Risk Factors for Sudden Infant Death in North Carolina

Background: Sudden infant death syndrome (SIDS) is the sudden, unexplained death of infants less than one year old. SIDS remains a leading cause of death in US infants. We aim to identify associations between SIDS and race/ethnicity, birth weight/gestational age, and socioeconomic/environmental factors in North Carolina (NC) to help identify infants at risk for SIDS.

Methods: In this IRB-approved study, infant mortality 2007-2016 and death certificate-linked natality 2007-2014 were obtained from the NC Department of Health and Human Services. General, NC natality statistics 2007-2016 were obtained from CDC Wonder. Association between SIDS/total infant death and covariates (below) were calculated.

Results: Total infant mortality decreased 2007-2016 by an average of 14 deaths/100,000 live births per year, while SIDS incidence remained constant. Over this period, SIDS deaths made up 13.5% of total infant deaths. Based on aggregate death statistics, relative to Non-Hispanic White children, risk of SIDS was 1.8-fold higher in Non-Hispanic Black children, while risk of any infant death was 2.4 higher. By contrast, risk of SIDS was 0.5-fold lower in Hispanic infants relative to non-Hispanic whites, and essentially the same as non-Hispanic whites for any infant death. Among individuals born 2007-2014, increased incidence of SIDS by 1 year was significantly associated with gestational age <39 weeks, birthweight <2500g, maternal education less than college, and maternal tobacco use (p < 0.05). Maternal previous children now deceased (from any cause) was just above the cutoff for statistical significance (p=0.06).

Conclusion: A thorough SIDS risk assessment should include maternal, socioeconomic, and environmental risk factors as these are associated with SIDS in our population.