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While rates of sudden infant death syndrome (SIDS) increased in 2020, evidence does not support direct or indirect effects of the COVID-19 pandemic on these increased rates, except among Black infants, an analysis suggested.

While the rates of sudden unexpected infant death (SUID) did not increase significantly from 2019 to 2020, the rates of SIDS did, from 33.3 to 38.2 per 100,000 live births, after a significant decreasing linear trend in the SIDS rate was observed from 2015 to 2019 (P<0.001), reported Carrie Shapiro-Mendoza, PhD, MPH, of the Division of Reproductive Health at the CDC, and colleagues.

Of the 19,446 infant deaths in 2020, 0.2% listed COVID as an underlying cause of death, and of the 3,328 classified as SUID in 2020, fewer than 10 had a COVID code indicating an additional cause of death, they noted in .

"To better understand what may have led to the increased SIDS rate, we considered changes in SIDS rates along with other SUID rates," Shapiro-Mendoza told 番茄社区app in an email. "Understanding how and why SUID rates and disparities are changing can importantly inform program planners so they can adapt and implement risk reduction approaches for those infants at highest risk."

"The lack of increasing SUID rates together with the small number of SUID that also had a COVID-19 cause-of-death code makes it unlikely that increased SIDS and SUID rates from 2019 to 2020 were directly related to infant COVID-19 infection," Shapiro-Mendoza and colleagues wrote. "However, 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."

Black infants had the highest SUID rates per 100,000 live births in 2020, at 214.0, followed by American Indian or Alaskan Native (AIAN) infants, at 205.1, compared with a rate of 75.6 for white infants. The 2020 SUID rate for Black infants was higher than any time during 2017 to 2019 (range 187.3-192.1). Furthermore, the SUID ratio for Black infants versus white infants increased yearly, from 2.2 in 2017 to 2.8 in 2020.

"Factors exacerbated by the COVID-19 pandemic and related stay-at-home orders (e.g., access to healthcare, changes to or loss of childcare, parental or caregiver financial and emotional stressors, and increased parental or caregiver substance use) may have also influenced the increased SUID rate among non-Hispanic Black infants in 2020," the authors wrote. "These factors affect family vulnerability and may have increased unsafe sleep practices (e.g., bedsharing), thereby increasing the occurrence of SIDS and other sudden unexpected infant deaths."

Asian and Hispanic infants had the lowest rates of SUID per 100,00 live births, at 23.3 and 59.0.

"These latest data about the SUID rates during the first year of the COVID-19 pandemic reflect our societal failures," wrote Rachel Moon, MD, of the University of Virginia School of Medicine in Charlottesville, and colleagues .

"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 added. "All infants deserve a better start in life than we in the United States are providing to them now."

For this study, Shapiro-Mendoza and colleagues used U.S. period-linked birth and death data from 2015 to 2020. SUID included SIDS, unknown causes, and accidental suffocation and strangulation in bed.

Among infant deaths classified as SUID in 2020, 41% were classified as SIDS. For all years studied, the percentage classified as SIDS was higher than deaths classified as unknown cause (range 31-37%) and accidental suffocation and strangulation in bed (range 24-28%).

Of note, Shapiro-Mendoza and team said that they could not definitively answer whether SUID rates changed because of the pandemic. In addition, data did not include deaths during the Delta and Omicron waves. The researchers also acknowledged that they did not further disaggregate racial or ethnicity groups, which may have masked higher rates of infant mortality, such as for Hispanic subgroups, like Puerto Rican infants.

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