A comparison of foetal and infant mortality in the United States and Canada

被引：30

作者：

Ananth, Cande V. ^{[1
]}

Liu, Shiliang ^{[2
]}

Joseph, K. S. ^{[3
,4
]}

Kramer, Michael S. ^{[5
,6
]}

机构：

[1] Univ Med & Dent New Jersey, Robert Wood Johnson Med Sch, Div Epidemiol & Biostat, Dept Obstet Gynecol & Reprod Sci, New Brunswick, NJ 08901 USA

[2] Publ Hlth Agcy Canada, Maternal & Infant Hlth Sect, Hlth Surveillance & Epidemiol Div, Ottawa, ON, Canada

[3] Dalhousie Univ & IWK Hlth Ctr, Perinatal Epidemiol Res Unit, Dept Obstet & Gynaecol, Halifax, NS, Canada

[4] Dalhousie Univ & IWK Hlth Ctr, Dept Pediat, Halifax, NS, Canada

[5] McGill Univ, Dept Pediat, Montreal, PQ H3A 2T5, Canada

[6] McGill Univ, Dept Epidemiol & Biostat, Montreal, PQ, Canada

来源：

INTERNATIONAL JOURNAL OF EPIDEMIOLOGY | 2009年 / 38卷 / 02期

基金：

加拿大健康研究院;

关键词：

Stillbirth; infant mortality; preterm delivery; clinical estimate of gestation; foetuses-at-risk; neonatal intensive care; Kitagawa analysis; SOCIOECONOMIC DISPARITIES; PRETERM BIRTH; RATES; REGISTRATION; WEIGHT; TRENDS; DEATH; CARE;

D O I：

10.1093/ije/dyn194

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background Infant mortality rates are higher in the United States than in Canada. We explored this difference by comparing gestational age distributions and gestational age-specific mortality rates in the two countries. Methods Stillbirth and infant mortality rates were compared for singleton births at 22 weeks and newborns weighing 500 g in the United States and Canada (19962000). Since menstrual-based gestational age appears to misclassify gestational duration and overestimate both preterm and postterm birth rates, and because a clinical estimate of gestation is the only available measure of gestational age in Canada, all comparisons were based on the clinical estimate. Data for California were excluded because they lacked a clinical estimate. Gestational age-specific comparisons were based on the foetuses-at-risk approach. Results The overall stillbirth rate in the United States (37.9 per 10 000 births) was similar to that in Canada (38.2 per 10 000 births), while the overall infant mortality rate was 23 (95 CI 1926) higher (50.8 vs 41.4 per 10 000 births, respectively). The gestational age distribution was left-shifted in the United States relative to Canada; consequently, preterm birth rates were 8.0 and 6.0, respectively. Stillbirth and early neonatal mortality rates in the United States were lower at term gestation only. However, gestational age-specific late neonatal, post-neonatal and infant mortality rates were higher in the United States at virtually every gestation. The overall stillbirth rates (per 10 000 foetuses at risk) among Blacks and Whites in the United States, and in Canada were 59.6, 35.0 and 38.3, respectively, whereas the corresponding infant mortality rates were 85.6, 49.7 and 42.2, respectively. Conclusions Differences in gestational age distributions and in gestational age-specific stillbirth and infant mortality in the United States and Canada underscore substantial differences in healthcare services, population health status and health policy between the two neighbouring countries.

引用

页码：480 / 489

页数：10

共 33 条

[31] Is more neonatal intensive care always better? Insights from a cross-national comparison of reproductive care [J].