Maternal and Child Health Journal

, Volume 23, Issue 12, pp 1670–1678 | Cite as

Accidental Infant Suffocation and Strangulation in Bed: Disparities and Opportunities

  • Joanna DrowosEmail author
  • Aaron Fils
  • Maria C. Mejia de Grubb
  • Jason L. Salemi
  • Roger J. Zoorob
  • Charles H. Hennekens
  • Robert S. Levine


Objectives (a) Update previous descriptions of trends in ASSB; (b) determine if factors previously associated with ASSB are replicated by updated data; and (c) generate new hypotheses about the occurrence of ASSB and racial inequalities in ASSB mortality. Methods National Center for Health Statistics files (International Classification of Diseases, Tenth Edition) Code W75 to describe race–ethnicity-specific ASSB occurrence. Results (a) ASSB mortality continues to increase significantly; for 1999–2016, 4.4-fold for NHB girls (45.8 per 100,000 in 2016), 3.5-fold for NHB boys (53.8), 2.7-fold for NHW girls (15.8) and 4.0-fold for NHW boys (25.9); (b) F actors previously associated with ASSB (unmarried mothers and mothers with low educational attainment, low infant birth weight, low gestational age, lack of prenatal care, male infant, multiple birth, high birth order) continue to be associated with both overall ASSB and inequalities adversely affecting NHB; (c) (1) geographic differences and similarities in ASSB occurrence support hypotheses related to positive deviance; (2) lower ASSB mortality for births attended by midwives as contrasted to physicians generate hypotheses related to both medical infrastructure and maternal engagement; (3) high rates of ASSB among infants born to teenage mothers generate hypotheses related to the possibility that poor maternal health may be a barrier to ASSB prevention based on education, culture and tradition. Conclusions for Practice These descriptive data may generate new hypotheses and targets for interventions for reducing both ASSB mortality and racial inequalities. Analytic epidemiologic studies designed a priori to do so are required to address these hypotheses.


Accidental suffocation and strangulation in bed (ASSB) Sudden unexpected infant deaths (SUID) Infant mortality Racial disparities United States (US) 



No external funding was received.

Supplementary material

10995_2019_2786_MOESM1_ESM.pdf (273 kb)
Supplementary material 1 (PDF 273 kb)


