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Persistent Racial/Ethnic Disparities in Supine Sleep Positioning among US Preterm Infants, 2000-2015

Sunah S Hwang1, Suhong Tong2, Ruben A Smith3

  • 1Section of Neonatology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO; Department of Health Systems, Management, and Policy, Colorado School of Public Health, Aurora, CO.

The Journal of Pediatrics
|March 7, 2021
PubMed

Insights

Racial disparities in supine sleep positioning (SSP) for preterm infants persist despite overall increases in safe sleep practices. Non-Hispanic Black infants consistently showed lower odds of SSP compared to Non-Hispanic White infants.

Area of Science:

  • Neonatal Health
  • Pediatric Sleep Medicine
  • Health Disparities Research

Background:

  • Supine sleep positioning (SSP) is recommended for all infants to reduce Sudden Infant Death Syndrome (SIDS) risk.
  • Preterm infants, particularly those born early preterm (<34 weeks) and late preterm (34-36 weeks), may face unique challenges in adopting safe sleep practices.
  • Understanding racial and ethnic trends in SSP is crucial for targeted public health interventions.

Purpose of the Study:

  • To assess trends in racial disparity in supine sleep positioning (SSP) among early preterm and late preterm infants.
  • To compare SSP trends across racial/ethnic groups from 2000 to 2015.
  • To identify persistent disparities in safe sleep practices for vulnerable infant populations.

Main Methods:

  • Analysis of Pregnancy Risk Assessment Monitoring System (PRAMS) data from 16 US states (2000-2015).
  • Inclusion of over 1 million infants, stratified by gestational age (early vs. late preterm).
  • Statistical modeling to estimate the adjusted odds ratio (aOR) of SSP trends and test for time-race interactions.

Main Results:

  • Non-Hispanic Black infants had significantly lower odds of SSP compared to Non-Hispanic White infants in both early preterm (aOR 0.61) and late preterm (aOR 0.44) groups.
  • Hispanic infants showed no significant difference in SSP compared to Non-Hispanic White infants.
  • While SSP increased across all racial/ethnic groups, the annual rate of increase did not significantly differ between groups, indicating persistent disparities.

Conclusions:

  • Supine sleep positioning (SSP) adoption increased for all racial/ethnic preterm infant groups between 2000 and 2015.
  • Despite the overall increase in SSP, significant racial and ethnic disparities in its use persist among early and late preterm infants.
  • Targeted interventions are needed to address and eliminate these persistent racial/ethnic disparities in safe sleep practices for preterm infants.
Abstract

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