A Comparison of Infant Mortality Rates in the United States and Canada:

1. A Comparison of Infant Mortality Rates in the United States and Canada: The Impact of Universal Healthcare Heather Bermudez, Department of Biological Sciences, College of Arts and Sciences, and Honors College Faculty Mentor: Susan Eve, Honors College ABSTRACT LITERATURE REVIEW RESEARCH METHODS Data pertaining to still birth and infant mortality rates for single infant births greater than 22 weeks and newborns weighing 500 g or more were used in comparing the United States and Canada. Comparisons of gestational duration and gestational age were also made. The data pertaining to the Canadian stillbirths were obtained from the Canadian’s stillbirth database from 1996-2000. The data on live births and infant deaths in Canada were compiled from the linked live births-infant deaths file for the same years. For the United States, data was compiled by the National Center for Health Statistics of the Centers for Disease Control and Prevention. The data included all live births and fetal deaths. Data pertaining to gestational age for both countries were used in the form of a clinical estimate. The United States has made considerable progress in the field of medicine throughout the twentieth century. Infant death rates decreased dramatically from about 100 deaths in every 1000 live births in 1900 to 6.89 in 2000. Despite such a promising decline and avid research in neonatology, infant death rates have reached a plateau, one that is higher than most developed countries. This study examines the correlation between universal healthcare and infant mortality rates by comparing the United States with Canada. Canada is similar in geography and demographics; however their healthcare system is publicly funded. The United States infant mortality rate was 23% higher than that of Canada in 2000. The differences in healthcare systems appear to have a significant effect on infant mortality rates. Of the 38 countries that boast infant mortality rates several support a universal healthcare system including Singapore with the lowest infant mortality rate in 2008. Infant mortality rates of recent years have reached a disconcerting plateau. Nearly 30,000 children under the age of one year die every year in the United States. Factors such as race, ethnicity, preterm delivery, and low birthrate have contributed to the infant mortality rate. But what about the healthcare system itself? The United States has increased spending on healthcare in the past decade. Despite the advancements in obstetrics and neonatology the IMR remains higher in the U.S than most other industrialized countries, including Canada. Despite the regional similarities between the sister countries, Canada boasted an IMR of 5.3 per 1000 live births in 2003, while the U.S. lagged behind at 6.9 1000 lie births. One major difference between Canada and the United States is the form of healthcare. Canadian healthcare is publicly funded and the majority of hospital care is provided through not-for-profit organizations. Data pertaining to still birth and infant mortality rates for single infant births show hat the IMR of the United States was 23% higher than that of Canada and preterm births were 2% higher in the U.S. The gestational age-specific late neonatal, post neonatal and infant mortality rates were also higher in the U.S. at virtually every gestation. The most common causes of death in the United States from 1996 through 2000 were congenital anomalies, low birth weight and intrauterine hypoxia/birth asphyxia among preterm births. For infants carried to term, the most common causes were congenital anomalies, sudden infant death syndrome, and injury-related deaths. The most common causes of death for preterm Canadian infants were congenital anomalies, intrauterine hypoxia/birth asphyxia, short gestation/low birth weight, and maternal complications. Full term infants experienced congenital anomalies, sudden infant death syndrome, and intrauterine hypoxia/birth asphyxia. The World Health Report 2000 reported that the United States’ healthcare system fell behind 36 other countries. In 2006, the United States spent more than any other country in the world (per capita), but the infant mortality rate of the U.S. ranked 39th in the world. The United States sinks further among the rankings each year. Many of the countries that reported lower infant mortality rates maintain a Universal Healthcare system including Singapore and Sweden who reported the two lowest IMR.   REFERENCES Ananth, Cande V., Shiliang Liu, K.S. Joseph, and Micheal S. Kramer. “A comparison of foetal and infant mortality in the United States and Canada.” International Journal of Epidemiology, (2009):480-489. MacDorman, Marian F., and T.J. Matthews. “Recent Trends in Infant Mortality in the United States.” National Centers for Disease Control Data Brief. No.9 (2008):1-8. Murray, Christopher, D. Phil, and Julio Frenk. “Ranking 37th—Measuring the performance of the U.S. Healthcare System.” The New England Journal of Medicine 362:2 (2010):98-99 National Center for Health Statistics. Health, United States 2010: With Special Feature on Death and Dying. Hyattsville (2011): 35-37. RESEARCH QUESTIONS/ HYPOTHESES Does publicly funded healthcare have an effect on Infant Mortality Rate? I suspect that universal healthcare does indeed affect Infant Mortality Rates of developed countries. Access to healthcare is a major factor in the health of a nation and in a system that is publicly funded, theoretically at least, healthcare is accessible to everyone regardless of ethnicity, insurance, or income. How does the United States compare with other countries who support a universal healthcare system? My hypothesis is that the United States has a higher infant mortality rate than other developed countries with universal healthcare. What are the leading causes of infant death in the United States and do they differ from that of other countries such as Canada? I do not suspect a difference in the leading causes of death between the United States and Canada. ACKNOWLEDGMENTS I would like to offer my thanks to the following people for encouraging me and supporting Scholars Day: Warren Burggren, Provost and Vice President for Academic Affairs Vish Prasad, Vice President for Research and Economic Development Gloria C. Cox, Dean, Honors College Art Goven, Chair, Department of Biological Sciences Micheal Monticino, Dean, College of Arts and Sciences Susan Eve, Associate Dean, Honors College HNRS: 1500 Students