Infant respiratory death rates mirror sudden infant deaths

BMJ 1995;310:1603 (17 June)

Letters

Infant respiratory death rates mirror sudden infant deaths

EDITOR,--E A Gilman and colleagues speculate about the reasonsfor the dramatic falls in sudden infant deaths that occurredduring the first and second quarters of 1992 as compared withthe decreasing trends in the rates for these two quarters overthe previous four years.¹ The dramatic falls occurred afterthe launch of the campaign to encourage parents to put infantsto sleep on their backs and to avoid smoking near them or overheatingthem.

The authors put forward as one possible explanation of thesefalls the interaction between the prone sleeping position andthe underlying pathogenic mechanisms that it affects. In thisregard, we would draw attention to the fact that the secularand seasonal trends in the monthly numbers of sudden infantdeaths over recent years have been mirrored by those for infantdeaths attributable to respiratory disease. The figure showsthe two series for the years 1986-92. The concordance betweenthese two series is evident in the summer troughs as well asthe winter peaks. This phenomenon suggests that whatever hasled to the seasonal variation and decreasing trend in suddeninfant deaths, including the pronounced decrease during 1992,has produced a similar pattern for infant deaths attributableto respiratory disease. Furthermore, we have shown that during1986-90 there was a close association between the monthly incidenceof respiratory infectious diseases in the age group 0-4 years.²

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Numbersof sudden infant deaths and infant deaths attributable to respiratorydisease, England and Wales, 1986-92 (source: Office of PopulationCensuses and Surveys)

Research consultant Statistical consultant Director BirminghamResearch Unit, Royal College of General Practitioners, BirminghamB17 9DB

D L Crombie, K W Cross, D M Fleming

Gilman EA, Cheng KK, Winter HR, Scragg R. Trends in rates and seasonal distribution of sudden infant deaths in England and Wales, 1988-92. BMJ 1995;310:631-2. (11 March.) [Free Full Text]
Birmingham Research Unit of the Royal College of General Practitioners. Weekly returns service report for 1991. Birmingham: Birmingham Research Unit, 1992:17.

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Misleading meta-analysis: M R Law and N J Wald
BMJ 1995 311: 1303. [Extract] [Full Text]

Trends in rates and seasonal distribution of sudden infant deaths in England and Wales, 1988-92: E A Gilman, K K Cheng, H R Winter, and R Scragg
BMJ 1995 310: 631-632. [Full Text]

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Law, M R, Wald, N J (1995). Misleading meta-analysis. BMJ 311: 1303b-1303 [Full text]