Racial and Socioeconomic Disparities in Sudden Unexpected Infant Death in the United States: A Population-Based Analysis Using Linked Birth-Infant Death Data

Background: Sudden unexpected infant death (SUID) remains an important contributor to infant mortality in the United States. Previous national surveillance reports have documented differences in mortality across racial, socioeconomic, and birth-related characteristics. Continued examination of these patterns using national vital statistics data is important for understanding population-level disparities and informing prevention strategies. Objective: To quantify disparities in SUID in the United States through 2023 by examining social determinants, including race, ethnicity, and maternal education, alongside clinical characteristics such as birth weight and gestational age. Methods: A descriptive cross-sectional study was conducted using the Linked Birth Infant Death dataset accessed through the CDC Wide-Ranging Online Data for Epidemiologic Research system. The study included aggregated national data from 2007 to 2023, representing 66,381,536 live births and 61,594 SUIDs. Maternal age, maternal education, maternal race and ethnicity, birth weight, and gestational age were examined. Mortality rates were calculated as deaths per 1,000 live births within each category. Results: Higher mortality rates were observed among infants born to younger mothers and mothers with lower educational attainment. Mortality also varied across racial and ethnic groups, with higher rates among infants born to non-Hispanic Black mothers. Birth-related characteristics showed similar patterns, with higher rates among infants with low birth weight and earlier gestational age. Conclusion: This study highlights persistent disparities in SUID across maternal demographic and birth-related characteristics in the United States. Continued public health efforts focused on safe sleep education, maternal health, and targeted prevention strategies may help address these disparities.