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. 2023 Apr 1;151(4):e2022058820.
doi: 10.1542/peds.2022-058820.

Sudden Unexpected Infant Deaths: 2015-2020

Carrie K Shapiro-Mendoza  1 , Kate R Woodworth  2 , Carri R Cottengim  1 , Alexa B Erck Lambert  3 , Elizabeth M Harvey  1 , Michael Monsour  1 , Sharyn E Parks  1 , Wanda D Barfield  1
Affiliations

Sudden Unexpected Infant Deaths: 2015-2020

Carrie K Shapiro-Mendoza et al. Pediatrics. .

Abstract

Objective: Although the US infant mortality rate reached a record low in 2020, the sudden infant death syndrome (SIDS) rate increased from 2019. To understand if the increase was related to changing death certification practices or the coronavirus disease 2019 (COVID-19) pandemic, we examined sudden unexpected infant death (SUID) rates as a group, by cause, and by race and ethnicity.

Methods: We estimated SUID rates during 2015 to 2020 using US period-linked birth and death data. SUID included SIDS, unknown cause, and accidental suffocation and strangulation in bed. We examined changes in rates from 2019 to 2020 and assessed linear trends during prepandemic (2015-2019) using weighted least squares regression. We also assessed race and ethnicity trends and quantified COVID-19-related SUID.

Results: Although the SIDS rate increased significantly from 2019 to 2020 (P < .001), the overall SUID rate did not (P = .24). The increased SIDS rate followed a declining linear trend in SIDS during 2015 to 2019 (P < .001). Other SUID causes did not change significantly. Our race and ethnicity analysis showed SUID rates increased significantly for non-Hispanic Black infants from 2019 to 2020, widening the disparities between these two groups during 2017 to 2019. In 2020, <10 of the 3328 SUID had a COVID-19 code.

Conclusions: Diagnositic shifting likely explained the increased SIDS rate in 2020. Why the SUID rate increased for non-Hispanic Black infants is unknown, but warrants continued monitoring. Interventions are needed to address persistent racial and ethnic disparities in SUID.

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Conflict of interest statement

CONFLICT OF INTEREST DISCLOSURES: The authors have no potential conflicts of interest relevant to this article to disclose.

Figures

FIGURE 1
FIGURE 1
SUID and cause-specific SUID rates per 100 000 live births, United States, 2015 to 2020. SUID included 3 underlying cause-of-death classifications coded per the ICD-10: SIDS (R95), unknown cause (R99), and ASSB (W75).
FIGURE 2
FIGURE 2
Percent distribution of sudden unexpected infant deaths by cause of death and year, United States, 2015 to 2020. Percentages may not sum to 100 because of rounding. SUID included 3 underlying cause-of-death classifications coded per the ICD-10: SIDS (R95), unknown cause (R99), and ASSB (W75).
FIGURE 3
FIGURE 3
Sudden unexpected infant deaths rates per 100 000 live births under 1 year by race and ethnicity, United States, 2017 to 2020. For groups with <100 deaths, statistical significance was assessed by comparing 95% confidence intervals. If confidence intervals overlap, the difference was not statistically significant (NS) at the 95% level.
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