(SDAS) The interplay between bedsharing and other known risk factors for SIDS in African American infants

Project Number: R40 MC 08963-01
Project Date: 2/1/2008
Grantee: Children's Research Institute
Department/Center: Goldberg Center for Community Health

Final Report

Pending

Principal Investigator

Rachel Moon MD,
Director, Academic Development, Children's Research Institute Goldberg Center for Community Health,
111 Michigan Avenue, NW
Washington, DC 20010-2978
rmoon@cnmc.org

Abstract

Despite the tremendous success of the Back to Sleep campaign, African-American infants remain twice as likely to die from sudden infant death syndrome (SIDS) compared with Caucasian infants. This racial disparity exists across all educational and income categories, and the extent of the racial disparity has increased rather than decreased over time. The Maternal and Child Health Bureau (MCHB) has highlighted elimination of health barriers and disparities as one of its goals and strategic research priorities. Epidemiologic studies have demonstrated that bedsharing, i.e., infants sleeping in a bed with other children or adults, is an important risk factor for SIDS. Studies have also demonstrated a protective effect of room sharing without bedsharing. As a result of these studies, the AAP recommends that infants sleep in a parent's room, but separately in a crib or bassinet to reduce the risk of SIDS. Studies have demonstrated an increased prevalence of bedsharing among African-American infants compared with infants of other ethnicities, potentially contributing to their higher rates of SIDS. However, very little is known about the interplay of other SIDS risk factors, including infant, maternal and sleep environment factors, with bedsharing in African-American infants. The Chicago Infant Mortality Study (CIMS) is the most comprehensive and largest existing case-control study that includes SIDS and other sudden infant deaths and it is the only one that focuses primarily on African-American infants. Previous analysis of CIMS found that bedsharing was a strong risk factor for SIDS. The current study will, through secondary data analysis, further examine the risk of bedsharing for SIDS among African-American infants, including interaction with factors not previously analyzed. In addition, the potential protective effect of roomsharing without bedsharing in this population will be examined. Our specific aims are: 1) to describe aspects of the sleep environment and characteristics of infants who bedshare compared with infants who do not bedshare (both cases and controls) to better understand what factors might influence the choice of sleeping arrangement (bedsharing) and risk associated with bedsharing, 2) to measure the interaction between bedsharing and other risk factors for SIDS, 3) to describe the effect of maternal weight on the risk for SIDS among bedsharing infants, and 4) to describe the effect of roomsharing with parents without bedsharing compared with either sleeping in a separate room or bedsharing. We will be performing secondary data analysis of the CIMS database. We will specifically analyze data from 195 African-American SIDS cases and 195 matched controls. The data sources include: death scene investigation for case infants, family interviews, birth certificates, and abstracted medical records. We will measure risk factors associated with bedsharing for SIDS by comparing those infants who died of SIDS and their matched controls on these factors. The variables to be analyzed include factors that have been found to be associated with bedsharing deaths in published studies from other countries and cover a range of maternal, social, infant and environmental variables. To compare the case infants with the living control infants, odds ratios (OR), 95% confidence intervals (CI), and P-values will be calculated taking into account the matched design. For multivariate analysis, conditional logistic regression will be run using the stepwise method for selection of variables. The results of this study will help us formulate a conceptual framework to better understand the factors that contribute to SIDS when infants bedshare with others. Since African-Americans bedshare more than other ethnic groups and have a higher rate of SIDS, focusing on bedsharing is likely to reveal important and new results that will help guide preventive strategies and recommendations, with the long-term goal of further reducing the incidence of SIDS and eliminating racial/ethnic disparities in this cause of infant mortality.

Publications

Pending

Keywords

African Americans, infant mortality, sudden infant death syndrome, urban population, anticipatory guidance, data analysis