7 ms·

Kind of relevant: https://www.noahpinion.blog/p/how-many-of-our-facts-about-society https://www.noahpinion.blog/p/how-many-of-our-facts-about-so... > In 2021,

by tyoma 2y ago

Kind of relevant: https://www.noahpinion.blog/p/how-many-of-our-facts-about-society https://www.noahpinion.blog/p/how-many-of-our-facts-about-so... > In 2021, Joseph et al. published a paper in Obstetrics & Gynecology demonstrating that the entire recorded increase in maternal mortality since 2003 was due to a change in the way data was gathered. In 2003, U.S. states began to include pregnancy checkboxes on death certificates. This led to a whole lot more women who died while pregnant being identified as such. The apparent steady increase in maternal mortality was due to the fact that states adopted this new checkbox at different times: > In fact, when the authors looked at the common causes of death from pregnancy, they found that these had all declined since 2000, implying that U.S. maternal mortality has actually been falling. Meanwhile, a CDC report in 2020 had found the same thing as Joseph et al. (2021) — maternal mortality rose only in states that added the checkbox to death certificates.

RheingoldRiver 2y ago
Additional info here: https://foreignpolicy.com/2024/01/31/united-states-maternal-mortality-crisis-statistics-health/ https://foreignpolicy.com/2024/01/31/united-states-maternal-...
gorbachev 2y ago
That may be relevant to something, but not to why the difference is so drastic between Norway and US. It is indicative of the US healthcare system, however, that up until 2003 it wasn't even known, statistically, that women were actually dieing of childbirth.
- vasco 2y ago
  NVSS has reported monthly updates on this since the 60s, it's wrong to say it wasn't known statistically I think. Maternal mortality review committees have existed since the 1930s also which provide extra data. Maternal mortality is one of the most important vital metrics to track for any country so it indeed would be surprising not to have more data.
- tyoma 2y ago
  It is very relevant. The US definition of maternal death is very expansive. The expanded definition counts any reason a woman who was recently pregnant and dies. The prototypical example is murder by a spouse. While tragic and extremely important to collect for policy reasons, it is not what “maternal death rate” typically measures.
  - sshine 2y ago
    > ... murder by a spouse ... is not what “maternal death rate” typically measures That is a good example. While perhaps unrelated to pregnancies, it is incidentally another difference between US and Norway.
    - insickness 2y ago
      You can't say that from these statistics if the statistic in Norway does not include murder by spouse.
      - sshine 2y ago
        That is correct. I am making that claim without backing it up by references. My point is that there are other correlated factors that explain death rates than pregnancy. Another one might be that the death rate in the fertile age group could simply be higher, too, although I don't know if that is true.
  - dtech 2y ago
    It is not relevant for the study cited in the article
    - wjnc 2y ago
      The study cited uses OECD data. If the US does not adhere to the OECD guidelines for the data fields, for example by collecting a too broad measure and not correcting for it, studies are going to compare apples to pears. Not saying that the conclusion is false. But researchers should do their due diligence on the way international statistics are compiled.
pj_mukh 2y ago
Man! this plus the teenage suicide/mental health rate stats also possibly being an illusion (Obamacare changed data rules the same time mobile social media was taking off, obfuscating everything) has really thrown me for a loop. Not sure what to believe!
jajko 2y ago
OK thats all fine, this kind of discrepancies/errors happen all the time in statistics. You for some reason completely avoid massive discrepancy between 0 and what US reports. The fact that its slowly falling from relative stratospheric heights gives no comfort to common US citizens, when clearly it can be done much, much better. I think we all know most probably the main reason - US healthcare is a business with huge prices compared to anywhere else in the world including nations with higher salaries, not public service. So its all nice and top notch if you have millions in some form, not if you are remaining 95% of the country. General compassion to fellow citizens in need is not a strong point of US in general, is it. People like me could move literally anywhere in the world if wanted. I moved to Switzerland from my crappy home country for example. But hell will freeze sooner than I would want to raise my kids or get old in US, no thank you for many reasons and this being one of biggest.
- dvt 2y ago
  > OK thats all fine, this kind of discrepancies/errors happens all the time in statistics. That's not what the article is tackling. Rather, it's quite literally about what types of deaths get categorized as "maternal mortality."
roenxi 2y ago
A related effect is there is a real tendency in online debates to use countries that speak exotic foreign languages as examples. So there is no way of working out what the data actually represents, what the known strengths and weaknesses are or what they are trying to measure. Or what the legal framework is.
- complex1314 2y ago
  Most statistical data in Norway is also available in English: https://www.ssb.no/en https://www.ssb.no/en
  - roenxi 2y ago
    I got a great laugh out of that, they've done an impressive job anglicising their website. But it doesn't really change the fundamental point. It doesn't take long to get to "Most of the content here is only available in Norwegian" [0]. And the articles on the Norwegen version of the site seem to be different to the English. It can take a surprising amount of research sifting through who-knows-what to figure things out. One fun introductory challenge I recommend is figuring out what the components of the inflation index actually are; it usually takes a few rounds of sleuthing unless you have a muscle memory of where the right manual is. It is hard enough in the same language and with a familiar government. It isn't easy to do in a foreign language and unfamiliar government. [0] https://www.ssb.no/en/innrapportering https://www.ssb.no/en/innrapportering
