Abstract
BackgroundSudden unexpected infant death (SUID) - including sudden infant death syndrome (SIDS) - continues to be a major contributor to infant mortality worldwide. Our objective was to analyse time trends and to identify country-clusters.MethodsThe National Statistical Offices of 52 countries provided the number of deaths and live births (1969–2012). We calculated infant mortality rates per 1000 live births for SUID, SIDS, and all-cause mortality. Overall, 29 countries provided sufficient data for time course analyses of SUID. To sensitively model change over time, we smoothed the curves of mortality rates (1980–2010). We performed a hierarchical cluster analysis to identify clusters of time trends for SUID and SIDS, including all-cause infant mortality.ResultsAll-cause infant mortality declined from 28.5 to 4.8 per 1000 live births (mean 12.4; 95% confidence interval 12.0–12.9) between 1969 and 2012. The cluster analysis revealed four country-clusters. Clusters 1 and 2 mostly contained countries showing the typical peak of SUID mortality during the 1980s. Cluster 1 had higher SUID mortality compared to cluster 2. All-cause infant mortality was low in both clusters but higher in cluster 1 compared to cluster 2. Clusters 3 and 4 had low rates of SUID without a peak during the 1980s. Cluster 3 had the highest all-cause infant mortality of all clusters. Cluster 4 had an intermediate all-cause infant mortality. The time trends of SUID and SIDS mortality were similar.ConclusionsThe country-specific time trends in SUID varied considerably. The identification of country-clusters may promote research into how changes in sleep position, smoking, immunisation, or other factors are related to our findings.
Highlights
Sudden unexpected infant death (SUID) - including sudden infant death syndrome (SIDS) - continues to be a major contributor to infant mortality worldwide
All-cause infant mortality decreased from an average of 28.5 per 1000 live births in 1969 to 4.8 in 2012
While all-cause infant mortality rates were available for all countries from 1969 to 2012, the completeness of available mortality data to calculate SUID mortality was initially low; it improved during the time period of interest
Summary
Sudden unexpected infant death (SUID) - including sudden infant death syndrome (SIDS) - continues to be a major contributor to infant mortality worldwide. In many Western countries, including Western Europe, Australia, Canada, New Zealand, and the United States, mortality from SIDS peaked in the 1980s and decreased during the 1990s [2,3,4,5,6]. In other countries, such as Japan, SIDS mortality was low during. Known risk factors for SIDS other than the prone or side sleep position include bed sharing, soft bedding, mothers’ smoking and alcohol use, overheating, and lack of immunisation [4, 12, 13]
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