Sudden unexpected infant death rates highest in some ethnic groups
MelissaJenco, News Content Editor
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
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
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,”
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.
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.