    - JumpCrisscross 2y ago
      > It isn't easy to do in a foreign language and unfamiliar government The IMF does this.
    - complex1314 2y ago
      If your're most interested in blog posts google translate is great for exotic languages. But for the data they're all there in English [0]. And if you're after methodology, analysis or understanding medical data, they follow WHO standards and publications are all in English on pubmed.gov [1] for the explicit purpose of international collaboration (which is the norm in medicine and public health for most developed nations). [0] https://www.ssb.no/a/en/histstat/ https://www.ssb.no/a/en/histstat/ [1] https://pubmed.ncbi.nlm.nih.gov/24780982/ https://pubmed.ncbi.nlm.nih.gov/24780982/
ks1723 2y ago
In the same direction: https://ourworldindata.org/rise-us-maternal-mortality-rates-measurement https://ourworldindata.org/rise-us-maternal-mortality-rates-...
- ZeroGravitas 2y ago
  World in Data's stats from before this 2003 statistical change happened: https://ourworldindata.org/grapher/number-of-maternal-deaths?tab=chart&time=earliest..2002&country=AUS~USA~CAN~GBR~NOR~SWE~ESP https://ourworldindata.org/grapher/number-of-maternal-deaths...
  - AnthonyMouse 2y ago
    Note that this data is the absolute number of deaths, not accounting for population size. This is what it looks like when you add "Europe": https://ourworldindata.org/grapher/number-of-maternal-deaths?tab=chart&time=earliest..2002&country=AUS~USA~CAN~GBR~NOR~SWE~ESP~FRA~DEU~WHO_EUR https://ourworldindata.org/grapher/number-of-maternal-deaths...
    - oblio 2y ago
      That's still apples and oranges because that's based on the WHO European Region which includes all these countries: https://who-sandbox.squiz.cloud/en/countries https://who-sandbox.squiz.cloud/en/countries Uzbekistan - GDP per capita $2,667 Tajikistan - GDP per capita $1,271 Kyrgyzstan - GDP per capita $1,922 Ukraine - GDP per capita $5,663 Meanwhile: US - GDP per capita $85,373 (LOL) To compare apples to apples you'd want: US vs EU to make it somewhat comparable, or maybe even better: US (334m) vs Germany (83m) + France (67m) + UK (67m) + Italy (59m) + Spain (48m) = 324m people
      - AnthonyMouse 2y ago
        So you want to use only the richest and most sophisticated EU countries but then compare them against a federation of US states that includes the likes of Mississippi and West Virginia?
omnicognate 2y ago
The CNN article is about this [1] study, which is based on OECD 2023 maternal mortality data. OECD says here [2] about "Definition and Comparability": > Maternal mortality is defined as the death of a woman while pregnant or during childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from unintentional or incidental causes. This includes direct deaths from obstetric complications of pregnancy, interventions, omissions or incorrect treatment. It also includes indirect deaths due to previously existing diseases, or diseases that developed during pregnancy, where these were aggravated by the effects of pregnancy. Edit: [1] Also references [3], a 2022 CDC report saying over 80% of pregnancy-related deaths were determined to be preventable. [1] https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison https://www.commonwealthfund.org/publications/issue-briefs/2... [2] https://www.oecd-ilibrary.org/sites/1ea5684a-en/index.html?itemId=/content/component/1ea5684a-en https://www.oecd-ilibrary.org/sites/1ea5684a-en/index.html?i... [3] https://www.cdc.gov/maternal-mortality/php/data-research/?CDC_AAref_Val=https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html https://www.cdc.gov/maternal-mortality/php/data-research/?CD...
outop 2y ago
[flagged]
- deleted 2y ago
  [deleted]
nonrandomstring 2y ago
How does moving the discussion to the legibility of the rate of change help us understand why large numbers of women are still dying from pre-industrial causes in the richest nation?
- throwawayqqq11 2y ago
  Yea, US americans in here try really hard to reason their numbers away and ignore the comparand.
refurb 2y ago
It’s amazing how often you find out the differences in metrics are due to how data is collected not due to actual differences. I read a good paper(1) about newborn deaths rates in Cuba. It’s often touted that Cuba has amazingly low newborn death rates which obvious means communism has far better healthcare than capitalist systems. Turns out it’s a reporting artifact. If you correct for it, they have the same death rate as other Central American countries with similar GDP per capita. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681443/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681443/
- throwawayqqq11 2y ago
  Can you please explain the different data collection of norway to reach almost zero? I just finished this comment before reading yours. https://news.ycombinator.com/item?id=40607378 https://news.ycombinator.com/item?id=40607378
  - refurb 2y ago
    It's explained in another comment. The US tracks it by asking "is this person who died, pregnant?". If the answer is yes, then it's a "maternal death". Norway only counts pregnant women who died because of their pregnancy.
    - throwawayqqq11 2y ago
      This implies the US data collection does not gather cause of death, with which a normalization before comparison would be harder. Ill check now for this and edit this comment. Edit: > https://www.cdc.gov/maternal-mortality/php/data-research/?CDC_AAref_Val=https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html#cdc_research_or_data_summary_res_data-the-data https://www.cdc.gov/maternal-mortality/php/data-research/?CD... > Among the 525 pregnancy-related deaths, an underlying cause of death was identified for 511 deaths. In 2020, the six most frequent underlying causes of pregnancy-related death—mental health conditions, cardiovascular conditions, infection, hemorrhage, embolism, hypertensive disorders of pregnancy—accounted for over 82% of pregnancy-related deaths (Table 4). > Among the 525 pregnancy-related deaths, a preventability determination was made for 515 deaths. Among these, 430 (84%) were determined to be preventable (Table 6). This shows they didnt just take a yes\no for pregancy and +1ed the statistic, like you suggested. They reasoned about the causality and preventability.

