Dhingra, M., Gaughan, J., and Feldman-Winter, L. Racial and Ethnic Disparities in Breastfeeding and SUID, Pediatric Academic Societies National Meeting. May 2020.
Background:
Racial and ethnic disparities in both breastfeeding and Sudden Unexpected Infant Deaths (SUID) have been persistent in the United States. Despite decline in overall rates, a 2017 study by Parks et al. showed that rates of SUID remain higher in American Indians/Alaska Natives and Non-Hispanic Blacks than in other groups. In addition, studies have shown persistent racial disparities in breastfeeding. Breastfeeding is associated with reduced risk of SUID. Several explanations have been posited for these disparities, such as cultural or socioeconomic barriers to increasing safe sleep and breastfeeding. However, certain trends complicate this hypothesis. For example, the most significant declines in SUID are in groups whose implementation of safe sleep practices has been most problematic. Therefore, it is important to explore the extent to which race and breastfeeding act independently and as confounding variables for SUID.
Objective:
Assess the relationship between racial disparities in SUID and breastfeeding rates, as well as the interplay of maternal and birth characteristics.
Methods:
Data was extracted from the CDC Wide-ranging Online Data for Epidemiologic Research (WONDER) database, including SUID cases between 2009 and 2014. National Immunization Survey (NIS) data was used to generate corresponding breastfeeding rates in that time range. Data was restricted to full term infants aged 28-364 days and sorted by year of death and race, as well as selected maternal and birth characteristics. Breastfeeding data was limited to exclusive breastfeeding at 3 and 6 months. Datasets were analyzed using multiple weighted linear regression with regression coefficients and 95% confidence limits.
Results:
SUID rates were sorted by maternal and birth characteristics and demonstrated in the tables below. There are persistent racial and ethnic disparities in both SUID and breastfeeding rates. In almost all variable sets, when controlling for maternal and birth characteristics, exclusive breastfeeding at 3 and 6 months demonstrated consistently lower mortality rates. Furthermore, there was a consistent dose-response relationship between breastfeeding and SUID rates, with 6 months of breastfeeding producing an approximately two-fold advantage in mortality over 3 months of breastfeeding.
Conclusions:
These data suggest that race and breastfeeding were confounding variables when predicting SUID rates because of established disparate relationships between race and breastfeeding.
Menaka Dhingra, M3, Cooper Medical School of Rowan University