Infant Injury Deaths in New York City Martine Hackett Ph.D., MPH Bureau of Maternal, Infant and Reproductive Health New York City Department of Health and Mental Hygiene
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