by tyoma 2y ago

RheingoldRiver 2y ago

Additional info here: https://foreignpolicy.com/2024/01/31/united-states-maternal-mortality-crisis-statistics-health/ https://foreignpolicy.com/2024/01/31/united-states-maternal-...

gorbachev 2y ago

That may be relevant to something, but not to why the difference is so drastic between Norway and US. It is indicative of the US healthcare system, however, that up until 2003 it wasn't even known, statistically, that women were actually dieing of childbirth.

vasco 2y ago
NVSS has reported monthly updates on this since the 60s, it's wrong to say it wasn't known statistically I think. Maternal mortality review committees have existed since the 1930s also which provide extra data. Maternal mortality is one of the most important vital metrics to track for any country so it indeed would be surprising not to have more data.
tyoma 2y ago
It is very relevant. The US definition of maternal death is very expansive. The expanded definition counts any reason a woman who was recently pregnant and dies. The prototypical example is murder by a spouse. While tragic and extremely important to collect for policy reasons, it is not what “maternal death rate” typically measures.
- sshine 2y ago
  > ... murder by a spouse ... is not what “maternal death rate” typically measures That is a good example. While perhaps unrelated to pregnancies, it is incidentally another difference between US and Norway.
  - insickness 2y ago
    You can't say that from these statistics if the statistic in Norway does not include murder by spouse.
    - sshine 2y ago
      That is correct. I am making that claim without backing it up by references. My point is that there are other correlated factors that explain death rates than pregnancy. Another one might be that the death rate in the fertile age group could simply be higher, too, although I don't know if that is true.
- dtech 2y ago
  It is not relevant for the study cited in the article
  - wjnc 2y ago
    The study cited uses OECD data. If the US does not adhere to the OECD guidelines for the data fields, for example by collecting a too broad measure and not correcting for it, studies are going to compare apples to pears. Not saying that the conclusion is false. But researchers should do their due diligence on the way international statistics are compiled.

