PEDIATRICS Vol. 110 No. 4 October 2002, pp. 772-780
The Contribution of Prone Sleeping Position to the Racial Disparity in Sudden Infant Death Syndrome: The Chicago Infant Mortality Study
* Department of Family Medicine, Loyola University Chicago Stritch School of Medicine, Maywood, Illinois
Office of the Medical Examiner of Cook County, Chicago, Illinois
Children’s Memorial Hospital and Departments of Pediatrics and Preventive Medicine, Northwestern University Medical School, Chicago, Illinois
¶ Epidemiology, Statistics and Data Systems Branch, National Institute on Deafness and Other Communication Disorders, Bethesda, Maryland
|| Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia
--> Background. Rates of sudden infant death syndrome (SIDS) are over twice as high among African Americans compared with Caucasians. Little is known, however, about the relationship between prone sleeping, other sleep environment factors, and the risk of SIDS in the United States and how differences in risk factors may account for disparities in mortality.
Objective. To assess the contribution of prone sleeping position and other potential risk factors to SIDS risk in a primarily high-risk, urban African American population.
Design, Setting, and Population. Case-control study consisting of 260 infants ages birth to 1 year who died of SIDS between November 1993 and April 1996. The control group consists of an equal number of infants matched on race, age, and birth weight. Prospectively collected data from the death scene investigation and a follow-up home interview for case infants were compared with equivalent questions for living control participants to identify risk factors for SIDS.
Main Outcome Measures. Risk of SIDS related to prone sleeping position adjusting for potential confounding variables and other risk factors for SIDS, and comparisons by race-ethnicity.
Results. Three quarters of the SIDS infants were African American. There was more than a twofold increased risk of SIDS associated with being placed prone for last sleep compared with the nonprone positions (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.6–3.7). This OR increased after adjusting for potential confounding variables and other sleep environment factors (OR: 4.0; 95% CI: 1.8–8.8). Differences were found for African Americans compared with others (OR: 1.8; 95% CI: 1.2–2.6 and OR: 10.3, 95% CI: 10.3 [3.2–33.8, respectively]). The population attributable risk was 31%. Fewer case mothers (46%) than control mothers (64%) reported being advised about sleep position in the hospital after delivery. Of those advised, a similar proportion of case mothers as control mothers were incorrectly told or recalled being told to use the prone position, but prone was recommended in a higher proportion of black mothers (cases and controls combined) compared with nonblack mothers.
Conclusions. Prone sleeping was found to be a significant risk factor for SIDS in this primarily African American urban sample, and approximately one third of the SIDS deaths could be attributed to this factor. Greater and more effective educational outreach must be extended to African American families and the health personnel serving them to reduce prone prevalence during sleep, which appears, in part, to contribute to the higher rates of SIDS among African American infants.
Key Words: sudden infant death • infant care • African Americans • sleep
Abbreviations: SIDS, sudden infant death syndrome • OR, odds ratio • CI, confidence interval • SD, standard deviation
Received for publication Aug 14, 2000; Accepted Apr 26, 2002.
