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Comment by dzink | Hacker News Reader

Infant mortality is also impacted by decisions of thresholds when to try to save a life. The US for example considers 24 weeks the cutoff, much earlier than other countries, which is why the infant mortality is higher - the % of babies who normally make it after being born at 24 weeks is about 50%. Same thing happens with cancer rescue statistics - the doctors who are considered best, risk doing invasive action when others would not, thus saving normally un-saveable people, and registering higher mortality than others who wouldn’t try. Thus anywhere mortality has a high % you have to also account for total # of cases and % of recovery from severe cases.

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Thanks for sharing, I had no idea about this. I have seen infant mortality numbers tossed out as evidence the US sucks and never realized the numbers were not so simply comparable between countries. I shouldn’t be surprised :/

In terms of comparing how countries do at the basics it would probably make sense to only compare the infant mortality for babies that were carried to the full term, or within a few days at least. I'm not sure if there's global data on that specifically, but it would be interesting to see and compare.

The gestation age threshold doesn't really matter across Europe, but a birthweight threshold does somewhat. [1,2] The US doesn't look as bad for infant mortality when only comparing only births at 28 weeks or later, 2nd to last to Denmark in this [3] comparison of Canada, US and the Nordic countries rather than being almost twice as high as the rest if using 22wks as a threshold. However, my understanding is the US has higher pre-term birth rates which is certainly a confounding factor so the difference might not only be due to birth registration differences.

[1] https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-...

[2] https://journals.plos.org/plosone/article?id=10.1371/journal...

[3] https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887...

The reason you had no idea about this is because it's complete bullshit. Of course other first world countries don't count it differently just to make the numbers sound better.

No, the US counts it that way for stupid reasons relating to abortion politics.

I wrote medical reporting software and yes the USA calculates it's numbers much differently than at least France and Japan. Why do you claim BS?

Because even with that, related normalized numbers are still shit. It's not just some counting problem.

"Women in the U.S. have long had the highest rate of maternal mortality related to complications of pregnancy and childbirth. In 2020, there were nearly 24 maternal deaths for every 100,000 live births in the U.S., more than three times the rate in most of the other high-income countries we studied"

"The U.S. infant mortality rate (5.8 deaths under one year of age per 1,000 live births) is 71 percent higher than the comparable country average (3.4 deaths)"

Because you cherry pick a couple of countries and ignore the ones who don't. Obviously.

What exactly is the difference you are claiming there is between the US and France/Japan?

Even if you use a different number, US ranks low

Number of children who died before the age of 5 is 6/1000 in the US, compared to 4/1000 in France and Denmark for example.

The < 24 weeks old definition of infant in the US is absolute bullshit. An infant is 1 year or younger across the board. Perhaps you have you wires crossed and are misremembering that some countries don't count live births if significantly premature like Norway (<12 gestation). But US does it like most of Europe.

What's your source on 'cancer rescue statistics'?

I remember reading years ago that the US tries very hard to save premature babies, and when they fail, it is counted as infant mortality. Whereas other countries do not act so aggressively, and count it as miscarriage.

This happens all the time with popular statistics, especially when politics are involved.

A few years back, there was a great hue and cry over the fact that half of corporations did not pay income tax. A little digging showed that that half had lost money, and so did not have income to pay tax on.

You share this little nugget of enticing unconventional wisdom without doing the briefest google search to find out you, too, are repeating bullshit.

Most countries, especially the developed countries the US is otherwise most comparable to, use WHO definitions, and any independent sign of life is considered a live birth. In other words if there is any life there to save, it doesn't matter if you try to save it or not, it counts.

It is ironic, because if the US was trying much harder to save babies than other developed nations (which doesn't pass the smell test IMO), that should only result in a lower infant mortality rate, not a higher one, unless their efforts were somehow having a negative impact on survival.

You as well may be mixing up the notion that a few countries don't count births before certain gestational lengths or bodyweights as live births (see [1]), however that has been accounted for in international comparisons and doesn't explain the discrepancy between the US and other developed (and some developing) nations.

Regarding corporate income tax example, you are missing the part where the corporations [2] that 'lost money' at tax time are often highly profitable and paying no income tax was only possible through offshoring of profits and use of accelerated depreciation with some favourable corporate tax breaks and loopholes.

[1] https://journals.plos.org/plosone/article?id=10.1371/journal...

[2] 55 of those on the S&P or Fortune 500 were profitable in 2020 and payed no tax https://itep.org/55-profitable-corporations-zero-corporate-t...

> if the US was trying much harder to save babies than other developed nations (which doesn't pass the smell test IMO), that should only result in a lower infant mortality rate, not a higher one, unless their efforts were somehow having a negative impact on survival.

Think about it some more - it will result in a higher rate because others would classify it as a miscarriage. Your own cite says:

"variations in recording of births and deaths at the limits of viability compromises international comparisons."

Depreciation is a legitimate business expense. You're arguing that corporations really have two sets of books - one for the IRS and then one where we use your definition of profits. They didn't make profits according to the IRS accounting rules. IRS accounting rules on what profits are are the only rules that matter.

My source supports me attempting to steelman your claim by suggesting you mistakenly are referring to live births gestational age thresholds. That's not at all the same as a difference driven by how aggressive attempts to save premee lives are across countries.

Do you have a source Walter, or are you just repeating something you remember reading a while ago?

I read it about 10 or 15 years ago. I'd google various things like "Canadian definition of miscarriage". I did this for a sampling of various countries. There was wide variation.

At the time America tried to save preemies earlier than anyone else. Of course, this had a high failure rate, and they were classified as infant mortality. Developing techniques to save them can only happen if you're pushing the envelope.

> which is why the infant mortality is higher

Is that actually the case? Or are numbers still out of whack when you combine deaths from miscarriages?

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