The risk for death among infants in the United States is 76% higher than in other wealthy countries in the most recent decade studied, and risk for death is 57% higher for youths aged 1 to 19 years.
Ashish P. Thakrar, MD, an internal medicine intern at the Johns Hopkins Hospital and Health System, Baltimore, Maryland, and colleagues compared mortality trends in the United States and 19 other nations in the Organization for Economic Cooperation and Development (OECD) for children from infancy up to age 19 years from 1961 to 2010.
Their findings were published online January 8 in Health Affairs.
Over the 5 decades, the child mortality rate declined for all of the countries, including the United States. However, the decline was slower in the United States, and the performance lag, which started in the 1980s, was linked with 600,000 excess deaths, the researchers write. Of those, 90% were in infants or in teens aged 15 to 19 years.
According to the report, between 2001 and 2010, teens in the United States aged 15 to 19 were 82 times more likely to die of gun homicide than in the other countries.
For infants in the United States, the two top causes of death in that decade were extreme immaturity and sudden infant death syndrome. US infants were 3 times and 2.3 times, respectively, more likely to die of those causes than were infants in other OECD countries.
The poor performance comes despite the United States’ spending more per capita than any other nation on healthcare for children.
Table. Countries With Poorest Performance
| Country | Rate (%) |
|---|---|
| Slowest declines for infant mortality | |
| Netherlands | 2.9 |
| United States | 3.1 |
| New Zealand | 3.3 |
| Slowest age-adjusted rates of improvement for ages 1 to 19 years | |
| United States | 2 |
| New Zealand | 2 |
| Ireland | 2.2 |
Causes of Disparities
Reasons for the poor performance in the United States are multiple and varied, according to the authors.
“Persistently high poverty rates, poor educational outcomes, and a relatively weak social safety net have made the US the most dangerous of wealthy nations for a child to be born into,” they write.
Children in the United States have higher injury rates, more adolescent pregnancy and HIV infections, and higher obesity rates than the other countries, according to the findings.
Additionally, “[d]uring 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,” the authors continue.
They note the current proposed federal 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.”
The current study is consistent with previous data that rank the United States low in health and safety measures. For example, a 2013 UNICEF report ranked the United States 26th of 29 among developed countries in child well-being. Only Lithuania, Latvia, and Romania were lower.
Countries other than the United States included in the current study were Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland, and the United Kingdom.
The authors acknowledge a limitation of the study is that the ways causes and numbers of deaths are reported, coded, and classified vary across countries.
This study was supported by institutional development funds from the Children’s Hospital of Philadelphia. The authors have disclosed no relevant financial relationships.
Health Aff. 2018;37:140-149. Abstract
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