Safe Sleep Dept. Homeless Services training

Infant Injury Deaths in New York City

Martine Hackett Ph.D., MPHBureau of Maternal, Infant and Reproductive Health

New York City Department of Health and Mental Hygiene

Source: Bureau of Vital Statistics

Infant Mortality Rate NYC 1898-2009

2009 Historic Low IMR: 5.3 deaths/1000 live births

Source: BVS

Infant Mortality Rate NYC by Gestational Age, 1995-2009

Source: Bureau of Vital Statistics

Infant Mortality Rate NYC 2009 by Race/Ethnicity

Geographic Disparities in Infant Mortality NYC 2005-2009

Highest IMR: Brownsville 11.3

Followed by:

East NY, Bed Stuy, Jamaica, St. Albans, Central Harlem, East Harlem

6

9.0

5.9

2.7

7.1

0

1

2

3

4

5

6

7

8

9

Ra

te p

er

10

,00

0 li

ve b

irth

s

Short gestation and LBW

Birth defects

Cardiovascular disorders

Respiratory distress of the newborn

4.3

3.5

0.10.8

0

1

2

3

4

5

6

7

8

9

Rat

e pe

r 10

,000

live

birt

hs

InjuryBirth Defects

SIDSOther Respiratory Causes

Neonatal Postneonatal

Leading Causes of Neonatal and Postneonatal Death, NYC 2009

Source: Bureau of Vital Statistics; compiled by BMIRH

Source: Bureau of Vital Statistics; compiled by BMIRH

Diagnostic Shift in Classification of Infant Deaths, Injury vs. SIDS

NYC 1993-2009

0

10

20

30

40

50

60

70

80

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

2008

2009

IMR

per

100

,000

Liv

e B

irth

s

SIDS Injury

Infant Deaths NYC 2004-2007

Infant injuryN=256

UnintentionalInjury Deaths

N=53

Undetermined Injury Deaths

N=165

Suffocation DeathsN=38

EXCLUDED:Intentional &therapeutic

complication deaths

Excluded: Fire, Drowning, Falls, Poisoning

Source: Bureau of Vital Statistics

SIDS

N=35

10

What are the characteristics of infants who die of sleep related injury deaths in

NYC?• Infant Mortality Review Committee reviewed

data from two sources– Office of Vital Statistics

• Birth and Death Certificates

– Office of Chief Medical Examiner • Autopsy • Death Scene Investigation • Family Interview• Provider Interview

• Data from 2004-2007 analyzed for Accidental Suffocation and Undetermined causes of death

Demographic Characteristics

• Infants who die of Undetermined Injury deaths are predominantly:– Between 28 days-4 months old– Born full term– Mothers are Black, non Hispanic– Mothers are U.S. born– Mothers age is <20– Mother’s education is </=12 years

Circumstances at time of death

*Chi-Sq p<.05

Excess Bedding** at Time of Death by Cause of Death, NYC 2004-2007*

17%

40%

43%

26%

11%

63%

22%

17%

61%

0%

20%

40%

60%

80%

100%

SIDS (N=35) Suffocation (N=38) Undetermined(N=165)

ExcessBedding

No ExcessBedding

Unknown orNot Applicable

** Defined as bedding in excess of bed sheets (any number) and 1 blanket

Prone Position at Time of Death by Cause of Death, NYC 2004-2007

6%

54%

40%

8%

47%

45%

14%

51%

35%

0%

20%

40%

60%

80%

100%

SIDS (N=35) Suffocation (N=38) Undetermined(N=165)

Prone

Not Prone

Unknown or NotApplicable

Bed Sharing at Time of Death by Cause of Death, NYC 2004-2007

3%

91%

6%

45%

55%

5%

29%

65%

0%

20%

40%

60%

80%

100%

SIDS (N=35) Suffocation (N=38) Undetermined(N=165)

Yes

No

Unknown orNotApplicable

*Chi-Sq p<.05

Location of Infant When Found Dead by Cause of Death, NYC 2004-07*

6%14%

80%

13%

13%

53%

21%

5%4%6%

62%

22%

0%

20%

40%

60%

80%

100%

SIDS (N=35) Suffocation (N=38) Undetermined(N=165)

Crib/Bassinette/PlaypenAdult Bed

Couch/Sofa

Other

Unknown or NotApplicable

*Chi-Sq p<.05

Unsafe Sleep Surface by Cause of Death, NYC 2004-2007*

80%

20%

21%

79%

6%

22%

72%

0%

20%

40%

60%

80%

100%

SIDS (N=35) Suffocation (N=38) Undetermined(N=165)

Unsafe SleepSurface

Safe SleepSurface

Unknown orNotApplicable

Risk Factors

SIDS: • Excessive

(soft) bedding

• Prone position

• Second hand smoke

Suffocation:• Excessive (soft)

bedding• Prone position• Unsafe sleep

surface• Bed sharing

Undetermined:• Excessive (soft)

bedding• Prone position• Unsafe sleep

surface• Bed sharing

Source: BMIRH

Type of Sleep Surface When Infant Found Dead, NYC 2004-07

n=203

Unsafe sleep

surface (adult bed, couch, car

seat)

62%

Crib or

bassinet or

playpen

34%

Had crib/bassinet

45%

No crib/bassinet or unknown

55%

Unknown or NA 6%

Summary• Accidental injuries (which are preventable) have

replaced SIDS as the second leading cause of post-neonatal death

• Characteristics of undetermined infant deaths similar to suffocation and SIDS deaths– Prone position still being used 15 years after Back

to Sleep• Many undetermined injury deaths are “sleep-

related”• Safe Sleep messages are new to many families;

not just SIDS

Summary

• Shift the conversation to Injury Prevention– Parent and provider education on the importance of a safe

sleep environment– Support families in need by providing the tools for safe sleep– Consumer advocacy for modeling safe sleep– Interagency collaborations for consistent messaging and

practices