Rates of sudden unexpected infant deaths (SUIDs) have decreased since the Academy recommended back sleeping, but racial disparities persist, a new study found.
American Indian/Alaska Native infants and black infants consistently had the highest rates of SUID over nearly two decades, and their rates were double that of white children in 2013, according to the study “Racial and Ethnic Trends in Sudden Unexpected Infant Deaths – United States 1995-2013,” (Parks E, et al. Pediatrics. May 15, 2017, https://doi.org/10.1542/peds.2016-3844).
The findings “suggest that while prevention efforts dating to the early to mid-1990s have positively impacted SUID rates, further effort is needed to continue decreasing SUIDs, a major cause of infant mortality in the U.S.,” authors wrote.
More than 35% of post-neonatal deaths can be attributed to SUID, which includes sudden infant death syndrome and accidental suffocation and strangulation in bed.
In 1992, the Academy began recommending putting infants to sleep on their backs to prevent some of these deaths and championed the Back-to-Sleep campaign in 1994. Rates of SUID dropped after the campaign and have been hovering around 93.4 per 100,000 infants since 2000, according to the study.
The team, which included researchers from the Centers for Disease Control and Prevention, used infant death data to study the post-campaign rates and ethnic disparities more closely.
From 1995-2013, SUID rates per 100,000 live births were highest for American Indian/Alaska Natives (215.2) followed by black infants (188.7), white (88.3), Hispanic (54.2) and Asian/Pacific Islander (41.9). While rates for black infants were among the highest, they also dropped significantly, along with rates for Hispanic and Asian/Pacific Islander children.
Most of the infants experiencing SUID were 1 or 2 months of age, and rates were highest for males throughout the study period. From 1995-’97, most ethnic groups experienced the greatest proportion of SUID during the winter, but the winter prevalence lessened for nearly all groups in 2011-’13.
“One explanation may be that safe sleep recommendations against over-bundling and overheating infants particularly during winter months have been successful, resulting in a more even distribution of SUID throughout the year,” authors wrote.
Preterm infants born before 32 weeks’ gestation experienced SUID at 2.5 times the rate of the overall population. In both 1995-’97 and 2011-’13, Asian/Pacific Islander and Hispanic children had the lowest rates of SUID for preterm infants, just as they did overall. Between these two periods, there were significant drops in preterm SUID rates for all except Asian/Pacific Islander.
Multiple factors likely tied into racial differences in SUID rates, authors said. Behavioral factors like infant sleep position and bed-sharing likely play a role, and studies have found racial differences in the prevalence of these behaviors. Biological factors like metabolic disorders and brain stem abnormalities also can increase risk.
“Teen maternal age, plurality, low socioeconomic or educational status, maternal smoking, not breastfeeding or decreased breastfeeding duration, lack of prenatal care, and unmarried status are other factors which may influence the observed SUID patterns,” authors wrote.
They called for improved messaging on how to prevent SUID.
“Perhaps public health campaigns to reduce SUID are not reaching certain race/ethnicities, not addressing the most important risk factors for these groups, or not being framed in the most effective way to ensure uptake among diverse populations,” they said.
Last year, the Academy renewed its educational efforts with a new policy SIDS and Other Sleep-Related Infant Deaths: Updated 2016 Recommendations for a Safe Infant Sleeping Environment.
Authors of a related commentary called the new study on racial trends “a significant contribution to our understanding.” They noted that in addition to education, medical advances that minimize biological factors also likely helped bring SUID rates down and will continue to be an important factor going forward.