Prior to the COVID-19 pandemic, infants, children and young adults in the U.S. were dying at higher rates than in other high-income countries, according to a new report.
Researchers say many of these deaths are preventable if the country takes steps to address issues like poverty, racial disparities and gun violence that are key contributing factors.
“We have all the wealth and the knowledge to improve survival. … But we need to prioritize those kinds of things that we’re talking about in our report that we show empirically,” said co-author Robert A. Hummer, Ph.D., Howard W. Odum Distinguished Professor of Sociology at the University of North Carolina at Chapel Hill.
The report was released Wednesday by the Population Reference Bureau, a nonprofit that analyzes and publishes data on population health and trends. It was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
In the U.S., nearly 60,000 people under age 25 years died in 2019, and about 21,000 of them were infants, according to the report. Youths in every age group under 25 years have a higher probability of dying in the U.S. than in 16 other wealthy countries that were used as a comparison group. The disparities were especially pronounced when looking at the infant mortality rate, which is three times higher than several wealthy nations.
Causes, risk factors
Infant deaths largely were attributed to preterm birth and congenital malformations, while many older children and young adults died of injuries, which included unintentional injuries, suicide and homicides. The report notes 7,580 children and young adults died of gun violence in 2019. About 61% of these deaths were homicides, and 39% were suicides.
Boys were more likely to die than girls, which researchers attributed in part to more risk-taking behavior. Youths were at increased risk of death if they lived in a household with low income or parents with low education levels. These socioeconomic differences also were a key factor in explaining why Black and Mexican-American youths had a 60% and 32% greater risk of dying, respectively, than their White peers.
Race and education level also were linked to infant mortality. Infants born to Black mothers died at higher rates than other races. Infants also died at higher rates when born to mothers with low education. Still, a Black mother with at least a bachelor’s degree was more likely to experience an infant death than a White mother without a bachelor’s degree, according to the report.
“Education itself or high income itself in the moment can help, but you have to focus on the whole life course, thinking about how issues of equity, income, education and access to health care are playing out across the life course,” Dr. Hummer said.
The data focus on the pre-pandemic era, but Dr. Hummer said he and his colleagues fear the potential long-term impact on children’s health from increasing rates of mental health issues, parental substance use, loss of family members, economic hardship and educational disruptions. He said more research will be needed to assess the toll.
Reducing child mortality rates
Authors of the report said, “aggressive action is required to reduce early life mortality, such as prioritizing social, economic, and health policies and programs.”
They called for reducing child poverty through expanded tax credits and funding for child care, preschool, housing, nutrition and health care.
“In a country as wealthy as ours, it’s unacceptable for children to be living in poverty, and they’re dying at higher rates than they should be because of this,” Dr. Hummer said.
Addressing socioeconomic issues also could have an impact on their goal of reducing racial and ethnic inequality. They also suggested looking at discrimination in health care settings and use of force by police.
To address gender differences in death rates, authors called for shifting cultural norms to destigmatize mental health care among males and to encourage nonviolent ways to resolve conflict.
The report also recommends increasing access to quality health care, mental health care and paid family and medical leave. In addition, it calls for broad measures to improve child safety, including strengthening gun ownership laws.
“All told, the United States has a substantial need to reduce child poverty, eliminate racial/ethnic inequalities, improve the health behavior of children and young adults, and increase health care access for everyone,” authors wrote. “More purposefully supporting infants, children, young adults, and young families is an essential way to ensure a brighter future for all Americans.”