mortality rate questions

[Tumbulu]

The other day while reading a post in GD about how much safer abortions were than giving birth I began to wonder how the risk of death from childbirth in the US compared to various occupations that I consider high risk.

The WHO lists the USA as having 24 maternal deaths per 100,000 live births.
FEMA has the current rate of death to firefighters at 2.7 per 100,000 fire incidents
http://www.usfa.fema.gov/fireservice/fatalities/statistics/history.shtm
The military site I found listed death to infantrymen in Iraq in 2007 at 7 per 100,000 and 64 per 100,000 in Afghanistan per rotation of active duty.
A search for rates among sheriffs deputy's and police officers gave me a figure of 18/ 100,000 per year of duty

So far the only group with a higher risk of dying than women giving birth are infantrymen in Afghanistan. Am I comparing these rates in a logical manner?

If I am then giving birth in the US is actually still riskier than fighting fires or being a police officer or fighting in Iraq in 2007.

As recently as 100 years about 1 in 100 women died in childbirth and perhaps the reductions in mortality are so great that people are assuming that the risk is at zero. I sure thought it was something around that. But it is not, at least not in the USA.

I wonder if the medical people in this group could venture an opinion of why when restrictions on abortion are brought up that people are not immediately educated by the medical community on the actual risk of death that childbearing opens up for the woman. Or is the medical community simply ignored on the subject.

Is there a stigma associated with these deaths? Does the medical community feel that maternal deaths are some sort of institutional failure, rather than being proud at the incredible achievement of reducing deaths from 1 in a 100 to 24 in 100,000 within such a relatively short period of time?

[napoleon_in_rags]

1. Sample time sizes should match up.

So if fire incidents, child births, rotations of active duty (military), and year of duty (sheriff) are about the same time, than you have a good premise. It actually sounds to me like you do! Who knew having kids was so risky.

This data also makes military service look a lot better than I thought.

[Tumbulu]

2. Thanks, that is exactly what I was worried about

sort of apples and oranges thing......with the incidents vs rotations vs years.

Which is why I posted here hoping to learn something from the many very bright people who come here and post.

But my worry is- if this is indeed true, why have I never heard of this before? And why are the risks of childbearing so dismissed in general?

Or should the military be advertising joining up by saying things like " serving in active duty is safer than having a baby" ........

Don't actuarials know about this- people in the insurance industry....maybe there is a forum for those folks that I could ask.

Maybe I need to go online and see if I can find something on one of their educational sites.

[dmallind]

3. sniff test iffy

7 deaths/100k in Iraq must mean the denominator is about 4500/7*100,000 or about 64.3 million. Way too big even for tours over nine years.

EDIT - noticed example was 2007 only - that's 904/7*100,000 or about 12.8 million. Still way too big even for tours.

[Tumbulu]

4. I took that number to be death per tour of duty, not over all the years

in Iraq. They were using 2007 dates, I believe. What I don't know is how long those tours of duty are. The denominator is per member of the services stationed there, not the entire population of Iraq, but US service members. Again, that is my reading of it, which could be wrong, which is why I am asking these questions here.

[dmallind]

8. There have been a set number of US military deaths - to get rates that low

they must be dividing by the numbers I used. That denominator is certainly far greater than number of soldiers OR number of tours. Only thing I could guess is number of "conflict" interactions - so every time a mililtary member has to encounter a potential enemy would be counted as 1. Even that seema high, but dunno what it could be. In any event the fatality rate is artificially decreased..

[Tumbulu]

13. I did some more looking- those figures

were for infantry soldiers, not marines, not medics, not officers, etc.

So it is not all military deaths in Iraq during that year, it is the number of infantry soldiers who died in a rotation.

[dmallind]

14. Cite?

[Tumbulu]

15. Yikes, you are correct-

this is the site that I was looking at originally

http://www.beforeyousignup.info/joining/army/54-danger

It has lots of info- pros and cons and somewhere on it are the statistics that I used in my OP.

But guess what- this site is all about the UK and not the US!

If I google the question of mortality US infantrymen I get numbers in the range of what I cited, but if I google army suicides I get 8.9/100,000 and so I think that you are correct. The mortality figures are higher that the numbers I posted.

But my question remains, why is the general public unaware that childbirth bears a high risk of mortality?

[Tumbulu]

5. So here is a link to

the most dangerous jobs with the mortality and injury rates per 100,000 workers (per year?)

http://www.thedailybeast.com/galleries/2010/04/07/dangerous-jobs.html

[SheilaT]

6. Since most women in this country

have only two children, the comparison to firefighters is a bit off. Most firefighters will have a LOT more than two fire incidents in their lifetimes. Indeed, are there statistics to show how many fire incidents a firefighter will have? Can I make some guesses, although I know that fire incidents will vary greatly depending on exactly where the firefighter works.

Is one a week typical? One a month? Even one a year puts a firefighter at far, far greater risk over a twenty-year career than a woman who only has two children.

So, indeed, the comparison of 24 maternal deaths per 100,000 live births and 2.7 deaths per 100,000 fire incidents isn't even remotely comparable. You have to look at the fact that women average two babies in their lifetimes (in this country) and firefighters average how many fire incidents in their lifetimes.

