Our study findings suggest that an approach to SUID disparities that focuses only on increasing breastfeeding may reduce SUID but would only minimally reduce racial/ethnic disparities. Specific political interventions, for example, those regarding tobacco, alcohol, and measures to reduce poverty, and those that address legacies of historical trauma are likely needed to reduce disparities and make further progress on reducing post-neonatal deaths. Future research to investigate the roles of specific social determinants of health on SUID may be important.
Breastfeeding remains 1 of the few achievable public health interventions that can lower infant mortality rates. However, breastfeeding is also influenced by policy affecting social determinants. Government-mandated paid parental leave has not been implemented in the United States, making breastfeeding challenging, especially for low-income women. The United States is 1 of just 30% of the world's countries that has failed to enact any legislation to restrict "harmful marketing" of breast milk substitutes.
Given that the overall SUID rate is high in the United States, any intervention that will decrease overall SUID risks would be worthwhile. Investing in breastfeeding would help all infants, but it would only marginally narrow the gap between NHB and NWH infants' SUID risk. Also, such a policy would narrow the gap between Hispanic and NHW infants' SUID risk, because it would lower the higher SUID risk of NHW as compared with Hispanic infants. Ultimately, reducing the rates of SUID of NHB and AI/AN infants will likely depend on confronting larger social and structural determinants of health through political solutions.
AdjRD, adjusted risk difference; aOR, adjusted odds ratio; CI, confidence interval; NHB, non-Hispanic Black; AI/AN, American Indian/Alaskan Native;NHW, non-HispanicWhite; SIDS, sudden infant death syndrome; SUID, sudden unexpected infant death.
Data are publicly available from the National Center for Health Statistics.
We thank Albert Dalmau-Bueno for statistical assistance and Dominique Heinke for early advice.
Am J Epidemiol. 2022;191(7):1190-1201. © 2022 Oxford University Press