Geographic and racial disparities in the investigation of sudden unexpected infant deaths

In the United States, approximately 3,400 infants die suddenly and unexpectedly each year, but these tragic events are not evenly distributed across the population. Death rates are significantly higher among Native American and Black infants than among white infants, and rural areas have some of the highest unexpected death rates in the country.

A new study from the University of Minnesota School of Public Health, published in Journal of Public Health Management and Practiceexamines the role that racial-ethnic and geographic differences play in the completeness of sudden infant death syndrome (SIDS) screening tests.

The researchers analyzed data from the U.S. Centers for Disease Control and Prevention (CDC) on 3,847 cases between 2015 and 2018. They examined cases of incomplete death investigations – that is, those in which crucial elements such as an autopsy, an examination of the crime scene or detailed information on the circumstances of death were missing.

The study also identified critical components that are often missing from investigations, such as reenactments and the use of investigation forms and protocols specific to sudden unexpected infant deaths, which are considered essential to fully understanding the circumstances of each individual case.

The study found:

• In 24 percent of sudden, unexplained deaths in infants, an incomplete investigation was found.
• Incomplete death investigations were more common among Native American and Alaska Native infants than among other ethnic groups.
• The likelihood of an incomplete death investigation was 1.5 times higher in rural areas than in urban areas.
• Death investigations by police were less likely to be complete than those by coroners. Native Americans and Alaska Natives were more likely than any other group to have a police-led investigation.

“Our work highlights the urgent need for standardized and thorough death investigations across all regions and demographic groups to ensure accurate data collection and effective prevention strategies,” said Naomi Thyden, SPH researcher and lead author.

“The integrity of these investigations could be greatly improved if all infant death investigations involved forensic pathologists or coroners rather than relying on law enforcement.”