Accidental Infant Suffocation and Strangulation in Bed: Disparities and Opportunities

Matern Child Health J. 2019 Dec;23(12):1670-1678. doi: 10.1007/s10995-019-02786-5.


Objectives (a) Update previous descriptions of trends in ASSB; (b) determine if factors previously associated with ASSB are replicated by updated data; and (c) generate new hypotheses about the occurrence of ASSB and racial inequalities in ASSB mortality. Methods National Center for Health Statistics files (International Classification of Diseases, Tenth Edition) Code W75 to describe race-ethnicity-specific ASSB occurrence. Results (a) ASSB mortality continues to increase significantly; for 1999-2016, 4.4-fold for NHB girls (45.8 per 100,000 in 2016), 3.5-fold for NHB boys (53.8), 2.7-fold for NHW girls (15.8) and 4.0-fold for NHW boys (25.9); (b) F actors previously associated with ASSB (unmarried mothers and mothers with low educational attainment, low infant birth weight, low gestational age, lack of prenatal care, male infant, multiple birth, high birth order) continue to be associated with both overall ASSB and inequalities adversely affecting NHB; (c) (1) geographic differences and similarities in ASSB occurrence support hypotheses related to positive deviance; (2) lower ASSB mortality for births attended by midwives as contrasted to physicians generate hypotheses related to both medical infrastructure and maternal engagement; (3) high rates of ASSB among infants born to teenage mothers generate hypotheses related to the possibility that poor maternal health may be a barrier to ASSB prevention based on education, culture and tradition. Conclusions for Practice These descriptive data may generate new hypotheses and targets for interventions for reducing both ASSB mortality and racial inequalities. Analytic epidemiologic studies designed a priori to do so are required to address these hypotheses.

Keywords: Accidental suffocation and strangulation in bed (ASSB); Infant mortality; Racial disparities; Sudden unexpected infant deaths (SUID); United States (US).

MeSH terms

  • Accidents, Home / mortality
  • Accidents, Home / statistics & numerical data
  • Adolescent
  • Asphyxia / mortality*
  • Ethnicity / statistics & numerical data
  • Female
  • Humans
  • Infant
  • Infant Mortality / ethnology*
  • Infant Mortality / trends
  • Infant, Newborn
  • Male
  • Maternal Age
  • Population Surveillance
  • Pregnancy
  • Racial Groups / statistics & numerical data*
  • Sudden Infant Death / ethnology*
  • Surveys and Questionnaires
  • United States / epidemiology
  • Young Adult