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