
American kids are 70% more likely to die before adulthood vs. other rich nations - christophilus
https://www.vox.com/health-care/2018/1/8/16863656/childhood-mortality-united-states
======
jandrewrogers
The correct approach to this is to sort the causes of death by number of
incidents and then look at those causes with the highest number of incidents
that also have an anomalously high incident rate. This article studiously
avoided that and was obviously an exercise in narrative construction.

The leading causes of child death in the US are somewhat uniquely American
things like automobile accidents (Americans children spend much more time in
cars) and drowning (the prevalence of swimming pools in many parts of the US
is a well-known major risk factor for younger children). These things are
endemic to the American landscape but few people are calling for a dramatic
reduction in driving or swimming pools, even though these are among the most
effective things you could do. Except for the first year of birth, where
medical causes of death dominate, the rest of childhood is dominated by
unintentional injury. Even during the peak years for homicide (the 20s),
unintentional injuries still dominate the statistics.

The "teenagers 82 times more likely to die from gun homicide" is a meaningless
number. The suicide _rate_ in the US is average -- that they sometimes use
guns as opposed to whatever they do in countries with higher rates of suicide
and fewer guns is largely immaterial. The criminal activity that accounts for
most gun homicide _is_ a problem but it is also extremely concentrated in a
few areas where the murder rate from _all_ causes is anomalously high. The
number of children that die merely from proximity to guns (accidents in the
home, stray bullets during gang warfare, etc) is below the noise floor of many
other causes. Guns per se, and there are at least as many guns as people in
the US, have little to do with it.

The "Congress isn't funding kids health insurance" is disingenuous. Whether or
not the funding changes are a good idea, for most analysts this has more to do
with which bucket money comes from than whether or not there is access to
healthcare. And in terms of child mortality, programs called out like CHIP
have almost zero statistical impact generally, so it is unclear why they are
relevant to the headline.

And as others have pointed out, infant mortality statistics (first year of
birth) are not easy to compare across countries due to widely varying local
standards. In a few parts of the US, such as the poor rural areas, the child
mortality rates are legitimately quite high and geographically you are a long
distance from good medical care. (I grew up in these areas -- there might be
one doctor for all the communities spread across a wide geographic area, in
large part because there is not a population dense enough to support more than
that.) Not sure what to do about that though.

In short, this is uninformative clickbait.

------
Clanan
Looks like the numbers are around 70/10,000 vs 50/10,000? I'm assuming they
used the percentage for the clicks.

It doesn't look like the author accounted for reporting differences, which can
have a huge impact. For example, U.S. babies born significantly pre-term (e.g.
20 weeks) who do not survive are counted as infant deaths, whereas in most
other countries they're counted as stillbirths and don't affect infant
mortality stats. Also the US has higher rates of infertility treatment-related
deaths because such treatments result in twins and triplets with lower rates
of survival.

~~~
skohan
The whole thing is lacking necessary context. For instance, the stat on gun
deaths _sounds_ shocking, but this article doesn't tell me whether gun
violence is a major cause of death in American teenagers, or whether it's
0.00084% of American teen deaths and 0.00001% everywhere else.

~~~
LyndsySimon
I agree. The gun commentary triggered my skepticism, but this is what really
pushed me over the edge:

> And US teenagers are twice as likely to die in car accidents than their
> peers abroad.

As of 2013, the average driver in the UK drove 7,900 miles[1]. The average
driver in the US drives 16,550 miles[2].

It should be no surprise that people who drive twice as much die twice as
often while driving.

As for guns - I'm interested in figuring out what the actual per capita and
absolute numbers are, but don't have time to dig that up at the moment; I know
from experience that it's very difficult to find and verify information about
"gun deaths" in the US. In the past I've found that anti-gun groups have
lumped in people as old as 24 as "children", while pro-gun groups have
excluded justifiable homicides including those occurring during law
enforcement activities. I may come back to this, if anyone is interested and I
have the time.

1: [http://www.bbc.com/news/uk-england-28546589](http://www.bbc.com/news/uk-
england-28546589)

2:
[https://www.fhwa.dot.gov/ohim/onh00/bar8.htm](https://www.fhwa.dot.gov/ohim/onh00/bar8.htm)

------
philbarr
Whilst I'm sure there are a lot of guns in the US, this metric sounds a little
skewed:

"America has 4.4 percent of the world’s population, but almost half of the
civilian-owned guns around the world"

Surely any country where guns are legal to own will have a higher percentage
of civilian-owned guns than it's population, because "the world's population"
includes countries where guns are illegal.

~~~
christophilus
Yeah. The article _clearly_ has a slant. It's not terribly surprising to find
that a country with gun rights baked into its constitution has way more guns
than countries who lack such rights.

~~~
LyndsySimon
It's about as surprising that there are more homicides using firearms in the
US than countries with far fewer civilian-owned arms as it would be to find
out that there are more salt-water drownings in Florida than there are in
Utah.

