After national intervention campaigns, considerable declines in incidence for both sudden infant death (SID) and prone position have been observed worldwide. In the following investigation. German data on postinterventional risk factor patterns are presented for the first time. We analysed data from a 2-year population-based case-control study on SID carried out in two German districts between 1993 and 1994. We confirmed Complete covering of the baby (OR = 44.9, 95%-CI 95, 291), prone sleeping position (OR = 11.7; 5.3, 26.2), heavy maternal smoking during pregnancy (OR = 8.5; 3.2, 33.2 for > ten cigarettes per day), nonbreastfeeding (OR = 7.7; 2.7, 22.3) and missing maternal professional training (OR = 7.6; 3.6, 16.2) as risk factors for cot death. After adjustment for other major risk factors in a logistic regression model, sleeping on cushions lost statistical significance, whereas all other major risk factors remained relevant.
Conclusions: Despite intervention campaigns, complete covering of the baby, prone position and heavy maternal smoking are still major risk factors for cot death. Except for sleeping on cushions, all major epidemiological risk factors for cot death act independently. Despite encouraging success in the reduction of risk factors for cot death, there is still substantial need for future endeavours towards a further reduction of modifiable risk factors for SID.