Friday, January 14, 2005

Infant mortality - another liberal shibboleth

James Taranto from Opinion Journal debunks a commonly heard refrain from liberals who lambast our health care system: how poorly the US stands in the world infant mortality tables. According to Nicholas Kristof, a liberal op-ed columnist for the NY Times:

Here's a wrenching fact: If the U.S. had an infant mortality rate as good as Cuba's, we would save an additional 2,212 American babies a year.

Yes, Cuba's. Babies are less likely to survive in America, with a health care system that we think is the best in the world, than in impoverished and autocratic Cuba. According to the latest C.I.A. World Factbook, Cuba is one of 41 countries that have better infant mortality rates than the U.S.

In reality, Taranto notes:

The United States . . . has the most intensive system of emergency intervention to keep low birth weight and premature infants alive in the world. The United States is, for example, one of only a handful countries that keeps detailed statistics on early fetal mortality--the survival rate of infants who are born as early as the 20th week of gestation.

How does this skew the statistics? Because in the United States if an infant is born weighing only 400 grams [14 ounces] and not breathing, a doctor will likely spend lot of time and money trying to revive that infant. If the infant does not survive--and the mortality rate for such infants is in excess of 50 percent--that sequence of events will be recorded as a live birth and then a death.

In many countries, however, (including many European countries) such severe medical intervention would not be attempted and, moreover, regardless of whether or not it was, this would be recorded as a fetal death rather than a live birth. That unfortunate infant would never show up in infant mortality statistics.

Taranto concludes: "Medical statistics can be tricky: An excellent hospital may have a higher death rate than a mediocre one because of differences in the patient population, with the former treating much harder cases than the latter. That is what seems to have happened here: Kristof has alighted on a statistical artifact of American excellence and misconstrued it as a sign of America's shortcomings."

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