Epidemiology of SIDS and explained sudden infant deaths
Epidemiology of SIDS and explained sudden infant deaths
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DOI：
10.1542/peds.104.4.e43
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发表时间：
1999-10-01
期刊：
影响因子：
8
通讯作者：
Golding, J
中科院分区：
文献类型：
--
作者：
Leach, CEA;Blair, PS;Golding, J
目标。旨在确定自 1991 年“重返睡眠”运动后死亡率下降以来，婴儿猝死综合症 (SIDS) 的流行病学特征是否发生了变化，并将这些特征与婴儿猝死和意外死亡 (SUDI) 的原因进行比较。设计。为期三年、基于人群的病例对照研究。死后不久就进行了家长访谈，并针对 4 名年龄和访谈日期相匹配的对照进行了访谈。所有突然的意外死亡都被纳入研究中，死因是由相关医疗保健专业人员组成的多学科小组根据母亲和婴儿过去的医疗和社会史、死亡情况以及全面的儿科尸检确定的。死亡的影响因素和最终分类是使用雅芳临床病理系统进行的。英格兰五个地区的总人口超过 1700 万，参与了这项研究。在参与研究的特定时间内，这些地区的活产人数为 473 000。 研究参与者。 325 名 SIDS 婴儿（占可用人数的 91.3%）、72 名解释性 SUDI 婴儿（占可用人数的 86.7%）和 1588 名匹配对照婴儿（占病例总数的 100%）。结果。尽管最近英国 SIDS 发病率有所下降，但 SIDS 婴儿和家庭的许多流行病学特征仍然保持不变。这些因素包括相同的特征年龄分布、出生后最初几周或 6 个月后死亡很少，在 4 至 16 周之间达到高峰、男性发病率较高、出生体重较低、妊娠期较短以及分娩时出现更多新生儿问题。与之前的研究一样，母亲年龄较小和胎次较高与单亲母亲和多胞胎婴儿的风险增加有很强的相关性。一小部分但相当大比例的指标母亲之前也经历过死产或婴儿死亡。大多数 SIDS 死亡（83%）发生在夜间睡眠期间，一周中没有哪一天死亡比例明显更高。自 SIDS 发病率下降以来，主要的流行病学特征发生了变化，包括先前冬季死亡高峰的减少以及 SIDS 家庭向更贫困的社会群体的转变。在本研究的 3 年中，只有超过四分之一的 SIDS 死亡 (27%) 发生在冬季的 3 个月（12 月至 2 月）。在半数 SIDS 家庭（49%）中，单亲或双亲都失业，而对照组家庭中只有不到五分之一（18%）。这种差异不能用指数组中单身母亲过多来解释。许多与 SIDS 婴儿和家庭有关的将其与正常人群区分开来的重要因素并没有区分 SIDS 和解释 SUDI。在单变量分析中，还确定了 SIDS 组中许多显着的流行病学特征，并且在因已知原因而死于 SUDI 的婴儿中也具有相同的方向。所解释的死亡具有相同的婴儿、孕产妇和社会因素，其中 48% 的家庭没有工资收入。使用逻辑回归对两个指数组进行直接比较，两组死亡人数之间只有三个显着差异：1）年龄分布不同，解释的死亡年龄分布在前2个月达到峰值，此后更加均匀； 2) 与 SIDS (8%) 相比，在解释的死亡 (20%) 中，出生时发现更多先天性异常（比值比 [OR] = 3.14；95% 置信区间 [CI]：1.52-6.51），这并不奇怪，因为这些死亡中有 10% 是由先天性异常解释的； 3）SIDS母亲在怀孕期间吸烟的发生率较高，解释的SUDI组中吸烟者的比例（49%）远高于对照组（27%），但SIDS母亲中吸烟者的比例仍然更高（66%），并且这种差异显着（66% vs 49%；OR = 2.03；95% CI：1.16-3.54）。解释的 SUDI 死亡的最大亚组是由感染引起的（46%）。感染死亡人数出现冬季高峰，最高数字出现在 12 月（21%），但这并不显着。这些死亡的多变量模型显示，父母失业是最重要的因素（OR = 27.74；95% CI：3.19-241.34）。胎龄短（OR = 11.67；95% CI：1.84-74.14）、新生儿问题（OR = 14.27；95% CI：1.89-107.81）和男性患病率较高（OR = 9.26；95% CI：1.63-52.52）也很重要。一半的感染死亡发生在拥挤的家庭中（每个房间> 1 名成人或儿童，不包括走廊、厕所、浴室和厨房（如果不用作餐厅））这也是一个重要因素（OR = 10.37；95% CI：1.08-99.59）。结论。该研究确定了“重返睡眠”运动后 SIDS 流行病学特征的变化，并证实死于 SIDS 的婴儿和因某种原因突然死亡的婴儿之间的许多潜在因素是相似的。许多调查 SIDS 的研究报告了与活体对照婴儿相比的许多流行病学特征和与 SIDS 密切相关的危险因素。人们普遍认为这些因素是 SIDS 所特有的，以至于该综合征被描述为“流行病学实体”。与对照人群显着不同的许多与 SIDS 相关的因素与解释的死亡相比并没有显着差异。这表明，无论临床或病理结果如何，SUDI 都具有一些相同的潜在因素，并挑战了 SIDS 作为流行病学实体的严格概念。这一特别的发现表明，虽然在解释性 SUDI 婴儿的母亲中，母亲在怀孕期间吸烟的发生率很高，但在 SIDS 母亲中，母亲在怀孕期间吸烟的发生率明显更高，这为越来越多的证据提供了证据，表明吸烟与 SIDS 之间的关联可能是因果机制的一部分。
Objectives. To establish whether epidemiologic characteristics for sudden infant death syndrome (SIDS) have changed since the decrease in death rate after the "Back to Sleep" campaign in 1991, and to compare these characteristics with sudden and unexpected deaths in infancy (SUDI) from explained causes.Design. Three-year, population-based, case-control study. Parental interviews were conducted soon after the death and for 4 controls matched for age and date of interview. All sudden unexpected deaths were included in the study and the cause of death was established by a multidisciplinary panel of the relevant health care professionals taking into account past medical and social history of the mother and infant, the circumstances of death, and a full pediatric postmortem examination. Contributory factors and the final classification of death were made using the Avon clinicopathologic system.Setting. Five regions in England, with a total population of >17 million people, took part in the study. The number of live births within these regions during the particular time each region was involved in the study was 473 000.Study Participants. Three hundred twenty-five SIDS infants (91.3% of those available), 72 explained SUDI infants (86.7% of those available), and 1588 matched control infants (100% of total for cases included).Results. Many of the epidemiologic features that characterize SIDS infants and families have remained the same, despite the recent decrease in SIDS incidence in the United Kingdom. These include the same characteristic age distribution, few deaths in the first few weeks of life or after 6 months, with a peak between 4 and 16 weeks, a higher incidence in males, lower birth weight, shorter gestation, and more neonatal problems at delivery. As in previous studies there was a strong correlation with young maternal age and higher parity and the risk increased for infants of single mothers and for multiple births. A small