Report of the International Conference on the Perinatal and Infant Mortality Problem of the United States / under the sponsorship of the National Center for Health Statistics, Public Health Service, U.S. Department of Health, Education, and Welfare.

  • United States. Public Health Service.
Date:
1966
Catalogue details

Licence: Public Domain Mark

Credit: Report of the International Conference on the Perinatal and Infant Mortality Problem of the United States / under the sponsorship of the National Center for Health Statistics, Public Health Service, U.S. Department of Health, Education, and Welfare. Source: Wellcome Collection.

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    over 2,500 grams at birth; however, there has been no decrease in the neonatal mortality rate among the low-birth-weight infants since then. class is a very important discriminating factor in infant mortality. However, there are no data available for the United States as a whole on this issue. Dr. Helen C. Chase has reported on the experience in New York State (excluding New York City) for 1950-52. One point of interest relates to the comparatively modest variations in perinatal mortality (defined as infant deaths under 28 days of age and fetal deaths of 20 weeks' or more gestation) by social class based on the father's occupation. A one-third gradient in the loss rate was found between the professional category and the laborer category (nonagricul- tural). There are many difficulties in drawing in- ferences from cause-of-death information be- cause of the great variation that may exist among countries in the way cause of death is assigned. Nevertheless, from the standpoint of international comparisons it would appear that the United States cannot single out any one or two particular causes of death to which to attribute the dif- ferentials in either neonatal or postneonatal mortality. The United States seems to have an elevated infant mortality in the great majority of the causes of death. The final point made was that very recent events indicate that the infant mortality rate in the United States is still declining very slowly. However, no segment of the population is ex- periencing a large-scale reduction in the rate. Discussion The discussion that followed Mr. Shapiro's report centered on the problem of social class differentials. It was pointed out that data from New York State, exclusive of New York City, of mortality differentials by social class, as defined by the father's occupation, became more apparent in the postneonatal and early child- hood periods. The chance of a low-birth-weight baby being born dead or of dying within the first month of life was shown to be the same for all occupational groups, but the chance of the low- 10 birth-weight baby surviving later was quite marked by social class. Professor Trolle re- marked that in Denmark, on the other hand, social class differences were seen both in the occurrence of low-birth-weight babies and in their neonatal mortality. The fact that social class is indeed a dif- ficult factor to analyze was emphasized, Problems of family disorganization, medical status before pregnancy, and the nature of prenatal care all contribute to make this a highly complex situation. Mr. Shapiro suggested that this view was supported by data from a study of births in New York City in 1955. In this study, births were classified by whether the mother was hospitalized as a general service ward patient or as a private patient. The results showed that nonwhite patients of private physicians had a perinatal loss which was very similar to the loss among white patients admitted to the general service ward. This would seem to indicate that a simple dichotomy between private care and general service ward care, or, for that matter, any single measure of social class will not entirely explain the situation. DIFFERENTIAL FACTORS IN INFANT MORTALITY Statistical Artifacts Dr. Bernard G. Greenberg Dr. Greenberg led the discussion on statis- tical artifacts which might possibly affect inter- national comparisons of infant mortality. He concentrated on three possible artifacts: (1) definitions and requirements for reporting, (2) registration and notification practices, and (3) coding and tabulating practices. Dr. Greenberg also summarized the significance of various demographic factors in relationship to inter- national comparisons of infant mortality.’ For all practical purposes, live births and - fetal deaths are defined alike in the United States and in the Western European countries under dis- cussion. However, requirements for reporting fetal deaths vary according to the period of ges-