International comparisons of infant mortality and related factors: United States and Europe, 2010.
Level 4 - case-series / case-control
Cross-sectional comparative demographic study of national vital statistics registries (by design analogy)
What was done
Vital statistics from 2010 were analyzed to compare infant mortality and preterm birth rates between the United States and European OECD countries. To adjust for international reporting variation at early gestational ages, births at less than 24 weeks of gestation were excluded. The Kitagawa decomposition method was applied, using Sweden as the reference country, to quantify the contributions of preterm birth percentage and gestational age-specific mortality rates to the US infant mortality excess.
What was found
In 2010, the total US infant mortality rate was 6.1 per 1,000 live births (ranking 26th among OECD countries). After excluding births under 24 weeks, the US rate was 4.2 per 1,000 live births, remaining higher than most European countries and approximately double the rates in Finland, Sweden, and Denmark. US mortality for very preterm infants (24-31 weeks) compared favorably with European rates. However, US mortality at 32-36 weeks was second-highest, and mortality at 37 weeks or more was the highest among studied countries. Compared to Sweden, 39% of the higher US rate was due to a higher percentage of preterm births, and 47% was due to higher mortality at 37 weeks or more. Matching Sweden's rates in both domains would reduce the US infant mortality rate by 43%, averting nearly 7,300 infant deaths annually.
Why it matters
The findings demonstrate that the US infant mortality disadvantage relative to Europe persists after accounting for differences in registration of extremely preterm births, and is largely driven by elevated mortality in late preterm and full-term infants.
Limits
The analysis relies on aggregate ecological registry data from a single year (2010) and the abstract does not state the exact sample size. The dataset does not control for individual-level clinical risks, socioeconomic disparities, or specific causes of post-neonatal death, and international reporting differences may persist despite the 24-week exclusion cutoff.
Cited by
- supports The United States ranks approximately 30th among top developed nations in infant mortality.