472 - National trends and racial/ethnic disparities in Sudden Unexpected Infant Death (SUID) among preterm infants

Poster Number: 472
Publication Number: 472.129

Sunah S. Hwang, University of Colorado School of Medicine, Aurora, CO, United States; Stephanie L. Bourque, University of Colorado School of Medicine, Greenwood Village, CO, United States; Kathleen E. Hannan, University of Colorado School of Medicine, DENVER, CO, United States; Molly Passarella, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Scott A. Lorch, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States

Background: SUID Is the leading cause of post-neonatal mortality among U.S.-born infants. Preterm infants ( < 37 weeks gestational age) are nearly 2-4x more likely to suffer SUID than full term infants.  Despite their higher risk, data on variation across sub-populations and by state in SUID among preterm infants are lacking.  Moreover, racial/ethnic disparities in SUID has been assessed for infants in aggregate and not stratified by preterm status.

Objective: Among U.S.-born preterm infants, investigate a) state variation in SUID rates and b) racial/ethnic disparities in SUID.

Design/Methods: In this retrospective cohort analysis of linked birth and death certificates from 50 states from 2005-2014, SUID was defined by the following ICD9/10 codes listed on death certificates: (7980, R95 or Recode 135; ASSB: E913, W75 or Recode 146; Unknown: 7999 R99 or Recode 134). Multivariate models were used to assess the independent association between maternal and infant factors and SUID. Racial/ethnic disparities in SUID were assessed by measuring the difference in unadjusted and adjusted ORs for each racial/ethnic group relative to non-Hispanic white (NHW) infants for the entire cohort and then for each individual state.

Results: Among 4,095,548 preterm infants born during the study period, 8107 infants (0.2% or 2.0 per 1000 live births) experienced SUID. State variation in SUID ranged from the lowest rate of 0.82 per 1000 live births in Vermont to the highest rate of 3.87 per 1000 live births in Mississippi (Figure 1). SUID rates across racial/ethnic groups varied from 0.69 (Asian/PI) to 3.51 (Non-Hispanic Black) per 1000 live births. In the adjusted analysis, compared to NHW infants, NHB and Alaska Native/American Indian (AN/AI) preterm infants had greater odds of SUID (AOR 1.5; 95% CI 1.42-1.59; AOR 1.44, 95% CI:1.21-1.72) with varying magnitude of disparities across states. (Table 1).Conclusion(s): Significant racial/ethnic disparities in SUID among preterm infants exist with variation across U.S. states.  Additional research to identify the drivers of these disparities within and across states is needed.
Table 1: Unadjusted SUID Rates and Adjusted Odds Ratios with 95% Confidence Intervals
Figure 1: SUID Rates (per 1000 live births) by U.S. States