pj_mukh 2y ago

Man! this plus the teenage suicide/mental health rate stats also possibly being an illusion (Obamacare changed data rules the same time mobile social media was taking off, obfuscating everything) has really thrown me for a loop. Not sure what to believe!

jajko 2y ago

OK thats all fine, this kind of discrepancies/errors happen all the time in statistics. You for some reason completely avoid massive discrepancy between 0 and what US reports. The fact that its slowly falling from relative stratospheric heights gives no comfort to common US citizens, when clearly it can be done much, much better. I think we all know most probably the main reason - US healthcare is a business with huge prices compared to anywhere else in the world including nations with higher salaries, not public service. So its all nice and top notch if you have millions in some form, not if you are remaining 95% of the country. General compassion to fellow citizens in need is not a strong point of US in general, is it. People like me could move literally anywhere in the world if wanted. I moved to Switzerland from my crappy home country for example. But hell will freeze sooner than I would want to raise my kids or get old in US, no thank you for many reasons and this being one of biggest.

dvt 2y ago
> OK thats all fine, this kind of discrepancies/errors happens all the time in statistics. That's not what the article is tackling. Rather, it's quite literally about what types of deaths get categorized as "maternal mortality."

roenxi 2y ago

A related effect is there is a real tendency in online debates to use countries that speak exotic foreign languages as examples. So there is no way of working out what the data actually represents, what the known strengths and weaknesses are or what they are trying to measure. Or what the legal framework is.

complex1314 2y ago
Most statistical data in Norway is also available in English: https://www.ssb.no/en https://www.ssb.no/en
- roenxi 2y ago
  I got a great laugh out of that, they've done an impressive job anglicising their website. But it doesn't really change the fundamental point. It doesn't take long to get to "Most of the content here is only available in Norwegian" [0]. And the articles on the Norwegen version of the site seem to be different to the English. It can take a surprising amount of research sifting through who-knows-what to figure things out. One fun introductory challenge I recommend is figuring out what the components of the inflation index actually are; it usually takes a few rounds of sleuthing unless you have a muscle memory of where the right manual is. It is hard enough in the same language and with a familiar government. It isn't easy to do in a foreign language and unfamiliar government. [0] https://www.ssb.no/en/innrapportering https://www.ssb.no/en/innrapportering
  - JumpCrisscross 2y ago
    > It isn't easy to do in a foreign language and unfamiliar government The IMF does this.
  - complex1314 2y ago
    If your're most interested in blog posts google translate is great for exotic languages. But for the data they're all there in English [0]. And if you're after methodology, analysis or understanding medical data, they follow WHO standards and publications are all in English on pubmed.gov [1] for the explicit purpose of international collaboration (which is the norm in medicine and public health for most developed nations). [0] https://www.ssb.no/a/en/histstat/ https://www.ssb.no/a/en/histstat/ [1] https://pubmed.ncbi.nlm.nih.gov/24780982/ https://pubmed.ncbi.nlm.nih.gov/24780982/

ks1723 2y ago

In the same direction: https://ourworldindata.org/rise-us-maternal-mortality-rates-measurement https://ourworldindata.org/rise-us-maternal-mortality-rates-...

