09/15/2011
Aaron CarrollEvery time I talk about infant mortality as a metric of quality, someone gets upset at me that it should never be used in cross-country comparisons. Can we all agree, though, that it might be instructive to look at infant mortality within the US? Because the CDC has released a brief with some interesting data on infant mortality in this country. For instance, here are the number of infants who died per 1000 births by race and ethnicity of the mother:
The infant mortality rate for non-hispanic blacks is shockingly high; it’s nearly double the rate of the country as a whole. Contrary to what many think. the rates for Mexican, Cuban, Central and South American, and Asian or Pacific Islander mothers were better than those for non-Hispanic white mothers.
Why is this so? It appears that a large part of it has to do with premature birth. Here are data comparing the causes of death for non-Hispanic blacks and non-Hispanic whites:
As you can see, most of the difference between these two groups is due to preterm-related causes. The same holds true for Puerto Rican mothers:
This would lead me to believe that if we want to have a major impact on infant mortality in the US, specifically in these high risk (and growing) populations, we should focus on preventing preterm labor and delivery. If anyone can think of a better way to do that than by making sure that pregnant women have easy and uninterrupted access to high quality prenatal care, I’d love to hear it.
by Bill Gardner on September 15th, 2011 at 10:21
Another thing that would help would be making smoking cessation programs available to all pregnant women.
by V on September 15th, 2011 at 13:54
Is there any evidence behind the assertion “easy and uninterrupted access to high quality prenatal care” would decrease this mortality? From my experience, other than Magnesium and steroids, very very little from a health care system has ever been shown to decrease preterm birth.
Once again demographics are key. African-Americans have long been known to have higher rates of preterm birth for unknown reasons that are likely genetic and lifestyle-based….
Also, infant mortality is tracked very differently in different countries (with the US having the most stringent standards) so I would be very wary of any cross country comparison…
by V on September 15th, 2011 at 13:58
The last part of my prior comment was meant to be deleted as Aaron already addressed them. Apologies.
by AB on September 15th, 2011 at 14:24
I’d like to see this data with age of the mother included. A lot of teen pregnancy in the black community, how big of a role does that play?
Grabbed some data: For 15-19 year olds the pregnancy rate is 4.3/12.3/12.5 for white/black/Hispanic, while the rates of miscarriage per pregnancy is about the same (actually the lowest for black), This is miscarriages not live births, but it would be interesting to see all of these statistics when controlling for age of mother. I’m trying to find a more complete dataset.
by Jonathan on September 15th, 2011 at 20:04
Hey Aaron,
Do you subscribe to the fetal origins hypothesis? I took an entire class on it last year and wonder what your perspective is. Doug Almond and Janet Currie just released their handbook on it recently called Killing Me Softly in JEP.
by Floccina on September 15th, 2011 at 21:12
Some are related to fertility treatments.
by Floccina on September 15th, 2011 at 21:24
Note: Hispanics have less access to healthcare and prenatal care. That though can cut both ways as they have less access to fertility treatments.
by Floccina on September 15th, 2011 at 21:27
And one more thing, Hispanics and Asians have lower rates on multiple births. I think that African descendants have slightly higher rates of multiple births and lower average birth weight.