Child mortality: Taiwan compared with OECD countries

Objectives: To determine the child mortality rate differences between Taiwan and Organization for Economic Cooperation and Development (OECD) countries. Methods: Data on live births, population, and mortality in OECD countries were derived from the mortality database of the World Health Organization. Taiwan data were derived from the Ministry of Health and Welfare. We first calculated the child mortality rate by age, i.e., infant (<1 year), neonate (<28 days), post-neonate (28-364 days), 1-4 years, 5-9 years, and 10-14 years. We then computed the mortality rate ratio and 95% confidence intervals using the mortality rate of Taiwan as the reference. We also compared the pattern of cause of death between Taiwan and Japan and examined the trends in child mortality of Taiwan between 1996 and 2013. Results: Between 2011 and 2013, the infant, neonate, and post-neonate mortality rate in Taiwan was 3.9, 2.4, and 1.5 deaths per 1,000 live births, respectively. The mortality rates in the 1-4 year, 5-9 year, and 10-14 year age groups in Taiwan were 25.8, 13.2, and 14.4 deaths per 100,000 population, respectively. Compared with 33 OECD countries, the mortality rate in Taiwan ranked 23rd, 16th, 24th, 27th, 30th, and 27th for each age group, respectively. The number of countries with mortality rates significantly lower than Taiwan was 19, 12, 21, 24, 26, and 22 for each age group, respectively. For infant deaths, the proportion attributed to perinatal causes in Taiwan (46%) was greater than Japan (25%); however, the proportion of infant deaths due to congenital causes in Taiwan (22%) was less than Japan (36%). For the 1-4 year age group, the proportion of deaths resulting from external causes in Taiwan (28%) was greater than Japan (16%). The decline in the mortality rate from 1996 through 2013 was greatest amongst children 1-4 years of age (annual reduction of 5.5%) and was less significant for infants (annual reduction of 3.4%). Conclusions: The child mortality rate in Taiwan, especially children > 5 years of age, was higher than most OECD countries, including Japan and Korea, which have a similar cultural background to Taiwan. Despite a drastic reduction in the mortality rate for children 1-4 years of age in Taiwan, the proportion of deaths attributed to external causes was greater than the corresponding children in Japan, which is a prevention priority.