Pathology review of sudden and unexpected death in aboriginal and non-aboriginal infants

Previous research showed that the sudden infant death syndrome (SIDS) rate for Aboriginal infants significantly increased during the 1980s in Western Australia (WA) and raised the possibility of a diagnostic transfer of Aboriginal infant deaths from other causes to SIDS over this period. Here, therefore we review the pathology of SIDS and other sudden and unexpected deaths in infancy (SUDI) for Aboriginal and non-Aboriginal infants in WA between 1980 and 1988. The aim was to investigate whether there had been differences in the diagnosis and/or classification of SIDS according to whether the infants were Aboriginal or non-Aboriginal. The study population comprised: (1) all Aboriginal cases of SIDS and other SUDI between 1980 and 1988, and (2) corresponding random samples of non-Aboriginal cases. A two-stage process was employed for the review. First, histology slides were reviewed for each case where the aboriginality of the infant was Aboriginal and the original cause of death were unknown to the pathologists. Second, all paper records (i.e. death scene investigations, laboratory tests and medical reports) except for the original cause of death information were reviewed by the pathologists. The results showed that there was excellent agreement between the final review diagnosis and the original diagnosis for both Aboriginal and non-Aboriginal SUDI. Thus, there was no evidence for a diagnostic shift among Aboriginal infant deaths and the review supported the observed increase in the SIDS rate for Aboriginal infants.