How can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy?
Abstract 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...
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doaj-975d9b670c3a49789c91ed4ca61777d52020-11-24T22:52:29ZengBMCBMC Pregnancy and Childbirth1471-23932017-12-011711710.1186/s12884-017-1622-zHow can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy?Ania Zylbersztejn0Ruth Gilbert1Anders Hjern2Pia Hardelid3The Farr Institute of Health Informatics ResearchUCL Great Ormond Street Institute of Child HealthCentre for Health Equity Studies (CHESS), Stockholm UniversityUCL Great Ormond Street Institute of Child HealthAbstract 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.http://link.springer.com/article/10.1186/s12884-017-1622-zInfant mortalityNeonatal mortalityPost-neonatal mortalityStillbirthInternational comparisonBirth weight |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ania Zylbersztejn Ruth Gilbert Anders Hjern Pia Hardelid |
spellingShingle |
Ania Zylbersztejn Ruth Gilbert Anders Hjern Pia Hardelid 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 Infant mortality Neonatal mortality Post-neonatal mortality Stillbirth International comparison Birth weight |
author_facet |
Ania Zylbersztejn Ruth Gilbert Anders Hjern Pia Hardelid |
author_sort |
Ania Zylbersztejn |
title |
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_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_sort |
how can we make international comparisons of infant mortality in high income countries based on aggregate data more relevant to policy? |
publisher |
BMC |
series |
BMC Pregnancy and Childbirth |
issn |
1471-2393 |
publishDate |
2017-12-01 |
description |
Abstract 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. |
topic |
Infant mortality Neonatal mortality Post-neonatal mortality Stillbirth International comparison Birth weight |
url |
http://link.springer.com/article/10.1186/s12884-017-1622-z |
work_keys_str_mv |
AT aniazylbersztejn howcanwemakeinternationalcomparisonsofinfantmortalityinhighincomecountriesbasedonaggregatedatamorerelevanttopolicy AT ruthgilbert howcanwemakeinternationalcomparisonsofinfantmortalityinhighincomecountriesbasedonaggregatedatamorerelevanttopolicy AT andershjern howcanwemakeinternationalcomparisonsofinfantmortalityinhighincomecountriesbasedonaggregatedatamorerelevanttopolicy AT piahardelid howcanwemakeinternationalcomparisonsofinfantmortalityinhighincomecountriesbasedonaggregatedatamorerelevanttopolicy |
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1725665839381741568 |