but significant proportion of index mothers had also experienced a previous stillbirth or infant death. The majority of the SIDS deaths (83%) occurred during the night sleep and there was no particular day of the week on which a significantly higher proportion of deaths occurred. Major epidemiologic features to change since the decrease in SIDS rate include a reduction in the previous high winter peaks of death and a shift of SIDS families to the more deprived social grouping. Just more than one quarter of the SIDS deaths (27%) occurred in the 3 winter months (December through February) in the 3 years of this study. In half of the SIDS families (49%), the lone parent or both parents were unemployed compared with less than a fifth of control families (18%). This difference was not explained by an excess of single mothers in the index group. Many of the significant factors relating to the SIDS infants and families that distinguish them from the normal population did not distinguish between SIDS and explained SUDI. In the univariate analysis many of the epidemiologic characteristics significant among the SIDS group were also identified and in the same direction among the infants dying as SUDI attributable to known causes. The explained deaths were similarly characterized by the same infant, maternal, and social factors, 48% of these families received no waged income. Using logistic regression to make a direct comparison between the two index groups there were only three significant differences between the two groups of deaths: 1) a different age distribution, the age distribution of the explained deaths peaked in the first 2 months and was more uniform thereafter; 2) more congenital anomalies were noted at birth (odds ratio [OR] = 3.14; 95% confidence intervals [CI]: 1.52-6.51) among the explained deaths (20%) compared with the SIDS (8%), which was not surprising given that 10% of these deaths were explained by congenital anomalies; and 3) a higher incidence of maternal smoking during pregnancy among the SIDS mothers, the proportion of smokers within the explained SUDI group was much higher (49%) than the controls (27%), but among SIDS mothers the proportion of smokers was higher still (66%) and this difference was significant (66% vs 49%; OR = 2.03; 95% CI: 1.16-3.54). The largest subgroup of explained SUDI deaths were those attributable to infection (46%). There was a winter peak of deaths from infection, the highest number occurring in December (21%) but this was not significant. A multivariate model of these deaths showed parental unemployment to be the most significant factor (OR = 27.74; 95% CI: 3.19-241.34). Short gestational age (OR = 11.67; 95% CI: 1.84-74.14), neonatal problems (OR = 14.27; 95% CI: 1.89-107.81), and higher prevalence of males (OR = 9.26; 95% CI: 1.63-52.52) were also significant.Half of the deaths from infection occurred in crowded households (>1 adult or child per room excluding hallways, toilets, bathrooms, and kitchens if not used as a dining room) which was also a significant factor (OR = 10.37; 95% CI: 1.08-99.59). Conclusions. The study identifies changes in the epidemiologic characteristics of SIDS that have followed the "Back to Sleep" campaign, and confirms that many underlying factors are similar between infants who die as SIDS and those dying suddenly of explained causes. Many studies investigating SIDS have reported numerous epidemiologic characteristics and risk factors strongly associated with SIDS when compared with live control infants. It has been generally assumed that these factors are specific to SIDS to the extent that the syndrome has been described as an "epidemiologic entity." Many of the factors associated with SIDS that were significantly different from the control population were not significantly different when compared with the explained deaths. This suggests that SUDI share some of the same underlying factors irrespective of the clinical or pathologic findings, and challenges a rigid concept of SIDS as an epidemiologic entity. The particular finding that the incidence of maternal smoking during pregnancy, although high among mothers of explained SUDI infants, was significantly higher among SIDS mothers, lends weight to the mounting evidence that the association between smoking and SIDS may be part of a causal mechanism.