Diagnostic drift in sudden infant death syndrome
Kolikof, Joshua S.
MetadataShow full item record
INTRODUCTION: In the years that followed the 1994 Back to Sleep Campaign (BSC), a public health initiative designed to prevent Sudden Infant Death Syndrome (SIDS), the prevalence of SIDS decreased by nearly 50%. However, recent research questions the decline in SIDS with an appreciation of contemporaneous factors which may have contributed to it. There is a growing recognition that other, often indiscernible causes of Sudden Unexpected Infant Deaths (SUID) have increased prevalence rates. Several researchers have addressed the possibility of the effects of a diagnostic drift. OBJECTIVE: To evaluate the impact of certain contemporaneous factors on the decline in the prevalence of Sudden Infant Death Syndrome. METHODS: We examined a historically significant time period surrounding the implementation of the BSC, 1984-2009. It is a time-period that incorporates mortality statistics prior to the BSC, as well as immediately following. We utilized 1984-2009 mortality data obtained from the Center for Disease Control and Prevention and evaluated the following prevalence rates: SIDS, unknown and unspecified causes, Accidental Strangulation and Suffocation in Bed (ASSB), and Neglect. We then amalgamated unknown and unspecified causes, ASSB and Neglect into a single representation of non-SIDS SUID. We then proceeded to perform an analysis on these prevalence rates to determine linear trends. RESULTS: All-cause mortality rate decreased linearly by about .929 per 100,000 per year (p<.0001, β=-.929). SIDS mortality rates also experienced a significant decline of about .951 per 100,000 deaths per year (p<.0001, β=-.951). In contrast, the SUID cohort prevalence increased significantly with a rate of .930 per 100,000 per year (p<.0001, β=.930). DISCUSSION: Over our study period, SIDS declined significantly, but by 2001 it experienced a stagnant decline that was different than that from 1984-2000. From 2001 to 2009, our SUID cohort increased dramatically. It is our conclusion that the potential exists for a possible diagnostic drift from SIDS to these other SUID.
Thesis (M.A.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at email@example.com. Thank you.