neonatal mortality. And yes, if they baby who we know cannot survive (example 21 weeks) takes a breath or any signs of life, then we count that. Why? I am not sure.

    What I do know is that if we all really just want to know the truth and not confuse the issues with hidden agendas, maybe we will get to the truth? At least that is my sincere hope.

    • Infant mortality would probably be a better thing, if it started with babies born at term (excluding those with lethal anomalies) — that would be a more accurate way to find out how good our health care system is at keeping babies alive, compared to other nations. Of course, it would also need to take into account abortions — I’ve read that France has a pretty high abortion rate for fetal anomaly (not sure how high compared to the U.S.; the context was compared to Ireland which does not have legal abortions), so some countries count as live births babies who would never have been born alive in other countries, which also skews statistics. Something more like a study and not merely reporting raw data, I guess, is what I’m looking for. In so many studies, they will exclude all women except those with a term baby, singleton, cephalic presentation, no fetal/neonatal anomaly, etc. So, if we include all babies (which is what the statistics are), we may have skewed numbers, because of different ways of reporting, or different risk groups, or whatever. But imagine the undertaking of looking at millions and millions of births to make sure the cohorts match! Ay-yi-yi! I wouldn’t want to sign up for that gig!

  2. That is so sad they don’t count those sweet lives as living, breathing human beings.

  3. […] gunshot wounds, or drowning, or cancer, or…?), but it is far from perfect. Especially, as I recently noted, if other countries use different data for their official statistics — for instance, not […]

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