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maltraitance animale suisse anti aging PLoS Med 15 3 : e Introduction Despite some progress made in recent years, infant mortality rates in the US continue to be high compared to other high-income countries . According to the latest estimates, the US currently ranks 44th among countries of all income levels, with an infant mortality rate of 5. While the high rates of prematurity and prematurity-related mortality in the US have been well documented in the literature [2,3], the US performs comparably to other high-income countries when it comes to the survival of preterm infants.
Fig 1 compares gestation-specific mortality rates in the US and 6 leading European countries in terms of low infant mortality rates with data available for On average, infant mortality appeared to be very similar for premature births in the US and in these European countries. The same was not true for children born after 36 weeks of gestation, where children born in the US faced more than twice the mortality risk of children in European countries with low infant mortality rates odds ratio [OR] 2.
Relative mortality risk in the US and Europe by gestational age category. Sources: Maltraitance animale suisse anti aging, US birth and death records, author calculations.
Gestational age in both the Euro-Peristat and US data is based on the best obstetrical estimate available, which in most cases corresponds to first trimester ultrasound. ES, effect size.
In this study, we used complete and geocoded birth records from the period — to better understand the high burden of mortality among full-term infants in the US. We identified the main causes underlying the high mortality rates among full-term infants overall in the aggregate data in a first step, and then explored differences in actual and potential birth outcomes across US states in a second step.
By first reviewing the causes of death in this population, we could identify the main risk factors for infants in this generally low-risk population, and could clearly distinguish the relative importance of preexisting conditions such as malformations relative to perinatal and post-neonatal conditions those arising in the 28— days after birth.
In order to provide a better sense of feasible outcomes in this population, we estimated and compared cause-specific full-term mortality rates at the state level both unconditional and conditional on maternal characteristics.
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While these state-level comparisons did not allow us to identify the specific reasons why certain states have particularly high rates of mortality, they did allow us to identify areas where major improvements were possible in principle. Methods Study design The study was designed as a cross-sectional study using birth and death records of all infants born in the US between January 1,and December 31, No pre-analysis plan was developed for this study.
The main objective of the project was to identify the primary causes underlying the high infant mortality rates observed in the US nationally as well maltraitance animale suisse anti aging at the state level.
Data sources Linked birth and death records including restricted geographic identifiers were obtained from the National Center for Health Statistics NCHS for the years to Outcome measures Our primary outcome measure of interest was the infant mortality rate among full-term births defined as the number of deaths per 1, children born alive between 37 and 42 weeks of gestation within the first year of their life.
For the purpose of this study, we used the traditional definition of full-term, which includes early-term 37 and 38 weeksfull-term 39 and 40 weekslate-term 41 weeksand some post-term 42 weeks births according to the more recent definition of the American College of Obstetricians and Gynecologists Committee on Obstetric Practice . To adjust for differential outcomes in this relatively wide 5-week gestational window, we controlled for differences in gestational age by including binary indicators for gestational age category 37 weeks, 38 weeks, 41 weeks, 42 weeks in our multivariable analysis, using the more narrow, revised full-term definition 39 and 40 weeks as our reference group.
Gestational age was computed by the NCHS based on last menstrual period reported by the mother. To ensure gestational age was not measured maltraitance animale suisse anti aging across states, we compared prematurity rates with rates of low birth weight in the full sample at the state level.
The correlation of these measures at the state level was 0.
Causes of death for all children who died under the age of 1 year were based on death certificates, which are required to be completed by either a coroner or medical examiner in all US states, following CDC guidelines.
Even though regulations vary by state, deaths due to violence or suspicious circumstances are further investigated and certified by a medical legal officer . Some more disaggregated statistics for major causes of deaths such as SIDS were also computed as described further below.
Exclusion criteria Children born prior to 37 or after 42 weeks of gestation were excluded from this study.
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All other children born alive in the US between January 1,and December 31,including multiple births and children born with malformations not reported in the NCHS datasetwere analyzed in this study. As for smoking, mothers reported the average number of cigarettes smoked per day during their first, second, and third trimesters.
We used indicators for previous diagnosis of diabetes, chronic hypertension, and eclampsia as provided in the dataset.
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Further details of all these variables are provided in S1 Table. The remaining groups were defined by sequentially adding 0. In a second step, we decomposed mortality differences at the group level by cause of death. Third, we used multivariable regression models to assess the extent to which survival differences across states can be attributed to observable differences in maternal and birth characteristics.
To do so, we first ran multivariable logistic models comparing infants born in the states with the highest mortality rates to infants born in the states with the lowest mortality rates.
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