Abstract 185: The Association Between Sudden Unexpected Death in Infancy and Neighborhood-Level Disadvantages: A Multi-Dimension Evaluation in the City of Chicago

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Introduction: The association between sudden unexpected death in infancy (SUDI) and low socio-economic status has been well described in the literature. While the rate of SUDI had declined dramatically following successful campaigns that promoted safe sleeping habits, it has remained stable over the past decade and increasingly been confined to the most socially disadvantaged and vulnerable families. Racial and ethnic disparities persist. Despite extensive research associating the multitude of societal level factors associated with social and economic disadvantage and the increased risk of SUDI, their mechanisms on SUDI remain poorly understood. Hypothesis: A novel composite multi-dimensional marker of neighborhood-level disadvantage may be used to evaluate the association between SUDI and neighborhood-level disadvantages in the City of Chicago. Methods: Sudden unexpected death in infancy cases were identified from the Cardiac Arrest Registry to Enhance Survival database. The composite neighborhood-level disadvantage index was derived using an explanatory factor analysis of the social economic factors recorded in the 2015 American Community Survey of the 77 community areas of the City of Chicago. We defined 3 levels of disadvantage: high, medium, and low. A geographic information system, was used to map the community areas’ disadvantage level and individual SUDI cases. Results: Ninety-one SUDI cases were identified. Non-Hispanic Black (64/91(70%)) and Hispanic (16/91 (18%)) comprised the majority of SUDI cases. Sudden unexpected death in infancy cases were highly concentrated in disadvantaged areas. Eighty-six cases (94.5%) occurred in high and medium disadvantaged areas while 5 cases (5.5%) occurred in the low and no disadvantaged areas (P < 0.0001). Finally, SUDI cases from high and medium disadvantaged areas had a lower hospital admission rate when compared to those from the low and no disadvantaged areas (OR 0.04). Conclusions: The study confirms the persistent racial and socio-economic disparities in SUDI in the City of Chicago. The study’s use of a multi-dimensional composite index of neighborhood-level disadvantage and domestic violence would serve as the basis for further analyses and potential social intervention programs.