This article has been cited by other articles:
 |
|
 |
|
  M. O. Hearst, J. M. Oakes, and P. J. Johnson The Effect of Racial Residential Segregation on Black Infant Mortality Am. J. Epidemiol., December 1, 2008; 168(11): 1247 - 1254. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. R. Hauck and K. O. Tanabe International Trends in Sudden Infant Death Syndrome: Stabilization of Rates Requires Further Action Pediatrics, September 1, 2008; 122(3): 660 - 666. [Full Text] [PDF]
|
|
|
|
 |
|
 R. Y. Moon, M. Kington, R. Oden, J. Iglesias, and F. R. Hauck Physician Recommendations Regarding SIDS Risk Reduction: A National Survey of Pediatricians and Family Physicians Clinical Pediatrics, December 1, 2007; 46(9): 791 - 800. [Abstract] [PDF]
|
|
|
|
 |
|
 T. Horsley, T. Clifford, N. Barrowman, S. Bennett, F. Yazdi, M. Sampson, D. Moher, O. Dingwall, H. Schachter, and A. Cote Benefits and Harms Associated With the Practice of Bed Sharing: A Systematic Review Arch Pediatr Adolesc Med, March 1, 2007; 161(3): 237 - 245. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. Luke and M. B. Brown The Changing Risk of Infant Mortality by Gestation, Plurality, and Race: 1989-1991 Versus 1999-2001 Pediatrics, December 1, 2006; 118(6): 2488 - 2497. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. M. Ostfeld, H. Perl, L. Esposito, K. Hempstead, R. Hinnen, A. Sandler, P. G. Pearson, and T. Hegyi Sleep Environment, Positional, Lifestyle, and Demographic Characteristics Associated With Bed Sharing in Sudden Infant Death Syndrome Cases: A Population-Based Study Pediatrics, November 1, 2006; 118(5): 2051 - 2059. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. R. Colson, S. Levenson, D. Rybin, C. Calianos, A. Margolis, T. Colton, G. Lister, and M. J. Corwin Barriers to Following the Supine Sleep Recommendation Among Mothers at Four Centers for the Women, Infants, and Children Program Pediatrics, August 1, 2006; 118(2): e243 - e250. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. E. Hunt and F. R. Hauck Sudden infant death syndrome. Can. Med. Assoc. J., June 20, 2006; 174(13): 1861 - 1869. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. I. Eidelman and L. M. Gartner Bed Sharing With Unimpaired Parents Is Not an Important Risk for Sudden Infant Death Syndrome: To the Editor Pediatrics, March 1, 2006; 117(3): 991 - 992. [Full Text] [PDF]
|
|
|
|
 |
|
 K. E. Pickett, Y. Luo, and D. S. Lauderdale Widening Social Inequalities in Risk for Sudden Infant Death Syndrome Am J Public Health, November 1, 2005; 95(11): 1976 - 1981. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Task Force on Sudden Infant Death Syndrome The Changing Concept of Sudden Infant Death Syndrome: Diagnostic Coding Shifts, Controversies Regarding the Sleeping Environment, and New Variables to Consider in Reducing Risk Pediatrics, November 1, 2005; 116(5): 1245 - 1255. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Gilbert, G. Salanti, M. Harden, and S. See Infant sleeping position and the sudden infant death syndrome: systematic review of observational studies and historical review of recommendations from 1940 to 2002 Int. J. Epidemiol., August 1, 2005; 34(4): 874 - 887. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. A. Hessol and E. Fuentes-Afflick Ethnic Differences in Neonatal and Postneonatal Mortality Pediatrics, January 1, 2005; 115(1): e44 - e51. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Y. Moon, R. P. Oden, and K. C. Grady Back to Sleep: An Educational Intervention With Women, Infants, and Children Program Clients Pediatrics, March 1, 2004; 113(3): 542 - 547. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. R. Hauck, S. M. Herman, M. Donovan, S. Iyasu, C. Merrick Moore, E. Donoghue, R. H. Kirschner, and M. Willinger Sleep Environment and the Risk of Sudden Infant Death Syndrome in an Urban Population: The Chicago Infant Mortality Study Pediatrics, May 1, 2003; 111(5): 1207 - 1214. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D.-K. Li, D. B. Petitti, M. Willinger, R. McMahon, R. Odouli, H. Vu, and H. J. Hoffman Infant Sleeping Position and the Risk of Sudden Infant Death Syndrome in California, 1997-2000 Am. J. Epidemiol., March 1, 2003; 157(5): 446 - 455. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. R. Neuspiel Do Used Infant Mattresses Increase SIDS Risk? AAP Grand Rounds, January 1, 2003; 9(1): 3 - 3. [Full Text] [PDF]
|
|
