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Comparative Study
. 2012 Feb 17:344:e746.
doi: 10.1136/bmj.e746.

Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study

K S Joseph  1 , Shiliang Liu, Jocelyn Rouleau, Sarka Lisonkova, Jennifer A Hutcheon, Reg Sauve, Alexander C Allen, Michael S Kramer; Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System
Collaborators, Affiliations
Comparative Study

Influence of definition based versus pragmatic birth registration on international comparisons of perinatal and infant mortality: population based retrospective study

K S Joseph et al. BMJ. .

Abstract

Objectives: To examine variations in the registration of extremely low birthweight and early gestation births and to assess their effect on perinatal and infant mortality rankings of industrialised countries.

Design: Retrospective population based study.

Setting: Australia, Canada, European countries, and the United States for 2004; Australia, Canada, and New Zealand for 2007.

Population: National data on live births and on fetal, neonatal, and infant deaths.

Main outcome measures: Reported proportions of live births with birth weight/gestational age of less than 500 g, less than 1000 g, less than 24 weeks, and less than 28 weeks; crude rates of fetal, neonatal, and infant mortality; mortality rates calculated after exclusion of births under 500 g, under 1000 g, less than 24 weeks, and less than 28 weeks.

Results: The proportion of live births under 500 g varied widely from less than 1 per 10,000 live births in Belgium and Ireland to 10.8 per 10,000 live births in Canada and 16.9 in the United States. Neonatal deaths under 500 g, as a proportion of all neonatal deaths, also ranged from less than 1% in countries such as Luxembourg and Malta to 29.6% in Canada and 31.1% in the United States. Rankings of countries based on crude fetal, neonatal, and infant mortality rates differed substantially from rankings based on rates calculated after exclusion of births with a birth weight of less than 1000 g or a gestational age of less than 28 weeks.

Conclusions: International differences in reported rates of extremely low birthweight and very early gestation births probably reflect variations in registration of births and compromise the validity of international rankings of perinatal and infant mortality.

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Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

Figures

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Fig 1 Association between reported proportion of live births under 500 g birth weight and crude neonatal mortality rates in 25 industrialised countries
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Fig 2 Differences in pattern of crude neonatal mortality rates and neonatal mortality rates excluding live births under 1000 g in 25 industrialised countries
See this image and copyright information in PMC

Comment in

References

    1. United Nations Children’s Fund. The state of the world’s children. Special ed. Unicef, 2009.
    1. Organisation for Economic Co-operation and Development. OECD health data 2010: statistics and indicators. OECD, 2010.
    1. Central Intelligence Agency. The world factbook 2009. CIA, 2010.
    1. Inter-agency Group for Child Mortality Estimation (UNICEF, WHO, World Bank, UNPD, universities and research institutions). World development indicators. World Bank, 2010.
    1. Martin S. Canada among leaders in OECD health results. CMAJ 2000;162:1032. - PMC - PubMed

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