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zoom RSS 米国の乳児死亡率 低下はしたが依然高値/米国医療事情

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 水曜日の政府の発表で、米国の乳児死亡が2%減少したが依然として他の先進国に比べ高く、米国の高額で利益の少ない医療システムを示唆する指標となっている。 乳児死亡率は長い間国家の健康と医療制度の品質の最も重要な指標の1つと考えられている。1960年に、米国は世界で12番目に低かったが、CDC疾病管理・予防センターによる最新2004年で、そのランキングは29番目に低下した。
 米国がその国富の他の国よりずっと大きいシェアを医療に捧げても、この国際的なギャップは広がった。2006年に、米国人は一人当たり医療費に他の工業国の2倍を超える平均6,714ドルを使った。
 米国では毎年1才以下の乳児28,000人以上が死亡している。
 2006年の乳児死亡率(1000出生に対し)は6.71で、2000年6.89、2005年6.86 とは少し異なる。2004年、22ヶ国の乳児死亡率が5.0以下で、多くのスカンジナビアや東アジアの国では3.5以下である。データの取り方にいくつか違いがあるが、それでは米国の死亡率の高さを説明できない。
 早期産は重要なリスクとなるが、2000-2005年で米国の早期産が9%から12.7%に急増した。特に妊娠34-36週の増加が最も急速で、増大した早期産の約92%が帝王切開による。アフリカ系アメリカ人で多い。
 米国は癌のスクリーニングや生存率で比較的成績が良いが、糖尿病・循環器疾患・喘息などの呼吸器疾患の問題から平均寿命や防止可能な死亡などの統計データは他の国に比較して貧困である。「肥満や薬物、銃と暴力、交通事故など社会経済学的な要因もそうだが、国家が私的医療サービスに信頼を置くことが非難されるべきである。他の国の倍以上の費用を使いながら、乳児死亡率のような重要な指標がますますランクが落ちている」。
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Infant Deaths Drop in U.S., but Rate Is Still High
http://www.nytimes.com/2008/10/16/health/16infant.html

By GARDINER HARRIS
Published: October 15, 2008

WASHINGTON ― Infant deaths in the United States declined 2 percent in 2006, government researchers reported Wednesday, but the rate still remains well above that of most other industrialized countries and is one of many indicators suggesting that Americans pay more but get less from their health care system.

Infant mortality has long been considered one of the most important indicators of the health of a nation and the quality of its medical system. In 1960, the United States ranked 12th lowest in the world, but by 2004, the latest year for which comparisons were issued by the Centers for Disease Control and Prevention, that ranking had dropped to 29th lowest.

This international gap has widened even though the United States devotes a far greater share of its national wealth to health care than other countries. In 2006, Americans spent $6,714 per capita on health ― more than twice the average of other industrialized countries.

Some blame cultural issues like obesity and drug use. Others say that the nation’s decentralized health care system is failing, and some researchers point to troubling trends in preterm births and Caesarean deliveries.

Many agree, however, that the data are a major national concern. More than 28,000 infants under the age of 1 die each year in the United States.

“Infant mortality and our comparison with the rest of the world continue to be an embarrassment to the United States,” said Grace-Marie Turner, president of the Galen Institute, a conservative research organization. “How can we get better outcomes?”

The data, collected by the Centers for Disease Control and Prevention, indicate that the nation’s infant mortality rate has been static for years despite enormous advances in the care given to preterm infants. Two-thirds of the infant deaths are in preterm babies.

In 2006, 6.71 infants died in the United States for every 1,000 live births, a rate little different from the 6.89 rate reported in 2000 or the 6.86 rate of 2005. Twenty-two countries had infant mortality rates in 2004 below 5.0 infant deaths per 1,000 live births, with many Scandinavian and East Asian countries posting rates below 3.5. While there are some differences in the way countries collect these data, those differences cannot explain the relatively low international ranking of the United States, according to researchers at the disease control agency.

Preterm birth is a significant risk factor for infant death. From 2000 to 2005, the percentage of preterm births in the United States jumped 9 percent, to 12.7 percent of all births. The most rapid increase has been among late preterm births, or babies born at 34 to 36 weeks of gestation. Some 92 percent of these increased premature births are by Caesarean section, according to a recent study.

Dr. Alan Fleischman, medical director of the March of Dimes Foundation, said that a growing number of these late preterm births might be induced for reasons of convenience. “Women have always been concerned about the last few weeks of pregnancy as being onerous,” Dr. Fleischman said, “but what we hadn’t realized before is that the risks to the babies of early induction are quite substantial.”

Dr. Mary D’Alton, chairwoman of the department of obstetrics and gynecology at Columbia University, said doctors should not induce labor before 39 weeks of gestation unless there was an urgent medical or obstetrical need. For unknown reasons, the number of preterm births is far higher among African-American women even when those women have access to good medical care, Dr. D’Alton said.

There is some evidence, she said, that steroids given to mothers at risk of giving birth early may help. A trial to test this theory is about to start.

Some economists argue that the disappointing infant mortality figure is one of many health indicators demonstrating that the health care system in the United States, despite its enormous cost, is failing.

Although the United States has relatively good numbers for cancer screening and survival, the nation compares poorly with other countries in many other statistical categories, including life expectancy and preventable deaths from diseases like diabetes, circulatory problems and respiratory issues like asthma.

Ms. Turner blamed socioeconomic factors like obesity, high drug use, violence with guns and car accidents ― factors that she said could not be addressed by health reform. Karen Davis, president of the Commonwealth Fund, a nonprofit research organization, agreed that socioeconomic factors played a role but said that the nation’s heavy reliance on the private delivery of care was also to blame.

“We’re spending twice what other countries do,” Ms. Davis said, “and we’re falling further and further behind them in important measures like infant mortality.”

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