It might also be interesting to see if those maternal deaths break out in other ways, such as a higher risk in first births, in those for a woman whose already had more than four (or some other number) of births. Or by location. I do know that socio-economic status matters, which means that pre-natal care matters. In this country a lot more women (surprise, surprise) don't get good pre-natal care, compared to countries (are you surprised yet?) that offer free health care to all. Which means, there's a reason our maternal death rate is so bad.

[Tumbulu]

7. Yes it is the apples and oranges problem I brought up in the OP

How does one compare the 10 month pregnancy with an occupational risk. Or a 5 day window around the birth with such risks?

If you look at the list of 20 most dangerous professions the range one can get an idea of number of fatalities per 100,000 - but no time frames are given. Per year of work? With firefighters OSHA had broken the statistics into incidents, but on this list from The Daily Beast is it within a year? Not sure http://www.thedailybeast.com/galleries/2011/04/12/deadliest-jobs.slide2.html.

If mortality of childbirth is only the mortality around the birth, then does this not compare more with fire incidents rather than a year on a job as a firefighter, coal miner or a roofer? Don't know, this is why I am asking here.

WHO had lifetime mortality risks for mothers in a separate figure and the mortality figures were much higher than the deaths per live birth. The ranges also followed the availability of medical facilities and pre-natal care.

http://www.childinfo.org/maternal_mortality_indicators.php

Here is how this site puts it:
Lifetime risk of maternal death

Lifetime risk is the probability that a woman will die from complications of pregnancy and childbirth over her lifetime; it takes into account both the maternal mortality ratio and the total fertility rate (probable number of births per woman during her reproductive years). Thus in a high-fertility setting a woman faces the risk of maternal death multiple times, and her lifetime risk of death will be higher than in a low-fertility setting. The lifetime risk of maternal death in the developing world in 2008 as a whole was 1 in 120, compared with industrialized regions with an estimated 1 in 4300. Among the regions, women in sub-Saharan Africa face the highest lifetime risk – 1 in 31 – followed by , South Asia – 1 in 110.
http://www.childinfo.org/maternal_mortality.html

Lastly, the US figures were not at all bad compared to many parts of the world. What surprises me is how actually risky it is, even with all the medical improvements.

[SheilaT]

9. And so now to compare,

we need the lifetime total risk for firefighters.

In any case, while it matters to reduce maternal deaths in or around childbirth, there is simply no valid way to compare that risk to any risk connected with a job. It's not merely an apples and oranges problem, it's more like comparing rice with avocados, or barn doors with Picasso paintings. Two totally dissimilar things that share only something very small in common -- food or paint.

[Tumbulu]

10. why not?

various paid occupations and producing a child both share a rather high risk of death.

I am trying to figure out how to compare the figures used to each other.

deaths per 100,000 seems to be a common way to measure risk of mortality and then there is the lifetime risk written in the form of 1/xxxx chance.

Here is a book that has some figures of risk in another way:

http://www.amazon.com/Risk-Practical-Deciding-Really-Dangerous/dp/product-description/0618143726

I see that in this book they separate medical risks from occupational risks. Is this what you are referring to? That since one is paid for work vs a medical reality, one should not compare them?

But having a baby is a choice now, and a mere 50 years ago it really was not. Warfare was also more deadly to the soldier.....things are changing for the better. But still, it seems to me that the risk of mortality for the childbearer is serious.

[SheilaT]

11. Well, actually having a baby

isn't always a choice, especially in our brave new world of restrictions on access to birth control, not to mention abortion.

Effective contraception has been around for a lot more than fifty years. Even the Pill is actually fifty years old now. And the birth rate in this country dropped precipitously during the Great Depression -- a strong clue that effective birth control was available. Indeed, until the post-war baby boom, demographers by the mid-40's were predicting that the U.S. population would start shrinking in the latter part of the 20th century.

But more to the point, childbearing is a uniquely female occurrence. For the most part, being a soldier is largely male, especially being a combat soldier. These days all of our soldiers are volunteers. It's probably reasonable to think of all jobs as undertaken voluntarily, and so the risks of any particular job, while perhaps not always well known, are the choice of the job-holder.

In any case, I'm not sure you can fully compare the various risks, since a simple deaths per 100,000 may not fully cover what's going on, or what the real risk is, as in the above posting about number of child-births a typical woman experiences vs number of fire incidents a fireman experiences. All you can do is look at the numbers, perhaps ask a few questions, and try to go from there.

Another thing to look at, however, could be insurance costs. What will an insurance charge a 30 year old firefighter for a specific insurance policy compared to that policy for a school teacher, or a car salesman. I'm under the impression that insurance companies are very savvy in their estimates of likelihood of death.

[Tumbulu]

12. Yes, I guess it is time to ask an insurance agent

I bet they have all the risks completely figured out.

But in the meantime, I beg to differ about the point of occupation vs vocation ( being a mother is just one of many possible vocations).

In our modern life in a "free society" we get the idea that we can choose what we want to do for a living- (vs in many traditional cultures if one is born within a family of musicians, then the child is expected to also be a musician, or children of physicians become physicians, etc) and if we want to have children.

We are given the idea at a young ages that these are choices we get to make if we work hard and apply ourselves to an education, etc.

I say that these choices each have risks and I find it mysterious that such high risks of death (as I see in these maternal mortality figures) are not at all discussed. If they are, I sure have missed the discussion.

I still have not gotten an answer about that- if it is something the medical folks feel is some failing on their part, or if the media simply ignores their input on the matter.