Department of Medicine, Cambridge Health Alliance and Harvard Medical School, Cambridge, Massachusetts.
Department of Anthropology, Parent-Infant Sleep Lab, Durham University, Durham, UK.
Matern Child Nutr. 2019 Jan;15(1):e12652. doi: 10.1111/mcn.12652. Epub 2018 Aug 23.
Sudden unexpected infant death (SUID) and sudden infant death syndrome (SIDS) prevention has focused on modifying individual behavioural risk factors, especially bedsharing. Yet these deaths are most common among poor and marginalized people in wealthy countries, including U.S. Blacks, American Indians/Alaskan Natives, New Zealand Māori, Australian Aborigines, indigenous Canadians, and low-income British people. The United States now has the world's highest prevalence of SUID/SIDS, where even Whites' SIDS prevalence now approaches that of the Māori. Using public databases and the literature, we examine SUID/SIDS prevalence and the following risk factors in selected world populations: maternal smoking, preterm birth, alcohol use, poor prenatal care, sleep position, bedsharing, and formula feeding. Our findings suggest that risk factors cluster in high-prevalence populations, many are linked to poverty and discrimination and have independent effects on perinatal outcomes. Moreover, populations with the world's lowest rates of SUID/SIDS have low income-inequality or high relative wealth, yet have high to moderate rates of bedsharing. Employing syndemics theory, we suggest that disproportionately high prevalence of SUID/SIDS is primarily the result of socially driven, co-occurring epidemics that may act synergistically to amplify risk. SUID must be examined through the lens of structural inequity and the legacy of historical trauma. Emphasis on bedsharing may divert attention from risk reduction from structural interventions, breastfeeding, prenatal care, and tobacco cessation. Medical organizations play an important role in advocating for policies that address the root causes of infant mortality via poverty and discrimination interventions, tobacco control, and culturally appropriate support to families.
婴儿猝死（sudden unexpected infant death，SUID）和婴儿猝死综合征（sudden infant death syndrome，SIDS）的预防主要集中在改变个体行为风险因素上，尤其是与床伴同睡。然而，这些死亡在富裕国家的贫困和边缘化人群中最为常见，包括美国黑人、美国印第安人/阿拉斯加原住民、新西兰毛利人、澳大利亚原住民、加拿大原住民以及低收入的英国人。美国现在是世界上 SUID/SIDS 发病率最高的国家，即使是白人的 SIDS 发病率现在也接近毛利人的水平。我们利用公共数据库和文献，研究了 SUID/SIDS 的发病率以及以下特定世界人群的风险因素：母亲吸烟、早产、饮酒、产前保健不佳、睡眠姿势、与床伴同睡和配方奶喂养。我们的研究结果表明，风险因素在高发病率人群中聚集，许多因素与贫困和歧视有关，对围产期结局有独立影响。此外，世界上 SUID/SIDS 发病率最低的人群收入不平等程度较低或相对财富较高，但与床伴同睡的比例较高。采用综合征理论，我们认为 SUID/SIDS 发病率过高主要是由社会驱动、同时发生的流行病共同作用的结果，可能会协同放大风险。必须从结构性不平等和历史创伤的角度来看待 SUID。过分强调与床伴同睡可能会分散人们对通过结构性干预、母乳喂养、产前保健和戒烟来降低风险的注意力。医疗机构在倡导通过贫困和歧视干预、烟草控制以及对家庭的文化适宜支持来解决婴儿死亡率根源的政策方面发挥着重要作用。
