Multiple environmental risk factors are associated with sleep-related infant deaths. Little is known about differences in risk factors for deaths occurring in-home and out-of-home. We sought to compare risk factors for in-home and out-of-home infant deaths.


We conducted a cross-sectional analysis of sleep-related infant deaths from 2004 to 2014 in the National Child Fatality Review and Prevention database. The main exposure was setting (in-home versus out-of-home) at time of death. Primary outcomes were known risk factors: sleep position, sleep location (eg, crib), objects in the environment, and bed sharing. Risk factors for in-home versus out-of-home deaths were compared using the χ2 test and multivariate logistic regressions.


A total of 11 717 deaths were analyzed. Infants who died out-of-home were more likely to be in a stroller/car seat (adjusted odds ratio, 2.6; 95% confidence interval, 2.1–3.4; P < .001) and other locations (adjusted odds ratio, 1.9; 95% confidence interval, 1.5–2.3; P < .001), and placed prone (adjusted odds ratio, 1.2; 95% confidence interval, 1.1–1.3; P <0.01). Bed sharing was less common out-of-home (adjusted odds ratio, 0.7; 95% confidence interval, 0.6–0.7; P < .001). There were no differences in sleeping on a couch/ chair, or objects in the sleep environment.


Sleep-related infant deaths in the out-of-home setting have higher odds of having certain risk factors, such as prone placement for sleep and location in a stroller/car seat, rather than in a crib/bassinet. Caregivers should be educated on the importance of placing infants to sleep supine in cribs/bassinets to protect against sleep-related deaths, both in and out of the home.

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