Unexplained Death in Infancy by deprivation and ethnicity

The final paper can be viewed at: http://dx.doi.org/10.1136/jech-2018-210453

We report a nearly five-fold disparity in risk of Unexplained Death in Infancy (UDI) across ethnic groups in England and Wales, and demonstrate that this disparity is not explained by deprivation. Formal adjustment for deprivation (IMD quintiles) does not even slightly reduce the ethnic variation (see Table 2 of the cited paper). A simple scatter plot of ethnic groups illustrates the lack of a relationship between deprivation and risk, with a virtually horizontal overall trend line (as shown in this Dataset). For example, Black Caribbean babies have nearly triple the UDI risk of Black African babies, but similar levels of deprivation. The Indian, Pakistani and Bangladeshi ethnic groups each have around half the risk of White British babies; the White British and Indian groups have similar (relatively low) levels of deprivation, and the Pakistani and Bangladeshi groups are the most deprived in England and Wales. In the cited paper we discuss various potential mediators of the ethnic differences, including sleep practices, breastfeeding and tobacco use, based on the ethnic-specific prevalence of these factors in prior survey data. We suggest that careful comparison of ethnic patterns of exposure and outcome might lead to a better understanding of the aetiology of these very distressing deaths.

最终论文可查阅：http://dx.doi.org/10.1136/jech-2018-210453

我们报告了英格兰和威尔士不同种族群体间婴儿不明原因死亡（Unexplained Death in Infancy, UDI）的风险存在近五倍差异，并证明这种差异无法用贫困因素解释。对贫困因素（IMD五分位数）进行正式调整后，种族间差异甚至未出现丝毫减少（详见所引论文表2）。种族群体的简单散点图显示，贫困与风险之间不存在关联，整体趋势线几乎呈水平状态（如本数据集所示）。例如，加勒比黑人婴儿的UDI风险几乎是非洲黑人婴儿的三倍，但两者的贫困水平相似。印度、巴基斯坦和孟加拉种族群体的风险各约为英国白人婴儿的一半；英国白人和印度群体的贫困水平相似（相对较低），而巴基斯坦和孟加拉群体则是英格兰和威尔士贫困程度最高的群体。在所引论文中，我们基于先前调查数据中这些因素的种族特异性流行率，探讨了种族差异的各种潜在中介因素，包括睡眠习惯、母乳喂养和烟草使用。我们认为，仔细比较暴露和结局的种族模式，可能有助于更好地理解这些极具痛苦的死亡的病因学（aetiology）。