Shipstone Rebecca A, Young Jeanine, Kearney Lauren, Thompson John M D
School of Nursing, Midwifery, and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia.
Departments of Paediatrics, Child and Youth Health, and Obstetrics and Gynaecology, Faculty of Medical and Health Science, University of Auckland, Auckland, New Zealand.
Front Public Health. 2020 Oct 20;8:563573. doi: 10.3389/fpubh.2020.563573. eCollection 2020.
Sudden Unexpected Death in Infancy (SUDI) is a leading cause of preventable infant mortality and strongly associated with social adversity. While this has been noted over many decades, most previous studies have used single economic markers in social disadvantage analyses. To date there have been no previous attempts to analyze the cumulative effect of multiple adversities in combination on SUDI risk. Based on sociological theories of social exclusion, a multidimensional framework capable of producing an overall measure of family-level social vulnerability was developed, accounting for both increasing disadvantage with increasing prevalence among family members and effect of family structures. This framework was applied retrospectively to all cases of SUDI that occurred in Queensland between 2010 and 2014. Additionally, an exploratory factor analysis was performed to investigate whether differing "types" of vulnerability could be identified. Increased family vulnerability was associated with four major known risk factors for sudden infant death: smoking, surface sharing, not-breastfeeding and use of excess bedding. However, families with lower levels of social vulnerability were more likely to display two major risk factors: prone infant sleep position and not room-sharing. There was a significant positive relationship between family vulnerability and the cumulative total of risk factors. Exploratory factor analysis identified three distinct vulnerability types (chaotic lifestyle, socioeconomic and psychosocial); the first two were associated with presence of major SUDI risk factors. Indigenous infants had significantly higher family vulnerability scores than non-Indigenous families. A multidimensional measure that captures adversity across a range of indicators highlights the need for proportionate universalism to reduce the stalled rates of sudden infant death. In addition to information campaigns continuing to promote the importance of the back-sleeping position and close infant-caregiver proximity, socially vulnerable families should be a priority population for individually tailored or community based multi-model approaches.
婴儿猝死综合征（SUDI）是可预防的婴儿死亡的主要原因，且与社会逆境密切相关。尽管这一情况已被关注数十年，但之前的大多数研究在社会劣势分析中仅使用单一经济指标。迄今为止，尚无研究尝试分析多种逆境因素综合起来对SUDI风险的累积影响。基于社会排斥的社会学理论，开发了一个多维框架，该框架能够对家庭层面的社会脆弱性进行综合衡量，同时考虑到家庭成员中劣势程度随患病率增加的情况以及家庭结构的影响。该框架被追溯应用于2010年至2014年在昆士兰州发生的所有SUDI病例。此外，还进行了探索性因素分析，以调查是否能识别出不同类型的脆弱性。家庭脆弱性增加与婴儿猝死的四个主要已知风险因素相关：吸烟、共用睡眠表面、非母乳喂养和使用过多床上用品。然而，社会脆弱性较低的家庭更有可能表现出两个主要风险因素：婴儿俯卧睡眠姿势和非同室睡眠。家庭脆弱性与风险因素的累积总数之间存在显著的正相关关系。探索性因素分析确定了三种不同的脆弱性类型（混乱的生活方式、社会经济和心理社会）；前两种与主要SUDI风险因素的存在有关。原住民婴儿的家庭脆弱性得分显著高于非原住民家庭。一个能涵盖一系列指标中的逆境情况的多维衡量方法凸显了采取相称普遍主义以降低婴儿猝死停滞率的必要性。除了继续开展宣传活动以推广仰睡姿势和婴儿与照顾者近距离接触的重要性外，社会脆弱家庭应成为采用个性化或基于社区的多模式方法的优先人群。