ZeroGravitas 2y ago
World in Data's stats from before this 2003 statistical change happened: https://ourworldindata.org/grapher/number-of-maternal-deaths?tab=chart&time=earliest..2002&country=AUS~USA~CAN~GBR~NOR~SWE~ESP https://ourworldindata.org/grapher/number-of-maternal-deaths...
- AnthonyMouse 2y ago
  Note that this data is the absolute number of deaths, not accounting for population size. This is what it looks like when you add "Europe": https://ourworldindata.org/grapher/number-of-maternal-deaths?tab=chart&time=earliest..2002&country=AUS~USA~CAN~GBR~NOR~SWE~ESP~FRA~DEU~WHO_EUR https://ourworldindata.org/grapher/number-of-maternal-deaths...
  - oblio 2y ago
    That's still apples and oranges because that's based on the WHO European Region which includes all these countries: https://who-sandbox.squiz.cloud/en/countries https://who-sandbox.squiz.cloud/en/countries Uzbekistan - GDP per capita $2,667 Tajikistan - GDP per capita $1,271 Kyrgyzstan - GDP per capita $1,922 Ukraine - GDP per capita $5,663 Meanwhile: US - GDP per capita $85,373 (LOL) To compare apples to apples you'd want: US vs EU to make it somewhat comparable, or maybe even better: US (334m) vs Germany (83m) + France (67m) + UK (67m) + Italy (59m) + Spain (48m) = 324m people
    - AnthonyMouse 2y ago
      So you want to use only the richest and most sophisticated EU countries but then compare them against a federation of US states that includes the likes of Mississippi and West Virginia?

omnicognate 2y ago

The CNN article is about this [1] study, which is based on OECD 2023 maternal mortality data. OECD says here [2] about "Definition and Comparability": > Maternal mortality is defined as the death of a woman while pregnant or during childbirth or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from unintentional or incidental causes. This includes direct deaths from obstetric complications of pregnancy, interventions, omissions or incorrect treatment. It also includes indirect deaths due to previously existing diseases, or diseases that developed during pregnancy, where these were aggravated by the effects of pregnancy. Edit: [1] Also references [3], a 2022 CDC report saying over 80% of pregnancy-related deaths were determined to be preventable. [1] https://www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison https://www.commonwealthfund.org/publications/issue-briefs/2... [2] https://www.oecd-ilibrary.org/sites/1ea5684a-en/index.html?itemId=/content/component/1ea5684a-en https://www.oecd-ilibrary.org/sites/1ea5684a-en/index.html?i... [3] https://www.cdc.gov/maternal-mortality/php/data-research/?CDC_AAref_Val=https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html https://www.cdc.gov/maternal-mortality/php/data-research/?CD...

outop 2y ago

[flagged]

deleted 2y ago
[deleted]

nonrandomstring 2y ago

How does moving the discussion to the legibility of the rate of change help us understand why large numbers of women are still dying from pre-industrial causes in the richest nation?

throwawayqqq11 2y ago
Yea, US americans in here try really hard to reason their numbers away and ignore the comparand.

refurb 2y ago

It’s amazing how often you find out the differences in metrics are due to how data is collected not due to actual differences. I read a good paper(1) about newborn deaths rates in Cuba. It’s often touted that Cuba has amazingly low newborn death rates which obvious means communism has far better healthcare than capitalist systems. Turns out it’s a reporting artifact. If you correct for it, they have the same death rate as other Central American countries with similar GDP per capita. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681443/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681443/

throwawayqqq11 2y ago
Can you please explain the different data collection of norway to reach almost zero? I just finished this comment before reading yours. https://news.ycombinator.com/item?id=40607378 https://news.ycombinator.com/item?id=40607378
- refurb 2y ago
  It's explained in another comment. The US tracks it by asking "is this person who died, pregnant?". If the answer is yes, then it's a "maternal death". Norway only counts pregnant women who died because of their pregnancy.
  - throwawayqqq11 2y ago
    This implies the US data collection does not gather cause of death, with which a normalization before comparison would be harder. Ill check now for this and edit this comment. Edit: > https://www.cdc.gov/maternal-mortality/php/data-research/?CDC_AAref_Val=https://www.cdc.gov/reproductivehealth/maternal-mortality/erase-mm/data-mmrc.html#cdc_research_or_data_summary_res_data-the-data https://www.cdc.gov/maternal-mortality/php/data-research/?CD... > Among the 525 pregnancy-related deaths, an underlying cause of death was identified for 511 deaths. In 2020, the six most frequent underlying causes of pregnancy-related death—mental health conditions, cardiovascular conditions, infection, hemorrhage, embolism, hypertensive disorders of pregnancy—accounted for over 82% of pregnancy-related deaths (Table 4). > Among the 525 pregnancy-related deaths, a preventability determination was made for 515 deaths. Among these, 430 (84%) were determined to be preventable (Table 6). This shows they didnt just take a yes\no for pregancy and +1ed the statistic, like you suggested. They reasoned about the causality and preventability.