The Role of Breastfeeding in Racial and Ethnic Disparities in Sudden Unexpected Infant Death: A Population-Based Study of 13 Million Infants in the United States

Melissa  Bartick; Alexis  Woods Barr; Lori Feldman-Winter; Monica Guxens Junyent; Henning  Tiemeier

doi:10.1093/aje/kwac050

The Role of Breastfeeding in Racial and Ethnic Disparities in Sudden Unexpected Infant Death: A Population-Based Study of 13 Million Infants in the United States

Melissa Bartick^*, Alexis Woods Barr, Lori Feldman-Winter, Monica Guxens Junyent, Henning Tiemeier

^*Corresponding author for this work

Child and Adolescent Psychiatry / Psychology

Research output: Contribution to journal › Article › Academic › peer-review

2 Citations (Scopus)

Abstract

Sudden unexpected infant death (SUID) disproportionately affects non-Hispanic Black (NHB) and American Indian/Alaskan Native infants, who have lower rates of breastfeeding than other groups. Using 13,077,880 live-birth certificates and 11,942 linked SUID death certificates from 2015 through 2018, we calculated odds ratios and adjusted risk differences of SUID in infants who were not breastfed across 5 racial/ethnic strata in the United States. We analyzed mediation by not breastfeeding in the race/ethnicity–SUID association. The overall SUID rate was 0.91 per 1,000 live births. NHB and American Indian/Alaskan Native infants had the highest disparity in SUID relative to non-Hispanic White infants. Overall, not breastfeeding was associated with SUID (adjusted odds ratio (aOR), 1.14; 95% confidence interval (CI): 1.10, 1.19), and the adjusted risk difference was 0.12 per 1,000 live births. The aOR of not breastfeeding for SUID was 1.07 (95% CI: 1.00, 1.14) in NHB infants and 1.29 (95% CI: 1.14, 1.46) in Hispanic infants. Breastfeeding minimally explained the higher SUID risk in NHB infants (2.3% mediated) and the lower risk in Hispanic infants (2.1% mediated) relative to non-Hispanic White infants. Competing risks likely explain the lower aOR seen in NHB infants of not breastfeeding on SUID, suggesting that social or structural determinants must be addressed to reduce racial disparities in SUID.

Original language	English
Pages (from-to)	1190–1201
Number of pages	12
Journal	American Journal of Epidemiology
Volume	191
Issue number	7
DOIs	https://doi.org/10.1093/aje/kwac050
Publication status	Published - 1 Jul 2022

Bibliographical note

Funding Information:
M.G. is funded by a Miguel Servet II fellowship (CPII18/00018) awarded by the Spanish Institute of Health Carlos III and acknowledges support from the Spanish Ministry of Science and Innovation and the State Research Agency through the Centro de Excelencia Severo Ochoa 2019-2023 Program (grant CEX2018-000806-S) and support from the Generalitat de Catalunya through the Centres de Recerca de Catalunya Program. H.T. was supported by grant T76MC00001, entitled Training Grant in Maternal and Child Health, from the Health Resources and Services Administration of the US Department of Health and Human Services.

Publisher Copyright:
© 2022 The Author(s).

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10.1093/aje/kwac050

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title = "The Role of Breastfeeding in Racial and Ethnic Disparities in Sudden Unexpected Infant Death: A Population-Based Study of 13 Million Infants in the United States",

abstract = "Sudden unexpected infant death (SUID) disproportionately affects non-Hispanic Black (NHB) and American Indian/Alaskan Native infants, who have lower rates of breastfeeding than other groups. Using 13,077,880 live-birth certificates and 11,942 linked SUID death certificates from 2015 through 2018, we calculated odds ratios and adjusted risk differences of SUID in infants who were not breastfed across 5 racial/ethnic strata in the United States. We analyzed mediation by not breastfeeding in the race/ethnicity–SUID association. The overall SUID rate was 0.91 per 1,000 live births. NHB and American Indian/Alaskan Native infants had the highest disparity in SUID relative to non-Hispanic White infants. Overall, not breastfeeding was associated with SUID (adjusted odds ratio (aOR), 1.14; 95% confidence interval (CI): 1.10, 1.19), and the adjusted risk difference was 0.12 per 1,000 live births. The aOR of not breastfeeding for SUID was 1.07 (95% CI: 1.00, 1.14) in NHB infants and 1.29 (95% CI: 1.14, 1.46) in Hispanic infants. Breastfeeding minimally explained the higher SUID risk in NHB infants (2.3% mediated) and the lower risk in Hispanic infants (2.1% mediated) relative to non-Hispanic White infants. Competing risks likely explain the lower aOR seen in NHB infants of not breastfeeding on SUID, suggesting that social or structural determinants must be addressed to reduce racial disparities in SUID.",

author = "Melissa Bartick and {Woods Barr}, Alexis and Lori Feldman-Winter and {Guxens Junyent}, Monica and Henning Tiemeier",

note = "Funding Information: M.G. is funded by a Miguel Servet II fellowship (CPII18/00018) awarded by the Spanish Institute of Health Carlos III and acknowledges support from the Spanish Ministry of Science and Innovation and the State Research Agency through the Centro de Excelencia Severo Ochoa 2019-2023 Program (grant CEX2018-000806-S) and support from the Generalitat de Catalunya through the Centres de Recerca de Catalunya Program. H.T. was supported by grant T76MC00001, entitled Training Grant in Maternal and Child Health, from the Health Resources and Services Administration of the US Department of Health and Human Services. Publisher Copyright: {\textcopyright} 2022 The Author(s).",

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doi = "10.1093/aje/kwac050",

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The Role of Breastfeeding in Racial and Ethnic Disparities in Sudden Unexpected Infant Death: A Population-Based Study of 13 Million Infants in the United States. / Bartick, Melissa ; Woods Barr, Alexis ; Feldman-Winter, Lori et al.
In: American Journal of Epidemiology, Vol. 191, No. 7, 01.07.2022, p. 1190–1201.

Research output: Contribution to journal › Article › Academic › peer-review

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N1 - Funding Information: M.G. is funded by a Miguel Servet II fellowship (CPII18/00018) awarded by the Spanish Institute of Health Carlos III and acknowledges support from the Spanish Ministry of Science and Innovation and the State Research Agency through the Centro de Excelencia Severo Ochoa 2019-2023 Program (grant CEX2018-000806-S) and support from the Generalitat de Catalunya through the Centres de Recerca de Catalunya Program. H.T. was supported by grant T76MC00001, entitled Training Grant in Maternal and Child Health, from the Health Resources and Services Administration of the US Department of Health and Human Services. Publisher Copyright: © 2022 The Author(s).

PY - 2022/7/1

Y1 - 2022/7/1

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The Role of Breastfeeding in Racial and Ethnic Disparities in Sudden Unexpected Infant Death: A Population-Based Study of 13 Million Infants in the United States

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