Differences in perinatal and infant mortality in high-income countries: artifacts of birth registration or evidence of true differences?

• Published in: BMC Pediatrics
• Main Authors: Deb-Rinker, Paromita, León, Juan Andrés, Gilbert, Nicolas L, Rouleau, Jocelyn, Andersen, Anne-Marie Nybo, Bjarnadóttir, Ragnheiður I, Gissler, Mika, Mortensen, Laust H, Skjærven, Rolv, Vollset, Stein Emil, Zhang, Xun, Shah, Prakesh S, Sauve, Reg S, Kramer, Michael S, Joseph, K S
• Other Authors: 1 Publ Hlth Agcy Canada, Ctr Chron Dis Prevent, Maternal & Infant Hlth Sect, Surveillance & Epidemiol Div, Ottawa, ON K1A 0K9, Canada 2 Univ Copenhagen, Dept Publ Hlth, Copenhagen, Denmark 3 Landspitali, Dept Obstet & Gynecol, Rekjavik, Iceland 4 Natl Inst Hlth & Welf THL, Helsinki, Finland 5 Univ Bergen, Med Birth Registry Norway, Bergen, Norway 6 McGill Univ, Dept Pediat, Montreal, PQ H3A 2T5, Canada 7 McGill Univ, Dept Epidemiol Biostat & Occupat Hlth, Montreal, PQ, Canada 8 Univ Toronto, Mt Sinai Hosp, Dept Paediat, Toronto, ON M5G 1X5, Canada 9 Univ Calgary, Dept Pediat, Calgary, AB T2N 1N4, Canada 10 Univ Calgary, Dept Community Hlth Sci, Calgary, AB, Canada 11 Univ British Columbia, Dept Obstet & Gynaecol, Vancouver, BC V5Z 1M9, Canada 12 Univ British Columbia, Sch Populat & Publ Hlth, Vancouver, BC V5Z 1M9, Canada
• Format: Article in Journal/Newspaper
• Language: English
• Published: BioMed Central 2016
• Subjects: Ungbarnadauði; Fetal Death/epidemiology; Infant Mortality*; nfant; Newborn; Birth Certificates; United States/epidemiology; Iceland; Canada; Denmark; Finland; Norway; Sweden
• Online Access: http://hdl.handle.net/2336/604511; https://doi.org/10.1186/s12887-015-0430-8

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access. Variation in birth registration criteria may compromise international comparisons of fetal and infant mortality. We examined the effect of birth registration practices on fetal and infant mortality rates to determine whether observed differences in perinatal and infant mortality rates were artifacts of birth registration or reflected true differences in health status. A retrospective population-based cohort study was done using data from Canada, United States, Denmark, Finland, Iceland, Norway, and Sweden from 1995-2005. Main outcome measures included live births by gestational age and birth weight; gestational age-and birth weight-specific stillbirth rates; neonatal, post-neonatal, and cause-specific infant mortality. Proportion of live births <22 weeks varied substantially: Sweden (not reported), Iceland (0.00%), Finland (0.001%), Denmark (0.01%), Norway (0.02%), Canada (0.07%) and United States (0.08%). At 22-23 weeks, neonatal mortality rates were highest in Canada (892.2 per 1000 live births), Denmark (879.3) and Iceland (1000.0), moderately high in the United States (724.1), Finland (794.3) and Norway (739.0) and low in Sweden (561.2). Stillbirth:live birth ratios at 22-23 weeks were significantly lower in the United States (79.2 stillbirths per 100 live births) and Finland (90.8) than in Canada (112.1), Iceland (176.2) and Norway (173.9). Crude neonatal mortality rates were 83% higher in Canada and 96% higher in the United States than Finland. Neonatal mortality rates among live births ≥ 28 weeks were lower in Canada and United States compared with Finland. Post-neonatal mortality rates were higher in Canada and United States than in Nordic countries. Live birth frequencies and stillbirth and neonatal mortality patterns at the borderline of viability are likely due to differences in birth ...