Racial Disparity and Modifiable Risk Factors Among Infants Dying Suddenly and Unexpectedly

Abstract

ABSTRACT. Background. Racial disparity in rates of death attributable to sudden infant death syndrome (SIDS) has been observed for many years. Despite decreased SIDS death rates following the "Back to Sleep" intervention in 1994, this disparity in death rates has increased. The prone sleep position, unsafe sleep surfaces, and sharing a sleep surface with others (bedsharing) increase the risk of sudden infant death. The racespecific prevalence of these modifiable risk factors in sudden unexpected infant deaths-including SIDS, accidental suffocation (AS), and cause of death undetermined (UD)-has not been investigated in a populationbased study. Death rates attributable to AS and UD are also higher in African Americans (AAs) than in other races (non-AA). The potential contribution of unsafe sleep practices to this overall disparity in death rates is uncertain.Objective. The objective of this study was to compare death rates attributable to SIDS and related causes of death (AS and UD) in AA and non-AA infants and the prevalence of unsafe sleep practices at time of death. Our hypothesis was that there is a large racial disparity in these modifiable risk factors at the time of death, and that public awareness of this could lead to improved intervention strategies to reduce the disparity in death rates.Methods. In this population-based study, we retrospectively reviewed death-scene information and medical examiners' investigations of deaths in St Louis City and County between January 1, 1994, and December 31, 1997. The deaths of all infants <2 years old with the diagnoses of SIDS, AS, or UD were included. Sleep surfaces other than those specifically designed and approved for infant use were termed nonstandard (adult beds, sofas, etc). Denominators for our rate estimates were the number of births (AA and non-AA) in St Louis City and County during the study period.Results. The deaths of 119 infants were studied (81 AA and 38 non-AA). SIDS rates were much higher in AA than non-AA infants (2.08 vs 0.65 per 1000 live births), as was the rate of AS (0.47 vs 0.06). There was a trend for increased deaths diagnosed as UD in AA infants (0.36 vs 0.06). Bedsharing deaths were nearly twice as common in AAs (67.1% vs 35.1% of deaths), as were deaths on nonstandard sleep surfaces (79.0% vs 46.0%). Forty-nine percent (49.1%) of all infants who died while bedsharing were found on their backs or sides compared with 20.4% of infants who were not bedsharing. Overall, the fraction of infants found in these nonprone positions was not different for AA infants and non-AA infants (43.3% vs 38.5%). In AA and non-AA infants, factors that greatly increase the risk of bedsharing, such as sofa sharing or all-night bedsharing, were present in all or many bedsharing deaths.Conclusion. Among AA infants dying suddenly and unexpectedly, the high prevalence of nonstandard bed use and bedsharing may underlie, in part, their increased death rates. Public health messages tailored for the AA community have stressed first and foremost using nonprone sleep pos...

Infant Sleep Location: Associated Maternal and Infant Characteristics with Sudden Infant Death Syndrome Prevention Recommendations

“…(30) Similarly, in a retrospective population-based cohort of sudden unexpected infant deaths, Unger et al found bedsharing deaths to be nearly twice as common in African American infants. (24) Other studies have found bedsharing to be linked to measures of poverty. Teenage motherhood may be an indicator of lower socioeconomic status which may explain why bedsharing was more common among these younger mothers in our study.…”

“…Currently, approximately half of all sudden and unexpected infant deaths in the US occur when the infant is sharing a sleep surface with someone else. (21)(22)(23)(24) There is growing evidence that roomsharing without bedsharing is associated with a reduced risk of SIDS. (9,15,16) Several countries, including the US, currently recommend that infants sleep in a crib or bassinet next to the parents' bed.…”

Ani Bebek Ölümü Sendromu

“…Geliflmifl ülkelerde yenido¤an döneminden sonra çocukluk ça¤›nda mortalitenin önemli nedenlerinden biri oldu¤u bildirilmektedir (3) ‹lk kez tan›mland›¤› 1969 (4) y›l›ndan bu yana yap›lan birçok araflt›rma, ABÖS'nun geliflimsel, çevresel ve biyolojik risk faktörleri içeren multifaktöriyel bir hastal›k oldu¤unu ortaya koymufltur (5,6). Bu etkenleri kontrol alt›na almak amac›yla al›nan baz› önlemler ve s›rtüstü yat›fl› öneren kampanyalar arac›l›¤›yla görülme s›kl›¤›nda anlaml› bir azalma gözlenmesine ra¤men ABÖS önemi-ni korumaktad›r (7)(8)(9)(10)(11).…”

“…Pek çok ülkede oldu¤u gibi ülkemizde de ço-¤u olguda, ABÖS mü yoksa flüpheli bir ölüm mü sorusu yan›tlanamam›fl, olgular "nedeni aç›klanamayan ölüm" kategorisinde de¤erlendirilmifltir (11).…”

“…Bunun olas› sebeplerinden biri kardefllerin daha zay›f do¤malar›d›r (7,11,17). Bir çal›flmada 625 ikiz bebeklerden 6's›n›n (%1'i) ABÖS yüzünden öldü¤ü bildirilmifltir (11).…”