Article Text
Abstract
Background Unexplained deaths in infancy comprise ‘sudden infant death syndrome’ (SIDS) and deaths without ascertained cause. They are typically sleep-related, perhaps triggered by unsafe sleep environments. Preterm birth may increase risk, and varies with ethnicity. We aimed to compare ethnic-specific rates of unexplained infant death, explore sociodemographic explanations for ethnic variation, and examine the role of preterm birth.
Methods We analysed routine data for 4.6 million live singleton births in England and Wales 2006–2012, including seven non-White ethnic groups ranging in size from 29 313 (Mixed Black-African-White) to 180 265 (Pakistani). We calculated rates, birth-year-adjusted ORs, and effects of further adjustments on the χ2 for ethnic variation.
Results There were 1559 unexplained infant deaths. Crude rates per 1000 live singleton births were as follows: 0.1–0.2 for Indian, Bangladeshi, Pakistani, White Non-British, Black African; 0.4 for White British; 0.6–0.7 for Mixed Black-African-White, Mixed Black-Caribbean-White, Black Caribbean. Birth-year-adjusted ORs relative to White British ranged from 0.38 (95% CI 0.24 to 0.60) for Indian babies to 1.73 (1.21 to 2.47) for Black Caribbean (χ2(10 df)=113.6, p<0.0005). Combined adjustment for parents’ marital/registration status and mother’s country of birth (UK/non-UK) attenuated the ethnic variation. Adjustments for gestational age at birth, maternal age and area deprivation made little difference.
Conclusion Substantial ethnic disparity in risk of unexplained infant death exists in England and Wales. Apparently not attributable to preterm birth or area deprivation, this may reflect cultural differences in infant care. Further research into infant-care practices in low-risk ethnic groups might enable more effective prevention of such deaths in the general population.
- ethnicity
- infant mortality
- inequalities
- cohort studies
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Footnotes
Contributors JH conceived the study and all authors contributed to the design. Data acquisition was primarily conducted by JH, and data cleaning and management by YL. Analyses were performed by MEK and supported by MAQ and JH. MEK drafted the initial manuscript and MAQ, JJK, ND, YL and JH significantly contributed to revising it. All authors read and approved the final manuscript.
Funding This paper reports on an independent study which is funded by the National Institute for Health Research Policy Research Programme in the Department of Health and Social Care (grant no 108/001).
Disclaimer The views expressed herein are those of the authors and not necessarily those of the Department of Health and Social Care.
Competing interests None declared.
Patient consent Not required.
Ethics approval The study was approved by the National Research Ethics Service Committee South Central—Oxford B (reference 15/SC/0493).
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The Office for National Statistics provided data for this study under an agreement which allows the data to be used only for the programme of infant mortality work of which this is a part.