Dwyer T, Ponsonby A L, Blizzard L, Newman N M, Cochrane J A
Menzies Centre for Population Health Research, University of Tasmania, Hobart, Australia.
JAMA. 1995 Mar 8;273(10):783-9.
To determine the independent contribution of changes in infant sleep position to the recent decline in sudden infant death syndrome (SIDS) rate in Tasmania.
(1) A comparison of the whole population incidence of SIDS before and after an intervention to reduce the prevalence of prone sleeping position. (2) A within-cohort analysis of the contribution of sleep position and other exposures to the decline in SIDS after the intervention.
Tasmania, Australia.
(1) All SIDS cases from 1975 through 1992. (2) A sample of one in five infants born in Tasmania who at perinatal assessment were scored to be at higher risk for SIDS since January 1988. Of 5534 infants included in the study, 39 later died of SIDS.
Multiple public health activities to reduce the prevalence of the prone infant sleeping position in Tasmania and verbal information on the association between prone position and SIDS to cohort participants from May 1, 1991.
Sudden infant death syndrome incidence.
The Tasmanian SIDS rate decreased (P < .01) from 3.8 (95% confidence interval [CI], 3.5 to 4.2) deaths per 1000 live births from 1975 through 1990 to a rate of 1.5 (95% CI, 0.9 to 2.2) deaths per 1000 live births in 1991 through 1992. The SIDS mortality rate in the cohort by period of birth was 7.6 (95% CI, 4.9 to 10.3) deaths per 1000 live births for those born from May 1, 1988, through April 30, 1991, and 4.1 (95% CI, 1.3 to 7.0) deaths per 1000 infants for those born from May 1, 1991, through October 31, 1992. The prevalence of usual prone sleeping position at 1 month of age was 29.9% and 4.3% in these two cohorts, respectively (adjusted odds ratio, 0.11; 95% CI, 0.08 to 0.13). Logistic regression demonstrated that 70% of the SIDS rate reduction in the cohort could be accounted for by the decreased prevalence of the prone sleeping position. Other factors examined individually contributed to less than 10% of the SIDS rate reduction.
The major contributing factor to the recent SIDS rate decline in Tasmania has been the reduction in the proportion of infants usually sleeping prone.
确定婴儿睡眠姿势的变化对塔斯马尼亚州近期婴儿猝死综合征（SIDS）发生率下降的独立作用。
（1）比较一项旨在降低俯卧睡眠姿势流行率的干预措施前后SIDS在整个人口中的发生率。（2）对干预措施实施后睡眠姿势及其他暴露因素对SIDS发生率下降的作用进行队列内分析。
澳大利亚塔斯马尼亚州。
（1）1975年至1992年期间所有的SIDS病例。（2）自1988年1月起在塔斯马尼亚州出生的五分之一婴儿的样本，这些婴儿在围产期评估时被判定为SIDS高危儿。纳入该研究的5534名婴儿中，有39名后来死于SIDS。
开展多项公共卫生活动以降低塔斯马尼亚州婴儿俯卧睡眠姿势的流行率，并自1991年5月1日起向队列参与者提供关于俯卧姿势与SIDS关联的口头信息。
婴儿猝死综合征发生率。
塔斯马尼亚州的SIDS发生率从1975年至1990年每1000例活产儿中有3.8例（95%置信区间[CI]，3.5至4.2）死亡降至1991年至1992年每1000例活产儿中有1.5例（95%CI，0.9至2.2）死亡（P <.01）。按出生时期划分，队列中的SIDS死亡率在1988年5月1日至1991年4月30日出生的婴儿中为每1000例活产儿中有7.6例（95%CI，4.9至10.3）死亡，在1991年5月1日至1992年10月31日出生的婴儿中为每1000例中有4.1例（95%CI，1.3至7.0）死亡。这两个队列中1月龄时通常俯卧睡眠姿势的流行率分别为29.9%和4.3%（调整比值比，0.11；95%CI，0.08至0.13）。逻辑回归分析表明，队列中SIDS发生率下降的70%可归因于俯卧睡眠姿势流行率的降低。单独检查的其他因素对SIDS发生率下降的贡献不到10%。
塔斯马尼亚州近期SIDS发生率下降的主要促成因素是通常俯卧睡眠的婴儿比例的降低。
