Comparison of Risk Factors for SIDS and Other Sudden Unexpected Deaths in Infancy

描述(申请人提供)：婴儿意外猝死占新生儿后期死亡总数的近一半。婴儿猝死综合征(SIDS)是新生儿后死亡的唯一主要原因，占意外死亡的一半。其余的死亡(以下称为婴儿期突然意外死亡或“SUDI”)是由窒息/窒息、其他伤害、感染、他杀、不明原因造成的。尽管自回归睡眠运动开始以来，所有种族/民族的小岛屿发展中国家的发病率都有所下降，但与白人相比，黑人的小岛屿发展中国家的发病率和新生儿死亡率仍然是白人的两倍。此外，小岛屿发展中国家和新生儿后死亡率已趋于稳定。为了扭转这些令人不安的趋势，必须更好地了解和处理与小岛屿发展中国家和其他可持续发展倡议有关的因素。这项研究建议分析之前从芝加哥婴儿死亡率研究(CIMS)收集的数据，以衡量产前和新生儿、社会和环境因素与SUDI风险之间的关联。其目的是确定风险因素：1)对于SUDI，主要集中在高风险的非裔美国人群体；2)小岛屿发展中国家和SUDI共同的风险因素；以及3)小岛屿发展中国家和SUDI之间的差异。CIMS是迄今为止对小岛屿发展中国家和南美登革热进行的最全面的病例对照研究。它使用标准化的诊断程序，包括尸检、死亡现场调查和临床病史回顾，以区分SID和其他SUDI原因。CIMS包括260名死于小岛屿发展中国家的婴儿和209名死于SUDI的婴儿(1993年11月至1996年4月)。大多数婴儿(76.8%)是非裔美国人；13.4%是白人，西班牙裔，9.8%是白人，非西班牙裔。活着的对照组婴儿在种族/民族、出生体重和年龄方面与病例婴儿匹配。分析将比较SUDI和SIDS病例与他们各自的对照组；将计算优势比(OR)、95%可信区间(CI)和P值。多元条件Logistic回归将使用逐步选择变量的方法进行。将计算SID和SUDI OR以及相关的CI和P值的比率，以检测它们之间的任何潜在差异。确定SUDI的风险因素将有助于制定针对这些可能可预防的婴儿死亡原因的教育干预措施。了解SID和SUDI共有的风险因素将使干预措施能够以一致的信息同时针对多种疾病。最后，通过研究小岛屿发展中国家与其他SUDI的危险因素的差异，我们期望提供进一步的流行病学证据，支持产前和出生后环境暴露在小岛屿发展中国家病因中的独特作用。NICHD的小岛屿发展中国家战略计划侧重于通过调查人口内部和人口之间的各种因素来缩小差距。这项研究的结果将有助于指导预防战略，长期目标是进一步减少小岛屿发展中国家和小儿麻痹症的发病率，消除这些婴儿死亡原因中的种族/族裔差异，并实现2010年健康人制定的国家目标。

DESCRIPTION (provided by applicant): Sudden unexpected infant deaths account for close to half of all deaths in the postneonatal period. Sudden infant death syndrome (SIDS) is the single leading cause of postneonatal mortality and is responsible for half of the unexpected deaths. The remaining deaths (hereafter called sudden unexpected deaths in infancy or "SUDI") are caused by suffocation/asphyxiation, other injuries, infections, homicide, unspecified, and other causes. Despite reductions in the rate of SIDS for all racial/ethnic groups since the Back to Sleep campaign began, Blacks still experience twice the incidence of SIDS and postneonatal mortality compared with Whites. Further, rates of SIDS and postneonatal mortality have stabilized. In order to reverse these disturbing trends, it is critical to better understand and address the factors associated with both SIDS and other SUDI. This study proposes to analyze previously collected data from the Chicago Infant Mortality Study (CIMS) to measure the association between prenatal and neonatal, social, and environmental factors and the risk for SUDI. The aims are to identify risk factors: 1) for SUDI, focusing largely on a high-risk, African American population; 2) that are common to both SIDS and SUDI; and 3) that differ between SIDS and SUDI. CIMS is the most comprehensive case-control study of SIDS and SUDI ever conducted. It used standardized diagnostic procedures including autopsy, death scene investigation, and review of the clinical history to make the distinction between SIDS and other causes of SUDI. CIMS includes 260 infants who died from SIDS and 209 who died from SUDI (November 1993-April 1996). The majority of infants (76.8%) were African American; 13.4% were White, Hispanic and 9.8% were White, non-Hispanic. Living control infants were matched to the case infants on race/ethnicity, birth weight and age. Analyses will compare the SUDI and SIDS case infants with their respective controls; odds ratios (OR), 95% confidence intervals (Cl), and P-values will be calculated. Multivariate conditional logistic regression will be run using the stepwise method for selection of variables. The ratio of the SIDS and SUDI ORs and associated CIs and P-values will be computed to detect any potential differences between them. Identifying risk factors for SUDI will aid in the development of educational interventions that target these potentially preventable causes of infant death. Learning the risk factors that are common to both SIDS and SUDI will enable interventions to target multiple disorders simultaneously with consistent messages. Finally, by examining differences in risk factors between SIDS and other SUDI, we expect to provide further epidemiological evidence that supports the unique role of adverse prenatal and postnatal environmental exposures in the causal pathway of SIDS. The NICHD's strategic plan for SIDS focuses on reducing disparities through the investigation of factors operating within and across populations. The results of this study will help guide preventive strategies, with the long-term goal of further reducing the incidence of SIDS and SUDI, eliminating racial/ethnic disparities in these causes of infant mortality, and achieving national targets established by Healthy People 2010.