American Journal of Epidemiology Vol. 147, No. 10: 960-968
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health
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Sudden Infant Death Syndrome: Risk Factor Profiles for Distinct Subgroups
1Department of Pediatrics, University Hospital of Innsbruck AnichstraBe 35, A-6020 Innsbruck, Austria
2 Department of Neurology, University Hospital of Innsbruck AnichstraBe 35, A-6020 Innsbruck, Austria
Reprint requests to Dr. Wolfgang Sperl, Children's Hospital, LKA Salzburg, Müllner HauptstraBe 4 8, A-5020 Salzburg, Austria.
The authors investigated risk profiles of sudden infant death syndrome (SIDS) as a function of age at death. A case–control study carried out in the Tyrol region of Austria enrolled 99 infants who died of SIDS between 1984 and 1994 and 136 randomly selected controls. Early and late SIDS (<120 days of age vs. 
120 days) were defined according to the clear-cut bimodal age-at-death distribution. Inadequate antenatal care, low parental social and educational level, and the prone sleeping position were risk conditions that applied to both early and late SIDS. A marked seasonal variation (winter preponderance) was the most outstanding feature of late SIDS. A gestational age of <37 weeks (odds ratio (OR) = 8.4, 95% confidence interval (Cl) 2.6–26.0), repeated episodes of apnea (OR = 5.7, 95% Cl 1.2–27.0), low birth weight (<2, 500 g) (OR = 3.4, 95% Cl 1.1–11.0), a family history of sudden infant death (OR = 2.9, 95% Cl 1.1–7.5), and maternal smoking during pregnancy (OR = 2.2, 95% Cl 1.0–4.5) were associated with early SIDS. This study identified two distinct subgroups of SIDS infants characterized by different risk conditions and ages at death. These results underline a multiple-cause hypothesis for SIDS etiology which involves a genetic predisposition, immaturity in the first months of life, and environmental factors acting at various ages. Am J Epidemiol 1998; 147: 960–8.
infant mortality; risk factors; seasons; sudden infant death
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