P0426 - Descriptive Analysis of Sleep-surface Sharing among Sudden Unexpected Infant Deaths, 2011-2017

Context: Sleep-surface sharing (SSS) increases the risk of Sudden Infant Death Syndrome and other sleep-related Sudden Unexpected Infant Deaths (SUID). However, few studies have examined factors associated with the practice.

Objective: To determine, among SUID cases, what infant and caregiver characteristics were associated with SSS (e.g., bed, sofa, crib) versus sleeping alone at the time of death.

Study Design: Descriptive.

Population/Dataset: SUID cases that occurred from 2011-2017 in states and jurisdictions participating in the Centers for Disease Control and Prevention’s SUID Case Registry. The SUID Case Registry is a surveillance system with detailed information on all SUID cases in the funded locations and their sleep environment at time of death.

Outcome Measures: Infant and caregiver characteristics were compared for infants sharing a sleep surface and those who were sleeping alone at the time of death, using Chi-square analysis and multivariable logistic regression, adjusting for infant age at death, gestation, race/ethnicity and sex.

Results: Deaths while SSS (n=2732) represented 59% of all SUID cases in the study population (n=4609). Those more likely to be surface sharing at the time of death were infants 0-3 months of age at death (aOR = 2.4) compared with infants over 6 months, multiples (aOR = 1.7) compared to singletons, non-Hispanic black as compared to non-Hispanic white (aOR = 2.2), infants with Medicaid as compared to those with any other insurance (aOR = 1.7), infants in a new or different sleep environment (aOR = 1.7), infants whose mothers smoked prenatally (aOR = 1.6), and infants whose supervisor at the time of death was impaired by drugs or alcohol at the time of death (aOR = 4.0).

Conclusion: Over half of SUID cases in a large, multi-state SUID population occurred while sleep-surface sharing. Significant differences in infant and caregiver characteristics were observed between infants who were sharing a sleep surface and those sleeping alone at the time of death. Understanding the characteristics associated with surface sharing among SUID cases may inform safe sleep promotion strategies and guide interventions toward populations at highest risk.