Why the US is 'the most dangerous of wealthy nations for a child to be born into'

[GMDino]

http://www.latimes.com/science/sciencenow/la-sci-sn-childhood-mortality-usa-20180108-story.html

Quote:It’s no surprise that the United States ranks absolutely 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 all the way back to the 1960s. It was during that decade that 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 United States 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 concluded.

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 Dr. Ashish Thakrar, a first-year resident in internal medicine at Johns Hopkins Hospital in Baltimore. “The U.S. outspends every other nation on health care per capital for children, yet outcomes remain poor.”

And things could soon get even worse, the authors added: The Trump administration’s budget includes “substantial cuts to the Children’s Health Insurance Program, which covers seven 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 United States 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.
The US [is] the most dangerous of wealthy nations for a child to be born into.— Dr. Ashish Thakrar and coauthors of a new study on childhood mortality

Thakrar and his colleagues compared the U.S. to the other countries in the Organization for Economic Cooperation and Development, or OECD. 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 us 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 respiratory conditions or diabetes); congenital problems; perinatal conditions that occur during pregnancy or the early days of life; and both 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 period, the U.S. had lower rates of both infant mortality and childhood mortality. And the U.S. and the OECD19 saw steep declines in their mortality rates over the 50-year period.

A comparison of infant and child mortality in the U.S. and other wealthy nations between 1961 and 2010. (People-to-People Health Foundation, Health Affairs)

But the gains in the OECD19 overtook those in the U.S. pretty quickly, 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% 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 kids and teens 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% higher than the OECD rate of 2 deaths per 10,000.

The more time that passed, the larger the number of excess deaths in the U.S. became. During the 1960s, the excess deaths were actually in the OECD19, which suffered 32,500 of them. But in the 1970s, there were 95,900 infant and childhood deaths in the U.S. that would have been avoided if the U.S. had experienced the same mortality rates as the OECD19. In the 1980s, that figure rose to 163,000, then to 189,000 in the 1990s and finally 207,300 in the 2000s.

Adding it all up, the total number of excess deaths experienced by American infants, children and teens was about 622,7000, the researchers calculated. Nearly all of those deaths (90%) were in infants or teens between age 15 and 19, they added.
The care of children is a basic moral responsibility of our society.— Dr. Ashish Thakrar and coauthors of a new study on childhood mortality

When comparing the U.S. against the 19 members of the OECD19 individually, Thakrar and his colleagues found that the U.S. ranked 14th out of 20 countries in the 1960s and ’70s, 19th out of 20 countries in the 1980s, and last in the 1990s and 2000s.

“There is not a single category for which the OECD19 had higher mortality rates than the US over the last three decades of our analysis,” the researchers wrote.

A few specific causes of death were noteworthy, the researchers wrote.

The leading cause of death among U.S. infants was extreme immaturity, and this was three times more likely to affect American infants than those born in the OECD19 nations. The No. 2 cause of infant mortality in the U.S. was sudden infant death syndrome; the risk of SIDS was 2.3 times higher here than in the OECD19.

For teens ages 15 to 19, the leading cause of death in the U.S. was motor vehicle accidents, and these were twice as deadly in the U.S. than in OECD19. The second-leading cause of death was firearm assaults, and the risk of gun deaths was 82 times higher in America than in the peer nations.

The study authors said their findings support the conclusions of the Institute of Medicine, which blamed a fragmented health system, poverty, a weak social safety net and other factors for “poor health outcomes” in the U.S. Thakrar and his team found that the disadvantages in the U.S. compared with the OECD19 arose in the late 1960s and the mid-1980s, “precisely the time when relative socioeconomic status for children fell in the US compared to other wealthy countries.”

Although the U.S. had higher per-capita spending on healthcare, it “spent significantly less of its gross domestic product per capital on child health and welfare programs, compared to other wealthy nations,” the researchers noted.

The result is that the United States is “the most dangerous of wealthy nations for a child to be born into,” the study authors concluded. “All US policy makers, pediatric health professionals, child health advocates, and families should be troubled by these findings.”

I wonder if this takes into account children in other, war torn countries?

[*TheLeonardLeap*]

I seriously wonder if the US being able to keep people alive from diseases that would kill others is contributing to this.

The US has the highest survival rate of breast and prostate cancer in the world. I wonder how much surviving things like that and then later reproducing will affect your future generation's birth defect rate, and cancer rate and such. These are people who back in the 60s and 70s would have likely died.

Not just cancer, but people are living much longer with HIV, and are able to manage Diabetes much better. Also people with severe allergies are much less likely to die these days with the prevalence of epipens at schools and such in order to save people from a bee sting. People are surviving drug overdoses due to ambulances being loaded with the lifesaving OD drugs now. All of those can't do good things to your body/genetics, and you then pass it on.

I'm not saying that we shouldn't save people from cancer, obviously. I am just wondering if this is an unintended consequence of it, like antibacterial soap creating worse things than if we had never had antibacterial soap.

