U.S. children have faced poorer health outcomes and higher mortality rates than children in other developed countries, despite higher per capita spending on children's health care in the United States, according to a study in Health Affairs.
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Study details
For the study, researchers conducted a repeated cross-sectional analysis of mortality rates from 1961 to 2010 for individuals ages 0 to 19 from 20 countries, including the United States, with similar economic development and political structure.
The researchers used two data sources for the analysis:
- The Human Mortality Database—which computes mortality rates across different age groups based on census data, population estimates, and vital statistics from 38 countries; and
- The WHO Mortality Database—which includes causes of death and mortality by age and sex for 144 countries that are a part of the World Health Organization.
The researchers classified all possible causes of death into nine categories:
- Accidental and intentional injuries;
- Cancer;
- Cardiovascular disease;
- Congenital problems;
- Infectious diseases;
- Neuropsychiatric conditions;
- Other noncommunicable diseases, such as diabetes or respiratory conditions; and
- Perinatal conditions, which occur either during a pregnancy or during the early days of an infant's life.
Findings
Child mortality rates
While the United States' child mortality rate has improved each decade since the 1960s, the United States since the 1970s has consistently ranked lower in terms of its child mortality rate when compared with the average child mortality rate of the other 19 countries included in the analysis. Specifically, the researchers found that the U.S. mortality rate for children under age one was:
- 240.7 deaths per 10,000 infants in the 1960s, compared with an average of 250.3 deaths per 10,000 infants among the 19 other countries;
- 157.4 deaths per 10,000 infants in the 1970s, compared with an average of 147.1 deaths per 10,000 infants among the 19 other countries;
- 107.9 deaths per 10,000 infants in the 1980s, compared with an average of 83.6 deaths per 10,000 infants among the 19 other countries;
- 79.8 deaths per 10,000 infants from 1991 to 2000, compared with an average of 53.7 deaths per 10,000 infants among the 19 other countries; and
- 68.8 deaths per 10,000 infants from 2001 to 2010, compared with an average of 39 deaths per 10,000 infants among the 19 other countries.
In addition, the researchers found that the U.S. mortality rate for children ages one to 19 has improved since the 1960s, but since the 1970s, the United States' mortality rate for such children has been lower than the average rate among the 19 other nations. According to the researchers, the United States' mortality rate for children ages one to 10 was:
- 6.7 deaths per 10,000 children ages 1 to 19 in the 1960s, compared with an average of 6.7 deaths per 10,000 children ages 1 to 19 among the 19 other countries;
- 6.2 deaths per 10,000 children ages 1 to 19 in the 1970s, compared with an average of 5.3 deaths per 10,000 children ages 1 to 19 among the 19 other countries;
- 4.9 deaths per 10,000 children ages 1 to 19 in the 1980s, compared with an average of 3.8 deaths per 10,000 children ages 1 to 19 among the 19 other countries;
- 3.9 deaths per 10,000 children ages 1 to 19 in the from 1991 to 2000, compared with an average of 2.7 deaths per 10,000 children ages 1 to 19 among the 19 other countries;; and
- 3.1 deaths per 10,000 children ages 1 to 19 from 2001 to 2010, compared with an average of 2 deaths per 10,000 children ages 1 to 19 among the 19 other countries.
According to the researchers, there were a total of 622,700 excess child deaths—deaths that would not have occurred if the children were born in other countries—in the United States from 1961 to 2010, including:
- 95,900 excess child deaths in the 1970s;
- 163,000 excess child deaths in the 1980s;
- 189,000 excess child deaths from 1991 to 2000; and
- 207,300 excess child deaths from 2001 to 2010.
According to the study, 90% of those excess deaths occurred among infants or teens ages 15 to 19.
Causes of death
According to the study, the two leading causes of death in the United States among infants from 2001 to 2010 were extreme premature birth and sudden infant death syndrome (SIDS). The researchers found:
- Extreme immaturity was three times more likely to affect U.S. infants than those born in the other 19 countries; and
- The risk of SIDS was 2.3 times higher in the United States than in the other 19 countries.
Among U.S. teens ages 15 to 19, the leading cause of death was motor vehicle accidents—which were twice as deadly in the United States as in the other 19 countries, according to the study. The second-leading cause of death among U.S. teens ages 15 to 19 was firearms. According to the study, the risk of gun deaths was 82.2 times higher in the United States than in the 19 other countries.
Discussion
Ashish Thakrar, an internal medicine intern at Johns Hopkins Hospital and Health System and the study's lead author, said, "We knew that U.S. infant mortality lags behind other wealthy countries, but we didn't know just how stark the disparities were for adolescents—this is the first time we came across this data that is so disheartening."
The researchers wrote that the "poor health outcomes" among U.S. children "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." The researchers wrote that these disadvantages "developed between the late 1960s and the mid-1980s, at precisely the time when relative socioeconomic status for children fell in the [United States] compared to other wealthy countries."
Further, the researchers noted that although the United States spent more per capita on children's health care when compared with the other countries included in the analysis, the United States "spent significantly less of its gross domestic product per capita on child health and welfare programs, compared to other wealthy nations." As a result, the researchers wrote that the United States is "the most dangerous of wealthy nations for a child to be born"—which should trouble "all U.S. policy makers, pediatric health professionals, child health advocates, and families" (Kliff, Vox, 1/8; Kaplan, "Science Now," Los Angeles Times, 1/8; Castellucci, Modern Healthcare, 1/8; Thakrar et al., Health Affairs, January 2018).
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