Postneonatal mortality in the United States: an international perspective

The international standing of the United States in postneonatal mortality has deteriorated from third in 1950 to sixteenth in 1986. The high rate among United States blacks is not the reason for the poor United States standing: ten other countries had lower rates than that for United States whites. Recent trends show a slowdown in the decline in postneonatal mortality between 1970 to 1981 and 1981 to 1986 in Canada, England and Wales, Netherlands, and the United States. Norway actually experienced increases during the latter period. Only France showed an acceleration in its decline during the 1980s. Canada has maintained the most rapid rate of decline between 1950 and 1986. Although all countries examined here reported Sudden Infant Death Syndrome as the leading cause of postneonatal deaths, there was twofold variation among the countries in the Sudden Infant Death Syndrome rate. Similarly, congenital anomalies, the second leading cause of death, showed a 50% range in mortality rates. Infections accounted for less than 10% of all postneonatal deaths. A reasonable approach to assessing the magnitude of preventable mortality in the postneonatal period is to use mortality from all causes except congenital anomalies among normal birth weight infants. United States whites had a lower "preventable" postneonatal mortality rate than Denmark, England and Wales, and Scotland, but a higher rate than Sweden. United States blacks, on the other hand, had by far the highest rates. Disaggregating the United States rates further into three broad maternal risk groups, there was a doubling of rates with increasing level of maternal risk. About half the postneonatal deaths among normal birth weight infants could be prevented if the entire population experienced the rates of the lowest maternal risk group.