Ambient Heat and Sudden Infant Death: A Case-Crossover Study Spanning 30 Years in Montreal, Canada

Abstract

Background: Climate change may lead to more severe and extreme heat waves in the future, but its potential impact on sudden infant death-a leading cause of infant mortality-is unclear.

Objectives: We sought to determine whether risk of sudden infant death syndrome (SIDS) is elevated during hot weather.

Methods: We undertook a case-crossover analysis of all sudden infant deaths during warm periods in metropolitan Montreal, Quebec, Canada, from 1981 through 2010. Our analysis included a total of 196 certified cases of SIDS, including 89 deaths at 1-2 months of age, and 94 at 3-12 months. We estimated associations between maximum outdoor temperatures and SIDS by comparing outdoor temperatures on the day of or day before a SIDS event with temperatures on control days during the same month, using cubic splines to model temperature and adjusting for relative humidity.

Results: Maximum daily temperatures of ≥ 29°C on the same day were associated with 2.78 times greater odds of sudden infant death relative to 20°C (95% CI: 1.64, 4.70). The likelihood of sudden death increased steadily with higher temperature. Associations were stronger for infants 3-12 months of age than for infants 1-2 months of age, with odds ratios of 3.90 (95% CI: 1.87, 8.13) and 1.73 (95% CI: 0.80, 3.73), respectively, for 29°C compared with 20°C on the day of the event.

Conclusions: High ambient temperature may be a novel risk factor for SIDS, especially at ≥ 3 months of age. Climate change and the higher temperatures that result may account for a potentially greater proportion of sudden infant deaths in the future.

Figure 1

Association between maximum temperature and SIDS, Montreal, April–October 1981–2010. Odds ratio (solid blue line) and 95% CIs (dashed outer bands). All temperatures are relative to the 20°C mark, and are adjusted for mean relative humidity.

Figure 2

Association between maximum temperature and SIDS by postneonatal period, Montreal, April–October 1981–2010. Odds ratio (solid blue line) and 95% CIs (dashed outer bands). All temperatures are relative to the 20°C mark, and are adjusted for mean relative humidity. Associations for neonatal mortality were not computed because the number of cases was too low (n = 13).