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How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy?
BACKGROUND: Infant 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...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738161/ https://www.ncbi.nlm.nih.gov/pubmed/29258452 http://dx.doi.org/10.1186/s12884-017-1622-z |
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author | Zylbersztejn, Ania Gilbert, Ruth Hjern, Anders Hardelid, Pia |
author_facet | Zylbersztejn, Ania Gilbert, Ruth Hjern, Anders Hardelid, Pia |
author_sort | Zylbersztejn, Ania |
collection | PubMed |
description | BACKGROUND: Infant 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. METHODS: We 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. RESULTS: Using 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. CONCLUSIONS: Our 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-017-1622-z) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5738161 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-57381612017-12-21 How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy? Zylbersztejn, Ania Gilbert, Ruth Hjern, Anders Hardelid, Pia BMC Pregnancy Childbirth Research Article BACKGROUND: Infant 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. METHODS: We 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. RESULTS: Using 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. CONCLUSIONS: Our 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12884-017-1622-z) contains supplementary material, which is available to authorized users. BioMed Central 2017-12-19 /pmc/articles/PMC5738161/ /pubmed/29258452 http://dx.doi.org/10.1186/s12884-017-1622-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Zylbersztejn, Ania Gilbert, Ruth Hjern, Anders Hardelid, Pia How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy? |
title | How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy? |
title_full | How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy? |
title_fullStr | How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy? |
title_full_unstemmed | How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy? |
title_short | How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy? |
title_sort | how can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy? |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738161/ https://www.ncbi.nlm.nih.gov/pubmed/29258452 http://dx.doi.org/10.1186/s12884-017-1622-z |
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