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Published online January 26, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. 533-539 (doi:10.1542/peds.2007-3746)
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ARTICLE

US Infant Mortality Trends Attributable to Accidental Suffocation and Strangulation in Bed From 1984 Through 2004: Are Rates Increasing?

Carrie K. Shapiro-Mendoza, PhD, MPHa, Melissa Kimball, MPHa, Kay M. Tomashek, MD, MPHa, Robert N. Anderson, PhDb, Sarah Blanding, MPHa

a Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
b National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland

OBJECTIVE. Accidental suffocation and strangulation in bed, a subgroup of sudden, unexpected infant deaths, is a leading mechanism of injury-related infant deaths. We explored trends and characteristics of these potentially preventable deaths.

METHODS. In this descriptive study, we analyzed US infant mortality data from 1984 through 2004. To explore trends in accidental suffocation and strangulation in bed and other sudden, unexpected infant deaths, we calculated cause-specific infant mortality rates and estimated proportionate mortality. Sudden, unexpected infant death was defined as a combination of all deaths attributed to accidental suffocation and strangulation in bed, sudden infant death syndrome, and unknown causes. Finally, we examined factors that were reported as contributing to these accidental suffocation and strangulation in bed deaths.

RESULTS. Between 1984 and 2004, infant mortality rates attributed to accidental suffocation and strangulation in bed increased from 2.8 to 12.5 deaths per 100000 live births. These rates remained relatively stagnant between 1984 and 1992 and increased between 1992 and 2004; the most dramatic increase occurred between 1996 and 2004 (14% average annual increase). In contrast, total sudden, unexpected infant death rates remained stagnant between 1996 and 2004, whereas the proportion of deaths attributed to sudden infant death syndrome declined and to unknown cause increased. Black male infants <4 months of age were disproportionately affected by accidental suffocation and strangulation in bed. Beds, cribs, and couches were reported as places where deaths attributed to accidental suffocation and strangulation in bed occurred.

CONCLUSIONS. Infant mortality rates attributable to accidental suffocation and strangulation in bed have quadrupled since 1984. The reason for this increase is unknown. Prevention efforts should target those at highest risk and focus on helping parents and caregivers provide safer sleep environments.

Key Words: accidental suffocation • sudden unexpected infant death • sudden infant death syndrome • SIDS • infant mortality • classification • reporting • death certification • vital statistics • death-scene investigation • unintentional injury

Abbreviations: ASSB—accidental suffocation and strangulation in bed • SUID—sudden, unexpected infant death • SIDS—sudden infant death syndrome • CDC—Centers for Disease Control and Prevention • SUIDIRF—Sudden, Unexplained Infant Death Investigation Report Form • NCHS—National Center for Health Statistics • ICD-9—International Classification of Diseases, Ninth Revision • ICD-10—International Statistical Classification of Diseases and Related Health Problems, Tenth Revision • CI—confidence interval

Accepted May 19, 2008.


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