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Then combine that with the US urban gang violence and the rural childhood dangers like dirtbikes/swimming in rivers/4-wheelers/horses/gun accidents... top it off with car crashes (something that's not even a factor for a lot of Europe teens, or children whose parents don't own a car) and I suppose I could see it add up.

[*michaelsean*]

(01-10-2018, 12:47 PM)GMDino Wrote: http://www.latimes.com/science/sciencenow/la-sci-sn-childhood-mortality-usa-20180108-story.html


I wonder if this takes into account children in other, war torn countries?

I doubt they are in the top 19 richest countries.

[GMDino]

(01-10-2018, 02:39 PM)michaelsean Wrote: I doubt they are in the top 19 richest countries.

[Belsnickel]

I found it interesting that the infant mortality and teen (15-19) mortality were what they were. It's hard to tie those to poverty, necessarily. The teen one, specifically, more about stupidity. I'd like to see more of the data on this.

Lucky for me, working at a university, I have access to the full article! I don't think most of you will get to download the full thing, but here: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2017.0767

Edit: It seems they may be jumping to causation out of correlation:

Quote:An Institute of Medicine report on US health from an international perspective determined that the nation’s poor health outcomes stem from adverse socioeconomic conditions, risky health behaviors, and a fragmented health system, all in the context of a weak social safety net that fails to buffer vulnerable populations from the impacts of these circumstances on health.4 Our findings on the child mortality disadvantage support this verdict. The disadvantage developed between the late 1960s and the mid-1980s, at precisely the time when relative socioeconomic status for children fell in the US compared to other wealthy countries. The US has had one of the highest rates of child poverty among wealthy nations since at least the early 1980s,4 and in the mid-1980s child poverty increased by almost one-third in the US.32 US children also have performed among the lowest of wealthy nations in educational outcomes since at least the mid-1960s, when international comparisons were first conducted.33 Both poverty and education have repeatedly been shown to track along a gradient of health in children, with lower incomes and lower education correlated with worse health outcomes.34–36

These two phenomena—increased relative poverty and stagnating educational attainment—occurred in the context of a relatively weak social safety net for children. During the period we analyzed, the US spent significantly less of its gross domestic product per capita on child health and welfare programs, compared to other wealthy nations.37 More equitable social policies have been shown to mitigate the accumulating disadvantages that can lead to poor health outcomes in children.38 In fact, two studies found strong associations between the style of welfare regime in a country and health outcomes. Anglo-Saxon/Liberal nations (with means-tested and residual welfare regimes) performed worse than both Conservative (with wage-earner social insurance models) and Social Democratic (with universalist models) regimes. One study found that governing style accounted for 47 percent of the variation in life expectancy,39 and another found that it accounted for 20 percent of the variation in infant mortality and 10 percent of the variation in low birthweight.40

[*michaelsean*]

(01-10-2018, 03:32 PM)Belsnickel Wrote: I found it interesting that the infant mortality and teen (15-19) mortality were what they were. It's hard to tie those to poverty, necessarily. The teen one, specifically, more about stupidity. I'd like to see more of the data on this.

I'm guessing we have a lot more teen drivers who drive a lot more miles as a percentage of the population.

[Belsnickel]

(01-10-2018, 03:33 PM)michaelsean Wrote: I'm guessing we have a lot more teen drivers who drive a lot more miles as a percentage of the population.

Oh, no doubt on the driving deaths. But, the reason why EMS in Virginia doesn't call them accidents anymore is because every MVC is preventable, so still stupidity.

[CKwi88]

Yeah, our early driving age, and our nearly nonexistent (outside of big cities) public transportation, almost certainly plays a role in those numbers.

I'd be interested in some sort of study comparing alcohol responsibility between American teenage consumers and European teenage consumers.

[Belsnickel]

(01-10-2018, 03:45 PM)CKwi88 Wrote: Yeah, our early driving age, and our nearly nonexistent (outside of big cities) public transportation, almost certainly plays a role in those numbers.

I'd be interested in some sort of study comparing alcohol responsibility between American teenage consumers and European teenage consumers.

I'm sure it's out there. Maybe I'll hit up some Google Scholar action to see what I can find, later.

[BmorePat87]

When people talk about why the US lags behind in education, one issue they rarely bring up is our higher childhood poverty rate than other developed nations.

[Au165]

We have more Catholic priests? Alright, I'll just show myself out the door now...

[fredtoast]

This is kind of strange, but it looks like there are just a couple of things that account for all the difference. With infants it is premature birth (300% higher in US) and Sudden Infant Death Syndrome (230% higher). With teens it is car accidents (100% higher) and guns (82%).

The cars and guns are obvious because American teens spend more time in cars than most other countries and are exposed to more guns than in most other countries.

The premature birth and SIDS problems are much more puzzling. It almost seems like the premature birth problem would have something to do with something in the environment or food.