How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy?

BMC Pregnancy and Childbirth

Research Article

Anders Hjern¹  Ania Zylbersztejn²  Ruth Gilbert³  Pia Hardelid³ 

[1] Centre for Health Equity Studies (CHESS), Stockholm University, SE–10691, Stockholm, Sweden;Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, 171 76, Solna, Stockholm, Sweden;The Farr Institute of Health Informatics Research, 222 Euston Road, NW1 2DA, London, UK;UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK;UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, WC1N 1EH, London, UK;

关键词: Infant mortality;    Neonatal mortality;    Post-neonatal mortality;    Stillbirth;    International comparison;    Birth weight;   

DOI  :  10.1186/s12884-017-1622-z

 received in 2017-02-25, accepted in 2017-12-07,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundInfant mortality rates are commonly used to compare the health of populations. Observed differences are often attributed to variation in child health care quality. However, any differences are at least partly explained by variation in the prevalence of risk factors at birth, such as low birth weight. This distinction is important for designing interventions to reduce infant mortality. We suggest a simple method for decomposing inter-country differences in crude infant mortality rates into two metrics representing risk factors operating before and after birth.MethodsWe used data from 7 European countries participating in the EURO-PERISTAT project in 2010. We calculated crude and birth weight-standardised stillbirth and infant mortality rates using Norway as the standard population. We decomposed between-country differences in crude stillbirth and infant mortality rates into the within-country difference in crude and birth weight-standardised stillbirth and infant mortality rates (metric 1), reflecting prenatal risk factors, and the between-country difference in birth weight-standardised stillbirth and infant mortality rates (metric 2), reflecting risk factors operating after birth. We also calculated birth weight-specific mortality.ResultsUsing our metrics, we showed that for England, Wales and Scotland risk factors before and after birth contributed equally to the differences in crude stillbirth and infant mortality rates relative to Norway. In Austria, Czech Republic and Switzerland the differences were driven primarily by metric 1, reflecting high rate of low birth weight. The highest values of metric 2 observed in Poland partially reflected high rates of congenital anomalies.ConclusionsOur suggested metrics can be used to guide policy decisions on preventing infant deaths through reducing risk factors at birth or improving the care of babies after birth. Aggregate data tabulated by birth weight/gestational age should be routinely collected and published in high-income countries where birth weight is reported on birth certificates.

【 授权许可】

CC BY   
© The Author(s). 2017