  1. Arcia, A. (2015). U.S. Nulliparas’ reasons for expected provider type and childbirth setting. Journal of Perinatal Education, 24(1), 61–72. Scholar
  2. Arias, E., Heron, M., & Hakes, J. K. (2016). The validity of race and Hispanic-origin reporting on death certificates in the United States: An update. Vital and Health Statistics. Series 2, 1(172), 1–23.Google Scholar
  3. Barnes-Boyd, C. (1995). Effects of sustained nurse/mother contact on infant outcomes among low-income African-American families. Public Health Nursing, 12(6), 378–385.CrossRefGoogle Scholar
  4. Bowers, J., Cheyne, H., Mould, G., & Page, M. (2015). Continuity of care in community midwifery. Health Care Management Science, 18(2), 195–204. Scholar
  5. Carlberg, M. M., Shapiro-Mendoza, C. K., & Goodman, M. (2012). Maternal and infant characteristics associated with accidental suffocation and strangulation in bed in US infants. Maternal and Child Health Journal, 16(8), 1594–1601. Scholar
  6. Centers for Disease Control and Prevention, National Center for Health Statistics. (1999). Compressed mortality file 1999-2016 on CDC WONDER online database, released June 2017. Data are from the compressed mortality file 1999-2016 series 20 no. 2U, 2016, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed 26 January 2019.
  7. Centers for Disease Control and Prevention & National Center for Chronic Disease Prevention and Health Promotion. (n.d). Sudden unexpected infant death and sudden infant death syndrome data and statistics. Accessed 26 January 2019.
  8. Freemantle, N. (2000). StatsDirect—Statistical software for medical research in the 21st century. BMJ British Medical Journal, 321(7275), 1536.CrossRefGoogle Scholar
  9. Gittner, L. S., Kilb Gittner, L. S., Kilbourne, B. J., Vadapalli, R., Khan, M. M. K., & Langston, M. A. (2017). A multifactorial obesity model developed from nationwide public health exposome data and modern computational analyses. Obesity Research & Clinical Practice, 11(5), 522–533. Scholar
  10. Guo, Y., Schwebel, D. C., & Hu, G. (2018). Infant mortality due to unintentional suffocation among infants younger than 1 year in the United States 1999-2015. JAMA Pediatrics, 172(4), 388–389. Scholar
  11. Kershenbaum, A. D., Langston, M. A., Levine, R. S., Saxton, A. M., Oyana, T. J., Kilbourne, B. J., et al. (2014). Exploration of preterm birth rates using the public health exposome database and computational analysis methods. International Journal of Environmental Research and Public Health, 11(12), 12346–12366. Scholar
  12. Kim, H. J., Fay, M. P., Feuer, E. J., & Midthune, D. N. (2000). Permutation tests for joinpoint regression with applications to cancer rates. Statistics in Medicine, 19, 335–351.;2-Z.CrossRefPubMedGoogle Scholar
  13. Langston, M. A., Levine, R. S., Kilbourne, B. J., Rogers, G. L., Kershenbaum, A. D., Baktash, S. H., et al. (2014). Scalable combinatorial tools for health disparities research. International Journal of Environmental Research and Public Health, 11(10), 10419–10443. Scholar
  14. Martin, J. A., Wilson, E. C., Osterman, M. J., Saadi, E. W., Sutton, S. R., & Hamilton, B. E. (2013). Assessing the quality of medical and health data from the 2003 birth certificate revision: Results from two states. National Vital Statistics Reports, 62(2), 1–20.PubMedGoogle Scholar
  15. Matthews, T. J., & MacDorman, M. F. (2013). Infant mortality statistics from the 2010 period linked birth/infant death data set. National Vital Statistics Reports, 62(8), 1–26.PubMedGoogle Scholar
  16. Mathews, T. J., Menacker, F., & MacDorman, M. F. (2004). Infant mortality statistics from the 2002 period linked birth/infant death data set. National Vital Statistics Reports, 53(10), 1–29.PubMedGoogle Scholar
  17. Miller, T. R. (2015). Projected outcomes of nurse-family partnership home visitation during 1996-2013, United States. Prevention Science, 16(6), 765–777. Scholar
  18. Miller, A. C., & Shriver, T. E. (2012). Women’s childbirth preferences and practices in the United States. Social Science and Medicine, 75(4), 709–716.CrossRefGoogle Scholar
  19. Moon, R. Y., & American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. (2011). Technical report-SIDS and other sleep-related infant deaths: Expansion of recommendations for a safe infant sleeping environment. Pediatrics, 129(5), e1341–e1367.Google Scholar
  20. Moon, R. Y., Hauck, F. R., & Colson, E. R. (2016). Safe infant sleep interventions: What is the evidence for successful behavior change? Current Pediatric Reviews, 12(1), 67–75.CrossRefGoogle Scholar
  21. National Cancer Institute. (2018). Joinpoint [Computer software]. Accessed 26 January 2019.
  22. Norr, K. F., et al. (2003). Maternal and infant outcomes at one year for a nurse-health advocate home visiting program serving African Americans and Mexican Americans. Public Health Nursing, 20(3), 190–203.CrossRefGoogle Scholar
  23. Northam, S., & Knapp, T. R. (2006). The reliability and validity of birth certificates. Journal of Obstetric, Gynecologic, and Neonatal Nursing, 35(1), 3–12.CrossRefGoogle Scholar
  24. Olds, D. L., Kitzman, H., Knudtson, M. D., Anson, E., Smith, J. A., & Cole, R. (2014). Effect of home visiting by nurses on maternal and child mortality: Results of a 2-decade follow-up of a randomized clinical trial. JAMA Pediatrics, 168(9), 800–806. Scholar
  25. Salemi, J. L., Tanner, J. P., Sampat, D. P., Rutkowski, R. E., Anjohrin, S. B., Marshall, J., et al. (2017). Evaluation of the sensitivity and accuracy of birth defects indicators on the 2003 revision of the US birth certificate: Has data quality improved? Paediatric and Perinatal Epidemiology, 31(1), 67–75. Scholar
  26. Shapiro-Mendoza, C. K., Kimball, M., Tomashek, K. M., Anderson, R. N., & Blanding, S. (2009). US infant mortality trends attributable to accidental suffocation and strangulation in bed from 1984 through 2004: Are rates increasing? Pediatrics, 123, 533–539. Scholar
  27. Shapiro-Mendoza, C. K., Tomashek, K. M., Anderson, R. N., & Wingo, J. (2006). Recent national trends in sudden, unexpected infant deaths: More evidence supporting a change in classification or reporting. American Journal of Epidemiology, 163, 762–769. Scholar
  28. United States Department of Health and Human Services, Centers of Disease Control and Prevention, & National Center for Health Statistics, Division of Vital Statistics. (2019). Linked birth/infant death records 1999-2016 [Data set]. Accessed 26 January 2019.
  29. Young, S., Acord, L., Schuler, S., & Hansen, J. M. (2014). Addressing the community/public health nursing shortage through a multifaceted regional approach. Public Health Nursing, 31(6), 566–573. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Joanna Drowos
    • 1
    Email author
  • Aaron Fils
    • 2
  • Maria C. Mejia de Grubb
    • 3
  • Jason L. Salemi
    • 3
  • Roger J. Zoorob
    • 3
  • Charles H. Hennekens
    • 1
    • 3
  • Robert S. Levine
    • 1
    • 3
  1. 1.Charles E. Schmidt College of MedicineFlorida Atlantic UniversityBoca RatonUSA
  2. 2.University of MiamiCoral GablesUSA
  3. 3.Department of Family and Community MedicineBaylor College of MedicineHoustonUSA

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