A new federal study highlights a striking racial disparity in infant deaths: Black babies experienced the highest rate of sudden unexpected deaths in 2020, dying at almost three times the rate of White infants.
The findings were part of research released Monday by the Centers for Disease Control and Prevention, which also found a 15 percent increase in sudden infant deaths among babies of all races from 2019 to 2020, making SIDS the third leading cause of infant death in the United States after congenital abnormalities and the complications of premature birth.
“In minority communities, the rates are going in the wrong direction,” said Scott Krugman, vice chair of the department of pediatrics and an expert on SIDS at Sinai Hospital in Baltimore.
The study found that rising SIDS rates in 2020 was likely attributable to diagnostic shifting — or reclassifying the cause of death. The causes of the rise in sleep-related deaths of Black infants remain unclear but it coincided with the arrival of the coronavirus pandemic, which disproportionately affected the health and wealth of Black communities.
“Evidence does not support direct or indirect effects of the … pandemic on increased rates of sudden unexpected infant death, except for non-Hispanic Black infants,” said the study, to be published in the April issue of the journal Pediatrics.
The study’s authors, who call for further research into their findings, point out that the pandemic exacerbated overcrowded housing, food insecurity and other stressors, particularly among Black families — potentially leading to less safe sleeping practices, such as bed sharing.
Before the pandemic, overall infant mortality — including diseases, accidents and injuries, and unexplained deaths — had been on a downward trend in the United States. Some of that drop can be attributed to the enormously successful campaign launched in the 1990s to encourage putting babies to sleep on their backs, as opposed to facedown when they may re-breathe the carbon dioxide they exhaled or suffocate in soft bedding.
Tracking and understanding the causes of sudden and unexpected infant deaths on a national scale has been challenging in part because of different local practices of reporting and investigating the deaths. Data based on death certificates is notoriously inaccurate, and the pandemic introduced further complications, including shortening the time overburdened examiners could devote to investigating individual deaths.
The CDC’s Division of Reproductive Health has tried to address those problems by setting up monitoring programs in 22 states and jurisdictions across the country and by working with medical examiners and coroners to standardize reporting procedures. The new study draws on that research.
“This study is using good quality data, putting what some of us have been doing on a local basis on a national scale,” Krugman said.
In addition, a shift in terminology has complicated the picture. SIDS, or crib death, refers to the sudden death of an infant under the age of 1, usually during sleep and for unknown reasons, though often related to suspected genetic or environmental factors.
That term has fallen out of favor among some medical examiners and coroners who have replaced it with the broader term SUID, or sudden unexpected infant death under the age of 1. SUID refers to the often sleep-related deaths of babies in which the causes include suffocation from being caught between cushions of a couch or strangulation beneath a sleeping parent as well as SIDS and other unknown causes. About half of SUID deaths are SIDS deaths.
>“It’s a terrible situation,” said Richard Goldstein, director of the Robert’s Program on Sudden Unexpected Death in Pediatrics at Boston Children’s Hospital. “There is so much inconsistency in what these deaths are called. That’s not tolerated in any other area of medicine.”
On average, about 3,400 U.S. babies die suddenly and unexpectedly each year, according to CDC data.
To examine racial disparities, researchers chose to use the overall SUID rate, which allowed for consistent comparisons that were not affected by the different ways medical examiners report infant deaths.
In 2020, the SUID rate was highest among Black infants (at 214 deaths per 100,000 live births), followed by American Indian or Alaskan Native infants (at 205 deaths per 100,000 live births), and nearly three times the rate for White infants (75.6 deaths per 100,000 live births).
Understanding the causes of those deaths, many of which are unobserved, is key to preventing them.
“We don’t know how to prevent SIDS,” said Michael Goodstein, a neonatologist at York Hospital in Pennsylvania, who said research is examining factors such as brainstem abnormalities and respiratory problems. “But we should be able to prevent suffocation deaths.”
Sharyn Parks, one of the study’s authors and a senior scientist at the CDC’s Division of Reproductive Health, said there are two clear messages to take from the study — the need for researchers to examine factors like poverty that make some families more vulnerable to poor health outcomes as well as the need for parents to remember the practical steps they can take.
“We want to continue emphasizing safe infant sleep practices, putting babies on their backs and removing all soft bedding,” Parks said.
Once it is available, data from 2021 and 2022 should provide a clearer sense of the role the pandemic may have played in widening disparities between different racial groups.
“We are getting more and more a sense that poverty and multi-factorial issues are really important for being able to protect children,” Goodstein said.
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