McLaughlin S A, Valdes M G, Jacobson R M, Wollan P C, Beard C M, Weissman L, Jacobsen S J
Mayo Medical School, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1995 Sep;70(9):837-43. doi: 10.1016/S0025-6196(11)63940-2.
To apply uniform diagnostic criteria for sudden infant death syndrome (SIDS) for an extended period for comparison of incidence rates from 1945 to 1992 in Olmsted County, Minnesota, to investigate the influence of a person-time or live birth denominator on the estimate of incidence, to calculate the proportionate mortality rate for SIDS over time, and to evaluate the accuracy of death certificates for case ascertainment and the role of interobserver variation in case classification.
We retrospectively reviewed the autopsy results and complete medical records for all infant death from 1945 through 1992 for residents of Olmsted County, Minnesota.
Cases were identified from a computerized list of all Olmsted County deaths of infants occurring at ages 48 hours to 365 days. All resident cases were categorized as non-SIDS, possible SIDS, SIDS, or incomplete, on the basis of findings from autopsy and clinical history. Incidence rates were calculated for two different SIDS groups and with use of denominators of person-time and live births.
For the study period, 82 cases of SIDS were identified (97% white and 3% Asian). The mean age at death was 12.5 weeks; male infants constituted 59% of cases. No significant trend in seasonal distribution was noted; 73% of deaths occurred between midnight and noon. The incidence rate, defined as SIDS definite and possible deaths per 1,000 resident live births, increased from 0.55 in 1950 through 1953 to 1.28 in 1990 through 1992. The secular trend was best described by a linear model with constant positive slope. Similar trends were observed with other definitions of incidence. During the study period, SIDS as a percentage of total infant deaths dramatically increased, ranging from 2.5 in 1950 through 1953 to 17.9 in 1990 through 1992. The death certificate diagnosis correctly predicted 72% of SIDS cases before 1970 and 100% of cases after 1970.
Since 1945, the incidence of SIDS apparently has increased, although diagnostic transfer from other causes of death probably contributes to the observed trend. The comparison of live births versus person-time as denominators showed no significant difference in incidence rates. Interobserver reliability is modest for SIDS cases diagnosed before 1970 and may contribute to the variability in reported SIDS incidence rates.
应用统一的婴儿猝死综合征（SIDS）诊断标准，对明尼苏达州奥尔姆斯特德县1945年至1992年期间的发病率进行长期比较，研究人时或活产分母对发病率估计的影响，计算不同时期SIDS的比例死亡率，并评估死亡证明用于病例确定的准确性以及观察者间差异在病例分类中的作用。
我们回顾性分析了明尼苏达州奥尔姆斯特德县1945年至1992年期间所有婴儿死亡的尸检结果和完整病历。
从奥尔姆斯特德县所有48小时至365天龄婴儿死亡的计算机列表中识别病例。根据尸检结果和临床病史，将所有常住病例分为非SIDS、可能SIDS、SIDS或不完整病例。计算了两个不同SIDS组的发病率，并使用人时和活产作为分母。
在研究期间，共识别出82例SIDS病例（97%为白人，3%为亚洲人）。死亡时的平均年龄为12.5周；男婴占病例的59%。未观察到明显的季节分布趋势；73%的死亡发生在午夜至中午之间。发病率定义为每1000例常住活产中确诊和可能的SIDS死亡数，从1950年至1953年的0.55上升至1990年至1992年的1.28。长期趋势用具有恒定正斜率的线性模型描述最佳。用其他发病率定义也观察到类似趋势。在研究期间，SIDS占婴儿总死亡数的百分比显著增加，从1950年至1953年的2.5%增至1990年至1992年的17.9%。1970年前死亡证明诊断正确预测了72%的SIDS病例，1970年后为100%。
自1945年以来，SIDS的发病率明显上升，尽管从其他死因的诊断转移可能导致了观察到的趋势。以活产与人时作为分母进行比较，发病率无显著差异。1970年前诊断的SIDS病例观察者间可靠性一般，可能导致报告的SIDS发病率存在差异。
