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