Why children in the United States die at a higher rate than in other developed countries

NBC News

Children in the United States die at a higher rate than in other developed countries.

A study published Monday in the journal JAMA Pediatrics attempts to estimate this “excess death” — that is, how many more children under age 19 die in the United States compared with similar countries.

The estimate: 20,000 more per yeara bleak outlook for pediatric health in the country.

“The chances of a child surviving to age 20 are declining” after decades of progress, said Dr. Steven Woolf, a co-author of the study and a professor of family medicine and population health at Virginia Commonwealth University School of Medicine.

For the study, Woolf and her colleagues averaged infant mortality rates in 16 countries excluding the United States — Australia, Canada, Japan and 13 European countries — from 1999 to 2019. They compared those rates to infant mortality rates in the United States during the same years, then multiplied the difference by the size of the U.S. population for each year.

According to the study, the observed disparity can be partly explained by the high infant mortality rate in the United StatesInfants under one year of age accounted for more than half of the excess deaths. For children over one year of age, Woolf pointed to four factors that may explain the difference: firearms, suicide, drugs and traffic accidents.

“The tragic thing is that in recent years we have made great progress in the fight against childhood diseases such as leukaemia and birth defects,” he said. “We have also made great progress in preventing deaths from injuries.”

High infant mortality

Each year, the United States records more than 5 infant deaths per 1,000 live births, far exceeding the rates of other high-income countries. Mortality rates are especially high among Native American and black infants.

Several factors contribute to the United States’ disproportionate infant mortality rate. One is the relatively high rate of sudden infant death syndrome, the unplanned and unexplained death of a baby under one year of age, compared with other developed countries. About 2,500 babies die each year in the United States from sudden infant death syndrome. Another is that The infant homicide rate in the United States is relatively high compared to neighbouring countries such as the United Kingdom or Canada.

Woolf noted that these deaths are often associated with abuse or neglect, including cases of “what used to be called shaken baby syndrome, where children are violently shaken or disciplined and the impact is fatal.”

Better addressing maternal health could help improve outcomes for babies, said Marie Thoma, an associate professor of family sciences at the University of Maryland School of Public Health, who was not involved in the new study. Other high-income countries offer more support to mothers caring for their newborns than the United States does.

“I remember having to drag myself to the pediatrician’s office after I gave birth. I could barely walk,” Thoma said. “In many of these countries, there is more midwifery care and more home visits after delivery.”

Guns, suicides and drugs

The United States relies more on cars for transportation than most other countries, which contributes to more accidents that kill children.

But Woolf said the most striking difference between the United States and its peers is the level of gun ownership, which is “unimaginable for most of these other countries.” The United States has the highest rate of gun ownership in the world.

Guns are a leading cause of death among American children and teens. The majority of these deaths are homicides.

Suicide deaths are also on the rise among teens and young adults: From 2007 to 2021, the United States saw a 62% increase in suicides among people ages 10 to 24. Woolf suggested that factors such as online bullying and social media use may be contributing to that.

The country’s opioid epidemic also plays a role in its relatively high mortality rate among minors.

“There is a difference in regulatory culture between the United States and other countries that has allowed dangerous products to become more prevalent,” Woolf said.

Juvenile deaths from fentanyl increased more than 30-fold between 2013 and 2021, according to a study published last year.

“Many of the deaths we’ve seen with fentanyl have occurred in children who are not even school-aged,” said Julie Gaither, an author of that study and an assistant professor of pediatrics and public health at the Yale School of Medicine.

“If they are old enough to walk, they can pick up something that has fallen off the floor or get into their mother’s purse,” Gaither added. “But there are also homicide cases where opioids have been administered. Whether the intent was malicious or not is not always clear.”

Woolf said some of the problems highlighted in her study – particularly suicide, drug use and gun homicides – have intensified during the pandemic.

“COVID-19 added fuel to the fire”he said, “and it really put the United States far behind other countries in terms of life expectancy and mortality rates.”