About 3,400 infants die suddenly and unexpectedly in the United States every year, but these tragic events do not fall evenly across populations. Rates of sudden, unexpected infant death (SUID) are notably higher among American Indian/Alaska Native and Black infants compared to white infants, and rural areas exhibit some of the nation’s highest SUID rates.

In an effort to understand why SUIDs disproportionately impact certain communities and to better inform prevention strategies, the Centers for Disease Control and Prevention (CDC) established a system to gather information on SUIDs. A new study from the University of Minnesota School of Public Health delves into this data to examine how disparities based on race, ethnicity, and geography play a role in the completeness of these investigations.

The researchers analyzed data from the SUID Case Registry from 2015 to 2018, encompassing 3,847 cases. They examined instances of incomplete death investigations, defined as those investigations that are missing crucial elements such as an autopsy, scene investigation, or detailed information about the circumstances of the death. The study also identified critical components often missing from these investigations, such as reenactments and the use of SUID-specific investigative forms and protocols, which are considered essential for a comprehensive understanding of the circumstances surrounding each death.

The study, published in the Journal of Public Health Management & Practice, found:

• 24% of SUIDs had incomplete death investigations.
• Stark racial and ethnic disparities in the completeness of SUID investigations. American Indian/Alaska Native infants were more likely to have incomplete death investigations compared to other racial groups (1.49 times more likely).
• Significant geographic disparities in the completeness of SUID investigations. The odds of having an incomplete death investigation were 1.51 times higher in rural areas than in urban areas.
• Death investigations led by law enforcement were less likely to be complete compared to those led by medical examiners. In addition, American Indian/Alaskan Native SUIDs were more likely than any other group to have an investigation be led by law enforcement.

“To more effectively prevent incidences of sudden unexpected infant deaths, we need a more thorough understanding of why SUIDs are happening in the first place—and thorough investigations are the best source of that information,” said Naomi Thyden, SPH researcher and lead author. “We found that structural inequities exist in SUID investigations based on race, investigating agency, and geography, suggesting that structural racism plays a role in which of these tragic incidents are investigated completely.”

The study underscores the urgent need for standardized and thorough death investigations across all regions and demographic groups to ensure accurate data collection and effective SUID prevention strategies. It also suggests that involving medical examiners or coroners in all infant death investigations, rather than relying on law enforcement, could significantly improve the completeness of these investigations. Finally, the study recommends the implementation and standardization of reenactments and SUID-specific forms and protocols.