High incidence of sudden infant death syndrome among Northern Indians and Alaska Natives compared with Southwestern Indians: Possible role of smoking

Abstract

Epidemiologic studies of sudden infant death syndrome (SIDS) in the United States have found a particularly high incidence among American Indians and Alaska Natives compared with whites. This report shows that there is a remarkable difference in the incidence of SIDS between Northern Indians and Southwestern Indians. From 1984 through 1986, the incidence of SIDS was 4.6 per 1,000 live births among Indians and Alaska Natives in the Northern region of the United States, while the incidence among Southwestern Indians was 1.4 per 1,000 live births (risk ratio = 3.4; 95 percent confidence interval = 2.4-4.8). Among whites living in the same regions, the incidence of SIDS was 2.1 and 1.6 per 1,000 live births, respectively. The incidence among Native Americans in the Northern region was high in all five Indian Health Service Areas. Differences in socioeconomic status, maternal age, birth weight, and prenatal care did not appear to explain the higher incidence of SIDS among Northern Indians compared with Southwestern Indians. However, the prevalence of maternal cigarette smoking during pregnancy is exceptionally high among Northern Indians and Alaska Natives, while it is low among Southwestern Indians. This difference in smoking habits may explain, at least in part, the excess risk of SIDS among Indians in the Northern region. This report points to the need for effective smoking cessation programs for Native Americans, targeting in particular women of reproductive age.

Sudden Infant Death Syndrome and Smoking in the United States and Sweden

“…In populations with high baseline SIDS rates, other factors not measured in this study (such as infant sleep position, breastfeeding, or other socioeconomic or environmental differences) may be operating to keep SIDS rates high and may have lessened the relative effect of maternal smoking. The high odds ratio for American Indians after adjustment for available covariates clearly suggests the presence of other factors in explaining the high SIDS rates for this group (20)(21)(22)(23). Still, the fact that excess risk for American Indians and American blacks decreased substantially after adjusting for available covariates suggests that intervention programs designed to decrease the proportion of high-risk births and to lower smoking prevalence might prevent a substantial number of SIDS deaths for these groups.…”

American Indian and Alaska Native Infant and Pediatric Mortality, United States, 1999–2009

“…25,42---44 The overall AI/AN death rate for SIDS was 2 times higher in AI/AN infants compared with White infants in this study, a finding that was consistent with studies conducted over the last 25 years. 8,45,46 Even more striking was the marked regional variation, with Alaska and Northern Plains AI/AN infants having regional rates 4 times that of White infants. The differences in SIDS rates have not been explained by socioeconomic status, maternal age, birth weight, or prenatal care.…”

Effects of alcohol and smoking during pregnancy on infant autonomic control

“…One obvious explanation for the extremely high SIDS rate on the Northern Plains Reservations is the high incidence of risk factors associated with impoverished prenatal conditions as well as an increased probability of postnatal stressors. These include smoking during pregnancy, maternal anemia, young maternal age, low education attainment, high parity, and crowded living and sleeping conditions (Bulterys, 1990; Oyen, Bulterys, Welty, & Kraus, 1990; Petersen et al, 1984). Maternal alcohol consumption during pregnancy is prevalent and has emerged as a SIDS risk on the Northern Plains Reservations (Oyen et al, 1990).…”