------
Steltek
[https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf](https://www.cdc.gov/nchs/data/nvsr/nvsr65/nvsr65_04.pdf)

This CDC report may help breakdown the US situation. PDF page 41, table 10.
The linking CDC page summarized things as:

Children aged 1-4 years

    
    
        Accidents (unintentional injuries)
        Congenital malformations, deformations and chromosomal abnormalities
        Assault (Homicide)
    

Children aged 5-14 years

    
    
        Accidents (unintentional injuries)
        Cancer
        Intentional self-harm (suicide)
    

For unintentional injuries, it's notable that motor vehicle deaths are as
heavily represented for 1-24 years of age as firearms are. Also worth noting
is that studying firearm deaths is heavily hampered or outlawed by a certain
national party because truth is an inconvenience.

------
opencl
The article is confusing because it fails to differentiate between _infant_
mortality rate (before 1) and _childhood_ mortality rate (defined in the cited
paper as 1-19). The article purports to be about childhood mortality but the
only graph shown is of infant mortality.

From the linked paper abstract: "From 2001 to 2010 the risk of death in the US
was 76 percent greater for infants and 57 percent greater for children ages
1–19."

So the numbers as presented in this article are kind of misleading but it
still looks quite bad for the US. Lack of decent healthcare access remains an
issue for a huge fraction of the population.

------
xbmcuser
Over the years I have come to understand that comparing USA with other
countries for healthcare etc is comparing apple's to oranges. As the variance
from state to state in the USA is too wide. Here is an interesting stat
[http://www.worldlifeexpectancy.com/usa/teen-death-
rate](http://www.worldlifeexpectancy.com/usa/teen-death-rate)

------
christophilus
Note: I edited the title slightly to get it to fit within HN's 80 char limit
while retaining the original's meaning.

This article does a good job of underscoring the need for healthcare reform
here in the U.S. I first encountered these stats when we had our first child.
Maternal death is also a lot higher here for a variety of reasons[0].

[0] [https://www.npr.org/2017/05/12/527806002/focus-on-infants-
du...](https://www.npr.org/2017/05/12/527806002/focus-on-infants-during-
childbirth-leaves-u-s-moms-in-danger)

~~~
ataturk
Could you elaborate on what you mean by "healthcare reform," please? We just
had healthcare reform and my access to healthcare went down and the price more
than doubled. I can't even imagine how brutal a so-called single-payer system
would be for Americans. Also, I don't see how one questionable correlation
makes your case--for example, maybe we need Tort Reform so that people stop
suing doctors? Or maybe we need to increase the number of people attending
medical school and graduate more doctors? Or maybe we get the blood-sucking
insurance companies to do something besides make billions of dollars?

~~~
christophilus
> "My access to healthcare went down and the price more than doubled"

That, to me, is a good signal that we need reform. The fact that people with
good insurance in the US find it more affordable to buy a round-trip ticket to
Japan and pay cash for medical services is another good signal.

I don't think anyone can look at the US health system objectively and say that
it functions well, unless you define "well" in a very narrow way, such as
"Provides high profit margins to certain groups."

I'm not saying I have the answers, but change needs to happen.

~~~
LyndsySimon
I _think_ what ataturk was saying is that it's not enough to say that we need
"reform". Reform can absolutely have a negative impact.

My own health insurance rates have gone up quite a bit, as have my deductibles
and copays. My raw healthcare costs have also gone up, and it's gotten much
more difficult to figure out how much things are going to cost before agreeing
to pay for them.

Summer before last I was living in Charlottesville, VA and working a job that
did not include benefits. My wife and I are in our early 30s and have two
young children; none of us have any significant long-term medical issues. The
most basic "bronze" plan available that exempted us from the ACA fine was
$1,400 / month. I did the math and saw that the break-even point for me where
insurance would actually save me money was somewhere around $35k / year in
healthcare costs. Since then, more insurers have pulled out of Virginia and
marketplace rates there are the highest in the country.

What we had prior to the ACA was objectively less efficient than most of the
developed world. What we had from 2014-2017 was _much worse_ than it was
before, though, for anyone except perhaps those whose coverage was highly
subsidized. It's yet to be seen what will happen now with the repeal of the
individual mandate, but I expect things will get worse yet. It's a positive
financial thing for me and my family if we have to go back out the marketplace
to be able to buy plans that don't meet the government minimums, but from a
system perspective it'll just increase the mean level of risk for those that
are actively insured and drive up premiums.

I think the way forward for my family if we're not under and employer plan is
to save the money that would have in the past been used to pay insurance
premiums, and to purchase catastrophic coverage that doesn't kick in until
those savings are depleted. I would welcome an expansion of tax-advantage
healthcare savings accounts - particularly if it were possible to manage that
money in a longer-term investment like a 401k plan. After all, the plan is not
to _need_ to spend a ton of money on healthcare when we're young.

