Applying a Social Exclusion Framework to Explore the Relationship Between Sudden Unexpected Deaths in Infancy (SUDI) and Social Vulnerability

Abstract

Background: Sudden Unexpected Death in Infancy (SUDI) is a leading cause of preventable infant mortality and strongly associated with social adversity. While this has been noted over many decades, most previous studies have used single economic markers in social disadvantage analyses. To date there have been no previous attempts to analyze the cumulative effect of multiple adversities in combination on SUDI risk.Methods: Based on sociological theories of social exclusion, a multidimensional framework capable of producing an overall measure of family-level social vulnerability was developed, accounting for both increasing disadvantage with increasing prevalence among family members and effect of family structures. This framework was applied retrospectively to all cases of SUDI that occurred in Queensland between 2010 and 2014. Additionally, an exploratory factor analysis was performed to investigate whether differing "types" of vulnerability could be identified.Results: Increased family vulnerability was associated with four major known risk factors for sudden infant death: smoking, surface sharing, not-breastfeeding and use of excess bedding. However, families with lower levels of social vulnerability were more likely to display two major risk factors: prone infant sleep position and not room-sharing. There was a significant positive relationship between family vulnerability and the cumulative total of risk factors. Exploratory factor analysis identified three distinct vulnerability types (chaotic lifestyle, socioeconomic and psychosocial); the first two were associated with presence of major SUDI risk factors. Indigenous infants had significantly higher family vulnerability scores than non-Indigenous families. Conclusion:A multidimensional measure that captures adversity across a range of indicators highlights the need for proportionate universalism to reduce the stalled rates of sudden infant death. In addition to information campaigns continuing to promote the importance of the back-sleeping position and close infant-caregiver proximity, socially vulnerable families should be a priority population for individually tailored or community based multi-model approaches.

Decision-making for the infant sleep environment among families with children considered to be at risk of sudden unexpected death in infancy: a systematic review and qualitative metasynthesis

“…While this has worked in certain contexts, it has failed those from lower socioeconomic groups. 32 Context certainly played a role in the success of the original ‘Back To Sleep campaign’, which took place when parental and societal concern about SIDS was high; deaths occurred across socioeconomic groups; and high profile cases in the UK brought public awareness of the risks and prevention strategies. 33 Targeting those with more complex barriers to adopting messages is where our greatest challenge now lies.…”

Trends in infant mortality and stillbirth rates in Scotland by socio-economic position, 2000–2018: a longitudinal ecological study

“…Reductions in post-neonatal mortality could be achieved by increasing support for caregivers, optimising the environments that infants are raised in and reducing risk factors for adverse events. For example, breast feeding support, improved access to mental health services and financial support for infant-care essentials could improve the environments that infants are raised in [4], whilst individually tailored or community-based interventions to address risk factors such as smoking and sleeping position, could reduce the risk of sudden unexpected deaths in infancy (SUDIs) amongst the most socially vulnerable groups [26].…”

Feasibility and Acceptability of a Tailored Infant Safe Sleep Coaching Intervention for African American Families

“…For example, several enrolled families reported experiencing housing challenges during the study, including housing in disrepair (such as broken plumbing, windows), unresponsive landlords, lack of affordable housing, and eviction. This finding reinforced the necessity of providing a broad array of resources to families living in under-resourced neighborhoods and emphasized the need for tailored interventions that can help respond to a caregiver’s highest priorities and unique circumstances, concerns, and needs [ 15 , 21 , 22 , 23 , 24 , 28 , 30 , 31 , 51 ].…”

“…Research has suggested the need for tailored interventions that respond to a caregivers’ unique circumstances, concerns, and needs, especially among families that are living in under-resourced neighborhoods [ 15 , 21 , 22 , 23 , 28 , 30 , 51 ]. To tailor their responses to specific family needs, MBS coaches ask families about perceptions and reasons behind infant sleep practices.…”