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Acta Paediatr ; 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32239524


AIM: To examine differences in the prevalence of risk factors for sudden unexpected death in infancy (SUDI) between Aboriginal and Torres Strait Islander and non-Indigenous infants. METHODS: A retrospective cohort study of SUDI in Queensland during 2010-2014 examined exposure to SUDI risk factors, to identify factors accounting for higher SUDI mortality among Indigenous infants. A multistage algorithm was applied to linked data to determine Indigenous status. RESULTS: There were 228 SUDI, of which Indigenous infants comprised 26.8%. The Indigenous SUDI rate was 2.13/1000 live births compared to 0.72/1000 for non-Indigenous. The disparity between Indigenous and non-Indigenous SUDI was accounted for by surface sharing (OR = 2.93 95% CI = 1.41, 6.07), smoking (OR = 2.49, 95% CI = 1.13, 5.52), and a combination of background antenatal and sociodemographic factors (inadequate antenatal care [OR = 6.93, 95% CI = 2.20, 21.86], young maternal age at first birth [OR = 4.02, 95% CI = 1.49, 10.80] and outer regional [OR = 3.03, 95% CI = 1.37, 6.72] and remote locations [OR = 11.31, 95% CI = 3.47, 36.83]). CONCLUSION: Culturally responsive prevention efforts, including wrap-around maternity care and strategies that reduce maternal smoking and promote safer yet culturally acceptable ways of surface sharing, may reduce Indigenous SUDI mortality.

Aust N Z J Public Health ; 43(6): 570-576, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31667984


OBJECTIVE: To investigate the under-identification of Indigenous∗ infants in death records and examine the impact of a multi-stage algorithm on disparities in sudden unexpected deaths in infancy (SUDI). METHODS: Data on SUDI in Queensland between 2010 and 2014 were linked to birth and death registrations, health data, and child protection and coronial records. An algorithm was applied to cases of SUDI and population data to derive Indigenous status. Numbers, proportions and rates of SUDI were compared. RESULTS: Using multiple sources of Indigenous status resulted in a 64.9% increase in the number of infants identified as Indigenous. The Indigenous SUDI rate increased by 54.3%, from 1.38 to 2.13 per 1,000 live births after applying the algorithm to SUDI and live births data. CONCLUSIONS: Applying an algorithm to both numerator and denominator data reduced numerator-denominator incompatibility, to more accurately report rates of Indigenous SUDI and measure the gap in Indigenous infant mortality. Implications for public health: Estimation of the true magnitude of the disparity is restricted by under-identification of Indigenous status in death records. Data linkage improved the reporting of Indigenous infant mortality. Accuracy in reporting of measures is integral to determining genuine progress towards Closing the Gap.

Mortalidade Infantil/etnologia , Grupo com Ancestrais Oceânicos , Morte Súbita do Lactente/etnologia , Algoritmos , Causas de Morte , Atestado de Óbito , Documentação/normas , Feminino , Humanos , Lactente , Recém-Nascido , Armazenamento e Recuperação da Informação , Masculino , Queensland/epidemiologia , Fatores de Risco , Morte Súbita do Lactente/epidemiologia
Int J Legal Med ; 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31317315


Despite being widely used, few studies have assessed the utility of the San Diego definition of sudden infant death syndrome (SIDS). The purpose of this study was to evaluate pathologists' application of the San Diego definition in all cases of sudden unexpected death in infancy (SUDI) that occurred in Queensland, Australia, between 2010 and 2014. Key coronial documents of 228 cases of SUDI were reviewed independently by three reviewers and classified according to the San Diego definition. Clear guidance regarding the evidentiary threshold for classification and interpretation of the San Diego definition was provided. All reviewers classified cases identically in 202 cases (88.6%). Consensus was achieved on the classification of the remaining 26 deaths following case discussion. After review, 79 cases were classified as SIDS, a one third reduction compared with the original classification, mainly due to a high probability of accidental asphyxia. The number of cases classified as undetermined (USID) almost doubled (75/228, 32.9%), and there was more than a fivefold increase in cases classified as asphyxia (43/228, 18.9%). Natural conditions decreased by approximately one third (21/228, 9.2%). This study demonstrates that with clear guidelines for interpretation, the San Diego definition can be applied reliably, with discrepancies resolved through a process of peer review.

J Forensic Leg Med ; 64: 20-22, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30897532


The classification of the cause of unexpected infant deaths by both pathologists and researchers may be quite inconsistent. For example, if an infant is found lying face down on soft bedding the death may still be certified as 'sudden infant death syndrome (SIDS)', 'accidental suffocation', 'undetermined', 'unclassified sudden infant death (USID)', or 'sudden unexpected death in infancy (SUDI)'. As the San Diego definition of SIDS does not appear to be rigorously or consistently applied, clarifying 'mechanical asphyxia not determined with certainty' may help to more clearly separate SIDS from USID. Including a classification algorithm with the definition may also help to better define unsafe sleep factors and suffocation. This commentary reviews the current situation with regard to classifying these deaths and concludes that the absence of diagnostic pathological markers with conflicting classification systems has led to idiosyncratic certification practices.

Morte Súbita do Lactente/classificação , Terminologia como Assunto , Asfixia , Atestado de Óbito , Medicina Legal , Humanos , Lactente , Recém-Nascido , Sono