Unexpected infant death rate increased among Black children in 2020

Key takeaways:

• The rate of sudden infant death syndrome increased 15% from 2019 to 2020.
• The increase was likely a result of a change in reporting practices.
• The rate of sudden unexpected infant deaths increased among non-Hispanic Black infants, possibly because of COVID-19.

The rate of sudden unexpected infant deaths increased significantly among Black children in 2020, possibly because of COVID-19, researchers reported in Pediatrics.

According to the study, the rate of sudden infant death syndrome (SIDS) increased 15% from 2019 to 2020 and accounted for 41% of sudden unexpected infant deaths (SUIDs), becoming the third leading cause of infant death in the country. This came on the heels of a downward trend in SIDS over the previous almost 2 decades.

The authors said the increase was unique to 2020 but it did not appear to be related to COVID-19, with less than 10 of the more than 3,300 identified SUIDs having a COVID-19 code. They instead attributed the increased to a “diagnostic shifting.”

“The declining SIDS trend during 2015 to 2019 without an increasing overall SUID trend is consistent with trends observed during 1990 to 2015 and provides evidence of a continued diagnostic shift,” they wrote. “Conversely, the 2020 uptick in the SIDS rate compared to 2019 may be initial evidence of new changes in reporting practices.”

Using national data, the researchers found that 3,328 of all infant deaths in 2020 were classified as SUID.

The only group in which SUIDs were observed to increase significantly was non-Hispanic Black infants. The 2020 SUID rate for this group was 214 out of 100,000 — higher than any of the previous 3 years and nearly three times the rate for non-Hispanic white infants (75.6 per 100,000).

According to the researchers, “the significant increased rate of SUID among non-Hispanic Black infants from 2019 to 2020, but not among other single race and Hispanic infants, deserves further attention because it could be attributable to the COVID-19 pandemic and its impact on social determinants of health.”

The study was accompanied by an editorial authored by Rebecca F. Carlin, MD, from Columbia University Irving Medical Center; and Fern R. Hauck, MD, MS, and Rachel Y. Moon, MD, both of the University of Virginia School of Medicine.

“We agree with the authors that, given that the overall SUID rate over this same period is stable, the variations in SIDS rates likely reflect shifting diagnostic criteria rather than a true rise,” they wrote.

The authors did note, however, that such diagnostic shifts highlighted the need for “increased uniformity in SUID investigations and cause of death certification.”

“Without standardization of certification of deaths, it becomes almost impossible to track true trends in the subcategories of SUID, which, in turn limits, our ability to better understand the pathophysiology of these deaths and to develop targeted educational interventions,” they wrote.

They said the disparity in SUID rates during the first year of the COVID-19 pandemic “reflect our societal failures.”

“The United States has one of the highest SUID rates for all middle- and high-income countries that track these deaths, and the findings regarding increasing disparities sound the alarm about the need for interventions that look beyond individual counseling and toward community- and society-level solutions,” they wrote. “All infants deserve a better start in life than we in the United States are providing to them now.”

References:

Carlin RF, et al. Pediatrics. 2023;doi:10.1542/peds.2022-060798.

Shapiro-Mendoza CK, et al. Pediatrics. 2023;doi:10.1542/peds.2022-058820.