American kids are 70% more likely to die before adulthood vs. other rich nations | Hacker News Reader

American kids are 70% more likely to die before adulthood vs. other rich nations

vox.com

41 pointschristophilus15 comments

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.

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.

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.

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

2: https://www.fhwa.dot.gov/ohim/onh00/bar8.htm

Came here to say exactly this. Thanks. Researched this years ago with our first child and discovered that most of the FUD about U.S. infant health care boiled down to honest reporting by the U.S.

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.

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.

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.

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.

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.

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

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...

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?

> "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.

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.

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